Horrible experience...

[sarabear]

I just had a baby two months ago. However, the ob nurses I had were HORRIBLE. I was shocked at the care I received because with my last baby and with GYN surgeries, I had EXCELLENT care at this facility. It is a small community hospital doing about 500 deliveries a year. Basically I was induced at 36 weeks with a mature lung amnio due to mild preeclampsia (protein increasing each week, CNS involvement (nosebleeds, visual disturbances, excruciating headaches for two weeks and brisk reflexes, labs were starting to go bad high uric acid and creatine level, and my bps had hit the 100 diastolic range on two bp meds and strict bedrest). My peri wanted to deliver at 34 weeks 6 days based on above symptoms and past history of severe pe and severe pih in the last two pregnancies. However I said no and my ob agreed with me. My next ob appt, my ob told me I could stay pregnant, get sicker, have my labs get to a critical point and have an emergency delivery or agree to a lung amnio and if mature take her. If I did not agree to an amnio, I would be doing blood work and 24 hr urine every 2 days till I became critical. He and my peri wanted to take her while still stable. So I agreed to the amnio. It was mature and I delivered at 36 weeks and she was fine. However, my nurses at night and my labor nurse were horrible.

The labor nurse acted like I was an inconvenience. I was not on mag this time thank goodness. She made us feel very unwelcome and uncomfortable. At one point I remarked to my husband that my blood pressure was too high still. She butted in and said then don't look at it and snapped off the machine. She then proceeded to tell me that she had personally reviewed my chart and file and to her I was not preeclamptic. She was just rude. The only time she was polite was when my ob was in the room and during the actual birth.

My ob and I discussed starting meds for ppd at delivery because of a 1 year anniversary for a 13 1/2 week miscarriage, new baby, had it with second baby. He agreed and started me on effexor. The nurse that brought me the meds said "you know it's normal to feel this way". No it was NOT normal for what happened last time.

I asked for motrin for cramping and dermoplast spray only to be told it was not ordered because I did not have stitches. I got copies of my medical records and it WAS ordered by my ob! I had to have my husband bring in motrin from home and just didn't tell the nurses.

The cbc was never done the morning after delivery.

I broke out in a an allergic rash to the effexor. The day shift nurses immediately called my ob who ordered benadryl. That didn't work. When I went up to the nurses desk to show them it had spread everywhere despite benadryl. They said "so what". I had to ask them several times to call my ob and get something else. They finally did and he ordered a different med that worked.

My ob ordered fiorinal for the severe headaches I was getting from the PE. I could not get the nurses to give it to me. I basically had to demand it. One nurse told me that she couldn't believe my ob would ever order that for a patient. I told her not only did he order it, he ordered it for the last two weeks and for my last delivery. Another nurse told me she was uncomfortable giving it to me due to an allergy to codeine. It had codeine in it. She is right, there is a fiorinal with codiene in it. I was prescribed plain fiorinal which did not contain codeine. I had to tell her I didn't care about her comfort only mine.

My ob and I had discussed iv antibiotics during labor because of a stuck kidney stone in the ureter. They wouldn't do surgery unless it was completely blocked because of pregnancy. Two urologists that I consulted said I needed to have iv antibiotics to prevent a kidney infection (had been plagued with blockages and kidney infections in pregnancy). My ob agreed but forgot to write the order. It was an office hours day for the induction. So he wasn't around as much when he was with my other daughter. I told the labor nurse about it. She told me we do not pretreat infections around here. She never checked with my ob about it. Had she of done that, he would have remembered. By the time he came back and broke my water, I knew I would not have enough time to get them in because I deliver fast when that happens. I ended up with a kidney infection right after delivery.

Not too mention all of my discharge paperwork was messed up, I never received the birth certificate packet till almost time to leave and only when I asked for it. They thought I had already done it. Nope. I was filling out a 12 page birth certificate app as fast as I could so I could leave.

It was very frustrating. I was very disappointed because I waited 8 days to deliver at my hospital with my ob only to have a terrible stay. I could have delivered at 34 weeks at the local children's hospital (nothing wrong with that, but I wanted my ob and had always had great nurses at my hospital). I debated a long time about what to do. I decided to write a letter to the nursing manager. I told her I was not expecting nor did I want an apology. She had to know what happened. I hope that it would not happen to another patient. I was especially irritated about being told that there were no orders for motrin and dermoplast spray when it was clearly marked in my records. The fiorinal was ordered throughout my records in labor notes, before labor, pp, etc and why it was ordered. The antibiotics was frustrating too. I was really upset with the nurse saying I was not preeclamptic when I clearly was with the protein, high bps, and CNS involvement. By her saying that to me meant that I could have avoided an amnio, an induction I did not want, etc. If it was another patient that did not know about pe, they could have walked out of the hospital with her saying that thinking it wasn't necessary. Basically the weekend night nurses were just lazy and didn't do what they were supposed to do. I wrote the letter because I have always thanked nurses for doing the great job they do. However, why not when it was terrible so that it could change. I havn't heard anything back about the letter. Some people that are nursing friends are telling me that I need to send it to Administration and Quality Management. I don't want to get anyone in trouble or fired. However there was a serious lack of basic functions here. Had the nurses bothered to look at my chart, they would have seen why things were ordered, they would have seen that it was ordered, etc. I don't ever want a nurse to tell a clearly preeclamptic patient that they are not. I have no idea how she determined that as my bps were noted in my record, protein was noted, peri consults were noted, CNS involvement was noted by my ob. My uric acid and creatine labs were missing out of my record. I did tell in the letter that the baby nurses were AWESOME. The day shift nurses were great. So should I let it go? Should I do what some people are telling me and send it to administration and quality management. My nurse friends were concerned about what happened. They said customer service was number one in their institutions and couldn't believe how I was talked to.

[rn/writer, RN]

You should not just let this go unless that is what you want to do.

If you feel that this is still unfinished business, by all means, do continue to pursue matters until you get a satisfactory reply.

This isn't about getting people in trouble. Their actions, if you depicted them accurately, will have been responsible for any trouble they end up in.

I'm just trying to imagine what kind of reaction you would have gotten if you'd written such a letter to my hospital. First, you would have been called and spoken with in person to make a connection and to address your concerns. The nurses (though I can't imagine any of my co-workers behaving this way) would have been called into the manager's office to hear their side, but also for them to hear the way their choices affected the patient in question.

There might have been write-ups for the offending nurses and re-education on the importance of communication and follow-through on meds and other matters.

If they treated you this way and you have the wherewithal to know that your care was questionable at best and substandard at worst, I shudder to think of how they would treat someone who had no medical background.

I am so sorry about the loss of your 13-week pregnancy and am grateful that you had the presence of mind to ask for ppd meds to help you cope. I'm glad your OB has been able to give you the care you deserve.

Please, send copies of the letters to the hospital administration, the DON, risk management, and anyone else you think may have something to say about the treatment you received while in their facility. If the hospital uses a professional evaluator such as Press Ganey or PRC, let them know about this as well. These scores and patient responses sometimes carry a lot of weight.

I hope all is well with you and your family now. Thank you for taking the time to share this with us and to make your feelings known to the hospital. You are correct in saying that the only way they can improve the situation is if they know what is happening.

Take care.

[sarabear]

Thanks. It is unfinished business. I am serious when I say I don't want another patient treated this way. I was not a demanding patient. I think I used the call button maybe 3 times the entire hospital stay. Twice for pressure for delivery and once to help me get up for the first time after delivery. This is all very accurate. In addition, my medical records were not correct. When I was in transition, my husband saw me shaking like a leaf. I knew what was happening, he did not. He asked the labor nurse why I was shivering. She rolled her eyes and said hormones and walked out of the room. When she walked out of the room, another nurse came in checked the warmer, said she was hot and turned DOWN the heat. My husband and I looked at each other like wth. I told him to go and turn it back up. The labor nurse wrote in her notes that I complained about the shivering, that she gave me warm blankets, and that she turned up the heat. NONE of which was done. I was hoping to get a PG survey. However, they only sent me one for the lab when my daughter was having her jaundice levels checked daily.

Everything is perfect now. My ob ended up changing effexor to celexa. WHAT A DIFFERENCE from my last birth. I am a very happy momma. So happy that I want to do it again, but my husband and drs are all saying I am nuts. Our daughter is perfect. She has already gained three pounds from her birth weight and is up to 8 1l2 pounds. :wink2: I just shudder to think about another patient that doesn't know! The sad part of the story, I was the ONLY labor patient that day on the floor. Only 2 patients were on the floor that day. The next day, I was the ONLY patient on the floor. The last day, there were two of us on the floor.

[emmalou*]

In Australia we have patient liaison officers who deal with complaints from patients, I'm assuming you guys would have a similar procedure in the US. Frankly, if it was me I would be placing a written complaint about all of your concerns as they are valid, IMO.

I'm glad everything is good now!

[labcat01, BSN, RN]

Yep, ditto to everyone else and when you send the letter make sure you have a cc portion on it which allows everyone to know who is getting a copy of your letter (and one of those people should be your PHYSICIAN). Where I live, there is a lot of competition between hospitals and our docs get very upset when their patient's aren't treated well.

[CoffeeRTC, BSN, RN]

My gosh...I ahad very similar problems with my first pregnancy and I couldn't imagine going about it without a good nurse for support. I ended up with a fast csection for that one and being so sick and 10yrs younger..I needed the support and teaching of a good nurse. They really blew it with you. I would listen to what RNWriter recomended. Pursue this issue. I would hate to think that they would act this way and have those bad apples ruin the bunch.

With baby #4, I went to "womens hospital" that gets a good bit of national attention. I wan't too impressed either, but got decent care only because I have a nursing back ground and pushed. (no bp meds, no pain meds ordered after delivery except for motirn 400 q 8hrs???)

[htrn]

I am so sorry that you had this experience - there is just no excuse for what you experienced. I understand how you feel about not wanting to get anyone in trouble. I hate to complain for just that reason myself.

Bottom line though - you received substandard care. Your MD's orders were not followed. All of your doctors had their judgement questioned by your nurses and those doubts were communicated to you and your husband while you were both in a very vunerable position - it wouldn't be much of a stretch to call this patient abuse.

You were very right to send a written letter to the nurse manager of the department and earlier posters were correct in suggesting you send copies to QA, the DON, patient ombudsman, both your OB and peri-natologist as well as the hospital administrator. You can always include a line about not wanting to get the nurses in trouble, but that you are concerned about the poor care you received.

Congratulations on your new addition - and yes, I can't believe that after being so sick that you are ready to have another child already. That said - You Go Girl - as long as it is safe.

[sarabear]

I was just surprised at the care that I received and how rude the labor nurse was. She also told me while telling me I was not preeclamptic in her opinion, I knew too much about my meds (which last time I checked was bp over 140/90 or 30/15 over baseline, 300mg of protein in 24 hr or 2+ on a dip, and/or CNS involvement). According to the peri, CNS involvement is more indictative of seizure risk than protein. I actually tried to argue my protein wasn't high enough yet at 237 (a week before delivery and was increasing each week). She told me she didn't care how much protein I had, I was a seizure waiting to happen with all of the CNS involvement I had. So I am not sure what the labor nurse's definition of pe was. At the very least, I was definitely PIH. Maybe she wanted to wait till my platelets and liver enzymes took a nose dive too. With the high uric acid and creatine level, protein going up each week up from 0 in the second trimester, bps of 150/100-105 on strict bedrest and 2 bp meds, I was mild pe. Why wait for it to get worse with my history. As it was, the week after I delivered my bp shot up to 160/120 and stayed there till my ob upped my meds. Now it is back down to normal. My ob on my admitting orders had all of this noted of the increasing bps, protein, labs, and then had the cns involvement listed too (headaches for 2 weeks, vision issues, nosebleeds, and brisk reflexes). He also had prior history of pe in two previous pregnancies and premature delivery.

It was infuriating to read that my ob had ordered motrin, senekot, dermoplast, and 5mg lortab for regular pain and 10mg lortab for severe pain after delivery. I didn't need the lortab, but I sure would have LOVED the other meds especially dermoplast spray. OWIIIEEE. I had to ask 4 times for a peri bottle for the bathroom. I refused to go to the bathroom till the nurse got it. She looked at me like I had 2 heads. I was also ordered nubain for the cervadil part. That was really uncomfortable with the cramping but not awful. I didn't need the nubain.

I think the labor nurse was mad that I got the epidural before my ob started labor (was very happy with that as I got it too late last time to work). Not sure why as that made me an easier patient and did wonders for my bp. Besides, that was ultimately between my ob and me. Even with the epidural before labor, I still had a fast labor - 2hours 29mins. My ob ended up cancelling his afternoon patients. Hey I warned him and the nurses on my birth plan. He walked in for delivery and said wow you were not kidding when you said you went fast. :chuckle He should have known better as my last baby he delivered was 3 hours 7 mins and that was an emergency induction at 35 weeks 5 days with just pit. No cervical ripening.

What it comes down to was they just didn't care. I was an inconvenience. All they had to do was check my records to see what had been ordered. None of that was done. Just nope, you didn't have stitches. Nothing for you. Grrrrrrrrr. There was no excuse for what happened with the labor nurse.

Yes I am nuts for wanting to do it again. I always saw 4 babies. I don't have the easiest pregnancies. However, we have stayed on top of things with the last two with careful monitoring and a lot of bedrest. I have an excellent ob and peri. In fact, after delivery, my ob said Dr. peri gets the first call before family and friends. lol. They took her this time before things could get really bad. The whole point in the amnio and inducing at 36 weeks. If I am fortunate enough to have another, my tubes are being cut and burned before leaving the hospital!!!

I have sent a letter to the hospital via email. I am also looking for their Quality Management person as well today on the website. If I can't find it, I'll call and get it.

Thanks for all of the advice. I really appreciate it.

[OBRN1994]

Since when do you need "stitches" to have dermaplast ordered? Many deliveries can result in "skid marks" that can be as uncomfortable as stitches! You blew those little guys out because you were at the very least PIH. I've never had a Doctor or Midwife NOT order both Motrin & dermaplast for a lady partsl delivery. Some schedule the Motrin around the clock, some order it PRN. The only time it isn't ordered is if the pt has an allergy.

I would definitely follow up with these complaints...they appear to be very valid. And, congratulations on your family addition!

[rn/writer, RN]

I have sent a letter to the hospital via email. I am also looking for their Quality Management person as well today on the website. If I can't find it, I'll call and get it.

Please, send hard copies as well. Email is fast, but there is nothing like an actual letter on a desk to get someone's attention. A hard copy also makes it easier for one person to show another or hand over for further action.

I hope you get a good response.

[Batman24]

My first reaction was that this nurse had a major beef with the doctor involved and it unfortunately was passed on down to you. It seems like she argued almost every single thing the doctor said and ordered so I wonder if there is a bad and long history here. She was unprofessional and acted poorly. Pain is what the patient says it is and orders are to be followed.

If she had a problem with any of the orders she should have gone up the proper chain of command. Did you make your OB aware?! They'd be intersted in knowing and be sure to mention the name of the nurse(s) you had a problem with so the correct ones are spoken to and they don't lump all them in one category as it sounds like some of the others were competent and caring.

BTW...you need to send hard copies not emails. They will be taken more seriously.

[sarabear]

I can't imagine anyone having a problem with my ob. He is one of the nicest guys/docs around. In fact, when I was pregnant, I was in the ER due to a partial blockage from a kidney stone which also caused a kidney infection. The ER dr called him at 1am. I felt terrible that they called him that late. The ER nurse said it was ok. That they love him. He often would take calls from the ER even when he was not on call. I havn't ever heard anything bad about him from other medical professionals. I don't know why she was the way she was.

I have gone onto the hospital's website and pulled the senior management team's names. So I will be reprinting the letter and sending it out tonight. Thank you so much for the help. I just don't want to see this happen to another patient.