Wednesday, December 20, 2006

It's over, that's the only good thing I can say

So, I worked again last night. Our induction schedule has been crazy lately supposedly because the docs and midwives dont want their patients to come in spontaneously on Christmas and the patients all want to be delivered before Christmas as well, so what do we do? We schedule them. Now, usually we have anwhere from 1-6 pit inductions scheduled for day shift and then usually at least one cytotec induction for night shift that is then "pitted" the next day. But, last night we had our usual leftover day induction who hadn't delivered yet but was progressing, one who had been a cytotec, then a pit, but didnt change so they were going to cytotec her again on night shift, 2 scheduled pit inductions (very unusual), a cytotec, 2 rule-out (r/o) labor observation patients, a transfer preterm rupture from a local smaller hospital and 3 long-term premature rupture (PROM) patients, 2 of whom were stable at the moment. Scheduled staffing was 6 nurses and a scrub tech. One RN called in sick so our boss stayed until ten, when one brave day shifter said she could come back if she could just go take a quick nap! So, our assignments were: Charge RN (20+ yrs experience): 2 stable PROMs and one cytotec, Whiny RN (3 yrs): unstable PROM and transfer, Pregnant RN (1 yr): pit induction just starting, Pretty RN (1 yr) pit induction just starting, Boss RN (10 yrs): leftover pit and Me (5 months) 2 r/o observes and the "re-cytotec." I got one of my observes out within the hour, one was scheduled to be rechecked at 1930, I got my cytotec girl dosed (of course she didnt speak any English and was diabetic so I was running the glucose management protocol on her, of which I had done ONCE). Another patient came down and I was up since I was supposedly the "least busy" of all of them. She was another rule-out, I got her written up while Boss RN got her baby delivered and Charge RN was her baby nurse. It was hectic but we were doing okay for the moment. Another observe came down, Boss RN got her written up while I got my other observe rechecked and out the door. Boss RN's girl ended up being a 6 cm admit so guess who got her, yep, me. :) The transfer ended up laboring and they werent stopping her so Whiny never came out of her room, I was trying to manage the non-English diabetic cytotec (NEDC) and the new admit when the NEDC called out and her water had broken spontaneously (of course she was poly so there was amniotic fluid EVERYWHERE!). I called the provider because I was due to redose the cytotec and they said to go ahead, so I did and of course that kicked her into active labor and she quickly progressed to a 5-6 with nice variables. My other laborer was GBS+ so were trying to hold her off until we could get the 2nd dose of antibiotics in and she got an epidural so she was slowly progressing without any augmentation from us. Boss RN admitted another laborer just as Day Shift RN came in to relieve her and then Pretty RN admitted another spontaneous rupture to add to her assignment. It was crap. And no one was progressing. We had all labor rooms full, all of us (except Charge RN) had at least one laborer. I checked my epidural girl and she was 8-9 and my NEDC was 6-7. I had variables in one room and lates developing in the other when I finally handed off one pt to Day Shift RN since her pt was still in early labor. I had a shift change delivery (of course!) and had to stay until 2 hours afterward trying to chart on both laborers and the observes who I had long since forgotten about. Details have of course been changed to protect privacy. I left wondering whether I would ever go back :) It's a good thing I'm taking PTO next week for 2 shifts.


designed by