Orientation to Providence Regional Medical Center Everett (PRMCE):
Women’s and Children’s Pavilion
Welcome to N231 OB Clinical at PRMCE. I have included some helpful information
regarding your clinicals on the OB Unit.
General expectations:
Please wear college ID, Everett ID badge and NSCC uniform for all your clinical days. I
also expect you to be prepared for patient care with stethoscope and watch with a second
hand, and writing materials. Please refer to NSCC Handbook and PRMCE’s apparel
guidelines for questions about shoes, jewelry and body art. If you need to go into the OR,
you will wear an OR gown over your NSCC uniform. However, you may change into
hospital scrubs if your nurse prefers, but please change back as soon as possible.
You may use a “brain sheet” to organize your care. PRMCE has a care organization sheet
that may be helpful since that is what your supervising nurse will use. The Moodle site
has forms that you will use to collect data to do your assignments and for care plans.
You may carry your cell phone, but it must be on silence. If you are in a delivery, you
may want to turn it off completely so as not to disturb the moment. You may use your
cell phone for personal reasons only on break and not in public areas.
I am available at 206-265-9907, my clinical cell phone number. I turn it on at 0500 on the
day of clinical. If you will be absent or late for clinical, please follow guidelines posted in
your syllabus.
I expect you to call me for any questions, concerns, support or acute changes in patient
status, including births. If you need to call me, please step out of the patient room and
into a private space to call. I try to carry a Providence Spectra phone that can be called
from any phone on the floor. I will post the Spectra phone number on the assignment
sheet posted on the report room door.
Logistics:
Our clinical experience is at the Women’s Pavilion on the Pacific Campus of PRMCE
Students park in the main garage on Nassau St., on the north side of the main hospital.
There is a door on the second floor that leads to an outside stairway, which will take you
to the front of the Women’s Pavilion. Note: don’t leave anything of value in your car
since there is a significant chance of break-in.
You must have a photo ID badge to get onto the unit and go anywhere on the unit. Nearly
every door has a badge reader which you swipe your badge through. I will collect the
badges on the last day of clinical.
Enter the Women’s Pavilion and take the elevator to the 4th floor. You may leave your
belongings in the staff break room across from the 4th floor nurses’ station. There is no
secure place for valuables, so don’t bring anything that you can’t lose. You may store
your lunch in the refrigerator and there is also a cafeteria in the main hospital. The
refrigerator in the 4th floor nurses’ lounge is less crowded. Staff restrooms are located on
the ends of pods (nursing stations) and in changing room. There is a sky bridge on the 3rd
and 4th floor that leads to the main hospital.
Report starts promptly at 0630 in the 3rd floor nurses’ lounge. I will post your assignment
on the door: look for the nurse, your name, and the room. I will also post my Spectra
phone number (if I have one) and the conference times and location on the bottom of the
sheet. I add to it during the day, so please check it occasionally. If you are doing postpartum, go to the room you are assigned to and meet your nurse there after report. If you
are assigned to a labor, go to the labor room and wait for your nurse. Please introduce
yourself as you arrive on the pod and say whom you will be working with. There are a
limited number of report sheets, so ask your nurse if you may copy info from hers. You
must shred any sheets that have patient identifying information at the end of the day.
Structure:
The 3rd floor is for vaginal deliveries and postpartum, the 4th floor is for postpartum C/S,
Gyn and antepartum patients. There is an internal elevator between the two floors that
requires a badge swipe: only use the green ones. The floors are set up as “pods” with a
north, center and south. If you can see the water from the window, you are in the north
one. The room numbers get larger as you go toward the south pod. There is a map in your
packet.
There is a nursing station in the center pod of each floor. Each pod has a family kitchen
with coffee, tea and water for patients and a refrigerator for patient food. Only the kitchen
in the center pod is stocked with food for patients, and requires a badge swipe to get enter
the nourishment room.
The operating rooms are on the 3rd floor in the center pod. There are 3 doors: the center
one leads to the scrub room with gowning supplies for you and any others attending the
delivery. The two large doors on the hallway open directly into the OR. Do not use those
doors unless you are helping move a patient into the OR, and then you should be gowned
with shoe and head coverings and mask. You must wear eye protection anytime you
are at a delivery, vaginal or C/S. You will need a pair with you every clinical day.
Please sanitize them after every delivery, as well as your stethoscope.
The unit is set up so that each patient is admitted, labors, delivers, recovers and has her
post-partum stay in the same room (LDRPs). The infants stay with their mothers in the
room; there is no low-risk nursery. Each room is set up with a bed, computer, supply
cart, infant crib, and day bed. Infant resuscitation equipment is in the wall panel above
the crib, and the adult equipment is at the head of the bed. There is an emergency button
over the bed, in the bathroom and by the door along with a code button. The supply cart
has everything needed to care for mother and baby. The code for the cart is 8511.
Thermometers and otoscopes are in each room in the infant resuscitation alcove.
Stethoscopes are attached to cozy cots, so you will need to bring your own stethoscope.
Remember to clean it frequently. BP’s are taken with the fetal monitor machine on the
third floor and directly transcribed into QS charting system. The thermometer is tethered
to the wall, and stretches to the bed. Press and hold the mode button to change to axillary
for infant temps. Full assessment and charting is done every 8 hours, and anytime in
between whenever information must be documented.
Clean supply room:
You will find mother and infant supplies that are not in the bedside carts. There is a
blanket warmer here, the Pyxis dispenser system and Transcutaneous bili-meter. Room
#322 is the ready room with supplies and labor carts.
Dirty utility room:
This is where you place soiled instruments; linens, food trays and you will find the med
disposal bins. Please refer to the color-coded list for the correct bin in which to place med
and fluids for disposal. Used cozy cots and delivery carts are wheeled to the ends of the
hall to be cleaned by the techs. Clean cozy cots for delivery are found at the end of the
halls.
Charting:
There is a computer in every room. Patient flow-charting and progress notes are kept on
computer in a system called QS. All of your charting in QS will need to be reviewed by
your supervising nurse or myself.
Medications are charted in a system called Prov Clinicals under the admin rx tab. You
will not have your own log in for medication administration and will need to view the
MAR and administer medications with the help of your preceptor or instructor.
.
Your QS log-in will be your last name, first initial: example-johnstonm and the initial
password is baby. You will get to change your password at orientation.
The medication dispensing system is Pyxis. I don’t have a Pyxis log-in, so your
supervising nurse can sign out the med and supervise your administration but I would like
to be present for any infant medications given and must be notified if you have not given
the medication before (this means, ANY medication for mother of infant). Remember,
you must always perform the 6 rights of medication administration before giving any
medication.
Providence does not allow you to administer medications to pregnant patients: this
means all antepartum and laboring patients. Post-partum medications can be administered
by students within the Providence limitations and under supervision as stated above.
Students may administer infant injections and eye meds under my supervision, or with
my permission, with your supervising nurse. Meds are documented in Prov Clinicals and
in QS. Computers are available in each patient room and at each nurse’s station for
documentation.
Security:
This is a secure unit and each infant wears a security device called a HUGS. The HUGS
is placed on the infant at birth and locks the doors when an infant is near. If the device
comes out of contact with the infant’s skin, it sends an alarm signal to the monitor at the
nurses’ station. Mom, baby and a support person wear matching bands. These are the
only people who are to be in possession of the baby. Babies are always to be transported
in their cribs and are not to be carried in hallways or outside the room. It is everyone’s
responsibility to ensure the safety of infants so always have awareness.
Orders:
Please review the order sets for Labor Induction Admissions, pre-C/S, post C/S, postepidural, postpartum, newborn and circumcision. You need to be familiar with the routine
care of each of these patients groups. Hard charts are pink colored for mothers and blue
for infants. They contain the orders, consents, stickers, and info sheets. The label on the
back is color coded by the medical practice group.
There is a signature sheet in each chart and everyone who is charting must sign it.
Resources:
Every computer has an icon that will take you to the internal web site. It is the e on the
bottom left. There is a wealth of information available here. I refer you to two in
particular:
1) Lucidoc is the resource for policies and procedures. For example, when you see
the order say “Feedings per Breastfeeding protocol # 12069” that is a cue to go
look it up. You can search by different keywords, or look to the left of the site to
find “Manuals” Click on it, and go to “PRMCE”. Click on this and go to “patient
care” then to “nursing” then “FMC Services”. This will also lead you to policies
and procedures.
2) Mosby’s Nursing Consult also contains a vast amount of information, both
written and visual, about nursing care and skills. There are also patient education
materials that can be printed which are approved by the hospital. These
documents print to the corresponding printer at the nurses’ station where the
computer is located.
As in every institution that you work in, patient information is protected. You may not
print anything that contains any patient information, nor take anything out of the hospital
that has any patient care information. In addition, please take care to mark your brain
sheet in a way that does not violate patient confidentiality, and shred any report sheets
that you have before you leave. We also want to emphasize that it is unacceptable to
discuss patient or clinical experiences on any social media (see NSCC Nursing
Handbook).
End of Shift:
Plan to be finished with patient care, complete all charting and report off to your nurse by
1700. We will meet for post conference from 1715-1830 for post-conference, location to
be determined. We will also have a mid-day conference as well, between 1200-1230.
I will post the locations on the assignments sheet.
Practice Issues
Clear and honest communication with your supervising nurse is very important. Your OB
Skills Checklist lists activities which students are allowed to do. I would like you to bring
your OB Skills Checklist with you each clinical day and have your preceptor sign off any
activities/procedures you have participated in. I also want you to bring your clinical goals
for the day and share them with your supervising nurse. Let your supervising nurse know
what you want to do, ask for experiences and be interested and enthusiastic. Offer to help
with their other patients and answer call lights because you may also get to do more
things that way. Be honest about what your experience is so far and how much help you
need.
Be aware of professional manners. Keep your papers and binders out of the staffs’ main
working areas. Be sure to introduce yourself when you go to the patient’s room and meet
the staff nurse and the patient. Yield the computer to the staff or MD who needs to use it.
If your nurse is on a break, she probably wants to be by herself for a while; if you break
with her, she may not want to talk patient care or do any teaching while she is recharging
her batteries.
Don’t let my availability get in the way of patient care. If a med or procedure is urgent
and I am not immediately available, let the nurse do it, and we will try to get the
experience again later. In addition, if the patient’s status becomes unstable and your nurse
becomes too busy to teach much, move into more of an observer role, and call me for
backup.
There are many joyful experiences in OB as well, and it is ok to express emotions
appropriate to the situation. However, if you find any emotion is getting in the way of
safe patient care, step out of the situation. It is never appropriate to express criticism of
the institution or of patient choices to your supervising nurse or to the patient. If you have
questions about how a treatment decision is made, it is okay to ask for information or
clarification from the MD or nurse outside the patient room. Remember, practice
situational awareness at all times when working with mothers, infants and their families.
This area of practice can be very rewarding and joyful but also difficult for some
students. You may have strong feelings about certain practices based on your personal
experiences. You may see or hear things that remind you of unhappy or stressful events.
If so, please let me know. I can offer a safe place for you to express those feelings.
I look forward to working with each of you and helping you obtain your clinical goals in
maternal/neonatal nursing. I hope it will be an exciting and rewarding educational
experience.
Margaret Johnston, RN-BC, M.Ed.
NSCC OB Clinical Instructor
Cell: 206-265-9907