PegRNBSN

What you are feeling is very typical of a new nurse. Labor and delivery is a very challenging place to work. Constant changes in patient status, healthy women usually but critical situations can happen on a moment's notice. I have a couple of suggestions... If you are thinking maybe you should update the MD, do it. The consequences of NOT calling can be harmful to the patient. As a charge nurse, I consult with my nurses all the time but I never discourage them from calling the MD unless it is something very very minor. What are the consequences of calling the MD when maybe you didn't need to???? Perhaps the MD will be upset but much better than an adverse patient outcome. The second suggestion is to have a discussion with the charge nurse and perhaps your manager about your assignments and your perceptions of lack of help, unfairness in assignments. The sooner this is discussed the better. There may be things you aren't seeing, or the charge nurse may need some coaching in changing assignments or encouraging good team attitude and a helpful staff. You were aware that the hypotension and hypothermia weren't normal.....you had the right instincts. Give yourself a pat on the back for that!!!

I don't think you can say with certainty that mother and baby were fine. I would like to know if preeclamptic labs were done. While the epidural may have been the factor that precipitated the fetal distress, you don't know what would have happended with advancing labor without the epidural. I too would like to see cord gases.

about 80% of our population has now recieved H1N1, ran stats from our log, no increase in respiratory distress in the last three months. We do 320 deliveries a month

We had a very similar resident on our unit about 5 years ago. She pulled the same stuff but no one ever talked to her outside the heat of the moment. I along with another charge nurse had a meeting with her senior resident and her when she was not on duty (and neither were we). We brought coffee and sweets and talked about the issues. We started by first having the senior express his appreciation of nurses when they question or discuss orders as no one is above making a mistake or listening to another point of view. We then told her what we thought her strengths were ( this one was very smart) and then told her what we needed from her. We didn't say " you do this and this and we can't stand it!". We said "We need to be respected as professionals and colleagues. We are part of a team with the goal of providing excellent and safe patient care" We then asked what she needed from us. It turns out there were several nurses who knowing her reputation were quick to question or complain and even if justified didn't do it in a professional manner. I or the other charge nurse met with her monthly for the rest of that year. She turned out to be an excellent physician and had great relationships with the nurses but it took alot of hard work on everyone's part. Don't write her off yet!

How do you self schedule. We tried a couple of years back but no one wanted to work the undesirable shifts and there were the same nurses changing their schedules to cover the holes. We have a large unit (50 nurses) so it is pretty complex. Mixture of 8 and 12 hour shifts. We divide the Christmas and New years holidays into 6 shifts (three on the eve and three on the day) The shifts that pay bonus are the "holiday" shifts the others "non-holiday". You work one of each, either all on one holiday or splitting the two. We work opposite of what we worked the year before. What shift you get is determined by seniority with everyone giving a first and second choice. You always have the option to switch. The day after TG is trickier but we look at who has to work the weekend and who had off the previous year(s)

Just had a very good experience with a new doula. She asked me after the delivery to evaluate her and we had a good discussion about why we worked well together. I treated her as part of the team from the beginning. I always gave reasons for interventions (pt was on Mag and Pit) and tried to negotiate when possible. She didn't come prepared for a battle and limited her role to support for mom. She made the comment that she was so afraid of getting a mean nurse because other doulas had warned her. I gave her the advice to treat the nurse like they are nice and that the hospital staff will honor requests until proven otherwise. Dont go in ready to fight!! There was also a lay midwife in attendance (the patient had planned a home birth) and she on the other hand undermined the physician's orders and compromises that I had worked out with the patient. She took off the monitors telling the patient that intermittent monitoring was okay, she got the patient up to the bathroom when the MD had wanted her to use a bedside commode. She told the patient I was being over cautious in taking her blood pressure so much. She encouraged the patient not to allow the NICU staff to be in attendance for standby. She frustrated me!!!!! The doula told me I hid my frustrations well. The important thing was not to stress the patient who managed an unmedicated birth.

I got to deliver my own nephew! It was my sister's fourth baby and she waited a little too long to come in. She was 6 cms on admit. Her doc was coming from across the street when her water broke and I got to say hello to my nephew first. They gave him a male variation of my name for his middle name.

Okchug Maybe you are a good doula :wink2:

I guess it is very easy to post things about labor nurses and make them sound horrible. The thing is they aren't here to defend themselves and I just know somewhere my actions are posted on a message board as being that of Nurse Kratchet. Perhaps there wouldn't be so much animosity if questions such as "Are you l and d nurses all for natural births? weren't asked in a judgemental way. I have had too many patients who want natural childbirth, who come with a doula, who are fighting with me before I even open my mouth. I feel as if there is no way I will meet thier expectations because they are expecting me to fail. They are critical before anything has even happened. And it is an aggressive encounter to boot. I always try my hardest to meet my patients requests and needs, but I also expect the patient to show me respect until I fail to earn it. I once had a patient who I brought into a room for induction. I asked if she had a birth plan or any requests that we needed to know about right away. She threw her gown at me(which was lying on the bed with robe and slippers): and told me if I made her wear that horrible confining gown, she knew I would never be able to take good care of her.

My point was that sometimes the mom doesn't see the urgency of the situation and could relay to friends and families that the nurse wasn't caring or didn't listen to her needs/requests. I also had to intervene as charge nurse where the patient wanted a new nurse. The baby had late decels, rising baseline and no variability. The woman didn't want an IV. She was angry with the nurse who was desperately trying to convince her to take the IV. The husband yelled at the nurse that the IV could wait until mom was in a "better place". Her attending was on the way in and she was sectioned 10 minutes after he got there. PH was 7.00. Sometimes it has to be about the baby and not the mom. The nurse who was caring for her was very appropriate in her communication.

It is important to listen shortly after a contraction if not thru one to evaluate baby. If you wait until the mom is "ready" many times you are listening well after the contraction. I try to explain this when mom isn't contracting. The other thing I have noticed in my 24 years of OB nursing is the complete lack of understanding some patients have about emergency situations. You hear them telling their family on the phone about the horrible gruesome procedure they just went through and it was really a frightening emergency in which the provider did a wonderful job of preventing a tragedy. I had a patient with a midwife who both wanted everything as natural as possible. Fine by me but after an AROM, I listen to FHTs as per AWHONN recommendations. They kept telling me you don't have to listen now, she's not ready. Well, this was one of the few cases where I didn't listen to them, I guess it was my gut feeling. I listened heart tones were in the 50's. Midwife wouldn't check her, so I did (while she was pulling my hands away) Prolapsed cord. What would have happened if I had waited til mom was "ready". Sometimes another side to the story. But I bet this mom was still telling people what a horrible nurse I was!

Can you shadow for a day or two at the new hospital. We are currently experiencing a HUGE shortage of RNs as our volumes are increasing at a rapid pace. We have lost three nurses during orientation because of the acuity and volumes. We do 300 deliveries a month, have a high risk antepartum unit and get really sick moms, multiples, and other medical complications all the time. It is like working in an ICU along with the stress of L&D. Like several other posters said if you are an adrenaline junky this is for you. Many of the nurses said they didn't get enough low risk patients. If you are happy at the PLACE you are at, maybe wait for that day opening. It is especially hard on a unit like ours when you are developing your confidence Best of Luck

I believe that stooping to subterfuge is just as bad for nursing as doctors. I always try to communicate as the professional I am and want to be treated like. If the patient hasn't changed and I am afraid the doctor will try to section, I would NEVER lie about a VE. I would state my reasons or plan for helping this woman obtain a lady partsl delivery. The MD is ultimately responsible and they deserve accurate professional information and communication from me. Using the SBAR is a great way to communicate this Example S (Situation) Your patient Mrs Jones' last VE was unchanged at 4cm B (Background) Her contraction pattern was irregular for the last two hours and she was very tense with contractions A (Assessment) She had an ineffective labor pattern and poor pain relief R (Recommendation) I think she would benefit from some IV pain meds which she is requesting and she is open to Pitocin augmentation (or other interventions which you would like to recommend to MD) Much better than lying about a VE. I know there are many MDs who will not respond well but we need to be take the high road in professional communication:)

I worked for three years on a med surg floor. I was only going to work for one and then transfer, but got complacent and just stayed where I was. It was the hardest work I have ever done, but also, gave me experience I know I would not have gotten in labor and delivery. I would say the three most valuable skills that I honed there were, prioritization, physical assessment, and organization. While all are used in labor and delivery, the setting of a med surg floor exposes you to a wide variety of experiences that you will rarely if ever see in labor and delivery. I found when I transferred to labor and delivery, being much more comfortable with some of the sicker patients we took care of, even over nurses with many years l and d experience. I work in a level three, high risk unit and thinking about the nurses who work there, the ones who are the most organized and skilled when it comes to the high risk patients are those who had med surg experience.

My son had to read the Disney book for an internship and I started to read it with much skepticism. It is written by a hospital exec (and he might have been a nurse to start his career) who trained with Disney and adapted lessons learned for the hospital setting. It really was intriguing, especially the part about being a team. He gives examples of how distructive it is to blame other members of the team ( example the bathroom isn't cleaned and you "blame" the housekeeper. I highly recommend it.