Doctor was yelling...told me I was negligent....am I?

Nurses General Nursing

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I have a question about an incident that happened on Friday. I was caring for a laboring mom that was at term and had gestational thrombocytopenia. She had had a pitocin gtt during day shift but it was ordered stopped after uterus was hyperstimulated. MD then ruptured membranes at 5 pm. I came on at 6:30 pm. Another night nurse had been there a few minutes earlier. We received report and then I took care of the patient. The nurse that had been there before me told me that the MD mentioned if we needed pit orders we could call her. She had also given report to the MD that was on call for the night. I spoke with the covering MD at about 8 pm. I told him that the contractions were more like irregular cramps. The pt had also told me that she would like to speak with her MD in the am. Apparently, her MD told her there is a possibility of a C/S. Pt. was now considering this option as she said she did not want another day of labor without progress. She was 3 cm. I told the covering MD the same. He was at another facility, as is the case for our on calls! I also told him that the platelet counts were due at 9 pm and will occur every 4 hours. I talked to him after each plt count was in (stable at around 100). I also always told him that her contractions were minimal. The covering MD happened to have to come to our hospital at 2 am for a transfer. He looked at her EFM strip and asked if she had decided yet on a c/s. She had not and was actually sleeping. He sent the transfer and left. So she dozed most of the shift.

The attending came in the next morning and blew up that she was undelivered. She told me that I was negligent and that the pit should have been running. She also told me that if the pt. had decided for a c/s, I should have had the covering doc do it when he was in earlier. Our pm c/s are a big deal, as the team is not present in the hospital. The attending then told me(about 4-5 times) loudly that SHE did care for her patients("I care for my patients. I really do care for my patients" to quote her). I was at a loss for words. I told her that I had been in contact with the covering MD every 4 hours and he had even been in. She told me that it was my responsibility to have made sure she had delivered. She said I had wasted 12 hours on doing nothing and I put her in severe danger. I have been a nurse many years and this is a first for me. Was I negligent?

I was completely embarrassed as this all happened in the nursing station in front of everyone. I feel like exiting this hospital right now as I don't know if, even if I was fully wrong, I can work with this MD any longer! Please give me your honest answer and let me know what I should do or should have done! I have worked OB for years but I try and stay away from L&D for this reason!

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Specializes in ICU/Critical Care.

Uh, I don't see where you were negligent. Sounds like the attending needs to get her head out of her orifice and yell at the covering MD not you. Did you speak with your manager?

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Specializes in Med-Surg.

If she was upset with anyone, it should have been the covering MD. You kept him/her informed, and if they choose to not react, that's their fault.

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No, I have not spoken with my manager yet. She is not one that backs up her staff anyways, be they right or wrong!

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Specializes in Operating Room Nursing.

If you have documented everything including informing the MD then hopefully this will show that you are competent.

I would file a complain about this doctors unprofessional behaviour as well.

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If you have documented everything including informing the MD then hopefully this will show that you are competent.

I would file a complain about this doctors unprofessional behaviour as well.

This same MD will be delivering my sister in February so I really don't want to complain on paper. I did document everything.

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Uh, I don't see where you were negligent. Sounds like the attending needs to get her head out of her orifice and yell at the covering MD not you. Did you speak with your manager?

But should I have thought to also call the attending when the labor slowed? I normally don't and I was speaking frequently to the covering MD. If I had known she was insistent that pt was to deliver overnight, regardless if it was pit or c/s, I would have told covering MD. My train of thought that she showed unchanging labs and she was strongly considering a c/s so I did not restart the pit. The attending told me that I should have known she needed to be delivered and that was why she had performed AROM. FHR was great throughout night. Just not much contracting!

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Specializes in Med-Surg.
But should I have thought to also call the attending when the labor slowed? I normally don't and I was speaking frequently to the covering MD. If I had known she was insistent that pt was to deliver overnight, regardless if it was pit or c/s, I would have told covering MD. My train of thought that she showed unchanging labs and she was strongly considering a c/s so I did not restart the pit. The attending told me that I should have known she needed to be delivered and that was why she had performed AROM. FHR was great throughout night. Just not much contracting!

If she were that serious about the patient needing to deliever that night, she should have made that clear to the covering MD. They report off patients just like we do. Dont' let her blame you for her lack of communication.

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Specializes in Oncology/Haemetology/HIV.
If she was upset with anyone, it should have been the covering MD. You kept him/her informed, and if they choose to not react, that's their fault.

Agreed.

Since when does the nurse make the decision to deliver the pt?

Second, There was nothing to stop her from calling to check up on the pt herself, if she was truly so concerned, if it was an urgent issue. I work with many dedicated MDs, and they frequently call about pts, even when off duty.

Third, I really get tired of MDs blowing up at the nurse when they are peeved at decisions made by the covering MD. If the attending does not care for those decisions, they should make arrangements for someone else to cover. Much like when MDs whine about being unable to read notes by consultants, they spend more time griping about it and insisting that nursing "translate" it, rather than confronting their colleague about their unprofessionalism, and lack of safe care.

Your manager should cover your back, but I also have worked with managers that play the "blame the nurse" game and appease MDs at all costs. I no longer work for hospitals that cater to that bad behavior. Would that none of us had to.

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Specializes in L&D,postpartum,acute rehab/medsurg.

This is exactly why I needed a break after five years of labor and delivery nursing. There is nothing more rewarding than helping a woman through the labor process but OBGYNS can be some of the Worst MDs to deal with. Darned if you do and darned if you don't. That's why I'm taking a little breather and working Mother Baby. And yeah, it sounds to me like you handled the situation appropriately. That Dr. also has no right speaking to you that way in front of everyone in the nurses' station. Sounds like an issue for your manager.

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Personally, I would have told the doctor how I felt in a polite manner. You handled the situation a lot better than I would have, because I don't think that I would have tolerated someone yelling at me. She would have had to start over and address me like we were both adults, and not like I was her child. As a nurse it is not your duty to decide when a patient should be delivered, if anything she should have made her request known to the on call M.D. I just think that this was a way to intimidate you. I believe that some M.D.s think that just because they have M.D. behind their name that they are mighter than thou, however I do not believe this. I look at it in a manner like this, yes I respect their education and their knowledge, but that does not give them the right to belittle a nurse. We are all human beings. But I understand how you felt. If you felt that you were wronged talk to your manager, and if she does not support you , then transfer to an area where you feel more comfortable if the situation permits.

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Specializes in Trauma, Teaching.

She was wrong.

You were right. You did the right things.

The covering MD obviously did not think pt. needed to deliver that night; if la grande dame wanted it done otherwise it was her job to make sure it happened. If she cares so much, where was she?

Since when did the decision about when to do an elective cs fall into the nurses' laps? Baby wasn't crashing so where's the emergency?

Are you sure you want your sister delivered by this person?

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