This week we bring you the second installment of our special four-part, “A Day in the Life of…” post, contributed by Naomi S., a Labor and Delivery RN in Texas. She provides a fascinating first-hand look at the life and work of a healthcare professional that you won’t find in hospital brochures or on recruitment sites. If you missed the first part, you can find it in our featured posts. Be sure to look out for part three next week!
- Paradise Writing
I get to work at 6:39, and clock in. I can’t clock in before 6:38; the hospital administration gets fussy about it. Too much time on the clock means less money for other things. I work for a non-profit, carefully selected so that the “other things” include patients, not administrators’ salaries and shareholders pockets.
I get to the locker room and drop my backpack-sized lunch bag on the bench so I can change. My badge, the key to all the doors on my unit, goes next to it, along with my phone. I pull my silicone water resistant watch out of the side of my lunch bag and strap it on my wrist before I squat down to put in the code on my locker. I used to carry my stethoscope around with me in my purse, but I don’t anymore. I just leave it and its hospital germs in my locker these days.
I change into the hospital’s official L&D scrubs, a pretty royal blue that I like, wrapped individually in little plastic bags. I try not to cringe when I throw them away. So much waste. But the industrial cleaning process they use means that we can reduce the hospital-acquired infections in the cesarean section moms and the new babes, so we do it. I reflect on how much money I’d make if I could make the wrappings recyclable and cheap enough to make it a no-brainer to recycle them. I pull my stethoscope out of the locker, lock up my jacket and scrubs, put on my badge, put my phone in my pocket, and pull some alcohol swabs and a pen out of my lunch bag. All prepped and ready, and it’s now 6:43. Time to get to the nurses’ station and find out which patients are mine tonight.
Sometimes I get the “ante’s”, the longer term residents who are there because they’re still pregnant, antepartum, but too high risk to go home. Other days I’ll get a labor or two, or I’ll do “TC”, which means I’ll catch the babies and get to actually do something involving breastfeeding. Other days, I’ll get a couplet, mom and baby, who are still in L&D instead of the Mother/baby unit for whatever reason, sometimes because upstairs they’re full, and sometimes because the mom can’t go up because she’s got a health problem that means she needs to stay under the watchful eyes of an L&D nurse instead of the intermittent monitoring of the Mother/baby care unit. Sometimes, I’ll get the NICU moms, moms whose babies are in intensive care, lonely, scared, and sad moms, who just want to get better so they can go downstairs to see their babies.
I like the days I TC or get the postpartum moms. I get to do “real” breastfeeding stuff. But I like labors, too. I like to watch the moms when they realize, “I CAN!” and they give that last, huge push; and the dads whose first glimpse of the hairs on their baby’s head makes their eyes go round; or the grandmother whose eyes fill with tears as we place a squirming, pink, squalling mess on mom’s belly, and everyone sighs in relief that, HERE, here is what we’ve waited for, for 9 long months and strained for hours.
But tonight, I’ve got the antes. It’s ok, usually it’s more chill. I’ll almost certainly have a chance to clean out my hospital email, which gets about 25 emails every 3 days with service outage notices for systems I don’t use, hospital announcements for stuff that happens while I’ll be asleep, and the ever-present reminders about which mandatory training session is next, and when. I walk back to the annex, where the antepartum moms stay, and head over to the nurses’ station where the day shift nurse waits to be relieved.
We do report at the nurses’ station, and then round on everyone, popping into the room of each patient to say hello and ask if there are any questions, any pain, any needs to address, and to review the plan for the night. I eyeball the IV pumps to make sure the fluids are running OK, that it’s the right stuff, that the antibiotics haven’t been left clamped by accident. I glance around to make sure there’s emergency stuff in case I need oxygen or something as well. In theory, we’re supposed to do the whole report at the bedside, from beginning to end, but it’s hard to do the sign-off on the computer that way, so we manage. It’s called a workaround, and every facility has them, but sometimes there’s more workarounds than there should be. Still, I try to keep the patients involved. It’s safer. These three patients that I have tonight have all been here a while, and I’ve had them so often we don’t even do the full report anymore. I’ve memorized the patients’ histories already.
“So what’s new?” I ask of the day shift nurse.
“Nothing for this one, nothing for that one, the other’s had some issues,” she says.
We discuss the updated ultrasounds, the medications they’re on, and go and see the patients so we can sign off. The day shift nurse is gone by 7 pm today, which is pretty fast. We had a good report, and there’s no drama to explain, so I’m in and she’s out in a flash. I log into the Vocera, a call system, a pin-on walkie talkie kind of device that lets my charge nurse call directly to me without needing to call my cell or on the overhead pager.
I round again on my patients, doing my shift assessments. We need to get a baseline, and it takes longer than the two minutes allotted to each patient for bedside shift report, so I go around and around. I’ll do that for most of the night. During report, I’m listening for any problems so that I can decide who I’ll stop in and see first. Sometimes it doesn’t matter and I’ll just go up and down the row. Other times, it does, and I’ll be back and forth dealing with whatever comes up.
I get their vital signs: temperature, pulse, blood pressure, how many times they breathe in a minute. I listen to hearts and lungs and bellies, check for swelling in the legs and feet and face and hands, check reflexes, ask questions, and apply jelly to a little ultrasound I’ll strap on the mom’s belly so we can have a “tracing”. I’ll watch the baby’s heart rate go up and down in little squiggles, hoping nothing drops too far for too long. The fetal monitoring machine will print out a sheet of specially marked paper for me so I can tell what the baby’s heart rate is doing from one minute to the next over the next hour. It will also tell me if the mom’s having contractions, and if so, how often and how long. I’ve already asked the mom, but it’s nice to get it on the tracing, too. I ask if they’ve had any pain, any problems, bathroom questions, and the like. It can get pretty personal in Labor and Delivery.
The antepartum moms have it a little less personal, though. I’d do everything just the same if I had a labor mom, except I’d also have to do a cervical check with a sterile glove to find out how the labor’s progressing. The monitor doesn’t come off of the laboring moms, usually. I spend about 8 minutes in each room this time, making sure that each mom is comfortable, that ice water is refilled, the empty dinner trays are removed, and that mom has everything she needs for right now. One of my patients has visitors tonight and doesn’t want to be on the monitor while they’re here. I’ll have to go back in later once they’ve left. In the meantime, it’s 7:20 and I can start on my charting.
Every time we go into a room, we need to put it in the patient’s electronic medical record, or EMR. There’s no really nice easy way to do it. I need to find a computer and log into two separate systems simultaneously. It would only be 1 system if they were postpartum moms, but for whatever reason, the folks who design EMR software always seem to forget about pregnant moms. So we use a weird mix of software so that we can get all the important stuff down somewhere. One system is for the tracing from the fetal monitor. The other is for everything else. Some fancy facilities have one system that does it all, but those are mostly in California from what I hear. Not here in Texas.
I have an average of about 15 screens to go through for each patient, no joke.
I do a fall assessment, to rate the chances of a fall during my shift.
I do a skin assessment, to rate the chances of dangerous skin breakdown.
I do a care-plan check, a chart check, a physical shift assessment, a pain assessment, a vitals sign assessment, a meal assessment, an IV assessment, nursing rounds assessment, activity level assessment, an assessment for blood clot prevention, check for new orders, check the electronic medication administration record (EMAR), the provider notification screen, and then I can get to the charting on the fetal heart tones, contractions, and what’s actually going on with the patient.
Sometimes the software will let me pull up two or three assessments on one page. I like it when I can do that, but you can’t always.
We hope you enjoyed this sneak peek behind the curtain.Be sure to read Part 3 of Naomi's story next Friday, July 20th. (or Saturday, July 21st!), and leave your comments below.
If you would like to contribute to this series, just email us here. We’d love to hear from you!