why was Dr. so upset? (long)

[RNinNWGA]

I'm new to allnurses - I've actually been lurking here for a couple of years. Some background - I've been a nurse for almost 3 years, but 6 months into L&D, so I still have a lot to learn. I worked this weekend, which was a full moon and I am now inclined to believe what they say about L&D during a full moon. Wow, were we ever busy! My question: One of my patients was a primip, 38 wks, induction for elevated BP. My strip is beautiful, no problems. Pitocin gets up to 20 mu and baby has a run of subtle lates. I cut pit in half, o2 per face mask, ivfluid open and left side. (SVE 1/60/-3.) I almost immediately see improvement in the strip. I call the Dr. to make him aware that we're fine now but this is what has happened. He comes out a little later and reviews the strip, says baby looks great now let's try to go back up on pit. Of course, once I hit that 20mu again (2 hrs later), same thing happens. Again, I see almost immediate positive results with the same interventions as before. BTW, absolutely no cervical change. My baby looks great again, but of course I'm thinking it will never tolerate induction and she's probably going to need a c-section. About that time, I hear one of my coworkers screaming for help and there is no one else at the station. She's about to have a precip delivery all alone and no crib set up in the room (no o2, no suction). I take the crib from my pt's room, who is doing fine, and run down to help my coworker. By the time I'm done there- being baby nurse, footprints, bracelets - it's been about 30 minutes. My pt's strip is still great but I call the Dr. and let him know about the problem with the lates, no progression, etc. Well, I was not prepared! He just lit into me and said "you can't just wait until the last minute to let me know these things. I want to know when they happen. I'm responsible ultimately" and then wants to drill me on the strip over the phone, when he's just 50 steps away in the call room. I know all of the things he says are true, however, he knew how crazy it was for us (and him) with delivery after delivery this weekend. I just feel like any confidence I was starting to gain is shot. how are you supposed to manage it all? Did I do the wrong thing? Should I have ignored my coworker's need for help and immediately called the doc, even though everything was fine with the pt at the time? I'm feeling like an L&D loser this morning.

[Altalorraine]

Did I do the wrong thing? Should I have ignored my coworker's need for help and immediately called the doc, even though everything was fine with the pt at the time? I'm feeling like an L&D loser this morning.

What you should do is take him aside and tell him privately never EVER speak to you that way again. Once you make that clear, you can indicate your willingness to work with him to establish a protocol for how he wants you to handle his patients.

I want to add: The doctor may have been upset because in case of legal action their decisions will be examined. If something were to happen, someone could look back and say, "The lates happened at 1400. Yet you took no action until 15:30." Considering what you said, that your nursing interventions were helpful, this doesn't sound to me like a critical case. It may have been more a matter of the doc wanting the baby to declare itself so he could section and go home.

If you were needed on the floor to emergently help another nurse out, that seems like a reasonable explanation for why you didn't call right away. (You might want to consider whether you could have called the doctor right after helping the nurse with the crisis of the precip delivery but before you helped with bracelets and footprints.)

It seems to me that the issue that really needs to be addressed is that how the physician wants you to handle funky strips and how the physician treats his colleagues. Some doctors would blast you for calling them repeatedly. Some blast you for not calling 10 minutes ago. It also may be a matter of the doctor learning to develop trust in you.

Altalorraine

[htrn]

I am sorry that this happened to you. It shouldn't have, but often we are forced to deal with behaviors from physicians that we wouldn't tolerate from anyone else. As you are new, it is not unheard of (ok, it is common knowledge) that docs will test you, both your knowledge and skill level as well as your BS tolerance level.

The only thing I can see that you may have done wrong is not picking up the phone after the new surprise was stablilized (5 minute apgar) and letting him know that you had to cut the pit and reposition her, she's fine now and you are attending to another crisis, but will be back in a few minutes.

The other thing is that if you were that busy, he was probably exhausted - and therefore cranky. We have docs that can get pretty pissy about me waking them up in the call room to show them an iffy strip - I will simply tell them "Sorry to wake you up, but I just need you to look at this strip". I will usually add that I'm not or am very worried and what action I want from them. Most of the time, it is "I just need you to see the strip, we're fine, but I have to show you" because their POS say notify MD of.....

Good luck, don't let them get to you and keep on doing a good job of taking care of your patients.

[SmilingBluEyes]

GREAT advice from Altalorraine. Live and learn. Don't be so hard on yourself and never let 'em get you down. You do deserve better than this from that dr. I would definately talk to that dr in private about how you were treated and make it clear you are not going to stand for it. I am so sorry---I know how badly you feel. Been there myself.

[flytern]

Unfortunately, you have to "prove" yourself to every MD on your floor. They have to feel that they can trust you with their patients (so that they can sleep soundly at home!).

I agree with everyone else, he could haved been cranky, wanted baby to declare itself... You know, all the stuff you can't control.

Don't take it personally. Who says we have to love everyone all the time?

Just be professional about it, and let it roll off your back.

:balloons:

[33-weeker]

You have to toughen your skin with docs like that. I would have simply stated (when you could get a word in edgewise) that you were called away to a crisis in another room and that you called him as soon as you had the chance. His patient was in no immediate danger. You could also reasure him that you charted the time he was notified to cover him.

As far as not tolerating the Pit. When you pound a baby against a 'locked door', distress is what you get.

[klone, MSN, RN]

I agree with Altalorraine. There's a happy medium between not helping your coworker at all, and doing everything for the baby, including prints. It may have been possible to catch the baby, give meds, put the bands on and get one set of vitals, and be back with your patient after 15 minutes instead of 30.