Because the days are long and Fridays stretch into Saturdays during the summer, please find our third installment in A Day in the life of... a Labor and Delivery Nurse, contributed by Naomi S., a RN in Texas. This is special month-long feature.
Naomi S. is a labor and delivery nurse in Texas. She has 4 kids and likes to read, sew and cook on her days off. She also does breastfeeding support and is studying for her lactation consultant certification.
- Paradise Writing
It’s 7:50, I’ve finished the beginning-of-shift charting for one patient, now. The patient with the family here wants me to let her family out. Our unit is locked, so people can’t run off with babies or harass moms in labor. There’ve been problems in the past. So I have to unlock the door for anyone to come in or out. I don’t mind. I’d rather that than lose a baby on my shift, even though today I don’t have any babies, just moms. I save the work on the computer and let her family out. I’ll have to come back later to finish the other two patients’.
I go and place the monitors on the last patient, and finish the questions that are too personal for visiting little ears or uncles or dads to hear. I check in on my other patients again, letting them know I haven’t forgotten them, and they have a few more minutes on the monitor before I can take them off. One of the babies has decided to play, and isn’t showing up on the strip. I have to adjust the monitor’s placement to find the baby again, and extend the monitoring time by another 10 minutes. These moms are pretty stable, so they only need 1 hour, give or take a few minutes, of monitoring. They’ve been here for weeks and will be here for a few more weeks, until their babies are old enough, strong enough, developed enough to need only a short stay in the NICU and we can induce their labor so they can finally have their baby and go home.
We’ve given all of them medicines to force the babies’ lungs to mature ahead of time. There are some risks, but the risks don’t outweigh the benefit of a little bitty baby being able to breathe on his or her own. We’ll manage the side effects.
Once the mom is in labor, she’ll be on continuous fetal monitoring until the baby is born. There’s evidence this is a bad idea—higher cesarean section rates with no improvement to maternal or infant health—but the risk of being sued for NOT keeping them on continuous monitoring is too high. The rising maternal death rate in the US is considered a secondary concern to the risk of litigation. But for now, blessed relief, I can turn off the monitor and stop charting in the second system for at least one of the moms. It’s 8:15 pm now. In a few minutes, I’ll turn off the fetal monitor on the second mom, and then I’ll just have to wait for the last to finish.
In the meantime, my stomach grumbles and I realize I forgot to eat breakfast on the way to work, again. I have toast and a yogurt in my lunch bag. We’re not supposed to eat at the station, but if you don’t, you never get to eat. I wash my hands and pull out a piece of raisin bread toast with cream cheese on it. I type with one hand on the never-ending screens of the EMR at the nurses’ station, trying to wolf down the toast fast enough that no one sees me. I get finished with one piece, and it’s now time to take the other mom off the monitor and by now it’s already 8:30, so I can give her her 9 PM medications at the same time, as well. It’s all about care bundling, I remember my nursing school preceptor tell me, years ago. Every time you go into a patient’s room, you do two or three things if you can. You have to chart less, and you disturb the patient less.
The charting is only half-finished on the patient I was charting on, much like my toast, but it will have to wait. I save my work, wash my hands again, and go pull the medications from the vending machine.
The medication room is probably the most futuristic room on the unit. Each patient’s medications are verified by the pharmacy, and then loaded onto a profile in a special vending machine called a Pyxis.There must be more manufacturers, but I’ve been to at least 5 hospitals spanning Hawaii to Texas, and I’ve never seen another. The Pyxis has most of the medications you’ll need loaded into numbered pockets and drawers. It’s meticulously inventoried, and locked so that every time you pull a medication, only that drawer and that pocket will open up. Some medications will make you count every pill, every vial, every shift and every time you open up the pocket. The controlled substances. Any deviations, called discrepancies, will need to be fixed within 15 minutes or it locks the whole machine and nobody can get any medications at all, the pharmacy will be electronically notified, and the shift house supervisor will show up. They take the controlled substances very seriously. There’s an epidemic of opioid abuse, you know. The hospital could get in big trouble with the DEA if they don’t take this stuff seriously.
I pull the medications from the Pyxis, and I go and pull the monitor off the second patient. I wipe her belly and the monitor so there’s no more jelly. There’s a computer in the room with a barcode scanner that you’re supposed to use whenever you give medications. All the patients have a bar coded bracelet, and every pill has a barcode. You log into the computer, log into the charting software, pull up the patient’s chart, pull up the patient’s EMAR (different from the EMR), scan the patient’s bracelet, and then scan the barcode on the pill. This process takes about 5 minutes when it works correctly. Sometimes it takes twice as long. It’s a safety check, helping nurses make sure they’re giving the right medication to the right patient in the right dose. It’s helpful sometimes; the rest of the time it’s a pain in the butt, but because it’s sometimes helpful, we continue. You never want to be the nurse giving the wrong medication.
People load the Pyxis, counting out each pill by each pill to tell the machine how many of each are there. Sometimes things are in the wrong pocket. There are workarounds for the scanning of each medication. Some nurses use the stickers on the patient’s chart at the nursing station so that it’s easier to scan the med. The ID bands on the patients aren’t always the most easy to scan. I don’t like to do that, so I climb into the weird corners to log into the computer to log into the program and do the whole process at the bedside.
What’s the point of a safety check if you’re not doing the check?
I give the patient more ice water, and then move on to the next patient. Most of them have 9 pm medications, so I go around and do this with the other two, as well.
By this point, it’s about 9:15 and I’ve finally been able to take the last patient off the monitor. I’m finally sitting down again to catch up on my charting. I’ve been in each patient’s room at least 4 times by now, and I’ve yet to chart anything at all on my third patient. My toast and yogurt are still by my computer. I wash my hands again. I’ve been using the alcohol hand sanitizer at every doorway before and after I go into a patient’s room, and my hands are smelling like alcohol swabs. I wash off the alcohol so I won’t taste it with my second piece of toast, and continue charting.
The patients are quiet until 10:30, so I can finally catch up on my beginning-of-shift charting, but now I have to do rounds again. I peek into each patient’s room, checking the “3 P’s” of pain, position, and potty, and that they each have enough water. Hydration is important for these moms because of their diagnoses. One patient is more needy than the others and I can already tell she’s going to have me in there half the night. Ice water, juice, and snacks are given, and I can sit down to chart everything I just did on the computer.
I’m finally caught up with charting for the night. I have to open the door a few more times for significant others to come and go. The needy patient calls me in to her room to check on her, and while I’m in there, I hear the call bell go off. I don’t know which room it is, but I can’t stop what I’m doing in this room just to check the call bell. The clerk will answer the call bell and let me know if it’s urgent over my Vocera. I finish up with my patient and find one of the other patients in the hallway looking for a way to let her husband into the unit. I apologize and let him in. That happens at least once a night.
One of the other nurses has delivered a patient and sent her and her baby up to the Mother/Baby care unit, and it’s not horribly busy at this time, so she offers to spot me so I can clock out for lunch. It’s only 10:50; I’m not ready to eat lunch, having only just finished my breakfast, but I need to clock out at some point during my shift anyhow, per facility policy. So I take her up on her offer and go clock out.
I’ll sit in the break room for 28 minutes, eat a sandwich because I can, and read something on my phone.
Then I’ll clock back in, and she’ll see if there’s another patient for her to take care of, or another nurse that needs a break. Later on, when I’m hungry, I’ll eat my lunch at the nurses’ station again.
I’m grateful for the reprieve. I don’t always get a break from the desk and the constant demands of the doorbell, the patients, families, the phone. Even on nights, it can get hectic. But tonight is fairly steady, with patients coming in one at a time, and then leaving us with enough time to chart on her before the next one shows.
Check back for the conclusion of Naomi's story next week and let us know what you think in the comments section.
If you would like to contribute to this series and give our readers a peek behind the curtain of your profession, hobby or life, please contact us here, we'd love to hear your story!