how to manage multiple patients on L & D

htrn · Feb 28, 2007

There have been some excellent suggestions already made, my only addition would be:

I'm sorry Dr. so and so. I realize that your patient does need to be delivered, but it is not safe for me to start or continue to increase pitocin on that patient right now. I will gladly monitor her until we get another nurse to come in or my currently active patients deliver.

We have had to do this several times. Docs will fill up our calander, then we get two or three patients that come in during the night and don't deliver before their inductions come it. Heck, if we have three labor patients, then we don't even have a bed to put an induction.

I agree with Dayray, I can take care of more patients than I can keep up on charting for. Worse case scenario, I run in, look at the strip, initial it, chart on it quick if I did anything, then sit around for 2 hours back charting at the end of my shift.

Your NM needs to do something about your staffing ratios - what you describe is VERY UNSAFE. Good luck - and get someone else to precept students or sit her down with your policy and procedure book.

TrudyRN · Feb 28, 2007

I think you should refuse to take the student. Especially if all the other staff have thrown her out, she must be a butt pain. You are not responsible for her education. Her instructor is. Raise a fuss if she is really stressing you out.

Be fair to her, she does need to learn. But her education is not your responsibility. Her Instructor might have to take a patient (God forbid) and teach her own student herself.

As for using paper towels for notes, why not just carry your clipboard and write on it then chart later all at once?

SpudID · Feb 28, 2007

Thanks for your help, everyone. You have all given me good advice.

Just to followup. I use a paper towel because I write notes on it and it is handy (like 2 pillows, extra blankets, water-no ice). Stuff that I wouldn't chart but may require me three extra visits if I don't get it down because I forget which room wants what.

I am going to be more proactive with the careproviders about increasing the pit. One medical student said his job was to insure that I was going up according to standard protocol according to the resident. I am learning to find my voice and, unfortunately, err on the side of being too obsequious because I feel continuously humbled and ignorant.

The above comment about the student RN was funny. We are actually parting ways. We are not a good personality fit. We both agreed on that and I contacted her instructor, our nurse educator and the nurse manager. She will leave soon. I don't know anyone that is willing to take her on. She has difficult interpersonal skills and I felt she was ungrateful as well as disrespectful. (See the above paragraph on finding my voice. I shouldn't hae allowed it.)

Thanks again. I thought I would quit nursing at each mo.end. I am starting to like it a little more. I had no idea that the stress load would be so incredible. You all have been a wonderful support. I felt relief from just reading your responses. I guess I am feeling isolated.

Kudos!

SmilingBluEyes · Feb 28, 2007

PS when I have more than one labor patient (and don't we all these days), I keep a clipboard of paperwork for each and keep them in the monitor drawer of the patient's room. That way, I don't get paperwork mixed up and I chart as I go. This is particularly a good time saver. Don't take the time to write vitals and other info on papertowels, only to copy it later to the chart. That is wasting precious time. Keep clipboards handy for each patient and when you go to check on them, chart the appropriate notes/vital signs before you leave their rooms.

If you are extremely pressed, chart things right on the fetal strip, but never over the fetal heart/contraction tracings, obviously. That way, you can at least catch up and chart things later from the strip, and the time stamp on the strip makes it very handy to remember what happened when. I always chart various interventions, position changes, meds given and what doctors do when at bedside, etc and initial my notes, on baby strips. They tell a story that is very clear, all on their own.

Like I said before, don't be too hard on yourself. 14 months is not a lot of time to "get a groove" that works for you as any nurse and OB is no different. You will get more efficient and confident after about 2 years' fulltime work, trust me.

And with that confidence, will come the courage to stand up to doctors who do things like insist you crank up pit when it's clearly inappropriate. I recently actually had to tell doctor if she wanted pitocin on my patient (who was having repetitive late decels) she would have to do it herself; I refused flat out to do it. She was steaming mad at me, but what is she gonna do, hit me? Think not. She stormed off but came back later and apologized when it was time for delivery. The patient's baby did straighten out and LO! she had the baby lady partslly without ANY exogenous hormones like pit to push it along. The doctor was shocked she needed no pit to go from 4 to pushing in about 6 hours. And, baby and mom came out just fine as a result. Had I pushed pit, we would have had a 3 a.m. emergent c/section for sure.

Being your patient's advocate is not an easy role, but essential.....and knowing you have TWO patients to consider (mom AND baby) you have to learn to be very proactive and strong. But you will; just give yourself time.

I wish you the best. We all are here for you if you need to talk.

magz53 · Mar 2, 2007

I had a primip who had been laboring on 30 mu/min of pit ( our max ) for hours and not progressing........got a multip in active labor with decels who was moving quickly. Being the only nurse, I told the care provider I was not comfortable running pit when I could not possibly be in the room so we shut it off while delivering the multip. ( Thinking she would be a c-section probably anyway ) Guess what ?? The primip went into a wonderful, co-ordinated contraction pattern with no pit and went from four cms to fully while we were delivering the multip whose baby was stressed but recovered quickly with support. Pet peeve of mine with pitocin. We recently changed concentration/dilution and nurses still speak of it in cc s and NOT mu s. I don't care how many cc s, I need to know the amount of pitocin going in, many mistakes have been made talking volume of fluid and not the amount of pitocin. Would be nice if we went 1:1 ratio so everyone on the same page. Just a thought.

RN BSN 2009 · Mar 2, 2007

Hope all goes well with this