M. Murray has scared the pants off me

[Bessie]

I have just attended the first day of M. Murray's Advanced Fetal Monitoring class and I am scared to return to work. I am nauseated and unable to sleep tonight. I am new to L&D and have been on my own since August. Practices that I thought were scary; she has confirmed my suspicions. I work in a hospital that does 120 deliveries per month and that number has been rising. We are responsible for triage, antepartum, c-sections, recovery and sometimes pp if our pp floor is full. We have a room that we put PTL and PIH pt's on MgSO4 that doesn't have central monitoring. Then we are expected to manage them and a second pt who may be actively laboring or second stage. I have had these pt's and sometimes not been able to go into the room for 1 or more hours to view the strip!

Our Docs don't stay in house and live 30 or more minutes away. We run pit on people at night without a doc immediately available. Docs miss deliveries and then tell us to deliver the placenta and write pp orders, and don't come to see the patient until the next day. Docs don't come to fetal demise deliveries unless fetus is term. We are the baby nurse and the mom nurse at delivery; sometimes we have a tech at delivery. The other day I had a mom hemorrhaging and a baby not crying and me and the secretary. The secretary can't hang my pit in the bag of LR or resus the baby so what good is she you say? She can dial the phone while I PPV the baby. The doc leaves the room to find help. I call help and don't leave either pt. He should have stayed. Our nurse manager is a pp nurse by training and a WHNP. I feel these docs get away with murder because she hasn't a clue as to how to labor a pt and how much staff is really needed. I work nights and hate the fact that I have to beg and plead for a doc to come in and they still don't.

One night I had a patient who started having early decels at 6 cm, down to the 80's, on pit. Started calling first doc at 2300, care transferred to different doc at 0100. Called him all night and he didn't come. Convinced 16yo pt to get an epidural in prep for c-section. Pt doesn't progress past 7, doc finally comes at 0600 and sections her and then teases me for calling him all night. Doc speculates CPD at delivery.

I called my the person who precepted me and she told me that there are hospitals that are worse then ours. I felt like she was telling me life is tough and then you die. I need to know that there are hospitals that support there nurses and practice within ACOG guidelines.

Thanks for listening! Any suggestions are greatly appreciated.

Bessie

[canoehead, BSN, RN]

Can you insist on an NRP class for RT's and the nursing supervisor so you can always have 2 people at each delivery?

You're right it does sound scary, but you are also right to keep calling the MD and keep charting it. Ask your NM when she feels going up the chain of medical command is called for. If she says "never" I would call that a strong hint to resign.

[chris_at_lucas_RN, RN]

Sounds very unsafe for the patients.

You may need to make your concerns known to appropriate authorities (DON? BON? JCAHO?) and then get the heck out of there.

If there are that many deliveries, you must be in a large metro area. Find a better hospital to work in, dear heart.

When we keep working in untenable situations, the message is that it is OK with us.

[L&D_RN_OH]

Definitely unsafe, and unethical on some of the docs parts. Is the NM aware of your concerns? Are the other nurses concerned as well?

And yes, there are hosp that support their nurses. :) I work for one. We have an RN and an RT at every delivery. And our docs sleep in the call rooms when they are on call. We've never had a problem getting a doc to come in, unless they are in OR.

If you think it's that unsafe and the situation can't be resolved, perhaps you should look elsewhere. I'm sure you could find another facility with better support for it's nurses.

[dawngloves, BSN, RN]

What the docs have you doing is out of your scope of practice, i.e. writing orders. Sounds like you need to blow the whistle here.

And playing devil's advocate, why couldn't the doc care for baby or hang the Pit? What a dumb a$$!

Good luck Bessie!

[Bessie]

Thanks to you all for your reply's. After day 2 of her class I am feeling scared but empowered. They ask me questions about why I am not going up on their pitocin as ordered, and I say because. Now I can say, well if I want hyperstim and a hypoxic fetus I will go up. But since that leads to brain damage and CP I think every 2 minute contractions is just fine. Or when one doc wants us to check every other hour I can tell him. I won't be the reason she and baby get infected so I will use other measures to judge the labor progress. Research shows that after the 7th check you increase the risk of infection.

Today I feel scared for my unit, because I want to know where the policy is and what it says and why everyone isn't following it.

I want to stay there for at least a year, if I can, and that will be up in February

Wish me luck,

Bessie

[PowercarveJen]

Originally posted by Bessie

Thanks to you all for your reply's. After day 2 of her class I am feeling scared but empowered. They ask me questions about why I am not going up on their pitocin as ordered, and I say because. Now I can say, well if I want hyperstim and a hypoxic fetus I will go up. But since that leads to brain damage and CP I think every 2 minute contractions is just fine. Or when one doc wants us to check every other hour I can tell him. I won't be the reason she and baby get infected so I will use other measures to judge the labor progress. Research shows that after the 7th check you increase the risk of infection.

Today I feel scared for my unit, because I want to know where the policy is and what it says and why everyone isn't following it.

I want to stay there for at least a year, if I can, and that will be up in February

Wish me luck,

Bessie

You go girl. I am so proud of the stand you are taking for yourself. :)

[BETSRN]

Feel good about attending her class and knowing what you know. However, I must say that your description of your hospital and its unsafe practices goes way beyond what Michelle Murray is talking about. Get out of there now. there are other good facilities. I work for one. We would never be asked to work in an unsfae environment as you describe. Good luck.

Betsy

[newbabycatcher]

I say to you get out of there and blow the whistle. That sounds like a disaster, or 20, waiting to happen. I recommend reporting those working conditions to as many people with the authority to change it ASAP. Just remember to cover your a**, because in a lawsuit they somehow always manage to blame the nurse for anything and everything. Good luck to you.

[mother/babyRN, RN]

Sounds like a regular community hospital scenario to me....

[OBNurseShelley]

motherbaby, I disagree, while this hospital she works at, does sound unsafe, that IS NOT THE NORM FOR EVERY community hospital, and I don't think it's right to lump them all together. I have worked at 2 community hospitals and they were both very safe, and supportive of nurses.

Shouldn't make such generalizations

[SmilingBluEyes]

Originally posted by mother/babyRN

Sounds like a regular community hospital scenario to me....

I., too, take real exception to this very generalized statement, working at a community hospital as a VERY conscientious RN in a caring environment. You ought know better, really.