Is it too much to ask?

Is it too much to ask for a "nice" shift once in a while? I don't mean to gripe and moan so much, but really, us nurses are burning out on L&D. It's been a constant influx of laboring women, inductions, emergencies, visitor issues, etc, for the past 2 months or so.

It hasn't freaking let up yet!!!!

And to think, this is only the spring time. This is not normally our busy time of year. It gets super busy in July and August. I can't imagine how much worse it's going to get when those summer months roll around.....and they are just around the corner.

Almost every single shift, I walk into the unit and see a full, or close to full board of patients. (Yes, those who complain about me and other nurses referring to laboring women as patients........that's what they are in the hospital......I am the nurse, they are the patients. Take it or leave it.)

Spontaneous labor, induction of labor x 2 days, induction of labor x 3 days, planned c/s, emergent/urgent c/s, UTI's, preterm labor, falls, assaults, preeclampsia, rule out preeclampsia, transfers from other hospitals whose NICU units are full (egads! ours is too...but we still accept the transfers.....go figure!), 24 hour observations for rule out "this" or "that" (please, can we just decide already????), gel inductions, cytotec inductions, NST's (can't the offices just do these???), the occasional OCT's............the list goes on and on.

And the powers that be are pressuring me to start orienting to be a charge nurse. NO THANK YOU! The experienced charge nurses are in tears during their times of being in charge from the overwhelming patient census, and not enough nurses to staff it. Do I want to take on that added responsibility and stress for a measly 50 cents more per hour? NO FREAKING WAY!!!

Ahh, yes, the under staffing. The powers that be come up with their magical numbers of how many nurses should be on per shift. For whatever reason, they think that it should be about half of the number of nurses for nights. Umm, excuse me? We barely make it with 11-12 nurses on days, and you want to cut it to 6-7 on nights? With the same full unit? With c/s happening day and night? Each c/s takes away 2 RN's from the rest of the unit. That leaves 4-5 RN's on nights to man the rest of the unit - all 14 labor rooms, and 8 triage beds. And the patients waiting for beds in the waiting room. Do the math - it doesn't add up to a good, sound nurse:patient ratio. It's lawsuits waiting to happen.

Every evening, I am asked if I could stay late. Sometimes I do. Sometimes I'm too damn tired and I say no. I feel guilty, knowing my co-workers on nights are going to be overwhelmed without a few extra nurses staying. So, the manager on call is called in. One particular manager will instead of coming in, make calls from home to try and convince off duty nurses to come in. When that doesn't work, she finally hauls her butt in, and promptly tries to get out of there as soon as possible. Other managers will stay over from days, into evenings, and even into nights, seeing just how busy things are - they know they can't leave. With managers having to cover from lack of nurses, you would think that they would be able to have more influence in encouraging the hospital to allow more nurses to be hired, or added to the budget...........but it doesn't happen. I don't know why. I'm not on the budget committee, or whatever it is that approves new nurse hires. All I know is that it pisses me off. They're burning us out, by working us so hard - overtime, no lunches, no pee breaks and the ensuing UTI's/kidney stones that we suffer from WHILE WORKING......dehydration.....low blood sugars....tempers flaring..........

Sigh........I'm tired already, and I haven't even gone to work yet today. The last time I worked, they asked me in the beginning of my shift if I would stay over 4 extra hours. I said I would think about it. I ended up staying over 2 hrs, to finish up the c/s and recovery of my patient, but that was it. I was done when the recovery was over. 10 hrs of working straight, no dinner break, but I did manage to pee twice. I think I drank only about 5-6 oz of water the whole shift.

Get out of my waiting room!

Listen up: if you don't have anything else better to do, coming in to the hospital and causing a huge commotion in the L&D waiting room and surrounding area is NOT A GOOD IDEA!

We will call security on you, and the city police, as well as make appropriate arrests, if needed.

Don't give us attitude when we ask you and your other "friends" to please keep your voices down, when we are caring for people who are trying to sleep in the early night-time hours, while walking past other patients rooms and acting like you own the whole place. I don't give a fuck that you say you're pre-med, and it's stated with a nasty ass attitude and flick of the hand. Pre-med my ass. I'm betting you're a nurse's aid, if that. You don't have enough brains in your head to be pre-med. The huge ankle-holder earrings, as well as the obvious bleach job on your hair, as well as the go-go girl/slut puppy outfit you're wearing screams "CHEAP HOOKER" and not pre-med student.

Just fucking shut the fuck up and don't yell on my L&D unit. It's totally uncalled for.

To the "men" who snuck in with the laboring woman that they weren't related to, after being denied entrance to the L&D unit to "visit" their "friend" who was still in stirrups getting her perineum stitched up: we WILL call security on your sorry asses, and have you escorted off the unit. No means no -- get it? No, you can't barge on to the unit and act like you own the place.

To the idiots in the waiting room having a farting contest to pass the time - you totally grossed out the normal visitors awaiting the birth of their adoptive newborn baby. You also scared off other visitors from the waiting room, after utterly destroying it. You've made quite the lasting impression upon quite a few normal acting visitors who were appalled at your childish behavior, and whom will probably write letters of complaint the administration at the hospital.

Thanks for being total, utter, morons.

Thanks for taking nurses away from their patient care to have to deal with your bullshit.

Thanks for making nurses feel like they were physically in harms way while trying to do their job.

Thanks for giving us all something to talk about for days to come - your complete, utter stupidity and ignorance, as well as your obviously depressing, dysfunctional lives.

Follow up: 1cm with an epidural

Well, slap me silly! The patient I was talking about, who had an epidural placed at 1cm, she delivered VAGINALLY! It wasn't until the afternoon the next day, but she did it!

I'm so relieved that she didn't have a c-section.

But - I will reinforce this - getting an epidural at 1cm, when you are being induced and NOT IN LABOR yet, will increase your risk of further interventions, and a c-section.



That is all.

A most unusual occurance

How to begin this post? I don't know. I'm still in shock at what has happened.

I suppose it's not unusual, working in a hospital, to come across death and sadness. However, working in L&D, you wouldn't expect deaths, with the exception of fetal demises or occasional stillbirths.

No, I'm not talking about a maternal death either, although that would be even more shocking and disturbing.

We had a visitor, an elderly woman, on the unit, fell, and appeared to be fine, just requiring some basic first aid, and some further treatment in the ER. When she arrived in the ER, however, she went into cardiac arrest, was coded, and died.

We, on L&D, just do not expect to see an adult die -- at least not on our unit. I'm grateful that this woman received the utmost superb care one could receive - right in the ER - when she went in to cardiac arrest. She was simply in the best place to arrest. However, it obviously was her time to go, because they just could not bring her back.

My heart aches for the young woman on L&D who lost her cherished grandmother, during a time that should be a happy time, the birth of her own child.

Oh what a slippery slope

And I'm not talking about snow-capped mountains either.

I'm talking about the slippery slope of medical interventions.

I had a woman having her first baby - a scared woman, and not well educated - who was being induced. Why? Because she was a whopping 6 days past her due date.

Oh holy crap! Stop the presses! She's postdates!

No, not really doctor. She's only 6 days beyond her due date. That's technically not postdates yet.

Anyhow. She was induced. Lucky her. She had pitocin given with an unripe cervix, all day, and all evening. Why no cervical ripening agents instead? Because she was spontaneously contracting too often for a cervical ripening agent.

So. Pitocin all day. Very minimal cervical change. A whopping 1 cm when the current doctor now wants to place a foley bulb for mechanical cervical ripening (see previous post on this topic). She can't get the foley bulb in, due to patient discomfort. So, I talk to the doctor, and the patient, about "how about the pitocin gets shut off for the night, and see if her contractions space out?" In private, I tell the MD that I feel that there is no need to push her induction (and she agreed) - she didn't have ruptured membranes, she wasn't in active labor, she was negative for GBS, etc. The doctor agreed, but was wanting to instead --- get the woman an epidural, so she could place the darn foley bulb.

UGHHHHHHHHHHHHHHH!!!!!!!!

I told her, good move, let's just do a c-section for failure to progress right now, because that's where this is going to end up.

Long story short, she consulted with her attending physician (this was a resident), and he said yes, do the epidural, then the foley bulb. So that's what we did. I wasn't happy about it, knowing that we were going down the slippery slope of unnecessary medical interventions...........weeeeeeee! Here we go!!

Of course, baby has late decels after the epidural - and continued to do so off and on for a few hours, before the end of my shift. I ended up shutting off the pitocin. She was a whopping 1.5 cm when I left for the night.

....sigh....

I predict she will have a c-section by 8am.

We'll see how things go, when I go back to work tomorrow.

Shoulder dystocia

So, I went to a fantastic medical/nursing conference the other week on Shoulder Dystocia. It was awesome! We got to do hands on practice on pelvises (pelvii?) at the end.

Wait a sec - didn't I already post about this? Major deja vu moment there............

Anyhow......

A few evenings ago, I had a shoulder dystocia right at a change of shift delivery. Of course, they always deliver at change of shift! The dystocia actually went pretty smoothly, as far as dystocias go. Got her in McRobert's, called for help, did suprapubic pressure. I already had a 2nd RN at the bedside, but we probably could have used a 3rd or 4th RN as well. Of course, almost every other nurse was busy in other deliveries at the time.......but all's well that ends well. No clavicular fx palpated by yours truly on the newborn, and baby was moving all limbs equally.

Here's hoping for a less stressful shift tonight........

One+ year update

Here I am - just over one year since gastric bypass! Some new pictures for you :-) I'm currently 149 lbs (well, this morning I was 148.8 lbs - lowest EVER!)

However, I am having more complications. I've been spilling blood into my urine (seen on urine dip), and at first, it was non-hemolyzed blood (whole blood cells - from the urethra/bladder) and I was without symptoms of a bladder infection. Last evening at work, I was in agony with back and flank pain, as well as epigastric/belly pain (a la gallbladder attack style). No fever, and still no symptoms of a bladder infection - however, I dipped my urine and found a large amount of hemolyzed blood (indicating either kidney stone or kidney infection). Of course, the shift was so super busy, I couldn't even imagine asking to be relieved from duty to go to the ER - believe me, I wanted to - the pain was THAT BAD!!! I debated going to the ER when I was done, but after discussing things with one of the physicians, I decided to just go home and take some vicodin and try and sleep. Well, I was in pain for a bit of the night, but a heating pad helped my back a bit. Still had waves of wicked belly pain, but this morning I'm back to feeling normal - except for an ache in my right flank area. No fever. No obvious blood in my urine (it's all on urine dip - microscopic). So, the thoughts of the doc I spoke with last night, and myself, is that it's a kidney stone. Not much you can do for it, unless the pain becomes unrelenting or severe like it was last night. So I'm going to wait it out, and see if a stone passes. If the pain gets worse, or I have no improvement, or run a fever, I'm calling the doc, or if it's after hours, going to the ER. When I was talking with the doc last night, he felt with all of the metabolic changes post surgery, it was more than likely a stone. Greeeeeeeeat.