OK, so yesterday toward the end of my 12 hour shift I get a new patient who had an IUFD last year and is now 38 weeks.
Work her up... have a good conversation... talk for a minute about all she went through last year.
Doc comes in and discusses plan of care, doc goes out and I translate some of the info, i.e. what pitocin is, what a glucommander is and who will be caring for her over the next day.
Change of doc's, new resident in to perform U/S on pt who was admitted from the clinic for NRNST, I am in and out of the room collecting care and IV supplies.
The doc completes the U/S then pulls me into the hall to tell me with brows knit and teeth clenched "this patient killed her baby last year". My response "Oh my goodness"
Now I have to go back and face the patient with info in my mind that is clearly detrimental to our relationship and try not to let it get to me. I think I did a pretty good job and the patient thanked me kindly for my care when I left her at the end of the shift.
It turns out that the resident who performed the U/S had cared for the patient last year and had attempted to educate and admit her for blood sugars out of control but the patient had refused leading to the IUFD.
I did not feel comfortable letting the doc know that I was not happy about her attempt to turn my mind against the patient...
Specializes in OB, Telephone Triage, Chart Review/Code.
"I think the doc was just venting frustration over the situation last year. Considering you are a co worker and a professional on the case, I don't think it was inappropriate."
Dawngloves, I have to disagree with the above. This "doc" was passing judgement on this patient. The only thing that should have been reported was that the patient was noncompliant with care and subsequently lost the baby!
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I disagree; it was very INappropriate. What exactly, is a nurse supposed to do with such information (whatever the story) now that this patient is UNDER HER CARE?
Specializes in OB, Telephone Triage, Chart Review/Code.
Yes, it was very inappropriate! Again, the only thing that should have been reported to you was that the patient was noncompliant with care and subsequently lost her baby. That "doc" had no right to judge that patient.
Specializes in Education, FP, LNC, Forensics, ED, OB.
I disagree; it was very INappropriate. What exactly, is a nurse supposed to do with such information (whatever the story) now that this patient is UNDER HER CARE?
I think it was very wrong.
As do I, Smilin'.
There is a time and a place to make these remarks. It is in a medical staff meeting for peer review and/or clinical case presentation.
This physician was venting her frustration ...... could have been justified or a personal vent. Somehow, I think it was the latter.
In any case, the physician tried to "bias" your care by making this remark. Totally unprofessional.
I had a (female) Anesthesiologist make a similar comment to me about a pt's previous TAB while we were in the OR doing a cerclage. Coincidently, this Anes. is also very soap boxish about DM, too. What kills me is that some people are so quick to make judgements - you NEVER know exactly why a pt will do some things, but that gives you no right to pass judgement on their actions. A pt that I had, G2 P0, was hospitalized for her second SAB, and here is why: she was a newly diagnosed Type 2 Diabetic for her first preg. and lost her baby - she blamed it on the insulin she was taking; when she was preg with her 2nd baby, she lost it because she did not take insulin and wound up in the ED with a blood sugar in the 800's. As much explaining and teaching as that resident probably did, DM is a very difficult disease, especially when it is newly diagnosed. Something was not clear or the pt may not even have had the means to GET treatment . . . wow. Isn't it amazing how ignorant one can be, even after all of those years of school?
Venting to a co-worker has its place but in this situation, it was a remark that was made without the nurse knowing the ramifications thereof. If the OP had been made aware FIRST of what had happened last year, and THEN the remark was made, perhaps it would have been taken in context. But without that bit of information, what on earth are you supposed to do with a comment like that?
OK, so yesterday toward the end of my 12 hour shift I get a new patient who had an IUFD last year and is now 38 weeks.
Work her up... have a good conversation... talk for a minute about all she went through last year.
Doc comes in and discusses plan of care, doc goes out and I translate some of the info, i.e. what pitocin is, what a glucommander is and who will be caring for her over the next day.
Change of doc's, new resident in to perform U/S on pt who was admitted from the clinic for NRNST, I am in and out of the room collecting care and IV supplies.
The doc completes the U/S then pulls me into the hall to tell me with brows knit and teeth clenched "this patient killed her baby last year". My response "Oh my goodness"
Now I have to go back and face the patient with info in my mind that is clearly detrimental to our relationship and try not to let it get to me. I think I did a pretty good job and the patient thanked me kindly for my care when I left her at the end of the shift.
It turns out that the resident who performed the U/S had cared for the patient last year and had attempted to educate and admit her for blood sugars out of control but the patient had refused leading to the IUFD.
I did not feel comfortable letting the doc know that I was not happy about her attempt to turn my mind against the patient...
Any one like to respond?
I think that resident you mention was very crass. I wouldn't have much respect for that. I agree that if the patient was non-compliant and her blood sugars were off the wall and the baby was stillborn because of this, her physical shape was probably the cause of the demise. But....to say that the ady "killed her baby" is a terrible thing to say.
Personally, I would speak right up to that resident. Why would you be uncomfortable? Her approach was most unprofessional. Remember, doctors are just people like you and me who decuided to go to medical school. They are not better than anyone else. Someone should knock a doc like that off her pedestal. You can be very professional in speaking with her about this.
I think the resident was disgusted w/ the pt. because she is human and felt that the pt's non-compliance caused her other child's death. Was the way in which she delivered the comment to you inappropriate? Yes it was. BUT she was not overtly rude to the pt. while doing the U/S. If she was professional at the bedside, then I think she is trying to do her job, but finding it difficult. I suspect that like many of us who have had the frustration of trying to work against pt's non-compliant behaviours, she was just disgusted w/ this pt. and probably angry to see her pg again and possibly not doing what she should for this baby. If she had said something like "It makes me really mad to see this pt. pg again. She was non-compliant last year w/ her insulin-management and lost that baby and now here she is again. I really hate having to take care of her." She feels, evidently, that the pt. caused her other child's death and that she is not "entitled" to another child. It's not in her hands, yours, or mine to decide that. Still, she is only human and who knows where she is coming from (the dr.) in her own life re. losing/wanting a child. Talk to her face to face. There are lots of uncomfortable situations to deal w/ in nursing, so I'd say just do it. You really have to if you work w/ her all of the time. It was awful for you to go back in the room not knowing what pt. "did" to "kill" this baby last year. Don't crucify the dr. over this. She used poor judgement in making her comments, but believe me this is not the worst dr. behaviour you will ever see. There are pt's who we all, if we are honest, don't like to deal w/. If we can maintain a professional presence at the bedside, then we are far ahead of many of our colleagues.
I would have liked to get the whole story in case the mother needed to be watched carefully so as not to harm the current baby and not just "she killed her baby" and left it at that.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I would have liked to get the whole story in case the mother needed to be watched carefully so as not to harm the current baby and not just "she killed her baby" and left it at that.
thank you.
And I have to ask those who feel the dr was being human, again---how is a nurse supposed to treat such information? How are we to be therapeutic with such info, given at this critical juncture? What are we to DO with such information?
I think the doctor made a mistake presenting the info. as she did. I have heard many nurses over the years say things very much like this about pt's. It happens. It shouldn't. WE all have our own feelings about things and sometimes to the detriment and the benefit of a pt. they seep (not sure I spelled that correctly) into our practice. I really do believe that is why this nurse should speak to the doc involved about this. Maybe she is a melodramatic hothead (the doc) and the nurse doesn't want to approach her. Since she was very upset by what the doc said she has no choice but to approach her. This may serve to let the physician know what she did was not appropriate and she'll state it differently next time. She may be very self-absorbed and see nothing wrong w/ her actions. She should have clarified her statement to the nurse to expound upon what the pt. did to "kill" the other baby. I won't crucify her for her feelings because after doing this job for 18 long years I know of no nurse, doctor, or other caretaker who is totally objective and totally understanding of her pt's feelings at all times. I know I personally have felt a lot of anger at drug addicted pt's or people who sign out AMA and then have a poor outcome they do not want to take ownership of. I am not unkind to them and try to deal w/ them professionally at the bedside, but I too have negative feelings about them and I feel it does not discredit me or the care I provide to admit this. My question to the OP would be did she respond to dr. when she said this by asking whaht the pt. did to "kill" the baby or was she just so dumbfounded that she didn't know what to say. I can imagine having either response. That is again why she must approach the doc over this situation and tell her "I didn't know what to do w/ the info. I wish you would've elaborated." If she is unapproachable go to the manager and have her/him deal w/ it.
webbiedebbie
632 Posts
"I think the doc was just venting frustration over the situation last year. Considering you are a co worker and a professional on the case, I don't think it was inappropriate."
Dawngloves, I have to disagree with the above. This "doc" was passing judgement on this patient. The only thing that should have been reported was that the patient was noncompliant with care and subsequently lost the baby!