Friday, February 10, 2012

I wish I'd been there to see this exchange...

So tonight I was told a hilarious story by our unit's Day Shift unit assistant.

I'd been taking care of a first-time-mom with twins for the last 3 nights, so I guess we'd built a bit of a rapport. I did a lot of teaching, especially breastfeeding and time-management. I shared some of the insight I'd gathered having been a nanny for boy-girl twins during nursing school. So apparently, a short while after I'd gone off shift, the mom came out of the room and went to the nursing station looking for me. Our UA told her I'd gone home, and the mom looked confused or something. (I'd even said "bye" during shift-change so I don't know why she'd thought I'd still be there.) Our UA asked if they needed help with something, or needed their nurse to come to the room. The mom said "No, I need PurpleRN! Can you call her and have her come back?" The UA replied, "Um, she's gone home for the day, and I don't have her number. Is there something urgent?" "She's going to be our nanny!! We need her number!" Understandably, our UA was simultaneously amused and confused. She tried to explain that I *had* a full-time (night shift!!) job already, but this lady desperately wanted my number. So the UA gave her the main number for the unit, and warned me that she may try to contact me some night.

I have *no* idea where she got the idea I would be her nanny. I've had people *ask* if I wanted to do some nannying on the side, but none so certain without first discussing it with me.

I hope she finds a good nanny. If her relationship to reality is *that* tenuous, she'll probably need one....

Tuesday, January 24, 2012

C-Section Rates at my hospital

It's been something I've been thinking about for awhile. What exactly *is* our C/S rate, and why are they being done? So I started writing down the stats this week on the nights I work. I'll update it every so often, till I get maybe a month's worth of data. We'll see.

C/S: Primary - 1 (Fetal Intolerance to Labor)
Repeat - 1

Vag: Spontaneous - 4
Assisted - 0

C/S: Primary - 2 (Failure to Progress. Twins)
Repeat - 0

Vag: Spontaneous - 3
Assisted - 1 (Vacuum)

C/S: Primary - 3 (Non-Reassuring Fetal Heart Tones/Code C. Breech. Fibroids)
Repeat - 1

Vag: Spontanous - 6 (one VBAC)
Assisted - 0

C/S: Primary - 6 (FTP/Failed elective induction. Decels/Failed Vacuum. FITL/IUGR. Breech. AOD/Failed elective induction. NRFHT/Post-dates.
Repeat - 2

Vag: Spontaneous - 7
Assisted - 1 (Vacuum)

So far we're at 42%. Granted, we are a hospital that specializes in high-risk pregnancies, but that still seems a little high....

Monday, October 31, 2011

It's here! Hooray!

50 Things Your Nurse Won't Tell You

Two of my ideas made it into the list, so that's pretty cool. I liked hearing what the other nurses came up with. So true, so true...

It was a very interesting process being included in a magazine, especially when the fact-checker called to see what my opinion was of what some of the other people said, like fudging the dosing on pain medication to keep your patient comfortable.

Friday, September 16, 2011

Quick moment of horror...

So there's going to be a sympathy strike in our region coming up, and the administration is trying to figure out how to cope with a few thousand nurses missing.

One of the things our Chief Nursing Officer said they'd do was "perform a few extra C-sections on the weekend before" so there would be fewer people delivering on Strike Day.

Talk about unnecessarean....

Friday, July 22, 2011

A short illustration of the difference between Mom/Baby and Telemetry.

While assessing a new admission, you notice a set of shallow, scabbed-over scratches on your patient's calf. You ask the patient the story behind them, and you are informed that the patient's cat was bad about retracting its claws when it wanted to climb up her leg to sit on her lap.

On Telemetry, this short exchange is immediately followed by you writing a nursing note mentioning the scratches, as well as charting it in the flowsheet. You get the camera out to document that the patient arrived with said scratches, and so you can have a basis for comparison should they change. You upload the pictures to the system in case someone needs wound care to see them. You also write an incident report, to CYA in case someone tries to say that they were incurred on the unit. You waste a fair amount of your shift.

On Mom/Baby, this short exchange is immediately followed by you extending your sympathies and sharing your own cat-related-injury stories. You and your patient share a laugh. You move on with your day.

Sunday, July 17, 2011

I do not understand some people....

Here in my state, you have the right to refuse any and all treatments offered to you or your children in the hospital. I don't know if it's a universal/federal deal, but it is how it is here.

So last night, I had the interesting experience of taking care of a set of brand new parents who refused everything. I mean everything. Mom was not tested for GBS (a bacteria that can cause fatal sepsis in the newborn), hepatitis (which can also be passed on during delivery) or rubella (which can cause mental retardation), which are all standard parts of prenatal care.

They also refused ultrasounds on the baby, except to determine gender. Because dad had read somewhere that the sound waves can cause developmental delays. Based on a study done on the cell division in mice. Having done some googling, it looks like the study itself admits that there is need for further investigation, and that they themselves cannot formally correlate anything to human babies. They finally agreed to one when the mom's fundal height at 34 weeks didn't correlate with the baby's age, which is a sign of IUGR, just to make sure the baby wasn't severely undersized.

While in labor, according to the notes, mom wanted IV pain medication, but didn't want an IV in place. Sorry hon, but they are not going to inject directly into a vein every time you need some fentanyl. Multiple breaks in the skin are just asking for infection risk. Or you'd look like a heroin addict.

When the baby is born, they refuse the "eyes and thighs," which means erythromycin eye ointment, a Vitamin K shot, and the Hep B vaccine. Ok. Here's my beef with this particular issue. I understand refusing the eye ointment if you are certain that mom does not have any dangerous vaginal bacteria (like GBS). I'm totally fine with that. But since they refused GBS testing, and GBS can cause blindness, it seems like a foolhardy risk to take. If they'd tested mom for GBS and she was negative, sure. Skip the eye goo. I'm not sure why they refused the Vitamin K. Probably to avoid the baby being poked. Again, it's their right to refuse things, but the baby had a rather large cephalohematoma. I would be *so* worried about continued bleeding into the space because of lack of clotting factors. And of course, the vaccine refusal was related to autism risks. Don't even get me started.

They refused the jaundice test. They said if the baby turns yellow, they'll just put it in the sun for awhile. She's a small baby, not eating very well, with a hematoma. Jaundice can cause brain damage if it's untreated, and this baby had so many of the risk factors for it.

They also refused the newborn screening which tests for treatable but possibly fatal metabolic and endocrine diseases, like the inability to digest milk sugar. Wouldn't you want to know if your baby could get brain damaged by breastfeeding?!

In addition they refused the hearing screening. I guess also because of dad's fear of sound waves? This is the most benign test we do. We put squishy rubber headphones on the baby and little sticky wires on the forehead and measure what the brain does in response to sound. It takes 15 min and the baby stays asleep through the whole thing.

I guess the thing that baffles me about all this, is why bother coming to the hospital in the first place if you don't want anything the hospital provides? I will defend people's right to make their own choices in medical care, but it would be *nice* if they were based on reality and sound scientific fact rather than "shit I read on the internet."

When you come to the hospital armed with information from Dr Google, while categorically refuting everything an actual MD tells you, it does not look good for you as a rational human being.

And when your stubbornness could impact the health of your baby.... ooooh not good. I just hope that the things they take for granted (the baby won't get an eye infection, the baby's hearing is just fine, the baby doesn't have any metabolic disorders, the baby will not become jaundiced) end up being true. They have a really sweet baby.

But for me, it seems so bizarre to refuse testing/treatment on the remote chance they may cause problems, when the chances are fare more likely that refusing these things will lead to problems.

It would be like spending all your money on alien-proofing your home, while neglecting to put locks on the doors. Sure, there's a *possibility* that ETs will invade your house, but it's far more likely that someone will waltz right in and steal your TV.

Monday, June 20, 2011

New dads are great....

Last night was a fairly strange shift for me. I was on committee for most of it, to finish up some computer-based training. Then I hung out in the nursery to help out a little, because we had 4 babies under bili lights and one on the blanket. It's too much for one nurse to handle, especially when they're screaming at the same time.

Around 0530, I finally took an admission, and then another around 0630.

The latter one was a c/section, first baby. Mom, understandably, not moving around a whole lot. I got them settled, and told them to call me if they needed any help. At 0700, when I'm giving shift report, I go into the room with the oncoming nurse.

I see a light on in the bathroom, hear water running, and don't see the baby's crib anywhere. I poke my head in the bathroom, and dad is trying to change the diaper.

He has obviously never changed a diaper before. He's wearing gloves (cute! lol), wiping haphazardly. He's trying to dodge the baby's kicking feet, which have poop on them. There is poop everywhere.

I try to suppress a grin as I ask him if this is his first-ever diaper change, and if he needs some help.

I clean the baby's feet, and show him how to do the one-handed grip to keep them from spreading the mess. He didn't set up any wipes ahead of time, so pretty much I started from scratch trying to explain the process.

He told me he didn't want to call for help because he knew he'd have to be able to do it when he got home. I told him that we are there to teach, and that our job is to make sure they can take care of the baby:
"You can do it by trial and error if you want, but it's generally easier to just learn from someone who's already made the errors...."