Feeling bad about Dr's complaint

[rnWinn]

Hello all

I just felt the need to vent in an anonymous forum about an experience the other night...

I work on L&D as a travel RN. The other night I had my first delivery with a notoriously picky Ob doc but thought everything with the delivery went fairly well. If you are interested, it was a lady partsl delivery, and this doc likes things done her way, and is persistent about it but not what I would call overtly rude or anything. She requested "20 units in a bottle" for after the delivery, which is not the norm at that hospital, so I and another nurse figured she just meant 2 fresh bags of Pitocin, and to discontinue the currently infusing one at delivery, which was only half full (which I did - that is what we do here). Anyway it was an unnecessary vac delivery (I've been at this for almost 8 years and know when a vac is warranted), and had me running to get a delivery table that was more fully set up (we don't set them up, and don't see what's under the sterile sheet until the doc removes it), then mineral oil for the perineum, all fine and dandy and done quickly by me. She wanted to straight cath the pt because she thought "there was a bladder" - which I palpated and said "no, it doesn't feel like it" (and I had just removed the foley about 15 mins before). But she insisted, and I got the straight cath and sure enough, no urine return. Anyway she did the delivery, I had my 2nd nurse in to assist with the baby (weight, etc) also assisting to hold mom's legs, and the charge RN there as well (I guess this doc didn't know me from Adam and wanted more people, I don't know). I had called peds for the delivery and they were there as well. Anyway, baby delivers, everything going well, then she starts complaining that I had the wrong Pitocin, so I sent the charge to grab it for me, had the 20 units in a litre up in no time, dripping slowly while awaiting the placenta (as we always do at this hospital). She says - "Why do you have the Pit bolusing? It make the uterus clamp down so I can't deliver the placenta" and I responded "I have it dripping slowly". That's it - no argument or rudeness from either of us. The placenta delivered about 3 minutes after delivery with no problem. Anyway, I get the pt recovered, she had the shakes, that settled down, was obstetrically stable; gave her Fentanyl which the doc ordered for abdominal cramping/peripain, replaced her 1st ice pack with a fresh one after removing the epidural catheter, washing her back, doing pericare and changing her gown. Pain went from 8 to 4 which was within pt's tolerance level. Sat up pt to get in wheelchair (90 mins after delivery) and she vomited everywhere, so I cleaned her up, changed her gown again and pt was feeling better. Got a wheelchair, assisted her to it, pt feeling some peripain which would be best treated with Motrin (which is given on pp unit, not L&D unless truly needed and then you need a special written one-time order). All ready to go, pt discharged from computer system and transferred in other computer system, all ready to go out the door. About to back out, Doc comes in room, says "oh she threw up? Give her Zofran IVP now, and Morphine 10 mg". So I give it, very upset because this was not necessary at this point, but she is not one to be questioned, explained it all to pt and pt agreeable. Then I gathered her stuff and the doc says "get her on a gurney for transfer". I call for a gurney, and it's in the room within 2 mins, but doc wants pt to lie in bed while waiting, so pt had to stand up, get off the wheelchair, lie down in bed, (she was not particularly groggy believe it or not) then immediately transfer to the gurney. We all said goodbye and thanked the doc, then left for the pp unit. Pt remained stable there although was complaining of cramping. I suggested Motrin for the cramping. Doc was back on L&D. Pt and family were very thankful to doc and me.

Anyway, today I am pulled aside but the charge RN and told that the Doc was complaining a mile a minute about me, saying I didn't know how to hang Pitocin, was running it before the placenta came out which would make the uterus clamp down and make the placenta hard to deliver (I know my third stage mgmt, and that is old school), stated I had no help in the room, didn't I have any friends on the unit to help (I have 2 extra nurses in there at delivery), etc. etc. etc. I was so upset I almost cried. Oh she (doc) did say one thing which was true, that I should have kept the pt there for 15 minutes after administering the Morphine and "shouldn't I know the hospital protocol"???? I concede her that point, but at the same time I was accompanying the pt down the hall to postpartum (we always do, and help settle them in and give full bedside report, which can take a good 15-20 mins), and mind you the meds were delivered while the pt was leaving the unit and discharged, and Morphine - a total overkill. I felt like the worst nurse in the world, because overall even with all the aggravation and pickiness, everything went well and the doctor did not confront at all and was fairly decent to me, and I to her. Thankfully the charge nurse told me to take it with a grain of salt (due to the doc's reputation, but it makes even an experience nurse like me feel like a big nothing, even knowing this doc's practise, while safe, is not usually "best practise" or research-based, although I won't go into detail.

Anyway, thanks for letting me vent, I just hope I don't have to experience anything like this anytime soon, and hope I can feel forgiveness and friendliness towards this doc from now on.:)

[klone, MSN, RN]

I'm sorry. I have just started as an L&D traveler, and I understand. I think my biggest challenge is knowing the doctors' preferences. My previous job, I work at for 4 years, and I knew exactly what each doc wanted, and was able to provide it before they asked. I think they grow accustomed to that, and don't like to have to explain themselves.

The second hardest challenge to being at a new facility is having to prove yourself to your coworkers and the care providers. They see a new nurse and think "new nurse" not someone who has years of experience and knows what she's doing.

Hang in there. Is yours a 13-week contract?

[rnWinn]

No, it's longer but only 12 weeks left. I have enjoyed it otherwise and the nurses seems to like me, and I them! Thanks for the response:)

[LoveANurse09]

Sounds like you know what your doing! I don't think you in any way harmed this patient and at the end of the day, the pt thanked you for your wonderful care and she'll always remember the nurse who helped her deliver her baby!