magz53

Oh yes, the latest buzzword is "horizontal violence". We are inserviced on it and instructed as to the liablity of commiting it but in a small community hospital nothing is done when it is reported. I recently called a physician to tell him that if he didn't come in to see his critically ill patient the family was transferring her to another facility. The foul language that he spewed out was sickening and ended with " Jesus f*&*ing Christ". I was horrified. I wrote him up as my manager instructed me to. But what will happen ?? Absolutely nothing.

I can't understand why no one is concerned with floating OB nurses to infectious floors. Of course, standard precautions etc. are implemented by all nurses but it seems to me the protection of the neonates has been lost somewhere. When I was a student nurse, we all had to have nasal cultures done. The heavy staph shedders were not allowed in the nursery. Now any Tom, Dick or Harry can wander anywhere. We tried to implement visitor restriction due to H1N1 and the first grandparent to complain and administration gave in like a too lenient parent who thus gets no respect. The biggest, most reputable facilities don't cave in. Their rules are rules period and they garner more respect from the general public. I think it is wrong for an OB nurse to float to units where there is C-diff, MRSA etc. and then possible get called back to the unit. Also used to be we had to shower when called back to the unit as well as change into hospital washed scrubs. Why have the standards fallen?

I will spend as much time as I can helping a Mom BF.....IF SHE really wants to as some desperately do. So sad when she has flat or inverted nipples ( why wasn't this addressed before delivery ? ) and a puckering, non-sucking baby. The Moms who are doing it only because someone else urged them to do it are so easy to spot and I will be the first to offer them formula. I BF all of my 5 kids for varying times for varying reasons. It is pointless if the Mom does not really want to do it. I watched in agony as my DIL timed her nursings to q4h and tapped her foot and looked at the clock while my grandsons were nursing for the 4 weeks ( to the minute ) of it. I would much rather she had bottle fed and been more relaxed as a Mom. As a nurse, I try to "read" my patients and support them in what THEY really want to do. I have seen careproviders ( docs, midwives ) be almost forceful in their breastfeeding promotion.

I did have a teenage mom who was doing her birth certificate worksheet "waiting for her mother to fill out her part". I had to break it to her " YOU are the mother". Heaven help these babies.

I came on duty 2 hours after AROM. Given the fact she was gravida 7 and ruptured for 2 hours and at the commencement of my shift now complaining of more discomfort, I thought it wise to check her. At our hospital the policy is a care provider must be present, does not specify OB. The medwives office is on hospital grounds and that qualifies ( in the hospital's eyes ) as "on the premises". No, I did not feel a cord on my check of a posterior 4cm. cervix. I suspect she had been walking around at that same 4 cm. for a few days. That was my point..........she was not in labor and should not have been ruptured artificially before the head was engaged in the pelvis. Variable decels are just that and were getting deeper and longer and the baby was getting tachy upon recovery which tells me he was in stress. Obviously the cord was being compressed. My feeling is it would not have had a chance to precede the vertex if the medwife had waited for engagement. Also, I do not like my concerns minimized by arrogant care providers. I am quite proud of myself for acting quickly in an emergency AND for not saying "I told you so".

I lost years off my life recently with a prolapsed cord. I am so angry that the medwife ruptured a G7 just to "get her delivered". Actually the term I received on report from the L + D nurse was "finish her off". The patient was getting uncomfortable and given her gravida, I felt I should check her which would have been more than 2 hours after the AROM. My check revealed a posterior cervix, head not applied to the cervix and a stretchy 4 cm., about -2. What on earth was she when the MEDwife ruptured her ?? 2 minutes after my shift started, she began variable decels........oh I forgot to say, she was also on Pit. The decels got longer and deeper at which time I called the MEDwife in to report what I was seeing. The response ??? " Oh yee of little faith ". The baby descended somewhat rapidly and what did we see ?? Not caput, but a shiny bright cord !!!! OK, pit off, trendelenberg, O2, IV open, pillow under hips and MEDwife on bed trying to get head off cord and off we go to the OR. Luckily the OR staff had not left the building. It seemed like an hour, but the babe was actually out 12 minutes from when we left the room.......and luckily OK. We were lucky that it was change of shift and we had help. Had it happened later in the shift, we would not have been so lucky. I don't believe the cord would have preceded the head if the vertex was well engaged in the pelvis and the head well applied to the cervix. I am soooooooooooooooooo sick of all this needless intervention to manipulate time schedules. The women go along with it, in fact sometimes demand it. When we nurses express concern, we are being told to be thankful we have a job. How is that for not addressing legitimate concerns ?? Anyone else have an experience with cord prolapse ?

It may not be anything at all.....your name may just be on a plaintiff's chart somewhere. Just tell the truth. If you don't recall, be honest. They will let you look at any notes you may have written. This may or may not refresh your memory. Most cases are settled prior to going to court. You would know by now if you were implicated in any med mal case. In a deposition, you would certainly want legal advice prior to being deposed. In most cases, meeting with the hospital attorney is part of the very preliminary proceedings.

Unnecessary interventions are why I am counting the days til I leave and I won't look back !!! I just hope to get out of there before I see another inverted uterus resulting in a hysterectomy on a 22 year old woman ( cord traction ) or another woman nearly bleed out from a nick of an artery during a c-section ( some have hysters, some don't ) If I never saw another case of pit to distress, do you think I will miss it ?? Tetanic contractions leading to prolonged bradycardia and an OR trip cause Mom wanted to be induced cause "she couldn't sleep". The only catastrophe waiting for me I haven't seen is a ruptured uterus with loss of babe and Mom.......I hope to escape it before retirement. These are reasons we are terrified.......we are EDUCATED women who are paid to be aware and alert for comlications. Contrary to what patients and some doctors think, we ARE more than the medical waitresses we have been reduced to. Too bad nurses are basically powerless in the system or things really would be different and better for the patients, but we are truly the last people anyone listens to...........patients or management included.

Thank you SmilingBlueyes !!!!!! You said it better than I could. Our current practice is epidural at FT or 1 cm. BEFORE labor even begins !!!!!!!!! So they are "comfortable" for the induction and ultimate "stretching" during vag exams. Forget tolerating labor, most of our patients are not tolerating PREGNANCY !!!!!!! And I am not talking sciatica or other major pain here, just the NORMAL feelings of being pregnant. I do feel sorry for the RARE woman who actually can do a labor with no drugs. I say again, my advice would be #1. Pick your care provider carefully ( but then again, most will tell you what you want to hear ). # 2 STAY HOME IN LABOR at least until active labor. Funny, on my days off a primip came in at 8cm. and delivered an hour later..........it is the talk of the floor, no one can beleive it. A primip with NO epidural !! We all had to go in and talk to her......she was a celebrity !!!!!!!!!!!!

I agree with everyone regarding OBs philosophy of birthing ( our MEDwives are right next to them in that regard ) However, I left work this evening with two patients being induced pre due date as they want to be home before Christmas. I am fairly certain ( will find out tomorrow ) that one of them will end up a section. How cost effective is that ?? A 2 day induction that ends in a section. What on earth are people thinking and why are insurances paying for this nonsense ???? There is a lot to be fixed here, the fault doesn't lie with nurses, that is for sure.

Wow, mom2michael.....it does sound like a dream job. I have read and re-=read these posts and I don't see anyone with a "bad attitude". The nurses who speak out are just telling it like it is. I seriously haven't taken care of a patient in MONTHS who was not induced or sectioned and MOST of the time it has been at patient request. I would love to have the luxury of helping a mom labor naturally. I can scarcely remember how to do it. I know nurses problems are not the patient's concerns but we really are between a rock and a hard place most of the time. Like I have said before, we need our jobs......no one I know works for the fun of it. We can only rock the boat so much or we will not have a job. We are advocates for our patients but in a court of law we can be fried if we did not adhere to hospital policies. I personally don't know any nurse who has ever been less than professional toward patients/clients/customers.

A few thoughts........I agree that MDs push inductions. They want total control. They want 9-5 obstetrics. They will jump into a section quickly as that is their defense in a lawsuit......that they "did everything they could" in a timely manner. A brain-damaged baby brings huge sums of money in a lawsuit as it is needed to care for the child for life. Most cases settle prior to going to trial as the jury is always sympathetic toward the baby and the family and the awards are even larger. We are talking millions of dollars awarded for one case. 2 of our OBs retired suddenly a few years ago when they got their bill for malpractice insurance as they simply could not stay in business. I see both sides of the issue being a nurse. For the record, I had 5 unmedicated births and left the hospital for the last 2 in 6 hours. I was I am sure I was perceived as a big pain by some nurses. I was also educated ( not a nurse for the first 2 ) and I did stay home until well into labor arriving at the hospital for a safe delivery with no time for interventions. Inductions were only done for medical reasons at the time. I am not defending the nurse who snapped at someone for unplugging the cords from the monitor but I know the little prongs are easily bent and broken and cost hundreds ( ridiculous, I know ) of dollars to replace. I do feel I am a patient advocate but agree with a previous writer that so much of this teaching should be taking place between the careprovider and the patient. There is only so much one can absorb when overwhelmed and in labor. Thanks to all of the fine professionals on this board who contribute to our stimulating and thought-provoking discussions.

Where ARE these women not wanting intervention ?? I must be living in the wrong part of the country ?? My advice to women with a birth plan.....based on over 20 years of experience in L & D during which time I have seen many changes.....some good, some bad..........would be to STAY home until labor is well established. Why do they come in at the first twinge ?? Or allow themselves to be induced when all is well with the babe ?? Come in to be induced and you are long, thick and closed prior to your due date because your mother can watch your baby......please don't hand anyone a birth plan. It is ridiculous.

L&Dwannabe, I agree with you that women are the ones who demand change and right now the pendulum is not swinging toward anything natural. Women are demanding ( and getting ) just what they want which right now is early induction of labor and elective c-sections !!! The only birth I can recently remember without pitocin and epidural happened in an ambulance on the way to the hospital. The women who have birth plans rarely do their homework. Do they ask the OB's section rate ?? Do they ask OB nurses who they would go to ?? Even our MEDwives are pitocin crazy and lounge in their room reading or sleeping while the patient labors with an epidural. All of these interventions do NOT make for better outcomes and we know that. We nurses are trapped and have to conform to the hospital policies and careproviders orders. We also are not working for the fun of it, we need the money and are sooooooooo sick of being blamed for things that are not in our control.

I can't remember what generated the new "rule" but about 2 years ago, it was mandated that the care provider come in and check the patient prior to discharge. Probably about the time they took our litmus paper and our amni check sticks away.......as we are not "qualified" to have them on the floor. As I said, the care providers are not happy and most of the triage patients end up spending the night. How cost effective is that ?? Obviously if they are in the hospital, we need to check VS and FH at least periodically. It could have been a patient complaint that caused the change......our facility SO over reacts to patient complaints. It would be comical if I weren't trapped in the middle.