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Learn what people really do at work

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Registered Nurse – Labor and Delivery

I’m a registered nurse, specifically working in the labor and delivery specialty.


I spend a lot of time touching people, sometimes in very intimate ways both physically and emotionally, and a lot of time washing my hands.


I am frequently exposed to various kinds of excreta and bodily fluids. Sometimes cleanup is as easy as washing my hands. Other times I need a shower. Once I had to throw away my underwear because I made the mistake of sitting on the bed while I caught a baby and ended up sitting in a puddle of amniotic fluid and meconium. I spent the rest of the shift going commando under my scrubs.


I spend a lot of time answering the same small set of questions (When will my baby come? Does it get worse than this? Is my baby OK? I’m afraid of pain and I don’t want to feel anything, can you make that happen? Do I have enough milk? Does my baby need formula?) over and over again to different people. It is really remarkable how these few questions transcend languages, life experiences, and cultures.


I do a LOT of writing via filling out tiny boxes on poorly-designed flowsheets. Fetal heart rate analysis and uterine activity analysis is done and recorded every 15 minutes during active labor. Blood pressures are charted every 15 minutes once an epidural is placed. Every conversation I have with a doctor or midwife needs to be recorded. Every pain assessment, intervention, and response needs to be written down. “If it’s not charted, it didn’t happen” is the conventional wisdom of nursing and is very true, especially from a medico-legal perspective. It doesn’t matter what I did, because if I didn’t chart it no one will believe it happened and it is the only thing proving my safe and appropriate nursing practice in the event of a bad outcome.


I do a lot of teaching. Student nurses, newer staff RNs, patients, families–all of them have things to learn about the process by which women have babies. There is a shocking amount of misinformation out there.


I do a lot of learning. The state of the science changes rapidly and there’s always a new study to review and new evidence-based practices to implement. And I learn a lot about the human condition, every day.


I start a lot of IVs and draw a lot of blood. I also assist with a lot of procedures, like placing a fetal scalp electrode or intrauterine pressure catheter, doing a sterile speculum exam, placing a cervical foley bulb, placing an epidural, performing neonatal resuscitation, or helping during a shoulder dystocia.


On any given day, I could assist with a vaginal delivery, actually catch a baby (not on purpose, as that’s outside my legal scope of practice, but sometimes those babies decide to come before anyone else is in the room), circulate in the operating room, scrub in for a c-section as a surgical technologist, spend the day doing antenatal non-stress tests and amniotic fluid indices for patients with high-risk conditions like gestational diabetes or hypertension, or very rarely sit on my butt and do nothing because it’s a slow day.


I do a lot of coaching (“You can do it! Push down in your bottom like you’re trying to poop!”), encouraging (“You CAN leave an abuser, we will help you”), negotiating (for example with a patient who doesn’t want something they really need, like IV iron before a fourth c-section when they’re dangerously anemic), and advising when asked (no, the guy who kicked you in the stomach to try to make you miscarry isn’t a great choice for life partner). Despite the fact that every baby eventually comes out in one of two very specific ways, the process of getting there is as unique as every women and family is, and I spent a lot of time calibrating my interactions to that uniqueness.


I do a lot of assessing for safety. (In real life this degree of worrying about and preparing for worst-case scenarios would be called pathological and I’d be encouraged to get therapy; at work it’s called being a good nurse.) Are the fetal monitor cables tangled? Is her blood pressure dangerously high or low? Is the bed locked? Are those antibiotics running too fast? Is there a clear path to the door so we can push the bed to the OR if needed? How is her hematocrit? Is she at risk for hemorrhage? Do we need blood crossmatched? Do I have all the hemorrhage meds in the room, ready to be used if needed? Who’s the surgical assist on call? Does anesthesia know about her low platelets? Is the baby tachypneic? jittery? grunting? blue? Was the surgical field contaminated? I could go on and on about the things I “worry” about every minute of every shift. It can be hard to turn this off when I clock out.


Sometimes I and the other team members save someone’s life, though it’s nowhere near as glamorous as you might imagine.


Sometimes I cry. Mostly it’s out of joy and relief, but occasionally out of real heartbreak.

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