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#121 of 1533 Old 12-16-2005, 11:15 PM
 
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Maybe some L&D RNs can answer this question for me...

I am worried about having to go along with the norms of hospital L&D. I think of everything I went through with my first baby's birth (awful experience with every intervention in the book and finally a c/s) and really don't want anyone else to go through that.. that is partly why I want to become a midwife, to help women take control of their birth experience.

But, as a nurse, how do you manage that inner conflict? You have to defer to the OB, who let's face it, may not always be looking out for the mom's best interest..(I'm mostly referring to the ridiculously high rate of c/s in many hospitals).... but you know that the mom in labor might not know all the facts or may like to know about alternatives (like I was never told when my son was having heart decelerations that it might help to move around, stand up, etc. and I didn't know any better at the time- and I wasn't told about the risks of epidurals, etc.). I am so worried that I'll get fired because I won't know how to keep my big mouth shut. Ideally, I'd like to work with midwives.. but there aren't that many around here

~e, wife to my sweet T partners.gif, mama to my turtleman (8) , sunshine (6 vbac.gif), and monkey (2)
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#122 of 1533 Old 12-17-2005, 12:49 PM
 
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Originally Posted by paloma
It is one of my dreams to get fired from a L+D job.


OMG!! Me too!!!! Of coarse I want to wait to be fired until I have enought hours to apply to CNM school.
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#123 of 1533 Old 12-17-2005, 04:32 PM
 
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I am worried about the same thing mama2babybeans. I have never had a hospital birth but I have studied birth extensively and worry how I will handle the cascade of interventions. How do you defer to the OB even when you feel it isn't the best thing for mom or babe? I guess you just have to work through it but not so sure I could.

Well, glad to see this thread is taking off.

Peace,
Shelbi
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#124 of 1533 Old 12-20-2005, 12:52 PM
 
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Hi, new here, just had to jump in what with the relevance of this thread to my life! I am a RN in L+D, just graduated/started in July. Can really feel a lot of what folks are saying aobut the school struggle and also the '(want to) work L+D but don't look forward to the head butting with MD over different philosophies'.

My two cents on it..basically, I went to Nursing School with the intent of continuing with midwifery. SO, L+D was the expected next step for me. I decided to work high-risk inner city versus cushy county hospital because I figured it would be A) great experience for later on, wherever nursing takes me, and B) easier to accept the interventions that occur becuase so many are inevitable with high-risk population. That said, I am pleasantly surprised by how much our residents/attendings make an effort to forgo a C/S or forceps/episiotmies (never seen one at the hospital)/etc. I also believe strongly in a woman's right to decide what she wants, even if it is an epidural or elctive repeat cesarean...not that I don't bite my tongue occasionally! The population I wirk with isn't nearly as educated about 'unconventional' interventions (like changing positions, etc)...as a new nurse, so much of my focus is on just functioning and meeting my job expectations. i need more confidence and experience before I start pressuring MD's to try something radical!! I try to cut myself some slack this way, it truly is a challenging job.

I do miss experiencing truly natural labor/birth but console myself with the knowledge that someday I will be there!

Would be glad to chat with anyone regarding this topic further.
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#125 of 1533 Old 12-20-2005, 06:01 PM
 
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Hello there you nurses in L/d or want to do L/d. I started in L/D as a new RN. This is an area where thick skin comes in handy when dealing with OB's. If you are the non interventionist type then L/D needs you. Believe me most units would be happy to have a crunchy nurse to defer their patients to who are into that kind of birth. If you arent into interventions then you will develop your skills to help people avoid them more than the average nurse who just might go along with whatever.

As far as pre-midwifery experience I think you would be better off in a community type hospital on night shift. This is where more natural labors are allowed to progress without doctors in house. If you want to be more autonomous as a nurse this is where you will get the most experience with decision making and assessment because there are not a bunch of doctors hanging around--at night you have to call them and make them come in. Heck sometimes you have to insult them just to make sure they are awake. A high risk hospital will do more stuff like manage seizures and extremely preterm birth and other surgical stuff like PUBS and management of twin to twin transfusion etc. However if you are more into midwifery then a community hosp. is where you are more likely to have to sort the normal from the non-normal. You are also more likely to have to help with births when a doctor doesn't arrive in time and such.

I did L/D full time 3 years and I still do PRN because I enjoy it. I did my masters in neonatal care because I wasn't sure about the legal climate for CNM and I still don't really like it. For example my CNM had her insurance cancelled by her OB because she wanted to put in her notice and she had appointments through the week and I was 40+weeks, so until her new office could get her insurance she couldn't see her patients! That totally stinks. The other stinky thing is that they are trying to follow the midwife model with an MD who will generally follow ACOG (they disagree on home birth for example). I think we need a new category called midwife-MD with admitting priveleges etc.


I also had a difficult return to work after having to have a c/s and a few months later having to attend tons of c/s (I attend the infant but usually have to "catch" the baby from the doc, so get a full view of the business end of the c/s). That was difficult but it is getting better. PM if you have any specific ? on L/D nursing.
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#126 of 1533 Old 12-21-2005, 10:53 AM
 
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Originally Posted by paloma
Come on Mamatobabybeans, is A=P II harder than A+P I?

Dish.

I heard that the nursing part is not harder than the prereqs. Everything feeds off each other. Very low dropout rate (maybe because everyone got weeded out in the prereqs?)
I know you weren't asking me but I and many of my classmates found A&P II to actually be easier. We think it's a combo of knowing the drill, being more comfortable with science, and the systems covered. It was like a huge sigh of relief--we were all worried it'd be harder.

And yep, actual nursing courses do have a much lower drop out rate than pre-reqs And nursing "drop outs" often are women who take a break to have a baby, or work more hours (nursing--especially LPN--seems to have a very high single mama population I've noticed), whereas a pre-req "drop out" tends to switch majors and go on to a ew career.

The two classes I thought were killers were Med Surg II (mostly because my teacher was horrible...material wise, I found Meg Surg I to be much more challenging) and Pharmacology was pretty rough at points. Loved OB, loved Peds, Community was okay, Psych was interesting....But Med Surg I and Pharm tend to have the highest # of withdrawls and failing grades/retakes, no matter what school you go to, or if it's ADN or BSN.

Hope that helped a little.
Kelly

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#127 of 1533 Old 12-23-2005, 12:52 AM
 
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I'm an RN, work surg/oncology right now... have done everything from L&D (hated it! keep me in the nursery, I'm ok, but those labors... ) to geriatrics (loved my little old people). I'm working almost part time now, can't wait to cut more hours to be home with the little ones when DH graduates...
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#128 of 1533 Old 12-23-2005, 02:31 AM
 
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Originally Posted by paloma
Come on, dish!

Who wants to be a CNM when they grow up?

I do! I do! But for now I'm just concentrating on the RN and IBCLC part. (I'm working through nursing pre-reqs at my local community college and will be eligible to sit for the IBCLC exam in 2007, I think.) I already have two degrees (undergrad in teaching, master's in English) so I don't know realistically how much more education I can justify for me when dh and I will (God willing) have 3 kids to put through college as well. But a girl can dream, right?
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#129 of 1533 Old 12-23-2005, 01:18 PM
 
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I do! I do! But for now I'm just concentrating on the RN and IBCLC part. (I'm working through nursing pre-reqs at my local community college and will be eligible to sit for the IBCLC exam in 2007, I think.) I already have two degrees (undergrad in teaching, master's in English) so I don't know realistically how much more education I can justify for me when dh and I will (God willing) have 3 kids to put through college as well. But a girl can dream, right?
It's an investment! You can work at more $ to put them through school. The perfect plan! Hmmmmm, you could be the head of patient education at a hospital with all the degrees you will have! Cool!
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#130 of 1533 Old 12-23-2005, 07:43 PM
 
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It's an investment! You can work at more $ to put them through school. The perfect plan! Hmmmmm, you could be the head of patient education at a hospital with all the degrees you will have! Cool!

Not to mention teaching at a college! they are desperate for nurse educators

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#131 of 1533 Old 12-23-2005, 10:07 PM
 
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I have read somewhere (sorry usually like to site resources but just can't remember which newspaper I was reading this in) had said that lack of nursing educators is the real reason there is a huge nursing shortage and long lists at many schools. So, you would be doing some very important work and working hours are probably even better than if you were working out in the field. I would imagine compensation would be much better as well. Definitely something to think about with already having an education background.

Good luck fellow student mama.

Peace,
Shelbi
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#132 of 1533 Old 12-23-2005, 10:46 PM
 
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Just wanted to pop in and say Hi! H! I am a nurse (BSN) IBCLC and now a lay midwife (taking CPM hopefully in 2006!-only need 4 more births). I went to nursing school first as a single mom and then after a short break and another baby, decided I wanted to get my Bsn because at the time I was going to be a CNM. After working in the real world for a bit, decided I would do much better as lay midwife and private lactation consultant. So I get to live my dream now, how great is that?

Nursing is just the greatest field. I have worked at several jobs including some seasonal part time work doing audits and getting paid very well. When my husband lost his job a few years back, I was able to find work immediately in a nursing home and make decent money. This spring I will start work 2 days per week as a clinical nursing instructor for our local community college. It is a great opportunity and I am looking forward to it, although I am nervous, there's lots to remember and tons of paperwork. I thought the pressure was on as a student, now I am the one supervising 6 students on the floor!

Good luck to everyone, let me know if you need any help, advice, whatever, I'll do my best!
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#133 of 1533 Old 12-23-2005, 10:49 PM
 
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Shelbi, nah the $ isn't that amazing for nurse educators generally, especially considering you need a masters, or in most places even a PhD or credits towards the PhD. But you're right about the nursing shortage. At my school, it got so bad (looking for teachers) that the Dean and the Associate Dean actually had to teach a few classes and do a few clinicals.

I'm going to teach--adjunct--I'd say in about 6 or 7 years....but on top of my regular job--maybe I'll do one or 2 classes per semester.

But it's a super important job, and I'd imagine can be very satisfying...one where you get to effect the future of nursing, influence those nurses (think of it--an AP/NFL teacher!), AND keep your skills up.
Always something to consider.

Kelly

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#134 of 1533 Old 12-24-2005, 05:14 PM
 
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Hi! What a great thread! I really want to go back to college and get a nursing degree/certification someday. I started doula training, attend some births, and had to stop that when I got put on bedrest. Then Nitara was born with her reflux issues. I have practically become an expert on her condition and related issues. I put an NG down her for 4 mos, then cared for her gtube, nursed her through some GI viral infections, croup, seizures, etc. I realize I want to help other people in the same way. Nursing seems right, b/c of the hours and the pay (hey, gotta start thinking about retirement and college funds). Doula hours are too crazy for me with 2 small kids, one of whom I can't leave with a sitter yet.

So anyway, I'm not sure how to get started. I would like to take night classes and do it at my own pace, but I have heard that you have to enroll full time in nursing school. How can I do that with small kids? How can I afford a caregiver during my classes? Are there any programs worth their salt that offer classes nights/weekends?

I have a BA degree with some science/anatomy classes under my belt. Started out working towards a BS but changed my major. Dh and I have a two year plan. He's going to work hard to increase our income so I can afford nursing school. Let's see how it goes.

Any advice? Thanks!

I went through nursing school as a single mom. DS was just a couple years old. I was in an evening program with clinicals on saturdays. I got around daycare by taking my son with me to classes. I was lucky, my teachers were cool.

I'm so glad I did it. I never planned on going to nursing school. I was pre med and got divorced and realized there was no way I could now do med school and residency. I was working at the hospital at the time and realized how much residency looked like it would suck. Especially as a single mom. Thank god my dad encouraged me to go to nursing school! It had never occured to me, I was the you gotta be either a doctor or lawyer type.
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#135 of 1533 Old 01-12-2006, 03:28 PM
 
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This thread's been quiet for a few weeks, but I just wanted to add my 2 cents- I think it's a great thread!

I trained as a direct-entry midwife in Australia, but came "home" to the US right after I finished & never established my practice. Have found that I'm really not qualified to do anything here (need way more homebirth experience than I have to be a CPM), but I'm going to nursing school next year to do an associates as quick as I can.

I day dream a lot about what it would be like to work in L&D. I an not especially crunchy, but HATE to see medical intervention used when it's not needed. I don't have especially think skin & can imagine feeling ripped up every day at work.

I think NICU might be a good fit... supporting families (& breastfeeding!) in challenging situations. Or maybe I'll end up somewhere with nothing to do with maternal/ infant.

Anyway, thanks everyone for sharing your stories!

Jen
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#136 of 1533 Old 02-12-2006, 02:04 AM
 
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Well, I think it's high time this thread got a bump (unless someone started a new one).

I currently work on a med/surg floor in a hospital, and the other day, one of the docs pulled me aside to tell me he was hiring an LPN for his office and that I should consider applying. I was really flattered, and it got me thinking. I've done rehab, nursing home, LTAC, hospice, case management, pretty much all an LPN can do except dr office.

So, any of y'all ever worked in a dr's office? What did you like/hate about it?

Monica , DH :cop , DD (8) , DS1 (5) , DS2 (2/09) , and the pup
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#137 of 1533 Old 02-12-2006, 03:36 AM
 
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Like it that it's less stress, less "work", HATE it that is's much less pay.

Kelly, mama (12yoDS), doula, RN, and writer.
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#138 of 1533 Old 02-12-2006, 02:37 PM
 
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Yeah, I was afraid it would be less $$. We really can't afford a drop in pay right now, but I would love to have less stress. We have been so short lately that a normal day has me taking care of 6-7 post-op patients. I'm so busy that I have no time to chart during the shift, and end up leaving at 8:30 or later when the shift is supposed to be over at 7:15.Besides being tired of the long hours, the patient load means I can't spend much time with any one patient; I'm afraid I'm gonna miss something important one of these days and someone will get hurt.

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#139 of 1533 Old 04-11-2006, 12:14 PM
 
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I'm hoping to revive this thread.....

I worked in a doc office/birth center for several years as an LPN; it was stressful but fun. Since it was a small office, I did everything--phone triage; pt histories; counselling on birth control, natural family planning, and nutrition; phlebotomy; ordering supplies; preparing and autoclaving sterile equipment: you name it, I did it. I also taught childbirth, infant care, and breastfeeding classes, and attended births as the midwife's assistant. I really loved it, and hope to go back to it some day, in a more part time capacity. Currently I am working 3 12s a week on a med floor, and about 3 8s a month for an agency (the agency work goes straight to our savings account; it's nice to have that extra income!).

A JuCo in our state recently got approved for an LPN to Rn online program. You do all your theory on-line, then your clinicals are set up in your geographic area. It takes approx 8 months to do, only 5-6 weeks are clinicals--but the clnicals are 3 12s a week. I plan on starting next January, so I can get my associates, earn a little more mooolahhh, and expand my career options.

I used to want to take on the world, you know, with birthing. I think I almost got burned out by it. It's hard to be that invested in natural birthing (or probably anything). I'm enjoying my time in med/surg right now; I find that my birth center experience is very helpful. Alot of people have pain that can't be completely controlled by meds; I have a much greater bag of tricks than most care givers. I also have pretty good assessment skills, if I do say so myself, I think in part because we didn't have any machines that went bing at the birth center--it was all what you could see, hear, smell, and feel. I think that really helps me at my current job. I find that if I trust my instinct, I am almost always right, in terms of pt assessment. My listening skills were also definately honed at the birth center.

While I know it can be a burden, working nights is what I recommend to any nurse here, no matter what the field. In general night shift has more allowance in their time--they have a greater ability to budget it. They are more autonomous, because the docs and supervisors aren't around. And we're just a wonky group; it definately takes a slightly off type of character to work on nights. I fit right in!!!

Should we start a new thread, or just keep this one going?

It's nice to see you all here. Sometimes medical professionals all get lumped into the "bad bad bad" group here on the natural living boards, and it makes me sad that my honorable profession is viewed by some in such a bad light. Some of it is no doubt well deserved, but I think alot of it is misunderstanding and sterotype. I'm glad to find so many AP mamas who are also nurses and future nurses. It makes me feel better about our profession AND attachment parenting!

Lori
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#140 of 1533 Old 04-11-2006, 12:23 PM
 
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We are all trying to save the birthing world. Nuts.

Yeah, nurses are a funny bunch, quite a varied group.
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#141 of 1533 Old 04-11-2006, 08:11 PM
 
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Well, I am in my first quarter of nursing school. I just took my first test and got the highest grade in the class I was so excited. We are just now covering meds and injections. My ultimate goal is to be a midwife but I know that I am going to check out many different options that all fall under the one umbrella of nursing. Glad to see actual nurses on the boards too. It helps to know that others have survived this pace of learning.

Peace,
Shelbi
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#142 of 1533 Old 04-12-2006, 12:35 AM
 
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A question for those of you working in hospitals: How do you do report on your floor? We've just started a new report where the oncoming shift(nurses and techs) is all together, and the offgoing nurses, one at a time, come in and give verbal report. It works well in theory, but in reality, we're in report for over an hour each time. So we don't hit the floor until after 8 o'clock for a 7-7shift.

The powers that be tell us that the new JCAHO requirements next Jan mandate that we do a face to face handoff and that's why the new system now. There must be a better way to do it. Any thoughts?

Monica , DH :cop , DD (8) , DS1 (5) , DS2 (2/09) , and the pup
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#143 of 1533 Old 04-12-2006, 09:56 AM
 
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Why does everyone need to hear report? Our aides/nurse techs give report to each other, in the nurses' station, and the nurses give report to each other, after they have read the chart (we are computerized). So, for example, this morning, the oncoming shift came it at about 0645 and looked at their assignments. Then they go to one of the many computers in the nurses' station and look up their patients. At 0700 I look at staffing and see who is taking my patients, then I seek those nurses out. Sure, I might have to wait a bit while someoneelse is giving report, but never long. The idea behind the computerized charting is that all the important info should be there; you should rarely have to spend more than a couple minutes on each patient. I had four patients last night, started report at 0705, and was done at 0715. If a patient needs something in that time period, the off-going nurse usually stops giving report to take care of it; if it is something someone else can do, then they might send an aide or another nurse who is waiting in line for report will go and take care of it.

Does that all make sense? How big is your floor? Ours is a 48 bed medical floor, usually has a census of between 25-40; usually night shift is a 1 care giver to 3-4 patients ratio; dayshift is usually 1:2-3. There is no reason for me to hear the report of anyone else's patients. There is a better way for your floor, I think! But the size of your floor will probably determine what works best.

Does that help?
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#144 of 1533 Old 04-12-2006, 10:39 AM
 
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Hi all! Just skimmed this thread and wanted to say Hello!

I've been an RN (BSN) for 7 years now. Graduated from the accelerated program at Johns Hopkins (LOVED getting it overwith in 13 months!). My first job out of school was in the PICU--loved the kids, hated what happened to them and hated the hours. After a year we moved to NW WA and I worked for an allergist as an office nurse for three years--LOVED the work and the hours. Now we live in Iowa and I work part-time for the local univ.'s student health clinic (where we currently are in the news for a mumps epidemic in our required-to-have-two-MMRs student population!), great hours now that I have a kiddo. I'm not sure what my plans for the future are? Maybe NP, med school, parenting research?????

DS is currently fully vax'd, it's been a gradual journey for me into natural parenting. But now I think he (and any other future children) will be delayed/selectively vax'd.

Anyway, that's my story--love reading about everyone else!
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#145 of 1533 Old 04-12-2006, 11:31 AM
 
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Quote:
Originally Posted by lorijds
Why does everyone need to hear report? Our aides/nurse techs give report to each other, in the nurses' station, and the nurses give report to each other, after they have read the chart (we are computerized). So, for example, this morning, the oncoming shift came it at about 0645 and looked at their assignments. Then they go to one of the many computers in the nurses' station and look up their patients. At 0700 I look at staffing and see who is taking my patients, then I seek those nurses out. Sure, I might have to wait a bit while someoneelse is giving report, but never long. The idea behind the computerized charting is that all the important info should be there; you should rarely have to spend more than a couple minutes on each patient. I had four patients last night, started report at 0705, and was done at 0715. If a patient needs something in that time period, the off-going nurse usually stops giving report to take care of it; if it is something someone else can do, then they might send an aide or another nurse who is waiting in line for report will go and take care of it.

Does that all make sense? How big is your floor? Ours is a 48 bed medical floor, usually has a census of between 25-40; usually night shift is a 1 care giver to 3-4 patients ratio; dayshift is usually 1:2-3. There is no reason for me to hear the report of anyone else's patients. There is a better way for your floor, I think! But the size of your floor will probably determine what works best.

Does that help?
Our floor is about the same size as yours. The theory is that by hearing about every patient, you are able to help answer any call light. I like the thought, but when I have 7 or 8 patients, I don't have time to answer my own call lights, much less anyone else's. It's such a waste. With all the overtime they're paying us to sit in the stupid report, they could hire another nurse or 2 and make it so we would have time to help each other more.

Monica , DH :cop , DD (8) , DS1 (5) , DS2 (2/09) , and the pup
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#146 of 1533 Old 04-12-2006, 02:44 PM
 
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I am an RN student with one year left. I also work in L&D as an OB Tech. Thinking that eventually I will persue the midwife route but work in the hospital on the floor for a while first. I don't exactly agree with all of the intervention but even as an OB Tech, I feel like I make a differnce in the section and breastfeeding rates. I enjoy getting my patients into alternative birthing positions and facilitating a non-surgical delivery. Also, there is alot to be said for going to work, doing your job, and then GOING HOME until your next shift. My family is too young to dedicate my life to practice. Someday (too soon!) they will be older....
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#147 of 1533 Old 04-12-2006, 05:54 PM
 
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I graduated last may w/my LVN and worked a bit in med/surg. 12 shifts while preggo was exhausting! I haven't worked since early Nov. ds born in Dec. Not currently working as we are getting ready to move to CO. Does anyone here live in CO?
I will, once settled, try to find pt work and eventually, I will be taking some classes to get my RN. I think I'll have to retake some prereqs because of the time limit.
Anyhoo-glad there's a thread here!

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#148 of 1533 Old 04-13-2006, 08:54 AM
 
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Quote:
Originally Posted by purpsurfer
Also, there is alot to be said for going to work, doing your job, and then GOING HOME until your next shift.
This is so true, and is one aspect of hospital work that I have enjoyed emensely. I always work under 40 hours a week. At the birth center, I sometimes was physically at work for 2-3 days at a time. Every time I left for work, I brought 3 days worth of clothes with me, in case I didn't make it back until later in the week. I really, really loved the work, but I also really missed my family!!
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#149 of 1533 Old 04-13-2006, 09:01 AM
 
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Quote:
Originally Posted by monkaha
Our floor is about the same size as yours. The theory is that by hearing about every patient, you are able to help answer any call light. I like the thought, but when I have 7 or 8 patients, I don't have time to answer my own call lights, much less anyone else's. It's such a waste. With all the overtime they're paying us to sit in the stupid report, they could hire another nurse or 2 and make it so we would have time to help each other more.
I just don't see the sense in that method of reporting, not for a floor that big. If you were a rural hospital with a regular census of under 15 or so, sure, that might make sense.

I would suggest you go to your management and tell them this isn't working, and request a committee be formed that can study how other hospitals do their report.

Search around on www.allnurses.net and see what you can find, as far as information regarding report goes. It sounds to me like you have at least one policy in place from decades ago; that is definately not something that is going to work in a modern hospital!

Good luck!

On another topic; does anyone do eMAR? We are about to go live with that, and I must admit I'm a bit concerned. I really, really like the idea of the MAR being on the computer; what I don't like is the hand-held device. It seems very awkward, big, and heavy. The keypad is in alphabetical order, not a keyboard style. The stylus is difficult to use--sometimes you have to "tap" the screen, and sometimes you have to touch and hold--but no apparent rhyme or reason. I'm sure I'll get used to it; but the first several weeks are going to probably make me grumpy.
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#150 of 1533 Old 04-14-2006, 01:31 PM
 
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We use eMAR, but it sounds like a different system. We have laptops mounted on carts with scanner wands. Scan the med, scan the patient(barcodes on name bands). I like it. It prompts you to enter bp for bp meds (though it won't tell you if it's out of range or anything like that) heart rate for dig, pain score for the pain meds. It's a pain for things like just hanging a bag of fluids or when you want to quickly toss a pill at someone; the COWs we have (Computer On Wheels-they all have names like Bessie and Elsie LOL) are very cumbersome and heavy. I like the idea of the handheld device you have, but the alphabetical order would really bug me too.

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