Day in the Life of a Labor Nurse

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Fetal Heart Rate Monitoring (Cheatsheet)
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Outline

Overview

  1. Things to Consider
    1. Technically critical care setting
    2. Emergencies and the unexpected do occur frequently

Nursing Points

General

  1. Key Skills for labor and delivery nurse
    1. Being able to be a support system
    2. Fetal monitoring strips
    3. Neonatal Resuscitation Program (NRP)
    4. Some facilities will have the labor nurse does the newborn care for the first hour
  2. Typical daily routine
    1. Report
    2. Morning scheduled C-sections
    3. Managing pain for the labor patients
    4. Assisting with the delivery of the newborn
    5. Frequent maternal postpartum assessment to prevent a hemorrhage
  3. Challenges
    1. Family drama
    2. The unplanned = patient walks in dilated and ready to deliver NOW
    3. Emergencies = stat c-sections
    4. Handling fetal demises
    5. Unknown newborn chromosomal abnormality
    6. Pain control for the patient

Assessment

  1. Pain assessment for the labor patient
  2. Frequent fundal assessments for the fresh delivery
  3. Fetal monitoring

Therapeutic Management

  1. Pain control

Nursing Concepts

  1. Comfort
  2. Patient education
  3. Patient centered care

Patient Education

  1. What to expect
  2. How to push
  3. The importance of fundal checks

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Transcript

Hey guys, let’s look at what it’s like to be a labor nurse and just a typical day of what this type of nurse experiences. All right. So first I want to tell you guys just some things to consider. So actually labor and delivery is considered a critical care. So you always have to be ready. There’s lots of emergencies that happen and lots of monitoring. So this area is considered critical care. Emergencies do happen. So you have to be really loving the adrenaline rush because a lot can happen and very quickly and unexpectedly.

Let’s go through a typical day. So first you’re going to get report on whatever patient you’re going to have. You might have some scheduled C-sections in the morning, um, or throughout the day, but typically they’re in the morning, so you’ll get report. Maybe have a few C-sections that you have to help be in, scrub for, circulate or whatever the role is at your facility. Pain management. So this is huge. So if you have a labor patient or a C-sections, just going to be helping to get that pain managed, help with getting the epidural in. You assist the anesthesiologists in holding the patient correctly or if they don’t want that, they want to use, just some other like medication like statol for their medication. Then you’re just going to help manage the patient’s pain, how they desire. You are constantly repositioning the patient, so you’re responding to the fetal heart rate and what it’s doing. You might have to adjust the bands on her belly that are holding the monitors, the baby has now spun from over here to over here. So now we gotta adjust the band to make sure we have it on the baby’s back and are measuring the heart rate correctly.

If the fetal heart rate is dropping, then we might need to reposition the patient and turn her to her left side or back to her right side or however, it may be to help fix that, um, heart rate. And then of course you’re going to assist with deliveries. So hopefully it’s your patient that gets the delivers. So you assist with that. A frequent assessment. So this is really important in, this happens a lot in a typical day. So especially our patients that are delivered. So if they’ve had their baby, we’re doing frequent fundal checks to make sure that that fundus is nice and firm and we don’t have a postpartum hemorrhage because all these patients are at a huge risk for that. So some special skills. So you have to work as a support person. Even if there’s a spouse, a partner, whoever in the room, um, the labor nurses looked at as being a huge support for that patient. They have been through this, they’ve seen delivery after delivery. So they need to know, you know, tell dad to, you know, put his hand here and massage back, whatever it may be. Just help to be that support person. Fetal monitoring, so you will learn this, don’t worry. You are going to learn how to read those fetal monitor strips so you can respond when that heart rate drops or all of a sudden is way too high. So you will get trained on that. And that’s really important. The other one is NRP our neonatal resuscitation program. We have a lesson on this. This is for baby resuscitation. Just kind of like your baby life or on basic life support, but for the newborn and the delivery. And even if you’re like, no, I’m a labor nurse, I’m not taking care of the baby.

You still have to know NRP to work in these fields so that you can be a helping hand. And then another special skill is multitasking. So some places, and even that, sometimes the doctor might not make it to the room. Some places the labor nurse catches the baby. So let’s say, uh, the doctor doesn’t make it. Who’s going to catch the baby? Well, that’s going to be you and your other labor friends. Um, usually that doesn’t happen, but it can, sometimes the facility is made that way where the labor nurses do the catching and take care of the patients. So you have to be able to get that baby delivered up on the moms, start the potatoes, then hand the doctor whatever they need. Um, so really being able to multitask. All right, some challenges that can happen, so much family drama can happen. So, um, whatever it may be, families don’t like each other.

You have drama between mom and dad. Um, there can be a lot of drama. So that’s a challenge. But I look at it as there’s drama everywhere, but just be ready for it. Unplanned delivery. So this can be a couple things. You have a woman that comes in off the street and she gets to be 10 centimeters. She’s ready to have a baby. You didn’t even get to introduce yourself right to the patient. She’s just coming in and having a baby so that it could be unplanned. We’ve had people that didn’t know they were pregnant and they’ve come in and had a baby. Um, it could also be people that are having babies that are, um, all of a sudden have a congenital anomaly that they were not expecting. So it was just unplanned. It wasn’t part of their plan for emergencies. So you have to be able to act fast. 

Like I said before you cannot be sitting around. Emergencies can happen so quick that all of a sudden that fetal heart rate drops and you have to be able to respond. And then another challenge, fetal demises. So this happens, there’s fetal death. People deliver stillbirths. You have people that maybe have a death shortly thereafter, needs to be that support person for that mother. So this does happen. I feel like they seem to come in threes that where I work, you know, we know like, okay, we’ll have a rough week where we have a few of them and then it’s better for a little while, but this happens. We one time had a mom come in and her cervix just wasn’t competent. She delivered a baby and it was at, I want to say around 23 weeks and that baby continued to have a heart rate for about an hour. The baby wasn’t really breathing or anything like that, but the heart was still pumping and she did not want to hold her baby. The baby wasnt at that point of viability and she did not want to hold her baby. She did not want to see her baby. And we had to respect that. We didn’t want to tell her that she might regret it. You know, you have to respect their wishes and we did not want that baby to be alone because it’s still had a heart rate. So I stood in the bathroom for 60 minutes and held that baby and it was hard. We did not want it just sitting in a box in a corner.

So fetal demises this happen and sometimes you have to do extra things, um, and be a part of that. So just make sure that that’s a challenge that you are able to face. So some other challenges that can happen are some unknown birth defects. Like I had mentioned before. Sometimes these patients don’t know that and that can be huge challenge to try to help talk them through it and be there for them. Pain control can sometimes be a challenge because everyone’s pain is different. Sometimes the pain management doesn’t work for one, like it does another. So it can be a challenge. Cooperation of the baby, sometimes those little suckers are flipping all over the place. They’re not getting into position the way that they should.

So this can be a challenge because you cannot just tell the baby to do it and it’s gonna do it. And then the last challenge I put here as birth plans. So it’s okay to have a birth plan, but sometimes it can be a challenge. Sometimes you have families that are expecting like all these different things that just can’t happen. Sometimes people come in with a birth plan that and you’re like, “Oh, we already do all that.” Like they want skin to skin the first hour or whatever. So sometimes it works out perfectly. We one time had a midwife who said that the birth plan of the family requested was that everybody in the delivery room was to be naked. Okay. The nurses, the doctors, nobody was doing that. And I know that that is crazy. Yes. But sometimes you’ll get patients like that. So these birth plants can sometimes be a challenge.

All right guys, so some key points here. It is a super rewarding job. You will have hard days, you will have great days. Um, I truly love working in the new life center and um, I hope that if it’s of interest of you that you get into the new life center and love it. So this image here, this is a freshly born newborn, just put up on the mom’s chest. So if you get all the feels when you see that picture, then this could be a great field for you.

Alright. We’d love you guys go out with your best selves today, and as always, happy nursing.

 

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Transitions HESI Prep

Concepts Covered:

  • Documentation and Communication
  • Preoperative Nursing
  • Legal and Ethical Issues
  • Communication
  • Studying
  • Prioritization
  • Postoperative Nursing
  • Fundamentals of Emergency Nursing
  • Intraoperative Nursing
  • Emergency Care of the Cardiac Patient
  • Delegation
  • Perioperative Nursing Roles
  • Community Health Overview
  • Factors Influencing Community Health
  • Integumentary Disorders
  • Concepts of Mental Health
  • Neurological Emergencies
  • Test Taking Strategies
  • Basics of NCLEX

Study Plan Lessons

Admissions, Discharges, and Transfers
Advance Directives
Advocating For Your Patient
Barriers to Health Assessment
Caring Licensed Practical Nurse Nursing Mnemonic (CLPN)
Charge Nurse
Climbing the Clinical Ladder
Collaboration for Progressive Care Certified Nurse (PCCN)
Communicating with Family Members
Communicating with Other Departments
Communicating with Other Nurses
Communicating With Other nurses
Communicating with Patients
Communicating With Pharmacy, RT, OT, PT
Communicating with Providers
Communicating With Providers
Communicating with UAPs
Communication Course Introduction
Communication of Patient Outcomes (Continuum of Care) for Certified Perioperative Nurse (CNOR)
Confidence Building as a New Grad Nurse
Confidence in Communication
Confidence in Communication – Live Tutoring Archive
Conflict Management (Patient, Perioperative Team, Family) for Certified Perioperative Nurse (CNOR)
CRNA
Daily Charting
Day in the Life of a Community Health Nurse
Day in the Life of a Labor Nurse
Day in the Life of a Med-surg Nurse
Day in the Life of a Mental Health Nurse
Day in the Life of a NICU Nurse
Day in the Life of a Peds (Pediatric) Nurse
Day in the Life of a Postpartum Nurse
Day in the Life of an ICU (Intensive Care Unit) Nurse
Day in the Life of an Operating Room Nurse
Delegation
Delegation and Personnel Management for Certified Perioperative Nurse (CNOR)
Delegation of Tasks to Assistive Personnel for Certified Emergency Nursing (CEN)
Documentation Basics
Documentation Course Introduction
Documentation Pro Tips
Documenting Escalation (Chain of Command)
Ethical and Professional Standards for Certified Perioperative Nurse (CNOR)
Facilitation of Learning for Progressive Care Certified Nurse (PCCN)
Fall and Injury Prevention
Finding Your First Nursing Job as a New Grad
Fire and Electrical Safety
First Year in Nursing Course Introduction
Flight Nurse
Forensic Nurse
Function Within Scope of Practice for Certified Perioperative Nurse (CNOR)
Fundamentals Course Introduction
Giving Handoff Report
Giving the Best Patient Education
Handling Job Rejection
Handoff Report
HCIR Management (Healthcare Industry Representative) for Certified Perioperative Nurse (CNOR)
Healthcare Team Member Supervision and Education for Certified Perioperative Nurse (CNOR)
HIPAA
How to Give a Perfect Nursing Report (plus report sheet)
How to Take Nursing Report
How to Write A Nursing Progress Note
ICU Nurse Report to Floor Nurses
Impaired or Disruptive Behavior Reporting (Interdisciplinary Healthcare Team) for Certified Perioperative Nurse (CNOR)
Implant Records and Tracking for Certified Perioperative Nurse (CNOR)
Interdisciplinary Healthcare Team Collaboration for Certified Perioperative Nurse (CNOR)
Interdisciplinary Team Member Functions for Certified Perioperative Nurse (CNOR)
Interdisciplinary Team Participation for Certified Perioperative Nurse (CNOR)
Interviewing with Behavioral Questions
Interviewing with Nurse Manager
Introduction to the Electronic Medical Record (EMR)
Invoicing Process
Joint Commission
Legal Aspects of Documentation
Legal Considerations
Legalities of Charting
License Maintenance
Linen Change
Live Bedside Report OB and PACU
Live Bedside Report Medsurg (Medical surgical)
MSN (Masters) vs. DNP (Doctorate)
Networking 101
NRSNG Live | From Student to Real Nurse
NRSNG Live | Avoiding Legal Issues as a Nurse
NRSNG Live | So You Want to be a Surgical Nurse?
NRSNG Live | The Successful State of Mind
Nurse Educator
Nurse-Patient Relationship
Nursing Care Delivery Models
Nursing Interviews & Resumes Course Introduction
Nursing Report & Communication Course Introduction
Nursing Skills (Clinical) Safety Video
Nursing Skills Course Introduction
OB (Labor) Nurse Report to OB (Postpartum) Nurses
Oncology nurse
Patient and Family Teaching (Per Procedure) for Certified Perioperative Nurse (CNOR)
Patient Communication Techniques for Certified Perioperative Nurse (CNOR)
Patient Confidentiality for Certified Perioperative Nurse (CNOR)
Patient Consent for Treatment for Certified Emergency Nursing (CEN)
Patient Education
Patient Privacy and Dignity Maintenance for Certified Perioperative Nurse (CNOR)
Patient Records and Care Documentation for Certified Perioperative Nurse (CNOR)
Patient Rights Advocacy for Certified Perioperative Nurse (CNOR)
Patient Satisfaction for Certified Emergency Nursing (CEN)
Patient Status Communication for Certified Perioperative Nurse (CNOR)
Patient Status Evaluation (Transfer of Care) for Certified Perioperative Nurse (CNOR)
Patients with Communication Difficulties
Portfolio
Precepting a New Nurse
Precepting a Student
Prioritization
Prioritization
Prioritizing Assessments
Professional Organization Participation for Certified Perioperative Nurse (CNOR)
Provider Phone Calls
Radiation Safety for Nurses
Remaining Calm
Safety Checks
SBAR and How to Give Handoff Report like a BOSS – Live Tutoring Archive
SBAR Communication
SBAR Communication Nursing Mnemonic (SBAR)
SBAR Practice Scenarios
The Top 5 Things You Need To Know About Documentation 1 – Live Tutoring Archive
The Top 5 Things You Need To Know About Documentation 2 – Live Tutoring Archive
Therapeutic Communication
Time Management
Transition To Practice
Transition to Practice Course Introduction
Trusting your Gut
Why CEs (Continuing education) matter