Mass Chaos

Time is apparently getting away from me...I don't think I've ever been such a slacker about posting! Work has continued to be chaotic. We are short staffed, we have mandatory call, and even with the call schedule, we are still short staffed. One night a couple weeks ago, we had 3 labor nurses on...and started the night with just a couple laboring patients. Then the gates opened and everyone, and I mean everyone, came in in transition! I think we had 6 admissions, all wither 7 or 8 cm. About the time I was unplugging the bed to take one of my patients to the OR for a c-section for failure to progress, another mom came in, 33 weeks, complete and breech. So mine got bumped and we had to rush to get her prepped. By the end of the am, no one really had assigned patients - we just went to each room, doing what needed to be done. "Ok, she needs an IV, this woman is waiting for an epidural, this room needs an exam to check for dilation. It was unsafe, but the charge nurse on that night did everything she could to get us help. But no one answers their phone at night, except one day shift nurse who came to help, but we needed about 2 more nurses with what we had going on. I can't remember the total number of admissions/deliveries/patients that night, but it was unsafe patient loads. At one point, the anesthesiologist that was doing the c-sections/epidurals we had going on was just standing at the desk, waiting for them to get our second OR up for my c/s that was bumped for the breech 33 weeker, and it was getting crazy, with patients needing things right now. So I handed him the lidocaine I had pulled for an IV start in one room and said "Here, help me, start her IV in room 6". He said "You can't get it?", to which I said "Well, I have to go into room 3 because she is going to deliver right now, and that patient needs her IV and wants an epidural, plus my patient who was bumped needs to go to the OR once they get it ready. If I could clone myself to do it, I would, and I don't think you want to go be the labor nurse & nursery nurse for the patient who is delivering. Please help". So he did. Patient delivered, baby was skin to skin with mom (love it! we're trying to do that more and more), give quick report to a post-partum nurse who was back to help with the recoveries, and out the door I go to help with the epidural for the patient I sent anesthesia to see to start her IV on. Epidural in, charge nurse comes in to monitor patient for 20 minutes after the epiural and I head back to the OR with my patient. It was crazy. The house supervisor had come up and was trying to help, but unless you work in OB, there's not much you can do but start IV's, and answer call lights. If one more thing would have come in, I think we all would have crapped. But we survived the night, patients delivered healthy babies, they didn't have great nursing care, but we really did the best we could do and tried our best not to look too harried! All my charting from midnight on was done after passing off to the dayshift...I didn't get home and to bed until about 10am. We need more nurses, but no one seems to be able to pull any out of their arse. Hopefully management will figure something out, but unless we get some experienced labor nurses in and fast, I have a feeling this will continue. February is statistically a SLOW month for us, has been the slowest since I worked there, so who knows what the rest of the year will bring!

Quote of the day

Said by a scrub tech when she explained why she decided to get a nursing degree instead of a business degree:

"I decided to go ahead and do nursing because I can make more money as a nurse than I can if I get a business degree and go work for Big Insurance Co. in town."

All us nurses who were in hearing range stopped, looked at her, and then laughed hysterically to ourselves. Money isn't the reason any of my coworkers or I went into nursing, it was for patient care. If we were looking for a big salary as an RN, we'd be sorely disappointed.

Dear Lovely Twin Ladies,

I apologize for last night. Work was super busy and I didn't have time to empty your compartments of the liquid gold you so diligently make for my child. It is much appreciated and I didn't make time for you last night, and I know how much you look forward to the emptying with either the pump or baby, and I am truly sorry. And I do understand your confusion when you hear crying babies and you aren't being taken care of. But is it necessary to make yourselves so firm that everytime I turned the wrong way, it felt like a boulder, or a tight water balloon, ready to pop? Mrs. Bladder was also ignored, but perhaps she is used to the neglect because she didn't cause any leakage and really didn't bother me until the end of the night, when I realized I hadn't peed all night, but then again, I ignored Thirst and Hunger, so there really wasn't too much to irritate her to begin with. I understand you are a bit more hormonal than she is, but really? Did you need to leak that liquid gold clear through my scrub top? I know that first time dad, who's wife was laboring and planned to breastfeed, sure enjoyed the show you put on. I can still see the mortification on his face when he realized what had caused the headlight style design on my scrubs. I know my caring coworkers sure enjoyed seeing that display of your abilities (I can still hear them laughing...) Message was received, I will not ignore you again for a full 12 hours.

Humbly Yours,
Nurse Lochia

You know you're a mother when..

When you go to a health screening and it's not until you get home that you realize that you have breastmilk spit-up on your shoulder and one side of your nursing bra is unsnapped.

Or when you start making lunch and your 3 year old comes down the stairs, sans pants, asking you to wipe his butt. You grab the wipes and realize he's covered in poo. A bath is necessary so you take him upstairs to the tub and you find his poopy underwear in his room, poop smears on the hardwood floor, on his freshly laundered comforter, on a towel and smeared all. over. the. toilet.

Or when you are rushed out of the shower because the baby is hungry and it's not until the next morning that you realize in your haste to get dressed, you put your underwear on inside-out.

Gimmee a Pee!

Something wonderful has been happening in our house... Isaiah is potty trained!!! YAY!! We decided with Isaiah to do things a little different this time around. Part of it, I'll admit, is because I'm lazy. I just didn't want to spend hours upon hours sitting in the bathroom, or forcing fluids down him, or getting him to sit on a potty chair while watching tv. Jacob and Clara were both 3 before they were potty trained and I don't think anything we could have done would have made them use the toilet any sooner. Yeah, some kids are completely potty trained before they are two. A nurse I work with was one of those lucky mothers, both her boys were out of diapers before they were 2, and I hate her for it. Ok, so I don't really, I'm just insanely jealous. I just don't think my kids were willing to give up the diaper until they were 3. With Isaiah, we never bought pull-ups. Maybe they work for some kids, but I think they were a hindrance for mine. We used them with the older 2, but really, I think they are just glorified diapers that still allowed them to poop or pee in their pants with little consequence. I figured I'd just go straight to underwear, and that way he would be really wet/dirty, not like how it feels and be more motivated to use the toilet. I bought underwear for him about a month ago and we'd put the underwear on over his diaper, and encourage him to use the potty. About 2 weeks ago, after changing a monster, nasty poopy diaper one morning, I decided I'd had enough. He would go on the potty sometimes, and he knew when he needed to go - he just wouldn't always want to do it. So I put him in underwear. Said today was as good as any to jump right in. He fought me for a bit, but eventually he decided that it was pretty cool to not have diapers on, plus I told him how happy I was, how happy his teachers at school would be, etc. I loaded his backpack up with plenty of underwear and pants/socks, shirts, etc and sent him off to school after lunch. His teachers are more than willing to help with the whole potty training thing, and I had told them my plan a week or so earlier. He came back in the same clothes, and we've been good since. He did have a couple accidents. The first one, he completely emptied his bladder, the next was just a dribble, and we only had one poop in the underwear but other than that, he's done fabulous! Those accidents helped him to realize that it doesn't feel good to go in his pants. He hasn't had an accident for a week, and while we still do diapers at night, he is completely daytime potty trained! I did promise to buy him a toy once he was using the toilet so I took him to the store and let him pick out a toy...that was a 30 minute ordeal, but it was fun. Over this last month, we've really seen major changes in Isaiah - he's talking more, he no longer demands a drink for bed, he sleeps all night (HUGE!!!) and now he's out of diapers! It sure feels good!

Get into the groove...

It's been awhile...guess I've been pretty busy lately. Work has been hectic, but I've had a string of wonderful births and I think I can finally say that Momma has her groove back! One weekend, I came on shift and took a laboring mom who had just gotten an epidural and the last she was checked she was 4cm. After report, I go in and introduce myself and check her cervix: 10cm and the baby's head was L-O-W. So called Doc, patient delivered and it was a nice, easy delivery. I get everything settled with the new family, baby is nursing like an old pro and I walk to the desk to give them some time alone. About that time, a patient came in after she fell on ice. She said she managed to keep from landing on her stomach, thankfully. She was in her late second trimester and needed some lab work, continuous monitoring, and a sono to make sure that everything was fine with the baby and placenta. Soon as I get her settled and gave a dose of terbutaline to stop the few contractions she was having, another patient comes in, preterm and contracting. I get her admitted and call the doc and got some needed terbulatine to stop her contractions. I'm running in between my two preterm patients, both contracting and needing terbutaline and labs. Thankfully, the pretermers settled and I was to keep the one who fell for 4 hours and then she could go if everything was stable, and the other I was given a discharge order. The charge nurse had been checking on my delivered mom while I got through these admissions, otherwise I would have never gotten in to check on her. Things start to settle for the moment, so I get my delivered mom moved to post-partum. As I'm heading in to discharge the now stable preterm patient, our OB/OR tech comes around the corner...and she's moving at a pretty good clip. I look at the patient and immediately understand why: the mom is sitting in that tell-all position that every OB nurse/tech/doc knows well. She's got sweat on her brow and upper lip, panting and sitting off to one side of the wheelchair, hands clenched around the wheelchair arms so tightly her knuckles are white. Me and my stellar critical thinking skills decide that I would have to discharge my patient later. We manage to get the patient in bed, pants off and I check her and she's 9cm. One of my fellow weekend-option coworkers came in to see if I needed help. We work together like a well-oiled machine. Within 15 minutes, we had her admitted, IV in (yes, I know an IV isn't always necessary but she wanted us to try to get her an epidural, but we all knew it wasn't going to happen), assessment and admission complete, delivery set-up done, and the infant warmer set and ready to go. I started to think that the doc wasn't going to make it in time, but the OB got there just in time to put on a pair of gloves and catch. Mom did fabulous. She had really wanted an epidural but her labor went too quickly and she was so in control that she really didn't need it. I think it was more the idea of not having one that was scary to her. Thankfully, the rest of the night seemed to be a bit calmer. I was able to finally discharge my preterm patient. It had been awhile since I had done a Leboyer bath (well, a modified Leboyer if you want to be technical) so I was able to help the parents give their new baby a bath. Since it was such a wham-bam-thank-you-ma'am birth, the mom said it was nice to be able to slow down, and just support her baby's head as he floated and kicked a bit in the warm water. Thankfully all the labwork and sono results came back normal on the momma who fell, so she was able to go home at the 4 hour mark. At the same time as all the action I was in on, there were a couple more births and other things going on, but by the time dayshift had come in, we had all but one of the delivered patients moved out to post-partum, and all the other outpatients were treated and discharged. It looked to them like we had a quiet night sitting at the nurses station, reading the paper and chatting while the patients sleep...that's all that happens at night, you know. ;)

Another example of my genius.

I had hoped after my example of genius last summer that my mind wouldn't be mush, as I'm not pregnant. If you've been following my mind ramblings, you'll remember my trip to the grocery store with my daughter and as I came out of the store, I couldn't find my keys...I found them in the ignition...with the van still running. Yup, it was a great moment of brilliance in my life, but I chalked it up to pregnancy brain. Well, maybe I don't have pregnancy brain now, but I'm not sure my brain is functioning at full capacity. Last night I went to work for an 8 hour shift, 11pm to 7am, and to get into the hospital after hours, without going through the E.D., you have to swipe your badge to get in. So I always have it out before I get out of the car so I'm not fumbling through my purse looking for it at night just in case there's some weird psycho waiting in the parking deck, and I put it back in my purse after getting in the building. After getting to the unit and changing in the locker room into the required hospital scrubs, I get my pockets filled with pens, hemostats, scissors, etc....all the things that I've come to *need* for my shifts. I rifle through my purse and can't find my badge. And I knew I had it because I got in the building. I look through my locker, purse again, around the locker room and this goes on for about 5 minutes and I'm thinking I'm going to have to trace my steps all the way through the hospital to find it. That is until one of my coworkers looks at me and asks "Are you looking for your badge?" to which I reply "Yes. And I know I had it because I got in the building.". She looks at me like I'm a fool and says "Um, Nurse Lochia, it's on your scrub top". Yes, my friends, I am a genius!