Frustrated new L&D nurse

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Specializes in L & D.

I am a new grad and have been off of 12 wks of orientation for about 4 weeks. I had one of the worst nights ever the other

night. It was so bad when my shift was over I came home and cried for several hours. Here's how my shift went...

I was working with 2 other nurses (with plenty of experience). Pt assignments were made as follows: The charge nurse got a pt (33wk gestation) with an infection of unknown origin getting IVPB antibiotics who was scheduled for an amnio the following morning. The other nurse got a pt who was 8cm and had uncomplicated vag delivery and was to the post partum floor by 2300. I had a postpartum pt who had c/s of twins the night before on Mag with BPs 170s/100s and an induction that had been laboring for 10hrs. She was 4cm and did not have a good contraction pattern. Her pit was maxed out.

At 2200, the induction's membranes ruptured spontaneously. She started having varibles. My immediate interventions were as follows: Left side, O2, fluid bolus, VE, and notify MD. (I had learned on orientation that you try those interventions and if they don't resolve the decels then cut pit off) Well, I got griped out for not turning the Pit off FIRST! So....I turn off the Pit. Then I see the nurse that griped me out emailing my manager.

As I am walking through the nurses station, the charge nurse tells me to go in and assess an outpt who just came up from ER c/o abd cramping and leaking fluids and then she'd come in and take over. I go in and get pt on monitors, no contractions, nitrazine negative and pt was 1-2cm 50% and -2 station. (multigravid) I thought that was "assessing" the pt. I go out tell the charge and she says "well is the pt profile finished on the computer?" I said no i thought you just wanted me to assess the pt for you and she says "doing the profile is assessing the pt sorry you didnt understand what i was telling you to do" So I had to go back and finish the profile on the computer.

The MD comes to assess my induction pt and says restart the pit. It would be a "sink or swim" situation. In the mean time I'm trying to get the Mag pt taken care of. Give her 20mg Labetalol IVP and get orders to d/c mag and send to pp floor. The pp floor gets really rude with me, which didn't help my mood.

(by this time one of the other nurses doesn't have a pt) I take the Mag pt to the floor and come back and the MD is asking why I haven't gone up on the laboring pt's pit in the last 30min.....Well, I've been taking the other pt out and NOONE else is helping me!!!!!!!

By 0400, the MD calls and says since the pt still hadn't progressed, we would go for c/s. At that point one of the nurses decided to get all up in my business telling me I'm not prepping the pt right....I need to have my computer set to a certain screen bc that's how she does it..etc. So I've been dumped on all night with NO HELP and now you want to come in and not assist me but cut me down and tell me all the things I'm not doing YOUR way????

By the time my night was over I couldn't get out of there fast enough.....

I am tired of getting all the patients. I know that is partly b/c I'm new, but I am wanting advice from some of you experienced nurses......Was that too much of a pt load for a very new nurse, especially since the other experienced nurses weren't that busy? How do you implement interventions with a pt having decels?

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Hey! From reading your post it sounds like you handled everything very well. Although, at some point I think you need to know when to ask for help...especially since you said at one point one of the nurses had no patients. In a perfect world, everyone would work as a team and you wouldnt need to ask for help but sadly sometimes its not like that. Im not an experienced nurse or anything (new grad) but that is my take on it. No input on how to handle decels, I work NICU.. good luck with everything, from a fellow new grad to another!

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Specializes in Ante-Intra-Postpartum, Post Gyne.

What state are you in? A patient on Mag should be one on one

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Specializes in L & D.

arkansas

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Specializes in Mostly OB and NSY, a little ER.

Wow, what a difficult evening. To say the least. I am with the previous message, what state do you live in? I am in Texas and a Mag. pt is one to one. There was absolutely no reason for you to have a Mag. pt and an induction. It sounds as though you handled the situation as best as possible. You do need to know when to say no and to ask for help. You worked hard for your license and it is your responsibility to except assignments that you are qualified for and that are safe.

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Specializes in Med/Surg.

Turning the pit off with the first sign of decels is important and is worthy of an incident report, just because its not what everyone does, doesn't mean its right. This is one thing I do remember from school despite how much of my L&D knowledge has been lost working med-surg. Agree with the other poster that said you need to learn when to ask for help and when to refuse doing someone else's work for them.

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What state are you in? A patient on Mag should be one on one

Not sure about your state...we used to have postpartum pts on mag all the time as part of regular assignment- 3 to 4 couplets

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Specializes in L&D, QI, Public Health.

I don't know about Mag patients being one on one, but I don't agree with the assignments. You should've gottent the postpartum/recovery patient paired with the mag patient.

And you should have NEVER triaged the 3rd patient. That's going way too far.

Having said all that, I think you handled it well...especially considering you're a new nurse.

As for the pitocin, always consider that a fourth resus. When in doubt, you'll be in less trouble turning off pit, than leaving it on.

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Specializes in Cardiac.

I think you handled things very well. You did the best you could with what you were delt. You used your interventions on your decel pt,its not like you did nothing! What is VE btw? It would have been nice if someone would have offered their help,but seeing as that didnt happen dont be afraid to ask either. That's one thing I have learned as well. Then if noone offers to help you can say that you DID ask for help/opinions.

Hang in there, things will get easier.

So..just to clarify.turn Pit off first or last?

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Specializes in ED.

I too think it sounds like you handled things well, and you sound like you know your stuff. I can't comment on the patient load because I don't have any L&D experience, but my advice would be to ask for help when you need it, and to stand up for yourself which includes saying no to assignments that compromise patient care/safety. Easily said, not always easily done. I still struggle with that at times. Talk with your charge nurse, and if that isn't working talk with your nurse manager. I'm sure with some more time in you'll feel more comfortable all around, but you shouldn't be dumped on simple because you are new.

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you did your thing girl! For a new nurse u did the right thing which was make sure the pt was okay. im a new nurse myself and the older nurses on my floor give me the difficult pts ( to say the least) it happends...why? I have no idea but keep your head up and never be afraid to ask for help better to be safe than sorry and without a license

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Specializes in Ante-Intra-Postpartum, Post Gyne.
Not sure about your state...we used to have postpartum pts on mag all the time as part of regular assignment- 3 to 4 couplets

California. We have safe nursing ratios. Although we can have up to four couplets; a woman on a mag drip is considered complicated and is one on one. I suppose you could take one other post-postpartum couplet that is stable and uncomplicated; but we have to do a focused neurological assessment every hour and re-set the volume control device pump every hour. Definitely not an induction patient! I am spoiled at my hospital, we are pretty much one-on-one for labor patients unless it gets crazy.

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