A “Typical” Day In the Life

While there is no one “typical” day for me, here’s a little glimpse into life as the intern on labor and delivery.

*day to day routine varies based on what rotation/service you are on…variety is the spice of life, right?*

Here goes:

4:45-5 am: ALARM!

[Thankfully, “getting” ready takes all of 10-15 min given I wear scrubs every day. I eat breakfast on the way – a Picky Bar and a green juice, usually. And coffee #1 of day.]

5:15-6 am: Get to the hospital somewhere in this time frame depending upon the number of postpartum patients to round on that morning. Get sign out on post partums from night resident.

[Sign Out = Running through the list of patients and active issues with them. Ie Ms X had a fever last night and x,y,z was done. Or Ms A has severe pre-eclampsia, is on magnesium until 5 pm today, tox labs q 6 hours, blood pressures have ranged X to X…or something like that]

Until 7 am: Round on the post partum patients. Write notes.  Usually ranges between 10-20 patients.

How best to describe post partum rounds?

Screen Shot 2014-02-16 at 8.45.57 PM

7 am: Get sign out on the “board” (triage and laboring patients) and antepartum patients from the night resident. Give sign out on post partums to nurse practitioner (aka the intern’s God send).

7:30 am: Didactics (educational activity)

8 am: Sign out “the board” to all of the staff on labor and delivery

8:45 am to 5:59 pm: “Run the floor”

There are four basic things you do as an intern in a day on labor and delivery.

***Intern = first year resident***

1. C-SECTIONS: There are always scheduled C-sections each morning, usually at least two and sometimes three. Interns do all primary C-sections, meaning the first C-section anyone has ever had. Repeat C-sections or those on people with prior abdominal surgery usually get bumped up to the second year resident, unless they are in clinic. Really complicated patients may get bumped up to a chief. In general, the labor and delivery intern ends up with at least a few sections every day.

All residents bow down to the holy check box so I’ll include that in this post as to neglect the check box in a post about “the day in the life” would basically be leaving out the meat of my day.

In “check box” terms, C-sections get five check boxes: history/physical exam, consent form, pre op orders, cross for blood products, post op orders, baby orders.

2. TRIAGE: Triage is like our OB emergency room. Anyone over a certain number of weeks pregnancy gets sent to our triage. Usually, it is people who are coming in to determine if they are in labor, if they broke their water, etc etc.

Triage patients get four check boxes: history/physical exam, consent form, triage orders, call attending to discuss plan for patient.

3. LABORING PATIENTS: This entails watching the “tracings”, checking in on them, monitoring or managing their labor course/starting an induction, and, hopefully, delivering them!

*Tracings = external fetal heart rate monitor and contraction monitor*

Laboring patients get the following check boxes: history/physical, consent form, admission orders, cross for blood, baby orders, post partum orders.

4. PAGES: It beeps (a lot). You answer it. Pages can be for anything – from a colace order to someone with severe range blood pressures who needs to be evaluated for pre-eclampsia to a post partum hemorrhage.

I wear my pager on my ID necklace/lanyard along with looping my four color pen. Suffice it to say I look super cool when I’m at work.

Screen Shot 2014-02-16 at 9.05.23 PM

During the day, our nurse practitioner covers the post partum pager and patients. This probably saves the intern at least a billion pages per day.

The antepartum service (i.e. those admitted prior to labor)  is covered by the second year resident. However, they are sometimes in clinic and you hold the pager at all times and, therefore, are also responsible for the antepartums in some capacity each day.

6 pm: Sing out the entire service to the night resident. Hand off the pager to said resident.

6:30-7 pm: Leave hospital!

***There is, of course, always the possibility of the 5-5:30 pm high acuity situation in which you get a bit delayed on the 6 pm sign out or you may need to catch up on note writing or some aspect of patient care from the day and stay a bit later than what is listed above.***

At some point, you eat lunch and, hopefully, drink water. I drink at least two coffees a day, minimum and sometimes shove down a Picky Bar in the afternoon, especially if I’m going to run or spin that evening.

I was on a huge diet ginger ale kick during my last month on labor and delivery. There’s something so satisfying about the little mini cans of diet Shasta (ginger ale) apparently only available at hospitals. Combined with hospital ice (the soft ice like they have at football games), its heaven in a small styrofoam cup.

Screen Shot 2014-02-16 at 9.10.44 PM

I usually crash by 10 pm. Sometimes earlier. And hopefully not any later than that.

And then you get up again and do it the next day!

So, that’s it.

Until next time…

[And if you have any questions, ask! Not sure if what I wrote is common knowledge or jargon…]

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14 thoughts on “A “Typical” Day In the Life

  1. My mom was a nurse in postpartum/L&D for 20+ years (she’s in nursing education now, teaching), I used to hang around the hospital with her on long 12-hour shifts, drinking all the apple juice I could get my hands on. Loved this post. I remember Shasta in the styrofoam cups!!

    Couple qs: were you nervous before you did your first C-section? How much supervision do you have?

    How did you learn what all the different pages meant?
    My mom used to call signout “giving report”- are they interchangeable?

    And, do you do this Monday through Friday, or different schedule each week? That’s grueling, you must love what you do 🙂

    • First C-Section: YES! Well, as an intern, yes. As a student, no because not really doing much! But, your first of anything is very supervised and the attendings “take you through it” i.e. give you step by step instructors which are usually very specific. We also do a lot of simulations on models so I had done “practice” C-sections on felt. I used to get nervous (our skills are always being judged after all and you don’t want to to anything to cause harm) but just did a month of OB at our private hospital and did at least 2 c-sections a day so I’ve gotten more comfortable with them.

      Pages: The page is usually just the number to call back 🙂

      Sign Out: Yes! Nurses call it “report” and residents/doctors call it “sign out” — no idea why but same thing although I’m sure the emphasis that we have in “sign out” vs “report” may differ somewhat…

      Schedule: Yep, Monday through Friday! The weekend schedule is different as it is a “call” schedule. We switch rotations (services) every 3-4 weeks. Ie now I’m on a 3 week stint of “swing” where I do a little OB and a little GYN.

      Thanks for the questions!

    • As Meggie said below (or above? not sure how these comment replies work…), for some reason, doctors call it “sign out” and nurses call it “report.” I don’t give doctor sign out, so I can’t speak for what they actually say, but physician sign out seems to be a bit more problem focused (as Meggie said, “Pt A had a fever, we did x, y, and z” and I’m assuming some sort of to do list…in an ICU, if a central line needs to be changed, lab values to follow up on) whereas nursing report tends to cover all the bases…head to toe with lab values, etc. (Example: We report on where access/IVs are [MDs don’t necessarily care] and when the patient last had a bowel movement, among other things.)

      I think physician sign out is a little more problem based and nursing report is a little more day to day. Neither one is better/worse, just more job-focused…correct me if I’m wrong, Meggie!

  2. Thanks for sharing, it sounds like maybe they have reduced the required number of hours you guys work now since 10-20 years ago when it meant 80 hour weeks? Still pretty brutal and exhausting but hopefully you get enough time away exercising/sleeping/time to eat and veg that you feel sufficiently mentally fresh when you are on – those crazy hours were one of the things that kept me from doing an MD/PhD program way back when, stuck with the PhD instead since I didn’t think I could survive the lack of sleep….

  3. My goodness, that’s an early day! Our residents get in at 6am to take sign out and the night PA comes in at 6pm to get sign out for the night…the residents can leave a little earlier if they’re not holding the pager and everything is done before 6pm. (They say we’re an “easy” rotation because we have PAs at night and they never have to take overnight call…ha.)

    Those Shastas are the best when I get a little nauseated at 3am at work, if I can ever find them! (Hard to come by, we don’t stock too well.)

    It’s always interesting to me how notes are written at the beginning of the day…as a night shift nurse, the only way to figure out what was decided during the day is to ask the night PA who might have no idea. Sometimes the day residents update the notes after afternoon rounds, but usually they don’t…or they’re just not accurate at all! Which is hilarious and concerning all at the same time.

    Do you always get paged with just a phone number, or can you get text pages? Our residents (from all services) seem to hate when you just page with a phone number…we can text page as well, so they like at least a little heads up about what they’re being paged about.

  4. I’m officially starting to get a wee bit nervous about going into labor. I have about 3 weeks left, give or take. My OB said she wouldn’t let me go very long past my due date so I hope baby girl arrives at the latest by May 1st. 🙂

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