Dealing with doctors.....

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Well I think one of our doctors is mad at me. In a way I really don't care. But I really like this guy as a doctor and I would like to establish a repoire with the group of doc's that we regularly work with. Here's the situation......

Dr. X like to schedule his inductions on the days he is on call so he can deliver his baby's. Well that's admirable right? So g2p1 shows up for induction 0700 (supposed to be here btwn 0500 and 0600 but he doesn't tell her that) I assume care from another nurse around 0830. She is 1, long, high. That's fine he comes in not long after I assume care to AROM.... he is unsuccessful. He doesn't come back 'til about 1330 Pit is at 20 (has been for several hours) 1-2, 30%, -3. He AROMs, clear fluid, He places and IUPC and says turn pit to 10 and go up as needed. I leave it at 10 for a while and ctx kinda space out so I start going up by 2's. She get's 10 of nubain. She had been trying to go natural but about 1530 she is asking for something else for pain. We discuss epidural .... she is 2-3, 70%, -3. I page anesthesia. We get epidural about 1630. At 1800 the doctor is back she is 6-8, 100, -2..... Before he checks her he questions me about why I didn't check her before she got her epidural.... I did check her before epidural... it's on the board.... it's in my notes. After he checks her he says, "it looks like it won't be long so I think I'll just hang around". I set up a delivery table. Talk to the patient.... she is very nervous and would like me to stay for delivery..... I try to be optimistic but don't promise anything.... At 1830 she is Rim, 100..... doctor knows and is in breakroom. At 1850 she is complete and complaining of pressure. Dr is notified...he is no longer in the hospital but says to go ahead and push her. I break down the bed and we start to push. Her epidural is pretty dense so she doesn't do too well the first couple of pushes. 2 nurses from nights come in to assist and one of them is very "encouraging". Well she pushes a few more times and during the last one she does great and we can see about a good amount of head. So we tell her not to push anymore till the dr gets here. She doesn't but the next ctx brings the baby down more until the head is really crowning good. I'm the only one with sterile gloves on and yep you guessed it the next ctx out comes the head. Loose nuchal cord.... I reduce it.... with help from the other RN and then encourage mom to go ahead and push.... well about this time the doctor show's up to do the rest. Well I say congrats to mom and dad.... admire baby for a few..... then leave because it's about 1910. As I'm leaving I visit with a couple of the other nurses and they ask.... "was he mad"..... It had never occured to me that he might be.... anyway. I go get changed and start to leave but see him sitting at the desk and he's is grilling the other nurses about "what happened" etc.... I walked up behind him and he wouldn't even talk to me..... what the he!!

..... anyway I keep wondering over and over what I could have done differently. I know I'm new. But I was not the only nurse there.... I just happened to be the one at the end of the bed. I think He would like to blame it on me because I'm new and he thinks I'm stupid or something. I don't understand what the problem is because there was a good outcome. I did not intentionally deliver this baby.... should I have tried to hold it in? I am very frustrated....

What are your thoughts....

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Specializes in cardiac, diabetes, OB/GYN.

I think you should just take him aside with a " Hey Dr. ---, can we talk a minute? I have kind of been feeling a little tension between us and just wanted to discuss it...I'd like to work with you and do things as you like but I need to know what that is.." I really enjoy working with you and don't want to start out on a bad note.." Try that...That has worked countless times for me...

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I definitely don't think you did anything wrong. I know as a patient I would definitely appreciate your being there versus the doctor. I think his acting out like he is his problem. You did everything in your power to make sure that he was aware of his patient's care. I would do what mother/babyRn suggests since you will be working with this MD, but I wouldn't let it get to you.

Good job!

Kris

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He told you to let her push, what does he want? You can't control how long the second stage is... Besides, I don't like the idea of "letting" women push. Her body was ready and as a doctor I am sure he knows that some women will push a baby out with one or two pushes and he was willing to take the risk.

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The minute this doc ruptured her at 1-2 and 30% and -3, I would have lost respect for the guy right then and there. This lady wants to go natural and he's putting in an IUPC? Doesn't sound like a nice natural labor to me. Why, by the way, was she induced?

As I read the rest of your post, one thing comes to mind........he is a total jerk! Don't waste your time on him.

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Bets..... she was 38+6 being induced for gestational diabetes. However, she had never had a 2 or 3 hour glucose and her sugars were not monitored by the patient, lab or office during pregnancy nor were we ordered to monitor them during labor. I was told by the patient that the doctor wanted her induced because he was afraid the baby would be too large if they waited (baby was 7lbs 3oz). She was a great patient for me but somewhat of a frequent flyer at the unit.

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

agree w/betsy.

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I feel for ya 4birds...I have definately run into these type in my short career. I like M/B's suggestion and will take that into consideration myself down the line.

What I can't figure out is why blame you for HIM not being there...he know the patient was getting close and infact TOLD you to start pushing, and no body ever knows exaclty how long it would take. It's his own fault. And why should he complain? He still gets paid by the insurance for the delivery!!!! He should be thanking you for taking good care of his patient and APOLOGIZE to her for missing the delivery! And NO monitoring of blood glucose during labor...sounds like a winning doc to me.

I agree with BETSRN: the guy's a jerk!!!

Take care, and know you did good by your patient!!!

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Why does he get mad? Because docs want you in BACK of them until the you-know-what hits the fan and then they want you in FRONT of them protecting them.

I would just mention to him next time that you will call him plenty early so that there is NO way that he will miss the delivery.

By the awy, the situation was probobly NOT lost on the patient.

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He may be a jerk, but you and he have to work together. I agree that you should pull him aside and talk about it; politely and professionally. That way you can both get past this.

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I gotta ask....I am not an OB nurse, but when you told the lady 'don't push till the doctor gets here' what was her reaction? I remember my labor and I think I would have expressed some colorful metaphors.

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

I don't just say "don't push"----- i STAND WITH THEM, BREATHE WITH THEM, HAVE THEM LOOK INTO MY EYES, and ask them to concentrate on my cadence to help them breathe thru contractions. YES this WORKS to get them through that strong urge to push and buys a small amount of time until the doctor can make it.

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