March 27, 2008

Medication Reconciliation

One of the more annoying things that I think all nurses working in hospitals must do is fill out the Medication Reconciliation form. It's a list of all the medications, OTC, herbals, vitamins, etc. that a patient takes. It's not so hard in OB because the majority of women having babies are healthy, and most aren't taking much more than iron and a vitamin. I can't even imagine the headache on the medical floors. When I worked ICU step-down, those people sometimes were on a dozen meds or more. But, anyway, we ask every patient who comes in what they are taking. I always ask what meds, vitamins, inhalers, OTC pills, because some people would forget about OTC Zantac, or their inhaler they carry just in case. But this past weekend, I had at least 3 patients forget about something they were taking. The worst one was a girl who came in about 32 weeks, not laboring but for spotting. She had been a regular visitor for the last month or so. So I start going through the long list of questions we ask everyone each time they come in and I got to the med rec. part. "Any meds?" She says no. Okay, so we continue on. We get to the health history part and I ask about asthma. She says, "Yes". Me: "any past medications, ever been hospitalized, any inhalers?: "Yeah, I have an Advair inhaler I use everyday." "Okay, that's a medication, so I'll put that on the sheet." So I go back to the med page and jot that down. Moving on, I get to thyroid dysfunction. She says "They put me on synthroid everyday, but I'm not sure if I'm hypo or hyper." I say "Okay, that's a medication also." I grumble under my breath but maintain a smile. I get to blood disorders/anemia. She says "Yes, I take iron twice a day". As I grit my teeth and smile, I say "Well, I'll add that as well to your list of regular meds/vitamins. Do you happen to take a prenatal vitamin?" To which she says "Yes". After the history portion, I do the assessment, in which I eventually ask if she has heartburn. Her mother pipes up and says "Yes, she takes Zantac every night". At this point I'm pounding my head against the monitor. I understand that coming to L&D is stressful, but damn. That's why I give every possible option when I first ask about meds. Most people just forget about the prenatal vitamin, but usually remember daily medications. It is a minor inconvenience, yes, but still a bit annoying.

3 months

Isaiah is already 3 months old. Man, time flies. He's doing really well with his head control. He's tried since he was born to hold his head up to look around, and he's doing pretty well with in when he's on his belly. He's also incredibly vocal. I don't remember Jacob and Clara making so many different noises when they were his age. He has a definate "I'm pissed" squeal, "I'm bored squeal" and just happy noises. As long as someone's talking to him he's good. But leave him alone when he's in the mood to talk and he'll start making noises, like he's saying "Hey, where'd you all go? I was talking here, get back here and pay attention to me." It's pretty cute. He's still not sleeping much better. Most of the time he falls asleep about 8:30, gets up to eat about 12:30 and 5:00. Last night though he threw in an extra feeding at 2:30. I know eventually sleep will come.

Here's his hair in all it's glory. If we comb it down while it's wet, it is more tamed, but still wild.

Clara with the bear she got from the Easter Bunny. He left it at Grandma's house and she brought it over for her.

Here's Jacob "webbing me". He's quite a character.

Can I call in sick?

Being sick was so much easier when I was a kid. I'd get to lay on the couch, wrapped up in a blanket and sleep all day. Mom would make sure there was warm 7-up or Sprite for me to drink and plenty of Ritz crackers. She'd even make chicken noodle soup if I was up to eating it. And I never thought about who would do that for her if she was sick. That's because mom's don't get sick days. I know, that's not profound conclusion I've come to, but it's true. I've been feeling pretty crappy since yesterday, and all I want to do is lay on the couch and sleep. I initially was blaming my achiness on a bunch of pumpkin seeds I ate on Tuesday (WAY too much fiber for my system), but since I feel the same way today as I did yesterday, only worse, I doubt they are the culprit. I slept little last night, even though I went to bed at 8:15, and I think I had a touch of a temp., but I'm not sure because I didn't feel like getting up to check. With as much as I want to lay around, I can't because the kids need to be taken care of. I can't call the boss and say "I'm not feeling up to par today. You'll need to get a substitute today". I will say that yesterday while I was doing my usual stuff around the house, I didn't notice that I was quite so achy until I sat down. I do plan on taking it easy today. I won't get much housework done, but that's okay. It'll be there waiting for me when I'm up to it. With as ornery as Jacob and Clara can be, they can also be quite charming. After breakfast this a.m., Jacob and Clara covered me up with blankets and gave me a back rub. They also told me they wouldn't fight today since I'm sick. Hmm, maybe, just maybe I should be sick more often!

March 26, 2008

Perks of being a mom

1. I get "webbed" on a regular basis. Jacob is into Spiderman, and he will come around the corner, make the hand gesture and pretend like he's shooting spider webs at me.

2. I get my hair done for free. Clara will occasionally decide to brush my hair and put barrettes in. She doesn't really do effective brushing, and the barrettes usually are half-way down my head, but she thinks it looks pretty.

3. There is usally a road in my living room. They will set up train tracks and drive their cars on them. And they'll have towers built around the road. They'll want me to "play toys", but usually I dont play right, so they just let me watch. They'll also decide which car I can play with, and then they'll instruct me on how to do it.

4. I also have in-house catering. They will bake me a cake about everyday. I first must be covered up with every blanket available, then they'll bring me my cake, either make believe or made of legos, and they'll pour me a glass of pop.

5. I now enjoy naps a whole lot more. And not just for the obvious reason of getting sleep. I have managed to get all 3 kids to nap about the same time most days. I've given up trying to lay Isaiah down in his crib to sleep during the day because it won't happen. So I lay down with him in the crook of my arm, and that way we're all able to get a good 1-2 hour nap. It's not quite the best rejuvenating, deep sleep, but nothing beats waking up to a sleeping baby nestled up next to you with their little hand holding the collar of your shirt.

6. Nothing beats the aromatherapy of a load of laundry in the dryer that was washed with Dreft. Except maybe the smell of a baby's hair/head after a bath.

March 25, 2008

Things I never thought I'd do that seem natural now

This morning as I picked dry boogers out of Isaiah's nose (yes, I know, it's gross), I realized there are a few things in my life that I do that don't seem that odd to me since becoming a mother, but 5 years ago they would have. Like the booger thing. Five years ago, I couldn't imagine that I would ever have a reason to pick someone's nose. But, on a fairly regular basis, I clean Isaiah's nose with my fingernail, wipe it on my pants until I get to a wipe and a sink. Over the last week, I've also pulled big ones off Jacob and Clara, so it wouldn't end up on me later on. Nasty, yes, but I'll admit that it gets done. Another thing: my breast pump. I didn't even know these things existed before nursing school. But everyday, I plug in my electric breast pump, put the milking device on my breasts, turn it on and express milk just like a cow. Except I don't think the cow willingly gets milked or is worried about putting the expressed milk in bags to freeze. But it's done nonetheless. And even breastfeeding itself . I never thought I'd lift my shirt, unharness one of the "ladies" and put it in someones mouth to feed them without a second thought. This is something I do in the presence of anyone, albeit discreetly. And I've even done it in a restaurant. With all three kids, they'd start rooting around and I'd promptly feed them and they are content. There are other little things I'm sure, like slobbery cookie kisses, but you get my point. Don't get me wrong. I don't mind doing these things. I guess motherhood has turned me into a nose-pickin', butt wiping, boob-pumping woman, and that's okay. Ah, isn't being a mom glamorous?! (Sorry about the crude descriptions)

March 24, 2008

Happy Belated Easter

Hope everyone had a Happy Easter. Nothing exciting happened here, thankfully. This past weekend with my inlaws around was surprisingly okay. Only complaint was the Easter baskets they gave the kids. They have always favored Jacob a bit, and they had gotten him a huge water gun and a motorcycle, and all I saw for Clara was a small water gun. She ended up playing with the dancing chicken they got Isaiah. She didn't seem to care, so I can't complain.

Work wasn't too bad. It was busy, but manageable. This a.m. at the end of my shift, a patient walked up and I recognized her friend. She apparently recognized me because she said "You helped deliver Sienna!!" So I tried to place her. I knew I had taken care of her, but couldn't remember details. I get her friend in the bathroom to change into a gown, and she shows me picture of her daughter that I helped deliver. She then told me "I hated you when I was delivering without an epidural for the second time, but you were exactly what I needed. I was just telling my mom I wish I could find that nurse and tell her how great she was." She said I grabbed her face and told her to focus, and that she could do it. Now, I have no problem telling someone they need to calm down and focus, but I'm not the type to grab someone's face. The whole drive home I tried to remember her delivery, because I remembered her. I finally remembered a bit ago. She was one of those who went from 2-3 cm to crowning in a matter of minutes. She had wanted an epidural, but it wasn't to be. Nor was having the physician deliver the baby. So when she said I helped deliver her daughter, she really meant it. It made me feel like I'm doing my job when a patient thinks about me 14 months later and wants to thank me for helping her birth her baby. I don't expect it, but its nice.

March 19, 2008

Just plain crabby

I'm pretty cranky today. I usually get that way the week before my in-laws come down. This weekend could be interesting. So I talked with my SIL, who I love dearly, but sometimes drives me batty, and I heard about how exhausting it is to babysit 3 kids for 10 hours. She says that, seeming to forget that I work elsewhere and come home to 3 kids. So of course she is more exhausted. But, anyway. The main reason for her phone call was to let me know what was going on with my MIL. The gist of it is that my FIL is giving her an allowance for gas and wine. And she's hit up my SIL and BIL up for $75 for "gas" this past week. SIL told FIL, which then provoked a huge fight I guess. So SIL thinks that this weekend would be a great time to tell her she can't see her grandkids. To which I said "what?". She seems to think that we're all going to sit down, on Easter Sunday, and husband and I are going to tell her she can't see her grandkids until she gets help. The last I had checked, we were the ones with the grandkids and the fact that they decided that we would be the bad guys, pissed me off. Who do they think they are? It's our house, our kids. We agree that she must be sober while she's here, and that she needs help. That's a given. But when it comes to the kids, that husband and my decision. We know that something has to be done, but after talking with a couple people who actually know something about addiction, they said that it probably wouldn't be a good idea to refuse to let her see the kids. That's why we went with requiring sobriety while she's here. Then to top off the conversation, she starts in about how basically, she knows all there is to know about raising kids because she baby-sits for 3 kids. She gave me all sorts of pointers on how to stop tantrums, get Jacob to eat, etc. Then she said "my kids will be well behaved, will eat everything, etc." I then had a great huge laugh. She didn't get it. And she won't until she has her own child and things don't go like she planned. She actually said we should make a bet once she has a baby. And that's a bet I'd love, love, love to make. There's only so much you can do with a 3 year old and behavior. They're going to act up, refuse to eat, argue, whatever.

Other things contributing to my catankerous mood today:
1. Ban.k of Ame.rica and the crap they pulled by taking unauthorized money out of my checking account and the lack of speed in fixing the situation. It worries me that any place that has my checking account number, which is any place I right out checks to every month, could do the same thing. And the bank wouldn't stop it because they wouldn't know it wasn't legitamate.

2. My lack of weight loss. I'm still stuck at the weight I was 6 weeks ago. My clothes don't fit right, I should go by new clothes, but I'm too stubborn. I did get into a pair of jeans I bought when I was about 12 weeks pregnant. I got a bigger size at that time beause I didnt' need maternity jeans yet. Well, I finally got into them, but it took some effort to button them. Jacob watched me with curiousity just shining in his eyes, but he didn't say anything. When I did get them buttoned, the repositioning of my belly fat was lovely. But, damn it, I got into them and I'm going to wear them. I guess if I worked out more regularly and ate better it would help.

3. My house is a disaster. The toilets are dirty, I need to clean the tub, I need to dust, the hardwood floor needs to be cleaned and as usual, I have laundry to do. And sitting here isn't getting work done, but I procrastinate a bit sometimes. :) Plus I need to get groceries, and I'll have to take all 3 kids with me unless I want to go at about 9pm because husband doesnt get off work until late tonight. I don't like going late because I want to go to bed at a decent time, but taking all the kids isn't really a good time. And I have to go today because we have 1 role of toilet paper left, thanks to the huge mess Clara made with several roles of TP this a.m. (she woke up before me, and I didn't hear her in the bathroom. not sure how long she was in there, but it was long enough). If it would have been someone else, it would have been a mildly amusing picture.
So I'm hoping all three kids will take a nap and I can get a nap in, too. Maybe that will make me not so cranky.

March 18, 2008

I'm not totally crazy afterall.

I had been wondering abot my 31 week patient I had the other night and wondering if I got all worked up over nothing. I mean, the docs didn't seem to be all that concerned. There was concern obviously, but not the level that I had expected, so I figured maybe I was wrong. Well, I got an update this morning. After I left at 7a.m., they did a biophysical profile and the baby scored 0. The baby never moved, there was very little fluid, no breathing movements. I guess the sono tech just kept looking because he couldn't believe he wasn't seeing any movement. So they called the local high-risk hospital and the neonatologists, to see about transfering the mom before she deliverd, but they said absolutely not, deliver her now. They waited until the team from the other hospital arrived and they delivered the mom by c-section about 11a.m. The baby had a 2 vessle cord, and a knot in the cord. If that mom hadn't decided to take her blood pressure and come in, her baby would have died. It just affirms what I already believe - that God was watching out for this baby. It makes me feel better because I was about to throw a clot the whole time I was watching the strip. I guess I knew that something was wrong, but it seems that they could've moved a bit faster, and because they didn't rush, I questioned myself. I need to stop doing that. :)

March 17, 2008

Morning Ramblings

It's been a busy weekend. Friday, husband and I went to the local comedy club and saw the Midnight Swinger. It was a lot of fun. The guy was hilarious, and he gave us a glimpse as to what Isaiah's hair may look like. To see what I mean, check out his site themidnightswinger. com and check out this dudes hair. I've posted a pic of Isaiah's do at the bottom. Anyway, it was good for us to get out away from the kids and the household duties for a couple hours.

At work, we had been waiting for a co-worker, who's due date was 3-23, to deliver. She works weekend option on day shift, and we were surprised to see her still working on Saturday. She's one of those thin women who feel great the whole time and you can't tell she's even pregnant from behind. Saturday, she looked like she was waddling, which she never did before, and she said she'd been having irregular contractions. She went home at 7:30 after working 12 hours, and her water broke an hour later. She came in for me and she delivered within 4 hours! Not bad for her first baby. I love watching someone go from being pregnant to the mother role. You don't always see it, but it's pretty awesome to see the transformation. It's hard to explain, but if you've ever been with someone through labor delivery and those first few hours after the birth, you know what I mean. Right afterwards, they are just in shock that they have a baby, but usually after they've been moved to post-partum and are settled, you start to see something change as they take on their new role. Not always, but sometimes. It's pretty awesome to see
I found out last night that the incident reports we fill out, like the one I filled out on the doc who was really rude to his patient last weekend, are basically worthless. I kinda figured as much, but I talked to a former nightshift charge nurse, who now is in the role were she gets such reports, and she said nothing is ever done. The reports are put into their file, and aren't seen until their contract with the hospital is up. Makes me wonder why the hell we even bother to fill out the damn things if it's just a waste of time. Ugh.

I also had a patient last night that raised my stress level to an all time high, but not on purpose. She had come in with a headache, 30 weeks pregnant, and after checking her BP at a store found it to be 150/100. Too high, so she came in. Well, the BP resolved, her labs were fine, reflexes were fine, but her baby started having what looked like late decels, but she wasn't having any contractions at that time. So I gave her oxygen, moved her around and it was all good for awhile. I called the doc, faxed her the strip and she said to just watch because she didn't want to deliver a 30 week baby if it wasn't warranted. She did start having very, very mild contractions and had late decels after each. And of course all the usual stuff didn't help for very long. After about 20 minutes of a decent strip, I start seeing lates again. Finally, the doc came in and ordered a sono and a biophysical profile to see what was going on, and this patient will be transfered to a high risk hospital with a NICU, or delivered and the baby shipped. It was just one of those strips that you look and and it makes you want to pull your hair out. I hope everything works out for her.

And lastly, when I went to daycare to feed Isaiah before going home, I found that they had warmed up a bottle for him, even though husband had told them I'd be in shortly to feed him. He wasn't fussing when I got there, so I'm not sure why they were warming his bottle. So I tried to feed him and he ate well on the right, but screamed and refused the left. And he did that once yesterday. Not sure what that's all about, but its a bit frustrating. Anyway, enough rambling for one day. I'm going to bed.

March 14, 2008

Comic relief

So husband and I had a chat about the whole issue of his lack of help and his attitude about me working nightshift. I think we got things resolved, and he said he'd pitch in and help more. And he doesn't hate that I work nights all that much. But, he's a man, and apparently there are a lot of men out there that complain about having to do housework, but like my sister says, "Just because you have a penis doesn't mean you can't take care of a baby or clean house". We'll see how it goes this weekend. We are also going out to the local comedy club tonight. He called a radio station and won the tickets this week and my mom is coming up tonight to watch the kids. It's a much needed break for the two of us because we rarely get to go out together anymore. We never went out all that much before we had kids, but now it's been like 1 or 2 times a year. So we deserve this.

I'm the one who writes the bills and manages our money. I've always done just fine and never had a problem with a discrepency in what my checkbook said we had and what the bank said we had. Last fall, I started having issues with this. I have a couple things taken out of the account automatically each month, our life insurance, a credit card payment and my gym fee. I noticed a couple times that the credit card payment seemed to have come out twice in a month, but I figured I was just going nuts and didn't really look into it. Until yesterday. I noticed that a payment of 4 times the amount was taken out. I was highly ticked off! So I called them and they said it was a phone payment, to which I said I never talked with anyone and NEVER authorized that payment. They acknowledged that a double payment was made last month, but the dude couldn't explain why. They refunded the money back to my account, and I cancelled all automatic withdrawls for the monthly payment, but WTF? I filed a complaint with the better business bureau, and I found several sites where people have complained about this company doing the exact same thing, taking more than one payment out a month unauthorized, taking more than the amount they are supposed to, etc.

March 13, 2008

Whiny post ahead

I'm a bit frustrated right now. Since I went back to work, my husband has done nothing but complain about having to be here with the kids over night. He does have to be with them from 6pm on Saturday until he drops them off at school on Monday morning. He complains that he doesnt get a break, but neither do I. We are their parents and he seems to forget that being a parent is a lot of work. I did go to my parents a couple days ago and he stayed here so he could have a "free" day. I had hoped it would help, but it didn't. He seems to think that on the days that I'm sleeping and the kids are at daycare, that it's a "free" day for me. But I'"m sleeping and I get up to pump as long as Isaiah still gets up in the middle of the night to eat. And I sacrifce sleep in general because I work nights. I thought that I've been working night shift long enough that he understood that. He wants sympathy and a pat on the back for doing so much around the house, but on the weekends, he doesn't do anything housework wise like he seems to think that he does. He is a good dad and does do more than what some dads do, but seriously, I'm at the end of my rope. On my days off, I clean the bathrooms, do laundry, dust, sweep and mop the floors, do things with the kids to help them learn things and I have dinner ready when he gets home. And then he sits down with a book aftter he gets off of work and does nothing, and I get up with the baby all night and he sleeps all night. The only thing he has done is load the dishwasher. I haven't gone to work out lately because if I do, he complains that the baby cried the entire time (although he's sleeping when I get home usually) and he hasn't given the big one a bath and so I then have to bathe them, they don't get to bed until late and I dont get into the shower. And last night he said he wants me to switch to a regular dayshift position because it's too hard on him with me working nights and weekends. God forbid he has to drop them off at daycare. That's what the weeknd option was created for - working moms so they can work while dad watches the kids. Plus, I would take a huge paycut that we can't afford right now. I would go from making time and a half for 30 hours of work a week to straight pay for 32 hours a week. The kids would be in daycare 3 days a week, instead of 2 so there would be more money coming out of my check and less money there for the increased amount of deductions. Plus I'm not a morning person and I hated getting up early when I did work dayshift, I don't want to work with the dayshift staff because they are all pretty highstrung because it gets so busy. My plan is to get off of night shift weekend option after all three kids are in school, so I don't intend on doing it forever. Maybe we need to get out away from the kids for a night, I don't know. It's so funny that some people think that if they are having trouble in their marriage that they should have a baby.

March 12, 2008

Another story about the inlaws

I've talked about how my MIL is an alcoholic in the past and how it's amazing that she can function. Here's another story. So Saturday, my MIL called and said one of my husbands cousins had delivered her baby 8 weeks early, gave us his weight and age, but didn't know details. I went to work and when my husband called to let the kids say good night to me, he said that his mom called back and the baby had died. I was pretty shocked. 32 weeks is early, lungs aren't mature, but most of the time they do okay after a few weeks in the hospital. So I thought I'd get a sympathy card and get it in the mail and start looking for a babysitter so we could go to the funeral without the kids. Monday, my MIL left me a message, wanting me to call her back. I assumed that she wanted to ask me questions about the baby, even though I wasn't there, I'm a labor nurse and not a NICU nurse, but it's all the same to her. So I call her back. At the same time, my husband decided to call and talk to his cousin and give him condolences. The first thing my MIL says to me is "So the baby is doing okay". I'm confused, obviously, because the last I heard was the baby was gone. At this point in time, my husband comes into the room and tells me the same thing. Husband had said sorry for what happened and his cousing said "Dude, he's not dead." Apparently, one of my MIL's sisters (an aunt to this baby) told her that they discharged her and sent the family home because there wasn't anything they could do at the hospital and my MIL took it to mean the baby was gone. She was drunk, of course so that's how the mistake was made. Luckily the family knows how she is, but come on. Have you ever heard of someone telling family that someone had died when they really hadn't? It's kinda sad because she's really sick, but you have to laugh. She was also very intoxicated when I was talking to her, and she didn't remember that she had told us that the baby had died, and I'm sure she doesn't remember the conversation I had with her on Monday. I guess the mom went to the hospital with a lot of bleeding. She went into labor and they couldn't stop it. They ahd done a sonogram and didn't see any issue, but after the delivery, they said that the placenta was slowly abrupting. The baby is doing well, by the way, he's off oxygen, is getting to eat some, but still has some issues with keeping his temperature regulated. Usual problems for a 32-weeker. A much happier ending to the story, and the family will have another laugh when they get the sympathy card I sent in the mail. So glad they have a sense of humor!

March 9, 2008

Bad Behavior

Sometimes I hear things come out of people's mouths that just make me go "Did you really just say that?" That happened this morning. I had a patient come in, prior c-section, scheduled for a VBAC induction Monday a.m., with contractions every 6-8 minutes. Cervix was closed and thick. Called the MD on call. He says "prep her for a c-section in an hour". It wasn't necessary because she wasn't in labor, the baby was okay, and she wasn't bleeding. Patient only spoke French, and FOB translated for her. I go and tell them what the Doc wants to do. They refuse. It's their right and really, I thought that was a wise choice. Why not see what happens? So I call the doc back. He says I'm coming in. He was so unbelievable rude to this couple. He said over and over "Your baby could die. Death. Do you understand that? Your uterus will come apart and your baby and you could die." The dad stuck to his guns and said no. The conversation was much longer than this with much more condesceding tone than I can describe in words. Then the doc asked the "Why did you come to America?". I stood there, felt all color drain out of my face and thought "You did not just say that, did you?". The dad came right back and told him that he shouldn't ask them that. After it was all said and done, the doc continued to bad-mouth this couple at the desk because they weren't married, were uneducated, etc. It was more than I could take. Funny thing, she wasn't in labor. Her contractions stopped after some IV fluids. So she didn't need to be delivered. I obviously turned in an incident report. Hopefully it will be taken care of appropriately. I went in and apologized to the family and they were okay with me. I also assured them that the appropriate steps were being taken to take care of the bad behavior of this physician.

March 8, 2008

To certify or not to certify, that is the question.

This fall, I may have the opportunity to take the OB nurse certification exam at the hospital I work at. It costs $275 to take the test, but if I pass, the hospital will reimburse me. A few years ago, they did this and I didn't take the test because I felt that I needed to work in OB a little bit longer before I felt I should take the test. Although another nurse with less experience than me took it and passed. So I'm trying to decide if I should do it or not. I now have 3 kids and I'm a bit worried about studying enough to pass the exam. I don't want to be out that money and I don't want people to know if I don't pass. Plus I don't get a raise for it. We have a clinical ladder that I don't participate in. If I did that, I would get some money. I was a good student in school and a good test taker, but I've also heard this test is extrememly difficult. Which I guess it should be. I've also considered maybe looking in to taking it somewhere else, so that way if I don't pass, the whole dept. wouldn't know. I have another week to make a decision because they have to send in the application to be a test site.

I also want to send a big CONGRATS to a co-worker who just found out she's pregnant with twins. Her and her husband tried for 4 years to get pregnant with their daughter, now 13 months, and they were going to do IVF when she went in for surgery for endo and the pregnancy test came back positive. She was still breastfeeding but had quit birth control and 2 months later she got a positive test. She handed me the us pic at work the other night that showed twins. If she gets to full-term, she'll have 3 kids under 2! They are excited and nervous. She went into preterm labor with her daughter at 30 weeks. We sent her to the high risk hospital on Mag, 3cm dilated. They did such a good job stopping her labor that she ended up being induced at 40 weeks. Hopefully she'll have a good pregnancy.

March 7, 2008

My new exercise routine

Man, if work keeps up at this pace, I'm going to finally get rid of the extra 15 lbs I'm carrying around. Heck with going to the gym, I get more exercise at work! Last night I recovered a c-section, admitted two grand multips for labor, delivered one, admitted an induction, delivered the other multip and got an epidural for my induction. I am beat. And I'm still trying to get back into my groove. Before Isaiah, I would have been a bit better at multi-tasking. But no amount of multi-tasking could have kept me up on charting and patient care. Luckily my two deliveries were similar and pretty low maintenance no epidural kind of gals. They came in because of contractions, but because they both delivered their baby last within 3-4 hours so they came in. They weren't active on admission, but all of a sudden, the baby would drop into the pelvis and then "hey, we have a baby". I'm just glad I was able to get both docs there in time. Another patient who came in had delivered her baby at home. She didn't know she was pregnant and thought something else was going on. By the time the ambulance arrived, she had delivered. The bab looked about 35-36 weeks. The patients who don't know they are pregnant really blow my mind. Can you even imagine truly not knowing, you start having bad stomach pains, stuff leaks out of your vagina and then "man, something's peaking" and you deliver a baby. Most people have 9 months to prepare for the baby, and you still feel unprepared. I just can't imagine how scary it would be. Although part of me thinks people know, but they are in such denial that they can't accept it until they have to. I don't know, I think I would wonder when my period didn't come, I started getting a bigger waist, and the whole fetal movement thing.
I saw the first deduction from daycare for 3 kids and I about died. It could be so much worse, but man, am I glad they only go 2 days a week and Jacob will be in school in August. So painful.

March 6, 2008

General complaints about my department

So I've been back at work for 2 weeks now and it feels like I was never off. The politics going on in the department I work in is just really frustrating. For some reason, gettting a schedule together seems to be the biggest hassle. I guess I understand that they have to make sure that there are nurses with the right skills to work all areas (nursery, labor and pediatrics) but come on. We are self-scheduling and for some reason people just don't get how it works. They basically refuse to follow guidelines and then the 2 people in charge of making sure the schedule "works" go in and change things, and usaully the changes affect the people who follow the rules instead of those who don't. We have also had mandatory call since last May. Of course while I was off on maternity leave, they had voluntary call, but now it's back to mandatory. And what I don't get is when I was off, there were 2 other nurses off on leave and all 3 of us are back for the new schedule so I don't get it. We are short staffed, especially on nights and we need a second full-time charge nurse, but there aren't any job postings for the holes. So they seem to want to piss off the staff they have by requiring call, would rather pay time and a half than find more nurses. And heaven forbid some of the recent hires have to work a Friday night, weekend or holiday. I obviously don't care since I work a weekend position, but part of the deal is working weekends and Fridays otherwise. Nurses like me have cut down the number of weekends they have to work from every other to one every 4 weeks. Yeah it sucks to have to work holidays but you know this when you work in a hospital because babies don't just take holidays off. The way new people are oriented is horrendous and I follow most of the new people because they work 3-11. Some of the things they do are scary. One nurse told me in report that she put in 50mcg of cytotec. Our policy is NEVER more than 25mcg every 4 hours. Apparently she never consulted the policy and has actually put the full 100mcg tab in on cytotec inductions!!! All based on her assessment. Luckily, those women were okay, but damn. Another nurse had a bag of pitocin in her hand and when I asked her what she was doing, she said "I'm thinking about starting some pit because her contractions have spaced out" My response? "Did the doc order it?" To which I got "No, I haven't called him yet." So again, I had another conversation about how we have to have an order for that. Don't get me wrong, we do have some wonderful, skilled nurses working and these two examples really are examples of how our orientation program is not working. And how because we are short-staffed they rush people through, they aren't getting the guidance they need, and 3-11 has a severe lack of experienced labor nurses. Ugh. There are so many things that make me want to scream, like not having a working dopplar for the tub (nice to find out after the woman's in the tub), not having a labor bed in a labor room (convenient) and severe lack of communication all around. Our charting system is an extreme pain in the ass and you have to move through 5 pages just to chart a set of vitals. And I'm not kidding. Oh, and we now have extra post-partum rooms so we no longer have to double patients up in our 4 double rooms (thank God) but they have a shared shower for those extra 5 rooms! Maybe someone will come in and wave a magic wand and at the very least get things back to how they were a few years ago.

March 3, 2008

A good weekend

I'm still pretty shocked about my old college friend. I've had to really evaluate my values and whatnot lately. Like do I keep talking to her or not? Do I tell her I know about what happened?I'll figure something out, I guess.
It still seems pretty weird. I had a pretty busy work weekend. I got to take care of a couple who had come in the Wednesday before for an induction at 41.2 weeks. She happened to have 1 of 2 docs in town who will fail an induction and not set them up for a c-section if they don't change their cervix. So she went home, and was induced again Saturday a.m. This time it worked. It was their first baby and they were a super nice couple. Once she started to go, she really went pretty quick. After 45 minutes of pushing, they had their baby. Just a really nice delivery. I also had a patient come in and get sent home early on in the shift because she didn't change her cervix, but she had the "look" of a labor patient. I told her I'd probably see her again in a few hours. She did come back about 1 a.m., but hadn't changed. 4 hours later, she also changed her cervix and delivered pretty quickly. I felt like I was able to give these women the support they needed. One of the dads was a big tough guy and he wasn't able to hold back the tears when he saw his daughter. It was priceless. This a.m., I had a Indian woman come in after her water broke. She was a repeat c-section. As I was getting her IV started, I just touched her arm where I planned to put the IV and she moaned like I had poked her. I told her it was just my finger. So the whole IV placement was a pain and the spinal was a nightmare. I actually have broken skin on my pinkie and middle fingers from her squeezing my hand so tight my wedding rings dug into my skin! But, she was a sweet patient and I really bonded with her. Her husband couldn't be in the delivery because they had just moved here, didn't know anyone, and they had a 20 month old daughter. All in all, this was a pretty good weekend. It's nice to feel like you helped patients through delivery instead of just doing tasks because you have too many patients.