Need some opinions

Tolerance used as a term denoting range of variability accepted - not requiring intervention ... yes, tolerance develops over time with experience - you knew this. Yet, you also know that experienced nurses may have developed a degree of informality or even slopiness that new grads are rather sensitive too. So, never hesitate to call on a higher power. Start first with ONE trusted, experienced coworker. Careful not to invite a committee. Often the oldest or loudest or most cantakerous wins out. Then escalate to nursing supervisor who should be responsible for finding the appropriate resources if they themselves are unsure. Of course, we must not bypass the so called charge nurse on the way up but, you can always invite the nursing supervisor into he picture, hopefully, quietly, as an additional resource. Yet, I never hesitate to call the on-call MD. They are the single best source. Before escalating past the road block, I try to represent my side of the argument diplomatically assuring the other that it's only a matter of differences in opinion due to knowledge and training. It's so hard navigating the sea of personalities... it makes my bones ache.

The charge nurse is there to be a help and as a resource, but you are ALWAYS able to call the MD for your patient yourself. I was on nights for a couple of years (I still do a night here and there now!) and I know it is hard to call, but your fellow new grad needs to know that it is a good idea. From what you have described, it was more than a 'bad feeling'. I have only been a nurse for 3 1/2 years and I remember feeling exactly as you guys do. It is SO frustrating.

IMO, tachy with loss of variability and prolonged decel down to 70s for two minutes should always be reported to the MD (except for maybe the almost expected PD post epidural as long as everything else looks reassuring). It is a quick phone call where you describe EXACTLY what you saw and what you see now and if you want the doc to come in. You document it exactly how you said it and now the ball is with the doc. If your charge nurse called and in your opinion didn't desribe the situation correctly then call yourself. I know it is so hard to do at first, but it gets easier!

Also, be very careful of more experienced nurses writing orders without calling the doc. NEVER do this. Nights are tricky. Practice wthin your scope. Be a patient advocate and CYA and you should be great. It sounds like you are off to a terrific start and really thinking and analyzing what is going on with your patients. Keep it up!

As the other poster said, you will develop a tolerance for some things but that shouldn't mean that you shrug everything off.

I agree with the above. A charge nurse is there to help you and to make sure you don't make mistakes. However it's your patient and your license and you have to make the final decision what to do. If your charge nurse doesn't agree with you she can take over the patient.

So in this situation I would have done as your friend did. Pull the cervidil and call the OB. I would have done it sooner but that is the benefit of experience.

Yes you do over time develop a comfort level and you are better able to ride out less then stellar strips. Still this needs to be tempered with common sense. A strip that progressively gets worse with a cervix that isn't nearing complete is justification to call a doc and reconsider your POC. When you have pit or cervadil going you must always ask yourself if it's endangering your baby. If you think it is, pull it.

Also if you aren't comfortable with something call the doc; make them responsible for it. They may think your crazy or cuss you out and hey maybe you were being crazy but still you have done your job. I would much rather get cussed out by a doc for being squeamish then kill a baby because I was afraid to look silly.

And dont' forget, you have incident/occurence reporting to do. you NEED to CYA in situations like this, believe me. Don't learn the hard way. Good advice from the folks before me; won't repeat it all.

This is what I tell our new grads (in a CCU not OB but the concept is the same)...

We have a charge nurse that often "makes up" orders or doesn't call for things he should and vice versa...sometimes his ideas are right and sometimes waaaaayyyy off, IMO....

I tell our new grads to first look at the situation and think it through.

Get a second opinion...and a third...and fourth if necessary...the charge nurse (though they should be "the end of the line" are not always right)...

I think that new grads should be going "by the book" for the most part...new grads don't know quite enough and it is better to call and verify than make a big mistake...bottom line is that it is your patient and your license...if you are uncomfortable with the advice given, seek out advice that makes sense to you or call the doc to verify...the docs get paid to be on call...if they get called and get mad, it is their problem as long as you are being a patient advocate (now some things, like a laxative or something, can wait until am)...but if it is a serious situation it is better to call...when I am in charge, sometimes my new grads will ask me an opinion and I will give it...occassionally they may not feel comfortable with my opinion and if that is the case, I encourage them to call, even if I wouldn't...

You all are absolutely right - the pt and the baby were her responsibility, period, and the charge nurse is not an end-all, be-all. It's still scary to be out on my own, and I just would hope that the person in the charge role was someone who could offer sound guidance. Still learning whom I can trust, I guess (but that is not to say defer to. You're right.)

As a side note, though, the baby did just fine and came out screaming in the OR. Go figure.

I agree with everyone else. Your charge nurse, as well as other coworkers are a good resource to bounce questions off and get opinions from, but, in the end, YOU are responsible for YOUR patient. If a strip looks funky, call the doc. It's not the nurse's responsibility to sweat a strip all night long. If there are concerns, call the doc.

You never want to sweat a bad strip. You may get the worst possible outcome. I saw the worst possible outcome happen in a coworker's patient, where she did just that (sweat a bad strip all night). It was horrible. Never do that----I would rather a doc yell at me for waking him/her up and dragging their butt in than to have a dead baby on my hands.

I totally agree with you Deb.

I was at an AWHONN conference last month and one of the things the speaker said is as professionals we have to stop worrying about "the doctor's gonna yell". We need to do our job - be an advocate for both our patients (mom & baby) - and expect the doc to do his. While it's inappropriate for docs to yell, it's more inappropriate to sit on a bad strip and thereby give inadequate care to the patient.