[L&D_RN_OH]

My pt the other day was doing great, I thought. She didn't want an epidural, and was doing okay with just Nubain. Well, another nurse came in when she was crying through the contractions. Had only been doing so for about 4minutes, and asked her what her goal was for pain relief, and if she wanted an epidural. Really ****** me off, since Mom clearly stated she didn't.
She then asked her if she wanted another dose of Nubain, and told me to call the doc to see if she could get an extra one. She was 7 cm at the time and a multip, obviously moving quickly, so I wouldn't have been comfortable giving her Nubain so close to delivery. Anyway, I understand wanting to take mercy on patients in labor (or make her job easier?), but I was sure this pt was in transition. Sure enough, by the time I walked out, called the doc, and got th Nubain, the husband was yelling out Nurse!!! I went in, she was complete and ready to push.

I think it's good to try to read your pts rather than assuming they are weak and need pain meds that they aren't asking for, KWIM? Any opinions? Would that have bothered you?

[L&D_RN_OH]

Oh,she had 10 mg of Nubain and 12.5 mg of Phen. about an hour before this. So babe would have been seriously sleepy if I gave her more.

[SmilingBluEyes]

From what I read here, you were doing right...

It almost sounds as if that other nurse was using a sort of power play in this situation. Sadly, that is not uncommon, especially if you are inexperienced. I had them do such things to me in my 1st and 2nd years, til I finally put my foot down. First....

Looking at the situation, you were correct to "know your patient" and the situation. She was moving rapidly---and yes, giving narcotics close to birth can be a real problem for the baby. IF she did NOT ask for further intervention---e.g. epidural or intrathecal---what can you do? This is not a first-time mom; she knows pain goes with transition of labor. As long as you were supportive and VERY available, I can't see any problem. That nurse was inappropriate in coming in saying that to the patient, without at least talking to you first to see where she was in labor.

I mean, did that nurse know:

Whether the patient WANTED more drugs even?
Whether the patient wanted another form of pain control?
What you were doing to help her through the rough phase of transision?
What that mother's coping mechanisms are? SOME PEOPLE CRY IN LABOR----yet cope. Each is different. I see nothing wrong with crying, yelling, swearing, whatever to get through, as long as I have done all I CAN TO SUPPORT HER.

Dont' be hard on yourself. We all second-guess ourselves from time to time. I STILL do with 6 + years under my belt. I am never completely "comfortable" in labor and delivery--I want that edge so I recognize when to act and fast in any situation.

As far as I can see, the best thing for you to take away is: "what can I learn from that situation?" and move on. And if other nurses make a habit of using power plays to push you around, it will be up to you to stop it with assertion and strength. You can be diplomatic yet firm in telling them you appreciate help WHEN YOU ASK FOR IT---and that you ARE doing what you can to keep your patients SAFE, comfortable and feeling supported in labor and when you need assistance, you will ask for it. You can respect their experience and knowledge, but you don't have to put up with the games they play that make you feel incompetent and leave you second-guessing yourself in every situation. Live and learn and move on. You will do just GREAT! We have all been there; it does get better with time and experience. Do NOT let ANYONE push you around; stand your ground! Take care and chin up!

[BETSRN]

I think the other nurse was out of line coming in to "manage" your patient when it was not her responsibility to do so. I would suggest havig a chat with that nurse before she does that you you again.

[Dave ARNP]

Give her an extra shot of Nub. and see how she can handle wrapping up the job!


-David