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?
I don't usually turn Pit off first....often variables will be resolved with bolus or position change. Of course, it depends on the other characteristics of the strip - do we have moderate variablility and accelerations present? If not, I am much quicker to d/c the pit.
So sorry you had such a rough time. I agree with the other posters, a mag pt. should be 1:1 care, no way should you have had a labor pt. as well, and then be expected to triage someone. It sounds like maybe your hospital is not up on safe nursing practices, or your fellow nurses are taking advantage of you. It is sooo hard, but you are going to have to stand up for yourself. Shoot, at 4 weeks out of orientation, I was not taking mag pts.!
The assignments were not appropriate. I understand the charge nurse taking a lighter load because it is her responsibility to stay on top of everything and to help out where necessary. That's not what she did. If she was going to give you two patients, one of them should have been the one she took and either the induction or the post section on MgSO4. Once the other nurse got rid of her delivered patient, she should have taken over one of yours, or at least helped you transfer the section patient, or run the Pit while you took care of the transfer. If you have 3 nurses and 3 patients, you don't ask the one with 2 of the patients to get the triage patient started.
When I have variable decelerations, the first thing I do is not to turn off the Pit. Position changes come first with fluid bolus and O2, then I turn off the Pit if there is no sign of recovery. I might have checked the patient before turning it off to feel for a cord or rapid descent. It depends on the rest of the strip: variability, accelerations, how deep and how long the variables, changes in baseline. But all things being equal, I'll try other things first for variables. Now lates--unless she's flat on her back, I'll turn the Pit off first, but that's a different mechanism.
It can be difficult admitting an assignment is too much for you, but your charge nurse was not only unfair, her assignment was unsafe. That assignment would not have been appropriate for an experienced nurse. When she told you to start the triage patient, it would have been appropriate to have told her that you were still trying to get Mrs A's BP under control and the doc wants the Pit restarted on Mrs. B. It is your responsibility to keep the charge nurse informed of the status of your patients. If she still insisted, at the least, I'd discuss it the next day with the Director of the department. Not as you being overworked, but as you feeling that an unsafe situation existed.
I think you did fine. I agree with the other posters, I do not necessarily turn the Pitocin off first, the goal is to get delivered, I acess the whole situation and try the interventions you did.
I have been an L&D nurse for a long time, but not so much postpartum, last week we had to keep a c section, twins, mom in L&d for 24 hours because of bleeding. I had only that patient and she kept me completely busy for 8 hours! And she wasn't on Mag! I had to give blood, teach pumping, manual expression, try to get 2 near term babies on, try to get her up, after she got the blood and could sit up without fainting, etc, etc, etc.
I agree that newbies should take the difficult pts, that's how you learn, but your assignment was too much and you should have gotten more help from your co workers. JMHO
Specializes in LABOR/ DELIVERY/ POSTPARTUM/NEWBORN NURS.
One thing I can tell u after taking a legal class is never ever have O2 on and pitocin running! As the legal adviser stated I canot defend you if that is ever the scenario. And as a nurse who was thrown to wolves when I graduated because I worked in materrnity for many years before earning my RN... If u ever feel overwhelmed/lost or unsure always ask for help or call doctor. Better that than a bad outcome. Good luck it gets better. Is a continual learning process.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Your instincts and sense of what was wrong are right on!
I agree with shortstuff and others who state this assignment was not safe. VERY NOT SAFE. And I would protest such assignments in the future. Your charge nurse knows better; acuity, not just numbers, counts.
Further, if this is the routine typical assignment, especially for a NEW nurse, then you have to consider, this place may not be a good fit for you. Not all hospitals are the same in how staffing matrices are made up and how safe staff assignments really are. Now, I know jobs are hard to come by, but even harder if you lose your license due to a very bad outcome. SAFETY FIRST. Your patients and career depend on this. Like said before me, this would be indefensible if something bad happened to one of your patients and believe me, the hospital administration would do their best to wiggle out of responsibility if they can blame YOU or your charge nurse in the case of someone being injured.
One thing I can tell u after taking a legal class is never ever have O2 on and pitocin running! As the legal adviser stated I canot defend you if that is ever the scenario. And as a nurse who was thrown to wolves when I graduated because I worked in materrnity for many years before earning my RN... If u ever feel overwhelmed/lost or unsure always ask for help or call doctor. Better that than a bad outcome. Good luck it gets better. Is a continual learning process.
Specializes in ICU, Home Health, Camp, Travel, L&D.
One thing I can tell u after taking a legal class is never ever have O2 on and pitocin running! As the legal adviser stated I canot defend you if that is ever the scenario. And as a nurse who was thrown to wolves when I graduated because I worked in materrnity for many years before earning my RN... If u ever feel overwhelmed/lost or unsure always ask for help or call doctor. Better that than a bad outcome. Good luck it gets better. Is a continual learning process.
hoppermom3
203 Posts
I don't usually turn Pit off first....often variables will be resolved with bolus or position change. Of course, it depends on the other characteristics of the strip - do we have moderate variablility and accelerations present? If not, I am much quicker to d/c the pit.