aren't there any uncomplicated births anymore??

  1. I can't understand what is going on! There is a joke that I have a 'black cloud' around me!
    This past two days, I have had a patient with about a 500cc hemorrhage, a pt that spiked fever, chest pain, body aches (turned out to be endometritis) the night before discharge, a PP patient who had earned a stay in ICU d/t not being able to breathe and being intubated, babies with jaundice needing the lights, a PP who's discharge was held up to r/o pneumonia, an antpartum w/ pyelo, another antepartum r/o PE who ended up having gallbladder surgery...what is going on? Where are all the uncomplicated patients?? Have they all decided to stay home for the winter???
    I am feeling the strain as a relatively new nurse. And to note, these are only the ones I've cared for. We've also had several antepartums, lots of TAH floats to our floor, some of which I've had the last week or so, and a PP mag pt also.
    They say they trust me and that's why they give me these patients. They say that I can handle it. And of course I do. But I still get cold sweats when I see my assignments. I've been doing real well and progressing nicely and I feel like I am comfortable in my role as nurse. But lately, there has been at least one patient a night that makes me question my career choice. Not because I don't like it but because I am scared of it. When I found out the ICU patient was coming last night, I almost cried. If it was just her, okay maybe it would be easier. But I had three other couplets as well, and two of them needed to be discharged home at 7pm. So it was tough and tight.
    We are not the largest facility and we are not the one for high-risk, acute moms or babies. It just seems like TPTB are trying to make us that way. We have moved many of our special-care babies to the regular nursery; that is scary in and of itself. We are too small to handle the demands that I think they are putting on us.
    I am questioning my choice to work there. With all the experience I have been getting in surgical patients, maybe I will just find a women's surgical floor to go work on and then at least I won't have to deal with the babies. There is rumor that we will go to 6 couplets per nurse. That will be the day I leave.
    I just feel that they expect too much out of us, and myself personally I feel like I have been having just really heavy shifts. I am sure I am not the only one but it feels like it today.
    Thanks for letting me vent.
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  2. 17 Comments

  3. by   strn96
    Hang in there! It will get better. My second year as an OB nurse I had the "black cloud" thing happen to me. First year in OB (LDRP) was great; nice healthy deliveries with the only exceptions being a couple of babies that responded nicely to a few puffs of PPV. Then the magic ended and I had a run where it seemed like if any pt was going to have problems it was going to be on my shift. Had several really bad outcomes in just a few months. A 26wk precipitous delivery where baby ended up only living a couple weeks, a 37wkr w/ thick mec that Dr couldn't get ET and ended up with brain damage, and then a term baby that had serious undx'd heart problems that didn't make it. And several NB codes (good outcomes, but still really stressful!). There were a few days when I seriously wondered if OB had been the right choice for me. But ultimately, on the good days I love my job. And fortunately, the bad times do pass, even when it seems they just keep coming. Like any job, OB has its ups and downs. Call me an optimist, but to quote "Annie", "the sun will come out tommorrow..."
  4. by   doglover21
    Who ever is in charge of your department is not concerned with AWOHNN standard guidelines. I think they may be confused when they say six couplets are alright. The guidelines clearly say 1:6 antepartum/postpartum patients without complications BUT THAT DOES NOT INCLUDE THEIR BABIES. If you are doing couplet care, which I think you are, the ratio is 1:3-4 NORMAL mother-newborn couplet care. If you start adding Mag and complicated AP patients to the mix the ratio goes back down. Many hospitals do not even take Mag patients onto the postpartum floor. When they do go to the floor they are 1:1. Sounds like someone needs to speak to risk management or bring it to the attention of the doctors. Most doctors don't know what the safe ratio is on post-partum. It is your license and when you are brought into court, the lawyers will look at what the national standard of care is. I am sure you are not the only one that feels this way at your job. Good luck.
  5. by   MIA-RN1
    Quote from strn96
    Hang in there! It will get better. My second year as an OB nurse I had the "black cloud" thing happen to me. First year in OB (LDRP) was great; nice healthy deliveries with the only exceptions being a couple of babies that responded nicely to a few puffs of PPV. Then the magic ended and I had a run where it seemed like if any pt was going to have problems it was going to be on my shift. Had several really bad outcomes in just a few months. A 26wk precipitous delivery where baby ended up only living a couple weeks, a 37wkr w/ thick mec that Dr couldn't get ET and ended up with brain damage, and then a term baby that had serious undx'd heart problems that didn't make it. And several NB codes (good outcomes, but still really stressful!). There were a few days when I seriously wondered if OB had been the right choice for me. But ultimately, on the good days I love my job. And fortunately, the bad times do pass, even when it seems they just keep coming. Like any job, OB has its ups and downs. Call me an optimist, but to quote "Annie", "the sun will come out tommorrow..."
    Thank you! I love my job and I love being a nurse but wow...some days are just so hard!
  6. by   MIA-RN1
    Quote from doglover21
    Who ever is in charge of your department is not concerned with AWOHNN standard guidelines. I think they may be confused when they say six couplets are alright. The guidelines clearly say 1:6 antepartum/postpartum patients without complications BUT THAT DOES NOT INCLUDE THEIR BABIES. If you are doing couplet care, which I think you are, the ratio is 1:3-4 NORMAL mother-newborn couplet care. If you start adding Mag and complicated AP patients to the mix the ratio goes back down. Many hospitals do not even take Mag patients onto the postpartum floor. When they do go to the floor they are 1:1. Sounds like someone needs to speak to risk management or bring it to the attention of the doctors. Most doctors don't know what the safe ratio is on post-partum. It is your license and when you are brought into court, the lawyers will look at what the national standard of care is. I am sure you are not the only one that feels this way at your job. Good luck.
    Yes the 1:6 seems like much; its still a rumor so I am keeping my eyes open. We just are slammed with patients, many high-acuity;. Today I had a pt who was 33wks pregnant with htn epigastric pain that resolved somehow, and ended up being diagnosed w/ hellp syndrome so I had to hook her to mag and then she transferred out. And I had three other couplets at the same time. That sort of thing is frustrating. Its do-able, sure, but its tough. Other nurses has harder pts--one w. PPH and PIH with really high pressures along with her other couplets. It did even out a bit but not for some time.
    I know I am not the only one who feels this way but TPTB just don't see it. I am joining a self-governance comittee, hopefuly that will be a way to be heard.
  7. by   doglover21
    Joining a self-governance committee sounds like a great idea. If you don't find it to be a place where you can voice your concerns right away I would consider looking at other avenues. I have looked at your threads and your place of employement looks quite scary not just for you. They seem to be putting many of the nurses in situations that could easily turn bad. Good thing for OB that many of our patients are basically healthy and young to begin with. I applaud you for taking some positive steps in the right direction.
  8. by   nurseangel47
    This reminds me of the reason I left hospital nursing....too many complications, too much stress=me losing my marbles! Hope things lighten up for you soon!
  9. by   strn96
    Please don't confuse my earlier post as encouraging you not to speak out about an unsafe situation. I certainly think that you should do your best to draw attention to any situation where pt safety is in jeopardy, and if TPTB don't pay attention then maybe it's time to look for another place to work. Between understaffing and hospital politics, nursing can be very frustrating. But I would hate to see you give up nursing altogether because of a run of bad luck.
    Last edit by strn96 on Feb 13, '07
  10. by   MIA-RN1
    Quote from nurseangel47
    This reminds me of the reason I left hospital nursing....too many complications, too much stress=me losing my marbles! Hope things lighten up for you soon!
    The idea of being an office nurse sounds more appealing but the money and the hours are still better at the hospital, so for now at least, I have to stay. I had a pretty good night a couple nights ago, so I will have to remember that next time I have another heavy assignment.
  11. by   MIA-RN1
    Quote from strn96
    Please don't confuse my earlier post as encouraging you not to speak out about an unsafe situation. I certainly think that you should do your best to draw attention to any situation where pt safety is in jeopardy, and if TPTB don't pay attention then maybe it's time to look for another place to work. Between understaffing and hospital politics, nursing can be very frustrating. But I would hate to see you give up nursing altogether because of a run of bad luck.
    Oh of course I want to speak out. The self-governance might be the way to increase nurset ratios, although I really doubt it. I will NEVER give up nursing though.
  12. by   SmilingBluEyes
    Good for you Cooper! I sometimes wonder too, what we are doing to our patients anymore. I dislike so much of what I see, I at times, question my working in a hospital at all.

    BUT I do feel priveledged to be part of these birth experiences and holding hands, and bonding w/the families is what keeps me going. I do whatever I can to make their rite of passage into parenthood a joyous occasion, no matter the complications that do arise. That is what keeps me doing what I do or else I would quit.
  13. by   SmilingBluEyes
    You know what gets me? They worry endlessly about errors. And we all should.

    BUT WHAT DO THEY DO about it? When Aiken et al have said over and over, in study after study, higher ratios lead to worse outcomes, they INCREASE OUR RATIOS to save money. And in the interest of "safety" they increase the paperwork we do----the double, triple and quadruple charting. And they tell us we can't add meds to existing IV bags due to potential error, but refuse to give us a pharmacy at night....no one there to DO this for us. No offer to have anyone either. I mean come on, what kind of solution is this?

    They give us computer charting system that takes 4 times the amt of time to accomplish and again, calls for double-charting, meaning even more time away from the bedside where we belong.....

    I mean COME ON. We all want to be safe, our patients to be safe. But the bureaucracy that says it seeks to increase safety is actually bringing about more potential for errors than saving us here.

    Good luck Cooper. It is an uphill battle you have----corporate interests lie in making money, not really caring for our patients. The talk about increasing safety is a lot of self-serving rhetoric on their parts, no substance at all exists, nor the mechanisms to help us DO OUR JOBS MORE SAFELY. That is the bottom line you are up against and it's tough to fight. Sorry to rant, but this really does hit a nerve with me. I think complications are often a direct result of over-intervention and and misplaced priorities on the parts of MDs, Admin and yes, even nursing staff. That is hard for me to swallow.

    Again good luck. I admire your taking a stand.
    Last edit by SmilingBluEyes on Feb 13, '07
  14. by   MIA-RN1
    I hear ya, Blue Eyes.
    I am glad that allnurses is here because its really helped me open my eyes to corporate stuff that I;d probably be naive to otherwise, and helps me see the deeper picture as to what fuels our floor operations.
    We are taking the 'magnet journey' and maybe...just maybe...there is a chance that things will go straight. The thing is, its like this everywhere. We all have to deal with poor ratios, sicker and sicker patients (thank you HMO's) and TPTB who don't work the floor don't see the real thing. I WISH my NM would come and work with us on a day like the ones we've been having. Can you believe we had a CODE on a mother the other day?? It was handled expertly by the nurses involved, and the outcome will likely be allright but c'mon...why did we have that sick a patient on the PP floor to begin with?? Aside from the fact she was PP, which of course is the kicker. Antepartum, postpartum--if they are sick, bring em on. No matter if its gallstones or PIH, if they have an upcoming or recent birth they come to us. Thats how it goes. Most of the time it is okay but we are NOT the high-level hospital in the neighborhood. I had one PP freshly extubated from ICU. Ok, so maybe she was stable when I got her but I was shaking in my nursemates all night, kept thinking what if. Can I handle it? I do LOVE nursing and I LOVE my patients and it sounds convoluted to say I love my job but I want it better, I want it safer and I want us to work at the acuity level we are capable of caring for. And if we have higher-acuity patients then I want more nurses on the floor. No nurse should have three couplets and a high-risk patient with or without a baby. Maybe I am too new a nurse and its just my comfort level isn't there but its bad enough with 4 couplets and one is a fresh c-sect who needs HOURLY checks for 12h.
    Good grief I am almost late for work; off the soapbox I go.

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