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!
I don't work in this area but this makes me furious. Next time you have to work with her, tell her to write orders that she is to be called at 3am for patient issues. Or ask her to document that you should have made a delivery happen.
What a jerk.
I would demand a written apology if someone accused me of being "negligent" in the middle of the nurses station. That is slanderous.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
Arrogant docs that posture and yell. Sigh. You did nothing wrong. As previous posters have commented, if she wanted something other than what happened it was up to her to spell that out. Her notes needed to reflect her medical wishes and her report to her peers needed to reflect that. You followed orders. You used good nursing judgement. There was no emergency and no reason to jump outside of the plan that was related to you in writing and in person.
I would recommend to my sister that she change OBs. This doc is apparently not trustworthy when it comes to playing nice with others in the sand box. L&D is one of those areas that needs to work extremely well as a team. I would complain to my supervisor and then to her supervisor. Management needs to understand that when doctors undermine the confidence that patients and families have in the people who are providing their 24h/day bedside care (nurses) they are undermining the confidence those people have in the hospital and make them more likely to find fault with their stay. In today's healthcare world there should be little tolerance for this type of bad behavior.
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.
When she kept saying how much she cares about her pts., she looked like she was going to cry. She even had to dab at her eyes. I am feeling like I should have known how dangerous the situation was but I thought I was keeping tabs on it. The MD obviously thought it was enough to come close to crying about it! If I had not been able to contact the call MD then I would have called the attending and she would have probably told me to restart the pit. However, the covering MD called me right back every time. Some of the nurses where I work have been there so often that they have no problems delivering the babies and the OB's (if they appear mid delivery) let the nurse finish. I am not close to that comfort level.
She was close to CRYING about it??? Ummm.....can we say psych issues???? Wow, that right there would definitely make me think twice about unleashing her on a family member. And as to delivering babies without the OB present....wouldn't touch that one with a ten foot pole, unless it was an absolute emergency and I was the only one there to do it and the mom couldn't wait for the OB, and even then I'd be documenting my orifice off. I don't think I'd ever be at that 'comfort level' to do it without an OB or midwife present.
Specializes in Acute Care Cardiac, Education, Prof Practice.
Sorry but if she was that worried about the patient she should have taken call for her herself. Plenty of physicians do it all the time. Screw her tears, they were probably more about her than you.
Write up an incident report on this orifice. Keep a copy of this for yourself and go up the nursing chain of command. What about your relationship with the chief MD of your department? If you have a good rapport with he/she, this may be another course. SHE should have been more attentive to her "underlings and minions". If mom and baby were not in distress, you kept the on call informed, and no changes in lab values, vitals stable...you did NOT do anything to put them in danger.
And since when is it nursing's responsibility to schedule deliveries, time of patient death, etc etc etc.....LOL ((((((((((((((((((hugs to you))))))))))))))))) and raspberries to MD :P :P
When she kept saying how much she cares about her pts., she looked like she was going to cry. She even had to dab at her eyes. I am feeling like I should have known how dangerous the situation was but I thought I was keeping tabs on it. The MD obviously thought it was enough to come close to crying about it! If I had not been able to contact the call MD then I would have called the attending and she would have probably told me to restart the pit. However, the covering MD called me right back every time. Some of the nurses where I work have been there so often that they have no problems delivering the babies and the OB's (if they appear mid delivery) let the nurse finish. I am not close to that comfort level.
1) can we all spell M A N I P U L A T I O N???
2) what danger?, just because the doc was ****** doesnt mean the patient was in danger....
This same MD will be delivering my sister in February so I really don't want to complain on paper. I did document everything.
Your sister and you are two seperate entities..I would hate to see that she would take out her anger against you on your sister.
That would be very unproffessional and grounds for some sort.That was an embarrassing situation to you. The on call doctor might probably want to step in.
Your sister and you are two seperate entities..I would hate to see that she would take out her anger against you on your sister.
That would be very unproffessional and grounds for some sort.That was an embarrassing situation to you. The on call doctor might probably want to step in.
My sister is a 5th year ped resident so I am sure that,if she is uncomfortable, she will transfer. But, I don't want her to have to go through the aggravation. I am the one that recommended this MD to my sister. MD has a history of giving nurses hell but has great skills. I am also positive that the covering MD got an earful so I will have to talk to him. The attending mentioned that WE will talk about this again in private. I really don't want to speak with her alone. I almost started crying at the nurses station so I can imaginge what I would do privately. I can write about this sanely but I really am not a person that is confident enough to make waves. If she had only said to call her and not the covering MD, I wouldn't be in this mess. I keep rehashing this in my mind and wishing that I had just told the pt. she should try the pit again and, if she hyperstims again, I will stop it and call the covering MD . At least then, I counld say that I attempted to get her delivered. I am hesistent to do this on night shift as the covering MD is always a trip away. It took 1.5 hours to get him there for the 33 week transfer with PROM.
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((((((((((((((((((hugs to you))))))))))))))))) and raspberries to MD 
:P
MedSurgeMess
985 Posts
My thoughts exactly!