RN- Labor and Delivery

The L&D RN is a Registered Nurse who is responsible for the professional nursing care of all assigned patients in accordance with the established standards of care and within the scope of the current Nurse Practice Act. The RN is responsible for maintaining the patient's medical record, paper and/or electronic, the proper documentation of nursing observation and actions taken. The RN plans, delegates, and coordinates the nursing care provided to the patient. Utilizing the nursing process and using evidenced-based practice, the RN is responsible for maintaining a safe and therapeutic environment, maintaining the patient's dignity and privacy at all times. This position requires a sound knowledge of all aspects of nursing care for the obstetrical patient, antepartum to postpartum including peri-operative and/or postoperative period.

Job Qualifications

Graduate of an accredited school of nursing and current licensure as a registered nurse by the Mississippi

State Board of Nursing

Current knowledge and skills appropriate to the age and type of patient population served

Participation in continuing educational programs on obstetrical nursing

Current Basic Life Support Certification (CPR)

Current Neonatal Resuscitation Certification (NRP)

Current Advanced Cardiovascular Life Support Certification (ACLS)

Chain of Command

L&D Surgical Tech L&D RN L&D Charge Nurse Labor & Delivery Unit Nurse Manager

House Manager Chief Nursing Officer

The L&D RN manages the L&D surgical tech, nurses' aides, nursing techs, or ward clerks that may be working in the unit.

Physical Demands

Occasionally = 1 - 33% of the workday

Frequently = 34 - 66% of the workday

Continuously = 67 - 100% of the workday

Standing or Walking - Continuously - The RN may be on her/his feet the majority of the day to perform direct and in-direct patient care.

Sitting - Frequently - The RN is required to sit at various desks for documentation via paper or electronically via computer or other tasks such as in-services.

Bending - Frequently - Bending is required in most job activities in patient care. The RN should be able to maneuver in small areas, such as around the birthing bed and fetal monitor, or during a delivery or c/section.

Climbing/Reaching - Occasionally - The RN should be able to climb a foot stool or small ladder when stocking supplies as well as reaching for supplies. The RN should be able to stand on foot stool at the patient's bedside if needed. Push/Pull - Frequently - The RN may perform push/pull motions when transporting patients and/or moving equipment on various surfaces. Handling/Lifting 0-24 lbs - frequently 25-100 lbs – occasionally

The employee may be required to help lift and/or handle objects from 1 - 300 lbs. Assistance in moving patients and use of the pull/push activity is done frequently. For heavier activities, staff should always seek assistance and use ergonomic training. Manual Dexterity Hands Simple grasp - continuously Firm grasp - frequently Fine manipulation - frequently Feet Standing and/or walking - continuously or frequently Fine and gross motor skills are used in venous punctures, sterile vaginal exams, handling surgical instruments, information entry on computers, and adjustments on equipment and/or pumps. Foot controls are used with some equipment. Speaking/Hearing - Continuously Speaking - ability to communicate with patients, co-workers, physicians, and/or visitors Hearing - must have functional with or without correction Seeing - must have functional with or without correction Patient Population The Labor and Delivery department is available for any female patient of child-bearing age, who is determined by the physician to have a condition associated with pregnancy which requires close monitoring/observation. The nurse may provide nursing care to patients from newborn to adult. Mental and Emotional Demands/Requirements

The L&D RN must be able to: Manage stress appropriately Make decisions under pressure Manage anger, fear, and hostility appropriately Handle multiple priorities Work independently, concentration and memory to detail.

Principal Accountabilities

1. Provides professional nursing care utilizing the nursing process to all patients all age groups in order to assure high quality nursing care.
2. Documents appropriately on the patient's medical record, paper or electronically to reflect established standards of care, policies, procedures, and/or protocols. Completes documentation in a timely manner. Keeps minor nursing documentation deficiencies found during chart review below 25 per year.
3. Practices effective communication skills, verbal and non-verbal
4. Works with others on duty including but not limited to physicians, surgical techs, and ancillary departments, and fellow RNs as a team to provide optimal care for the patient.
5. Knowledge of & adheres to policies of the unit, department, & facility
6. Maintains a professional appearance adhering to the dress code. Maintains professional behavior at all times.
7. Demonstrates leadership abilities by effectively controlling patient care activities within the unit.
8. Has read and has knowledge of Employee handbook and other HR policies including attendance and tardiness
9. Notifies appropriate ancillary services when needed: Social Services - teen pregnancies, + drug screens, adoptions, social problems Infection Control - contagious diseases, + HIV, significant febrile pts or culture results House Manager - transfers, c/sections, administration of blood
10. Stays current with hospital, nursing, and unit required certifications and in-services. Attends unit meetings and all mandatory in-services.
11. Maintains a level of supplies, equipment, and medication to meet the daily and emergency needs of patients (birthing rooms, recovery, and c/sect).

Fetal Monitoring

1. Responds appropriately to all maternal and/or fetal complications/emergencies initiating extra-uterine resuscitation when indicated.
2. Reads all posted material which includes current evidenced-based obstetrical and nursing practice including "Strips of the Month"
3. Competent to accurately read and interpret monitor data including interpretation of uterine contractions, internal & external, fetal heart rate interpretation, internal & external using NICHD definitions and nomenclature. Describes fetal monitoring strips to the physician accurately when physician is not present in the unit. Able to interpret NSTs, CSTs, OCTs
4. Completes an annual Fetal Monitoring Course provided by the hospital by deadline assigned.
5. Demonstrates correct application of internal scalp electrodes. Knowledge of when ISE is needed and/or contraindicated.

C/Sections and Post-Anesthesia Recovery

1. Completes the "Time Out" prior to any invasive procedure including c/sections.
2. Anticipates and meets the needs of the surgical team during c/sections.
3. Initiates, maintains, and documents all sponge, needle, and instrument counts during vaginal or c/section deliveries.
4. Identifies, labels, and transports specimens to the laboratory per policy & physician order.
5. Ensures that birthing rooms, c/section rooms, and recovery rooms are ready for a patient at all times.
6. Assists the anesthesiologist or CRNA as needed during intubation and the patient's emergence from anesthesia.
7. Demonstrates competency with aseptic and sterile technique and enforces strict standards of asepsis.
8. Coordinates the care of the patient in the OR including delegation of specific duties such as scrub tech, infant care RN, and 2nd RN circulator if needed.
9. Supervises the work of the surgical tech in the OR; is familiar with the surgical techs' job description, responsibilities, and role in the OR, reporting any variances.
10. Documents all pertinent patient information and data in the medical record.
11. Maintains c/section circulation competency by circulating at least 12 c/sect/yr.
12. Understanding of the Danner score (Aldrete) with documentation complete.
13. Appropriately manages acute pain of the immediate post-op period.
14. Appropriately manages recovery from regional anesthesia- assessing movement of extremities and spinal levels via dermatome chart.
15. Demonstrates accurate assessment of the patient's post-op cardiovascular, respiratory, and neurological status including hemodynamic stability, airway management, and mental status evaluation.
16. Appropriately manages the post-anesthesia patient according to discharge criteria.
17. Maintains competency of post-anesthesia recovery by recovering at least 6 patients per year.

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