Frustrations about L&D nursing

[RNLaborNurse4U]

What are some of your frustrations about your job in L&D?

For me...I can list quite a few, but I'll keep it simple:

1 - Triple and quadruple charting - more time spent on paperwork/computerized charting means less time I can spend with my patients. :uhoh21:

2 - The girls/women who are on public assistance and come in every 1-2 years bearing another child onto our already overly burdened welfare system. :angryfire

3 - Sometimes, feeling like you need to clone yourself so that you can adequately care for all of the patients you are assigned. On our really busy days, we can sometimes have 2-3 active labor patients at once.

Jen

L&D RN

[lauriesalRNC]

Ohhh yes the famous " social induction". I HATE THAT! I have to say I was induced twice, once for postdates and once b/c I had a precipitous labor the first time and was 4 cm in the office.... justified reasons in my book. But I;ve had indcutions for " well, I'm tired of being pregnant" or " the doc asked me do I want to be induced and I said yes". Do the docs even explain to them that with a 1cm long thick cervix and a vertex at a -4 that the chances of having an unnecessary C/S are pretty high? It makes me sick! I am not against inductions for valid reasons... but being tired of being pregnant is not a vaild reason IMO.

The frequent practice of inductions is one of my greatest frustrations. I guess it wouldn't be quite so bad if they would actually wait until mom is actually due, but we have many, many inductions at 37-39 weeks. It's exhausting. And at least 50% end up being failed inductions as you would expect. Our doctors usually end up letting mom rest overnight and then re-pit the next day and of course those moms end up being sections on that 2nd day. What a bunch of stress and crap to put an unborn baby through because you are selfish and can't wait 2 more weeks when the baby is actually ready to be born. I don't understand why doctors can't grow balls and tell their patients "no" when they come into the office asking to be induced early. A little education would go a long way, but this takes time and they aren't willing to spend the extra time with their patients to explain why uterine receptors aren't as sensitive to pitocin at 37 weeks. And we as nurses can talk until we are blue in the face but the patients aren't going to listen to us. In the past, I've tried to educate these women, telling them that if they wait a couple of weeks, the success rate will be much higher, heaven forbid they go into labor on their own. Of course, 5 minutes after talking with them, they opt for the c-section that the doctor is offering as being the "only way" to get the baby out. :angryfire

[lauriesalRNC]

I am rolling on the floor at the ambulance scenario... we crack up about that all the time where I work. There are like 50 people waiting downstairs to come up and see the patient but no one could bring her to the hosp!

My favorite is when someone comes in at like 32 weeks, not even due with like 1 contraction in 3 hours and calls her entire family to come to the hosp b/c she is having the baby and they all show up. Then we get 50 calls to the floor from security wanting to know can they come up, or calls from family asking if she had her baby....SHE ISNT EVEN IN LABOR!

I agree with everyone of your frustrations.....thought I'd add a few more...

--the boyfriend who comes in at 2am smelling like pot and demands a work excuse for the day.

-- the patient who comes in with her 3rd preg and doesn't understand why she's hurting (round ligament pain) and so tired all the time--she has a 2 year old and 9 month old at home--can't we just do something for her.

--the patient who comes in via ambulance, you know the 34 wk tired of being preg one mentioned earlier, and her family gets to the hospital before the ambulance but no one could give her a ride.

-- the drug addicted mom who denies doing any drugs and wants to know what we gave her baby to make them positive for cocaine and marj.

-- the family of 50 who thinks they can all stand in the middle of the hallway in the unit and watch, hear, comment on and see every thing and everyone. How dare we ask them to wait in the waiting room.

-- the visitor who goes to the medical floor and visits a peds pt on isolation with RSV before coming to visit the newborn ..... and how dare we say a word to her!!

OH I could go on and on and on. You just gotta love them though. I've done other things and always come back to OB. It's just in my blood. As I've gotten older I've learned to just smile at some of them and shake my head.

I guess people aren't so different anywhere are they?

[NPinWCH]

Sooooooo ... you explain that they are only 34 weeks - you explain everything that could happen if they delivered right now - you send them home and spend an hour wrapping up their triage chart - and they come back two days later to replay the entire scene!!!!!!!

I know exactly what you mean. Rate pain 10, but the first question out of their mouth is "How do you dial out," or "Can I use my cell phone in here?".

Not to mention the ones they dial 911, come in by squad because "I didn't have a ride." BUT 4 people show up to the unit asking for Sally Smith, who's ETA is still 10 minutes.

What about "Can I have some extra formula when I go home because I can't get to the WIC office until ..... and I don't have any money" BUT, she has gone out to smoke every hour on the hour for the past 2 days...has a new digital camera and ordered almost $100 worth of baby pictures.

No kidding, we had a patient that made no fewer than 22 trips to our unit for "I think I'm in labor" between 35 - 40 weeks. Which brings me to my all time hated statement, "My doctor told me I could go any time now!!!!"

[SmilingBluEyes]

It makes me sick! I am not against inductions for valid reasons... but being tired of being pregnant is not a vaild reason IMO.

Nor is there validity to the the one where the doc wants to make his/her trip to DisneyLand or Aruba in time, so he/she hurries up and delivers the patient so he/she won't have to deal with her "all night long" and delay that all-important trip or tennis match. UGH. "social" inductions are just as much for the DOCS as patients really!

[lauriesalRNC]

The other night I had a patient, a prime, 19 yrs old.... obviously not from the best family background and obviously uneducated.... who spent 8 hrs cursing and yelling and being uncooperative.... then THREW a pillow at me and refused to push. She started off stating she was never getting an epidural b/c " there is something wrong with a needle that you have to sign a paper saying you cant sue". I said " what on earth are you talking about?" she said she signed " that paper"....which I told her, its a consent form... obviously you didnt read it, it says nowhere on there that you cannot sue. So... anyway she got 2 doses of Stadol and was cursing the whole time ( I had Pit running) . She refused to turn onto her side when she had some decreased variability ( b/c IT F-ING HURTS, F THAT!) ....so then she said she would try the epidural. Well lucky for me we had to do it twice b/c the first one didnt work. During the epi she was squeezing the crap out of my collar bone and thrashing all over the bed. To add fuel to the fire the anesthesiologist was getting pissed and slamming things around too while the patient was yelling the F word. So then she gets comfortable for about an hour, then its time to push... which she refused to do... yelling I CANT F-ing PUSH! I CANT F-ing HOLD MY LEGS BACK! I told her repeatedly the language was not necessary and to stop yelling and listen to me so that i can help her get the baby out. I also reminded her that if she didnt push then the only other way for the baby to come out is by c-section. So the throws a pillow and it hits ME. I was so mad it took everything I had in me not to snap! Itook off my gloves, told her " no you are not going to throw things at me"...and left the room. I called the OB and told him, one way or another you have to come out here and get this kid out! I told him what was going on, he seemed like he didnt want to come out of the call room ( he was asleep)... but he did...and by then she had pushed a few times and got the head down to a +3. The doc comes in to do the delivery and during the pushing she SCREAMS " YOU HAVE YOUR FINGER UP MY A$$$$$$$$$$!". ( he didnt) The doc looked like he wanted to leave!

After the delivery she apologized, her mom and her aunt apologized to me.....her mother told me I was the best nurse for putting up with that and gave me a hug. My coworkers told me I got the gold star for that night.... in 7 yrs of nursing I think she was definitely my biggest challenge!! I was never so happy to GO HOME!

:angryfire

[webbiedebbie]

I burned out on L&D. One of my frustrations was with a woman who experienced back labor. I tried everything...including talking to CNM, and giving medication. I spent a lot of time with her. At the same time, I had another on pitocin. We had two others in labor (one other nurse working with me), and two walked in.

My back labor pt was supposed to receive medication to induce labor. I didn't feel comfortable giving it because I could not document ctx or fhr on monitor adequately because the pt was all over the bed. I was constantly going back in to readj the toco, etc. I informed the CNM of everything.

I got chewed out the next night because I "forgot" to give the medication as ordered.

I was on overtime to complete my charting.

I also don't think it is right to stop someone on pitocin because I have to attend/assist for another delivery.

I agree that inductions are abused.

I now work Mother/Baby and moms are too exhausted to pay attention to the teaching. Not to mention that they want to breastfeed, but "not right now, I'm too tired".

[brigaily2000]

My biggest single frustration? Computerized charting and medications. I feel more and more like I am nursing "machines", NOT humans. It's enough to make me consider leaving OB altogether. This is NOT what I signed up for when I became a nurse. I just want to care for my patients, period. All the paperwork is truly getting in the way more and more. Betsy is right; these frustations will NOT go away, but realizing this does not make me able to just let it go, either. OB nursing is not what it should be anymore. And I have only been at it 8 years----too soon for burning out!

Yes, this is true of all nursing...not just OB...the result of an extremely litigious society. Very sad. This is what made me give up my love of home health.

[FrumDoula]

The other night I had a patient, a prime, 19 yrs old.... obviously not from the best family background and obviously uneducated.... who spent 8 hrs cursing and yelling and being uncooperative.... then THREW a pillow at me and refused to push.

You deserve a medal of honor, girlfriend. It sounds like she had abuse issues going on ....

Whenever I've had a client who refused to push, something was always going on psychologically. Labor can bring up really scary feelings for some moms.

Alison :balloons:

[lauriesalRNC]

I think part of the issue was that she got attention from her mom and aunt when she acted out like that, so of course she kept doing it. When I got a little tough on her I think she realized i wasnt going to coddle her and put up with her crap. I think I actually pissed her off b/c I wasnt giving in to her childish behavior and saying ' awww honey its ok if you curse and act like a lunatic'. But it got the job done!

You deserve a medal of honor, girlfriend. It sounds like she had abuse issues going on ....

Whenever I've had a client who refused to push, something was always going on psychologically. Labor can bring up really scary feelings for some moms.

Alison :balloons:

[obnursesteff]

My BIG frustration is the duplication of documentation on NOT ONE but TWO computer systems which do not communicate w/ each other. ARRRRRGGGGGHHH!!!!! Plus most of the info. we have gather (about two tractor trailers full) has already been obtained on the prenatals. We are asking something new just about every week. Soon we will go out and check their oil and tire pressure too. I don't REALLY have PMS today but I will also tell you my two biggest gripes w/ pt's are abused women who come in pg every year, esp. when the guy is beating their young children too (sorry two small children beaten to death in our area in past 2 months by "boyfriends" and another little 4 year old about 75 miles from here too by her coke snorting stepdad) and those who expect nurses to have the knowledge of Einstein and Plato while they treat us like we clean the restrooms at McD's ... :angryfire and my all time worst gripe... BEING PULLED TO MED-SURG or to babysit psych pt's/drunks in the ER. Thankfully most of our pt's in ob are great and most of the other nurses are too. I think we do a difficult job and rarely get the credit we deserve.

AMEN!!!