"Pit to distress..." (Rant)

Specialties Ob/Gyn

Published

I'm gonna try to make a very long story short...

I had the chief resident today give me an a** chewing because I had turned off the Pitocin of a pt who had persistent episodes of hyperstimulation. I had only turned it down a few minutes before he came in, so I had not informed him of this. He asked why I turned it off, and I showed him on the strip the pts ctx pattern. He looked at it and said, "Well, there's no fetal distress." I told him I understood that, but the pts uterus was not getting any rest between ctx. He then proceeds to tell me, "You need to call me before you do anything like this again, this is my pt." It took everything I had to keep from saying, "No, she isn't your pt, she's our pt, and it is my license on the line should something happen at your wanting to misuse the Pit." I didn't say anything though. So, I restarted the Pit, but only after I saw the pt had resting tone, and I started from the beginning, 2mu/min. She handled that okay, but when I got up to 6mu/min, she started having the ctx one on top of the other again. I pointed this out to the resident and he said, "Keep upping the Pit until there is distress, then you can back down on it." OMG, my tongue was almost bleeding by this time! Well, lucky for me, but not for the RN who followed me, this was right at change of shift, so I'm not the one having to deal with the aftermath. Which hopefully, there won't be one.

You know, I know I am new to this whole L&D experience, but when I have my preceptor and my RN educator agreeing with the actions I took, I can't help but think my actions weren't that far fetched.

I'm sure I left tons out, but I think I covered what I wanted to.

Thanks for letting me rant!

Sorry, double post..Guess I got excited.....

Specializes in Hemodialysis, Home Health.

Wow, Camay... I don't know beans about L&D, other that what I learned in school and haven't used since. But I do recall enough to know that you were absolutely correct in your concerns and anger !

Good for you for BEING disturbed about this.. and thank you for being a great nurse !!! :balloons: :balloons: :balloons:

Specializes in LTC, Home Health, L&D, Nsy, PP.

I had a similar run-in with one of our physicians just this past week. I won't drag you into all the details, but what my supervisor said to me later stuck with me. She said, "We can't let people like him keep us from being good nurses."

If I were in L&D I would want YOU as a nurse!

Just an update on the pt from OP. It sounds like the delivery was awful! Shoulder dystocia with mom put in every possible position to deliver lady partslly, which she finally did, however, baby was in bad shape. Had to resuscitate baby and from what I heard through the grapevine, he is in the NICU.

I know what happened with the delivery may be totally unrelated to the pit issue, but, I still think it was a bad sign of things to come. And not to sound like a heartless witch, but, I'm glad I left when I did.

Specializes in Emergency.

I don't know much bout labor and deliery, but i'd call the attending.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

so unfortunate for those parents and that baby. I hope the baby does ok.

Shoulder dystocias are the pits. Other than a rupture, it was always my biggest fear in L&D.

You handled the situation well. I agree, always use your chain of command. The days of doing what the doctor said because he said so are long gone and we are expected to be accountable for what we do. This is especially difficult in L&D. Kuddos to you for biting your tounge. I've been in L&D for a long time and haven't learned that one yet. You'll learn that when you call the doc and he doesn't come or when he has a fit and doesn't agree with the hyperstim or even decels...make it a point of letting him know you'll document what you reported and what his response was.......this always makes them think twice and usually calms them down too.

Keep up the good work and always trust your instincts.

Camay- I do not work in L&D, but I do not think that your thoughts (what you wanted to say about your license) were out of line. It is perfectly acceptable to let anyone know that YOU, as a RN, are responsible for this pt's safety as well. Speak up! Good idea about hi-lighting the P&P though!

We have residents all the time get upset with the nurses for 'managing' the patient :) (last I checked this was our job). We have tried the thing where we say, 'if you want to up it you will have to do it yourself.' There have actually been times when they have upped the pit themselves on a non-reassuring strip/hyperstimmed uterus! Problem is, they don't know how to work the pumps, and they don't stay in the room after they up it. So then who's responsibility does that patient become when they up the pit and leave the room???

Shoulder dystocias are the pits. Other than a rupture, it was always my biggest fear in L&D.

You are so right . . . . so very scary.

steph

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Lord, so glad I dont' work in a teaching hospital. I avoided it due to things like this. Yes, residents NEED to learn, but many are very stubborn in their newness and ignorance, and nurses are NOT allowed to manage their patients. Like pointed out, I thought that WAS nursing's job. I feel for you who work in situations like this.

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