loss of confidence

Okay, i'm very embarrased to admit this but here is my stupid mistake. I was also VERY new off orientation, like 3 weeks off. Anyway I had a multip come in ruptured, contracting. I check her and I got so wrapped up in getting the dilitation right, I forgot to feel for fontanels on the baby's head. The baby was soooooo high up there I could barely feel it. Anyway, called the doc gave report on the patient. Doc orders Pitocin, epidural etc. So mom gets her epidural, I start her on Pit and she gets to 8cm. Low and Behold, I can't tell what i'm feeling now. Doesn't feel like any baby head i'd ever felt before. Call in another RN for second opinion, holy crap!!!!! BREECH!!! I just Pitted and labored a multip with a breech baby. I was so mortified, & embarrassed I wanted to just die and quit right there. I called the doc, she came in and actually amazingly wasn't mad, she even offered a vag breech delivery to the patient but the pt declined and had a c section. Everything turned out okay and the only harm done was to my ego and confidence. Healthy mom's and healthy babies of course is our goal. We all make mistakes (esp new OB nurses). I don't think you're mistake was really that bad and you learned from it which is the most important thing for you. I'll never take my hand out of that lady parts til I know for sure its a head now! Don't beat yourself up. :pumpiron:

Don't feel bad at all! When I was relatively new off orientation my pt's cervix was so thin that I missed it and called her complete. It was the pt's 4th baby and 36 weeks so I had called the MD, NICU and everyone in the room to start pushing. The MD came in and she was 7cm but very very thin. I felt so embarassed! But I got over it and I'm sure the MD did too. Nobody is perfect. Don't be too hard on yourself.

As far as the amnioinfusion goes. Where I am nurses cannot place IUPC's. An amnioinfusion is something the MD initiates where I am (not sure about other places). Most of the MD's I work with only use amnioinfusion for repetitive deep variables and heavy mec. Even still, they hardly use them. I have been on L&D for two years now and I think I have taken care of 3 patients who had amnioinfusions.

Some people just don't feel good about themselves unless they feel they know more than someone else. This is HER problem, not yours. You took good care of your patients, you bonded and regardless of her being 8 or 10 she had made progress. IF she really was only 8, and who's to say she was since it's just her word against yours, the upright positioning of laboring down is still the best thing for her.

As far as the whole amnioinfusion goes it has repeatedly been shown to be at best useless for amniotic stained fluid, while on the other hand it has been associated with a post partum maternal fever. She's the one out of the loop...amnioifusions are 'so not evidence based practice'!

http://www.medscape.com/viewarticle/485125

http://www.medscape.com/viewarticle/511895

http://www.medscape.com/viewarticle/558124

As far as the amnioinfusion goes. Where I am nurses cannot place IUPC's. An amnioinfusion is something the MD initiates where I am (not sure about other places). Most of the MD's I work with only use amnioinfusion for repetitive deep variables and heavy mec. Even still, they hardly use them. I have been on L&D for two years now and I think I have taken care of 3 patients who had amnioinfusions.

In a year, I can only think of one patient who got amnioinfusion on our shift. And it wasn't my patient so I haven't done ANY.

And I can beat you on the mis-dilatation. Both my preceptor (eons of experience) and I thought a pt was complete and she was FIVE!!! LOLOL - It wasn't funny at the time... I think I wrote a post about it here. LOL. I still don't know what the deal was that we both totally thought she was complete??? We could feel that she was five after the MD so kindly informed us of such. ??? It really was one of the nice MD's thankfully.

We have one doc who notoriously calls her exams less dilatation than anyone else. I try to remember to be very conservative when she's on duty but sometimes she still comes up with some crazy lower number (in front of the patient, of course!!).

Anyway, I've done lots of dumb things in my learnings... where to start? Ummm, this was not very cool: The other day I got orders to d/c a triage lady having some mild contractions, got everything ready to send her on her way and realized she was a repeat section! @#(* ... had to call the (moody) MD back and rethink that plan (she actually did still end up going home, but that was kind of an important point!). Eek

A HUGE thank you to everyone who responded. I have been beating myself up all day! I don't know why, I guess I am just trying so hard, and it is always difficult when you are new and struggling to learn everything. It REALLY helps to know others out there have doen the same thing! And Lizzy, thanks for you post, I could see myself doing the same thing! Now I will remember your story and hopefully always remember to make sure it is head I am feeling!

I feel better now... (until the next time...)

Earlier today I was ready to go apply for a position at the nursing home!

Thanks again!

I'm glad to hear that you didn't apply for that nursing home position. I know how you felt. I've done that before. Shortly after I got off orientation I told a pt that she was complete. We called the MD and got set up for delivery. He comes in and the pt was only 8cm!! Thankfully, he was so nice about it. He mentioned to me that I must have checked with a contraction. The cervix will stretch out more during a contraction and that's probably what happened to you too. Ever since I only check between the contractions. Keep up the good work and don't get too discouraged when you mess up. we all do.

PLEASE dont beat yourself up!! L/D like any other area new to someone in nursing, takes lots and lots of practice! And lots of teamwork especially. if you ever doubt yourself, ask for a small "conference" and ask a more seasoned nurse. thats what i do. i too, am 6 months in to l/d and i always get my resources when i need them.

as for the amnioinfusions, we do them. nurse initiated usually for paraticulate mec and progressively worsening repetitive variables.

good luck to you and keep your head up. this forum is excellent for advice. it helped me out on endless issues!!

That was pretty mean of the oncoming RN. If she was gunna tell you she could have done it outside the room. Some people just like to make you feel bad under the guise of teaching. It is never okay to embarrass another nurse in front of the patient, tell them outside... bah

I wouldn’t have even told ya I mean she could have just let you go home and called the MD, maybe mentioned it later in a less abrupt fashion. "Oh you know that patient, turned out she had just a little cervix left, it was really hard to feel"

anyway like others said its not a big deal, I work wit a nurse that can't check a cervix after 3 years loll , then you should start to worry but everyone is wrong sometimes. I once had a 10yr Rn Swear to me that a patient was 5 yet I and another Rn called her closed.

also the mec thing, isent bad. All the new rcomendations are saying that it doesnt help. they are even saying that we shoudl be deleying them so much. Amnioinfusion just makes us feel better becuse its pretty =P. I do it on thick mec becuse well honestly becuse I dont have anythign else to do about it =P but allot are saying this doesnt even help.

Don't worry, it happens to everyone, including the MDs and midwives!

We had a 20 year experienced RN call a co-worker an ant lip when she was only 3!!

The thing you can take away from this is how to treat your co-workers when things like this happen.

I usually use humor and kid about wishing there was a better way to check the cervix when someone (especially someone new) is wrong about a cervical check.

You will be fine. When I started in L&D after 4 years of Med Surg, I cried everyday and really questioned why I wanted to work there. Now, I would never do anything else!

Even after 18 years in OB I still will on occasion ask another nurse to check behind me if I am not sure of a VE. Don't beat yourself up. I was nervous in OB for the 1st year wanting to do everything just right and that does not happen.

You sound like you will be a great labor nurse, keep up the good work. Just remember to keep your pt's first and formost.

A HUGE thank you again to everyone who has posted. I feel so much better now. I have picked up a few lessons out of this, and Peg you are right this will help me remember not to embarass a co worker in front of a pt. I kept thinking the other morning, why didn't the new nurse just say, "hmm, I still feel a little cervix left, let's just keep laboring down..." and then tell me in the hall. ?!? Oh well. If this is the worst thing I have done in my 6 months of OB then I guess I am doing alright!

Thanks again. You guys are great, and this forum has sooo much valuable info.

ps

I found it very helpful when everyone was sharing their mistakes. We have so much to learn from each other. It is hurtful to our pride when we make an error, but it is great when we can help prevent others from making that same mistake.