Another busy night

Another glorioius weekend shift at work. Saturday was pretty busy, but man did the 12 hours go by quickly! I started out working on Mother-baby and was called back to admit a patient who was 23 weeks, no prenatal care, and cramping. Assessed her, found out she was not cramping but coughing. Just goes to show you how fast ER is at getting pregnant women off their unit. "Oh, you're pregnant, you must have some cramping...great, up to OB you go. I had just about finished triaging her when another nurse called me out of the room. We had another patient that they decided I should also admit come in. She had been transferred from a small town hospital that doesn't have maternity services. She was in active labor with her 2nd kid, no prenatal care and 6 cm according to the speculum exam the MD there had done. We were quite surprised she didn't deliver in the ambulance. Anyway, i'm a little peeved because I hadn't called the doc on admit #1 and there was no reason this other nurse could have done the new one. So I check her cervix, expecting to be close to delivery, but no, she is 8 cm and I don't feel head, I feel scrotum. Crap, crap, crap. The nurse who rode over with the patient asked if she was in position for delivery, and I said, well, in position for a c-section as the baby is breech. Then, finally the patient says, "Yeah, I didn't figure he had flipped". First, that's important info that she should have given the first hospital. Second, and most importantly, the MD who examined her should have been able to tell that she was not vertex (head down) as it was very obvious. And to top off all things, she stated she saw Dr. T when in fact she saw Dr. D. After 39 weeks, usually you know your MD. So off to caesar we go, baby born, dad didn't make it in time. He comes strolling in 20 minutes after we've been in recovery and asks "So you getting ready to have the baby". Oh, he was wasted, and the reason he missed it was because the police who went to his house couldn't wake him up. So we talked about time, weight and all the birth stuff. I sent him to the nursery to see his son. He comes back, after our conversation about how he missed the birth and says to his girlfriend "So you had him not long after I got here, huh". I thought she was going to come off that bed and strangle him, even with dead numb legs. All in all, the patient was very sweet and the baby was beautiful. So I get her settled on mother-baby, decide to sit down and chart and get a call that a 24 weeker, 10th baby, is coming in bleeding by ambulance. She arrives, has blood caked all the way down her legs, and is only 22. 3 weeks. No active bleeding at that point. She had bled like this a week ago and they found she had a hematoma behind her placenta. Her and her pregnant 14 yo daughter were laughing, talking about how they hoped he was coming today, how he just wanted to be born, etc. The dad of this baby also kept leaving and coming back, smelling strangely like he'd been smoking some pot in the car. Finally, I had to tell them that we would do all we could to keep her pregnant, that this was serious, and that if he was born today that he would not have a chance. Man, I felt like the grim reeper, but I had to let them know the seriousness of the situation. The tone did change and they were no longer worried about their 4a.m card game they left and were more appropriate. We got her stabilized and safety helicoptered to a hospital with a NICU at 7:00. I would have kicked my husbands backside had he acted like any one of the dads that were with the 3 patients I took care of. At least they did come in, which is more that some. I was able to finish about 7 hours of charting on three patients by 8:00. What I wouldn't give fore a nice, normal labor and vaginal delivery and a night where I can actually chart at least half of what I need to chart before the end of my shift.

Happy (belated) 4th of July

Hope everyone had a happy 4th of July. We spent some time with our friends from college who set us up, watched some fireworks and had a pretty good time. My last weekend shift was really busy. I work Sat and Sun nights from 7p-7a. Sunday afternoon, work called and wanted me to come in early, at 4:30. I like extra hours from time to time, but not added on a 12 hours shift during a pregnancy. After a little negotiation, the charge RN agreed to change my shift from 5p-5a that day. I knew that when 5a.m rolled around that I wouldn't get out of there. It was a pretty slow night. I was taking care of a former co-worker and she was progressing a bit slow, but not unusual for first baby. At 4:30 a.m., 3 patients came through the door at the same time. We also had a schedule c/s patient who would arrive at 5:00a.m. We had 3 labor RNs on at the time and one on call. She got called in, but of course, with a total of 4 admissions and the great timing of my patient going to complete dilatation, I didn't get out of there at 5a.m. Even after I had reported off on my patients and every patient had a RN, the charge RN was reluctant to let me leave. I clocked out at usual time of 7:15 a.m. And to top off a long night, I was spotting a bit when I got home. Everything is fine, baby's great, cervix long closed and hard as a rock. Just too much activity, I guess. Doc said no more 14+ hours shifts and I readily agreed. Got a sono scheduled in 5 weeks and I'm starting to waver when it comes to finding out the sex. We plan on waiting since I could end up with a scheduled c-section and we want some surprise if we know date and approx. time. But it's SO tempting to just find out. We'll see if we can hold out.

The good and bad

Last night was one of those great nights where I had to be charge RN and labor nurse at the same time. Doesn't really work well doing these 2 things together, but we're so short staffed that it happens. We now have mandatory 12 call every month to try to help, but sometimes you just need another set of hands. Anway, my patient last night was in labor with her 1st baby. Her MD, one who is a very good physician but can be very manipulative told the patient from the beginning of her pregnancy that her pelvis is small and that she most likely would end up with a c/s. They are trained to know these things, I know. Well, the MD came in at 11 pm for another patient. She told me before she left that she was planning on sectioning her tomorrow morning so to turn off the pitocin, get her an epidural and let her rest. Anestheia was of course thrilled with this because it meant he had to stay in house all night when the OB expected to do a c/s in the a.m. All of us were crossing our fingers, hoping she would deliver vaginally. At 3:30 a.m she did just that. After weeks of being told her pelvis was too small. Very unfortunately, she ended up going up to surgery for a retained placenta. Turned out it was a placenta increta, where the placenta imbedded itself to deeply into the uterine wall and she ended up losing her uterus. This had been an IVF pregnancy and it was her first child. I know the family is happy that both she and the baby are healthy, but what if they wanted more children? Sometimes things happen that just aren't fair, but like my folks always said, Life isn't fair. But sometimes I wish it was.

Fugitive

Today I got pulled over for the first time in 12 years. Sucked. I deserved it though. The fam and I were heading into town and I was just driving with the flow of traffic. We stopped at a light and a cop pulled up with the lights on behind the truck next to me. Light turned green and I soon realized that I was getting pulled over, not the dude in the truck. Lucky me. To make matters worse, I couldn't find my current insurance card. The officer that ticketed me was a woman who I took care of when she had both of her children, AND my husband knew her from the football team in college because she was an athletic trainer. When she came in with her first child, her husband (also a cop) said that if they ever pulled me over, they'd let me go because I took care of them. Well, she didn't. I doubt she remembered me. Only reason I remembered her was because she has an unusual name. I wanted SO bad to ask about her kids and bring it up, but I didn't. She didn't give me a citation for the inurance and I didn't want to take the chance that perhaps she didn't like my nursing care and would decide to ticket me for the insurance too. The irony in all of this: I'm usually the one giving my husband a hard time for speeding and I usually don't speed. At least I don't think I do. Lesson learned I guess. :)

My post-weekend mind wanderings

Yet another busy night in L&D. It was one of those nights where people came in, not really sure if they were in labor or not, then all of the sudden, all of them become active at once. I also think that this pregnancy and the hormones are making me stupid. Here's my point. I admitted 2 patients within 1 hour of each other for the same MD. I sent urine specimens on both. On patient #2, her urine looked pretty nasty and I was sure she had a bladder infection. Well, I got the results was much surprised that it was clean and called the MD. 30 minutes later, I'm putting my charts in order and notice that the urine results I had given the MD on patient #2 actually was the results of the 1st patient I admitted. And patient #2 had an infection. Luckily, he was coming in for a delivery, so I didn't have to call him back. And he was nice and even laughed about it. A couple of the other docs wouldn't have found it too funny. I was so incredibly embarrassed, but what can you do? Anyway, after a long, busy 12 hours, one of the anesthesiologist thanked me for taking care of his wife (who's a pediatrician) when she had their baby back in May. Said they aprreciated that I treated them like normal parents, thought I was excellent and was professional. Its funny how great that felt to hear that I was appreciated. We don't hear much about not patients who thought they got good care. So many times all we hear is how bad their nurses were, how we didn't do this or that, etc. Yes, there are bad nurses out there, but most of the time it's just because we are working short-staffed, and have multiple patients needing things and we have to prioritize what call light we answer first. It also makes for better stories to talk about how bad the hospital stay and nurses were too. ;) Anyway, I don't know how many people actually read my musings here, but just know that 95% of nurses want and try our hardest to provide good care and we do it to the best of our abilities. We go 12 hours without eating, peeing or sitting down to try to provide good care.
The last few days my belly just popped out. I felt like I've looked pregnant for the last week or 2 but now I definately do. And I'm only 13 weeks!! I'm not so big I can't wear my normal jeans, but the ruber band I've been using to hold the buttons together is stretching a bit more. My chest is also bigger I noticed which is nice since I wasn't given much up top.
The kids were a little high maintenance this weekend. It stormed pretty much all week, so we were cooped up inside and I think that's what did it. But man, they just wouldn't leave each other alone. I don't know if it's because they are so close in age, or if they're bro-sis, but they pick at each other so much more that my mom said my sister and I did, but we're 3 1/2 years apart. Oh well, they're awfully cute, so we'll deal with it.

Top Reasons I Love Night Shift

1. No "white shirt and ties" walking around
2. Doctors are around only when I need them (no offense to MD's)
3. More autonomy
4. Staff work together well because we have to in emergencies because there aren't MD's in house.
5. Higher pay
6. Fewer visitors
7. JCAHO visits rarely take place between 11pm and 7 am
8. More patients come in and deliver quickly because they try to go back to sleep instead of coming in.
9. Our director of over 1 year still doesn't know any of our names.

Disadvantages of night shift
1. Lack of sleep
2. No doctors in house
3. The overall view that night shift is full of inexperienced people, so we don't know what we're doing.
4. Patients that come in because they can't sleep.
5. No one from other shifts will come in/stay over to help when we're short-staffed.
6. Administration don't see our work, so we go unnoticed, not always a bad thing.
7. Our director of over 1 year still doesn't know any of our names.

In-laws or out-laws?

WARNING: very negative and whiny post here!!!
I know everyone, or a lot of people can complain about their in-laws. But, I think mine might actually be in the running for the worst set in the United States. Here's a quick overview: My MIL is an alcoholic to the point she is hurting herself because she is always drunk. She knows she's killing herself and she doesnt care and refuses treatment. My FIL also an alcoholic but is more functional than MIL, but he also does a variety of illegal drugs, plays in a band and still thinks they are going to "make it someday". He is also atheist, verbally abusive to his wife and sons, and is so closed minded that even if you prove that he is wrong, he will still argue that he is right. they come down to visit about 2 times a month or more and they drink as they are driving the 2 hours trip down. And that's just some basic background on these people. How their sons turned out decent is quite amazing. I am uncomfortable with these people around my children for so many reasons. One being all the drinking. They are always drunk. Always. When they were still allowed to babysit, my daughter was about 4 months and son about 18 months. I had worked a busy nightshift and they were babysitting while I was sleeping. I woke up at 11:30 the the sound of my daughter crying like she was in pain. I waited, and waited for them to comfort her. Finally I got up and found both MIL and FIL feeding my son who was perfectly able to feed himself at that time and my daughter downstairs, alone, in the swing shrieking. She was in her PJ's as well as the same diaper I had put her in when I put her to bed the night before. I knew it was the same diaper because I had used the last Huggies diaper. (We always used pampers b/c they don't leak, and we had problems with breastmilk poop running out the back of huggies). Her diaper was so saturated, the diaper stuffing had turned to gel and was all over her. Needless to say I took her upstairs, changed and bathed her, breastfed her and she was fine. My in-laws response? "I guess she just wanted to nurse again". I won't get into the conversation that followed, but they were no longer allowed to babysit unless my br0 and sis in law were around.
They were down this past weekend. Luckily I had to work and my hubby wasn't working. But they managed to make a mess of my house, stuffed my children full of chips, cookies and the sort instead of decent meals and drank an enormous amount of alcohol. I'm talking 2 JUGS of wine for my MIL, and about 2 cases for my FIL. And I had to break up a fight between the two grandparents b/c FIL was yelling and cursing at his wife in front of my kids. It was a fight over how much charcoal she thought we had of all things. Hubby and I are considering not allowing his parents down unless they can control their drinking because I worry about the safety of my kids, and frankly, they are poor influences. Not only the drinking, but their lack of spiritual beliefs. Not sure it's going to go over well. Hubbys brother and sis-in-law are also considering doing the same once they get pregnant. Having a plan to do this is the easy part. Actually doing it is the hard part. Anyway, I feel better getting that off of my chest. I apologize again for such a negative post.