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 would definitely NOT agree to speak with this physician again in private. Any further discussion should take place with your management present, union rep present if that applies, on-call physician if possible, nurse who gave report to you, etc. Since she has already slandered you in public, I feel confident she would have no problem intimidating you and manipulating you into unwarranted admissions of "error" should she get you alone.
If she was that concerned about this patient it behooved her to have communicated exactly what she wanted to the nursing staff, to the on-call physician, or to have said she would take call herself on this particular patient. She did none of these, now she's second guessing herself and looking for a scapegoat. This is all too common behavior for some OB's. She has looked at you, seen your concern and questioning yourself as insecurity, and she has pounced. Now, don't let her make a meal of you! If anybody messed up, she did, NOT YOU!!!!
Please take to heart what the other posters are saying. You acted appropriately.
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.
did you have an order for that?? if not, you would have been practicing med without lic. i dont know what your issue is here, repeatedly you have been reassured by the nurses here that you acted in a prof. manner....but you keep saying "i should have done something differently" why is this? the doc was wrong, plain and simple. and slanderous. and DO NOT meet with her alone, take anyone with you, preferably some one with a cool head and a backbone.
I would definitely NOT agree to speak with this physician again in private. Any further discussion should take place with your management present, union rep present if that applies, on-call physician if possible, nurse who gave report to you, etc. Since she has already slandered you in public, I feel confident she would have no problem intimidating you and manipulating you into unwarranted admissions of "error" should she get you alone.
If she was that concerned about this patient it behooved her to have communicated exactly what she wanted to the nursing staff, to the on-call physician, or to have said she would take call herself on this particular patient. She did none of these, now she's second guessing herself and looking for a scapegoat. This is all too common behavior for some OB's. She has looked at you, seen your concern and questioning yourself as insecurity, and she has pounced. Now, don't let her make a meal of you! If anybody messed up, she did, NOT YOU!!!!
Please take to heart what the other posters are saying. You acted appropriately.
Agree with this.
I have had manipulative MDs try the "talk to me privately". They just want to heap on the blame. If she truly felt that you were negligent, then she should would be calling a get together with your manager, a HR/risk manager, you, medical director. Doing things "privately" means that they cannot bear the light of day, and as far as I can see, YOU have nothing to hide. These are the same MDs that will play on your guilt to drive you to do things that normally you wouldn't because you feel guilty, and you worry about repercussions. But the fact is SHE is the one that should be worried about repercussions.
I do have the caveat that often HR will not side with a nurse against an MD (I've been there, done that, and have psychological scars to prove that), even if that MD is WRONG!!!! That and you standing up for yourself sometimes makes you a target. Many facilities and MDs want nurses to be good little obediant girls that tolerate bad behavior and do not complain about it. How they deal with you when you hold your ground, should tell you whether you want to continue working there. There are plenty of places that do value nurses, and require acceptable behavior. And remember that any place/nurse that makes excuses for this MDs unacceptable behavior....eventially it comes back to bite them in the butt, as the out of control MD will continue to behave badly, and eventially will harm someone. Do you really want to deal with having to be a witness in court/involved in a lawsuit because of this MD? Or worse, get thrown under the "legal" bus to save them, when something goes wrong.
How a facility handles these issues, says a lot about their ethics. If they play the "blame the nurse" game, you may find it better to find a better employer.
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.
Stop second guessing yourself. As at the time this occurred, the decisions you made at the time were the ones you could have made
given what facts, information or whatever you had at hand. I understand that in any other situation, if there was the slightest bit
of suspicion, that you would have gone beyond the on-call physician in making sure your patient recieved the best care.
She wants to talk with you? Fine, hear her out, but don't try to let her create such doubts that you begin to doubt yourself.
Or then again, she may want to apologise( which privately to me sucks- I hate to be ripped apart in public and apologised to in private).
You wouldn't know until you hear her out. And this may be very hard to do ( I KNOW!), try not to bad-mouth along with your colleagues. You're the bigger
person and you earn more respect that way. You and your longsuffering self:D
Good luck and God Bless. You'll do just fine-you always have!
How a facility handles these issues, says a lot about their ethics. If they play the "blame the nurse" game, you may find it better to find a better employer.
It's always easy to egg on-The grass is NOT always greener on the other side.
You are being manipulated by her. Absolutely do not have a "private meeting" with her. Pit takes an order which you did not appear to have.
Write down all the details for yourself now while they are fresh in your mind. Date and time it. Ask if the nurse who gave you report will do the same about the report she gave.
Yes, it is very intimidating to be yelled at like that. I asked a doc one time why he had been so pushy about a non-significant issue that created problems for us (later when I had calmed down from being really annoyed about!). He smiled and said that he found he often could get his own way by doing it, and it was now just a habit. We actually had a good talk about what the cost was to the rest of us to comply with that particular (stupid) request, and he apologized. Haven't had much problem with him since, we get along well. ( He wasn't being manipulating, I don't recommend this approach to you right now :) )
You are being manipulated by her. Absolutely do not have a "private meeting" with her. Pit takes an order which you did not appear to have.
Write down all the details for yourself now while they are fresh in your mind. Date and time it. Ask if the nurse who gave you report will do the same about the report she gave.
Yes, it is very intimidating to be yelled at like that. I asked a doc one time why he had been so pushy about a non-significant issue that created problems for us (later when I had calmed down from being really annoyed about!). He smiled and said that he found he often could get his own way by doing it, and it was now just a habit. We actually had a good talk about what the cost was to the rest of us to comply with that particular (stupid) request, and he apologized. Haven't had much problem with him since, we get along well. ( He wasn't being manipulating, I don't recommend this approach to you right now :) )
Excellent idea and I have not done that yet. There was an original pit order that was stopped because of hyperstimulation. The attending had told my co-worker before I arrived that if we needed to restart the pit, we could call her. I talked to the covering, told him she was stable(as stable as she had been)and was considering a c/s after talking to attending in AM. I let it go after that but did continuously monitor her with q 1 hour VS and every 4 hr platlets and kept covering MD aware of progress, which was irregular contractions, good FHR, and leaking the clear amniotic fluid lady partslly.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
Stop beating yourself up...the doc is the pro at tongue lashing nurses. To parrot the other posters...DO NOT MEET WITH THIS DOC ALONE...invite your supervisor. This doc needs to realize that she is not your boss. She is a physician who practices at the hospital that employs you. If she has a legitimate complaint about your professional conduct she should take it up with your management at this point...she already had her verbal shot at you...you are not a target for her frustration or emotional issues.
And, yes, sometimes L&D nurses deliver babies. Actually, they sort of deliver themselves...we just make sure they are safe, etc.
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.
It wasn't 12 hours wasted...the mother and baby are safe, the mother got some rest, and you got paid...sounds like a good shift to me.
Update: Went to education day today. The attending did go to my floor manager. Manager did ask that my co-worker also on that night to write a description of what happened. She did and will leave me a copy also. Talked to a union steward who also works on the ob floor. She told me that because I spoke with the covering md throughout the night, I am covered. If the attending had wanted to address this pt all shift, she should have made that clear. I have not spoken directly with my manager, just my co-workers. Union rep told me not to speak privately with the attending. I have been off since that night. I work Thursday. Should I try and contact my manager directly or wait and see what is going to happen? Scared if I have to stand up and tell the attending that I don't want to speak privately. I guess I don't have much of a backbone and I am one to shy from confrontation. This has shaken me. I asked the other girl that was on that night why she scooted away when I was being reamed out. She said that she was embarrassed for me. The great news is that the pt. did deliver a good baby at 6 pm the day that this happened. Had restarted pit, got to 9 cm, baby wouldn't descend and a c/s was done. Baby had a true knot in cord. Pt had also heard the ruckus and felt badly. Now, have to get over my humiliation and walk back on that floor! I hope that I can!
Update: Went to education day today. The attending did go to my floor manager. Manager did ask that my co-worker also on that night to write a description of what happened. She did and will leave me a copy also. Talked to a union steward who also works on the ob floor. She told me that because I spoke with the covering md throughout the night, I am covered. If the attending had wanted to address this pt all shift, she should have made that clear. I have not spoken directly with my manager, just my co-workers. Union rep told me not to speak privately with the attending. I have been off since that night. I work Thursday. Should I try and contact my manager directly or wait and see what is going to happen? Scared if I have to stand up and tell the attending that I don't want to speak privately. I guess I don't have much of a backbone and I am one to shy from confrontation. This has shaken me. I asked the other girl that was on that night why she scooted away when I was being reamed out. She said that she was embarrassed for me. The great news is that the pt. did deliver a good baby at 6 pm the day that this happened. Had restarted pit, got to 9 cm, baby wouldn't descend and a c/s was done. Baby had a true knot in cord. Pt had also heard the ruckus and felt badly. Now, have to get over my humiliation and walk back on that floor! I hope that I can!
If the attending makes any indication he wants to speak privately, just say no! Tell him you have been advised not to do so, and will not put yourself in that position. Don't let him bully you!!!!!
maxthecat
243 Posts
You did nothing wrong!
I would definitely NOT agree to speak with this physician again in private. Any further discussion should take place with your management present, union rep present if that applies, on-call physician if possible, nurse who gave report to you, etc. Since she has already slandered you in public, I feel confident she would have no problem intimidating you and manipulating you into unwarranted admissions of "error" should she get you alone.
If she was that concerned about this patient it behooved her to have communicated exactly what she wanted to the nursing staff, to the on-call physician, or to have said she would take call herself on this particular patient. She did none of these, now she's second guessing herself and looking for a scapegoat. This is all too common behavior for some OB's. She has looked at you, seen your concern and questioning yourself as insecurity, and she has pounced. Now, don't let her make a meal of you! If anybody messed up, she did, NOT YOU!!!!
Please take to heart what the other posters are saying. You acted appropriately.