Tuesday, May 7, 2013

Day In The Life: L&D Nurse

In honor of nurse's week and L&D 1102 question and answer time, I thought it'd be fun to do a "day in the life post." It just so happens that today ended up being one of the busiest, most crazy and chaotic days I've had in quite some time.

Disclaimer: The times are a little arbitrary and I've omitted all names... you know, HIPAA and all. This is also why there are no pictures. Just use your imagination, ok? Me: hair in a ponytail, rocking some teal-colored hospital-issue scrubs. My patients in those awesome butt-baring gowns making cringe-y faces during contractions. I think you'll still get the gist of what my day was like.

Lets get started, shall we?

5:20am: Alarm goes off and I'm out of bed. I get myself dressed and ready, throw back a Spark, and have a date with my breast pump. Oh boy its early. I shouldn't have spent so much time reading Sparkly Green Earrings last night.
6:14am: In the car and on my way.
6:33am: I'm not quite to work yet, but I realize I've taken the car seat and left my cell phone. Whoops. Already off to a good start.
7:07am: Clocked in, changed clothes and hitting the floor running. My patient is 7cm dilated and is ready for an epidural. The CRNA is hanging out nearby reviewing her chart and gathering the things he needs. I get report from the off going shift and assume care of my patient. Because she is more advanced in dilation, she's the only patient I have for now. But the floor is already almost full, so that will surely change soon. Within the next few minutes, we're moving forward with her epidural placement.
7:40am: Epidural is in, foley catheter is in, and the contractions are "gone" according to my patient. Never fear, they're still there though, and she's now 9cm dilated. Her water hasn't broken yet, so I encourage her to take a quick nap until her doctor comes by. I fluff her pillows and head out to catch up on some charting. The Alexis retractor rep is on the unit and brought us all doughnuts. #winning
8:51am: My patient's doctor makes rounds, checks her cervix and she is now completely dilated!
9:09am: Her water breaks spontaneously (All on my arm. Ew.) as we begin the pushing process. For now, I'm alone with my patient and her family, but once she can push that baby to the "crowning" point, I'll call in the rest of the delivery team.
9:30am: Delivery team is called and within the next few minutes, we have a baby! The nursery attends to the baby while I attend to mom and over the next hour, I'm checking to make sure she's stable and helping her breastfeed.
10:45am: The baby is taken to the nursery and the new mama is loaded onto a stretcher. In the time between getting report and now, the floor has gone from almost full to busting at the seams. Since my patient is stable, it's time to transfer out to postpartum.
11:10am: I make it back to the unit to find I already have a new patient waiting on me. This patient came up from the emergency room and believes her water has broken. I start her admission process, which includes like a bajillion screens worth of health history, obstetrical history, and head to toe assessment. A quick cervical exam leads me to conclude that she is not in labor and her water has not broken. Unfortunately, this patient's doctor is doing a surgical procedure and so I'll wait until she's finished to give report..... which means I've got a few precious minutes of down time.
11:46am: So I use that down time to pump! I pull up my current and previous patients while I'm pumping to catch up on charting. Once I'm finished pumping, I shovel down half a sandwich and bottle of water before I see the doc walking down the hall and scurry out to give report.
12:20pm: I have another patient coming and discharge orders for my non-ruptured patient. I serve her papers and wrap up the last bits of her charting, just as my new patient rounds the corner. She's been contracting for the last few hours sitting in triage waiting for an empty room. Oh, and she wants an epidural... but so does a majority of the other patients on the unit. It's a madhouse today and we've only got one CRNA free at the time. Not only is the labor unit busy, but we also have a pretty full surgery schedule, which means we have 2 staff nurses and a CRNA rotating patients through the OR also.
13:10pm: After tucking my patient into her labor room and setting up all my supplies, I wrangle a CRNA into her room and it's epidural time. I make the mistake of comparing an epidural to a root canal (not exactly a great correlation between the two-- in fact, that's probably the most frightening thing EVER to compare an epidural to). I don't think the anesthetist will ever let me live this down, even after explaining my reasoning, but we're both laughing over my ridiculous comments. Note to self: just stick to the routine spiel. Soon thereafter, the patient can laugh at me too, because she's smiling again and her family is breathing a sigh of relief. She's 5cm dilated.
14:40pm: My new patient's doctor is making rounds and swings by to break her water. Unfortunately, the fluid is meconium stained, so I get suction set-up at the bedside and notify the nursery personnel. Regardless, my patient is comfortable, her strip looks reassuring and she's now 6cm. I fluff her pillows and fill her ice cup and hope she takes a quick nap.
15:00-17:00pm: My own patient is stable and "cruising" but the rest of the unit is hopping. Leaving my phone at home turns out to be no big deal, since I have zero time to do anything leisurely like check email or text my husband(all in non-patient care areas, of course...). Babies are popping out in almost every room. There aren't enough labor nurses or nursery nurses to keep up with what's happening, so I'm running from room to room doing whatever I can to help out. Printing paperwork, relaying messages, helping out in the OR, catching up charting, assisting with breastfeeding, transporting patients, rubbing funduses... or um, fundi? transporting babies, checking cervixes...or um, cervi? Anyway, everyone is doing the doggy paddle and we're hardly keeping our heads above water. Somewhere in the middle of all this, I'm also routinely repositioning my patient, who is now 9cm. Because most of my coworkers are delivering their patients, I'm keeping a watchful eye on two other ladies, one of which is 9cm, and the other is 10cm. We're doing a lot of delivering and a lot of laboring down around the unit. Deep breaths.
17:35pm: My patient is uncomfortable, so anesthesia gives her epidural a little extra juice. While I'm waiting for her to feel some relief, one of my coworkers gives me the green flag to take care of some business. In other words, the "girls" are feeling extra full. Surprisingly, despite the chaos, I carve out like 8 minutes to get some pumping in.
18:00pm: My patient is feeling the pressure and is 10cm dilated. Her doctor is close by, so we get the room set up for delivery and begin the pushing process (again, pushing alone until crowning). She pushes like a champion and just a few minutes before 7pm, I call the delivery team and baby arrives! #readyforshiftchange
19:17pm: I give report to the oncoming shift. It just so happens to be the nurse I got report from this morning, so we talk about our mutual patient for a minute and then I whine about how busy the day has been. I get wrangled back in to my patient's room to help her breastfeed, but I had formed a fun little bond with this new mama, so I was happy to be of assistance.
19:43pm: Licked my wounds, changed my clothes, clocked out, and in the car. My big comfy couch can't come soon enough!

Whew! We aren't quite that busy every day, but I think I can safely say that Labor & Delivery is always interesting, keeps me on my toes, allows me to use my brain, and sometimes reminds me that I can hold my bladder for 14 hours. I love delivering babies.


aimymichelle said...

wow that is one crazy day.

vuhelp.net said...

So nice blogger

Erika said...

Dang. You spend significantly less time looking at blogs during the day than I do. ;)

Rachel said...

My head is SPINNING after reading this. I always tell people that teaching is the hardest job out there....but only after nursing! It's the one job I have always thought seemed tougher than teaching 4th graders!

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