RN2Bn2006

My first "delivery" without a doctor present was a hispanic 38 weeker, delivered in bed with bag intact. I ruptured the bag to remove the baby. It freaked me out at first, as I had never seen it before - I agree with the above poster about something from a sci-fi movie! lol

Well, Thought I would let everyone know that I have read all responses, and have considered them all. I went back to work last week for my 3 days, and did not have a delivery with him, so haven't seen him yet. I did however Triage a couple of his patients during the night and spoke with him on the phone - which I just stated my names and facts & waited for orders - and he did his usual "Hey *my name* how's it going" and telling me about his new puppy, etc.... as I politely listened! I still haven't decided exactly what I am going to say when I DO see him - but at least I am not "emotionally" charged anymore. I'll let you know. Thanks to all for your advice!

I'm an OB/PP nurse, and I've never heard of Hemabate - can you enlighten me?

You are right. As much as I would like to do some of the things that have been suggested - most of them just aren't within my personality or nature. I am naturally a person who tries to keep peace in most situations, and have been known many times to overlook things from time to time, but even I can't seem to let this situation just slide. I mean you have to draw a line! So I plan to say something, but it will be in a private setting, and hope for the best. Even though I did lose alot of respect for him today, I still respect him as a person, would not treat him the way he treated me! I wouldn't treat ANYONE that way! I hope you are able to resolve your issues. Sometimes I think it takes a strong person to not immediately react to a situation. Some people need to take a few to gather their senses, so that the reaction/response is not based soley on emotions. Emotionally charged rebuttals can get out of hand - I've seen that many times. Good luck to you!

Glad you are able to stand up for yourself! It takes a strong person to do this!

yes, the other ob would have covered for him - so i have no idea what his problem was. and, i honestly didn't think she was even going to need pitocin. as an ob nurse - we have to make judgement calls too - i mean if i had started the pit - and had hyperstimulation causing fetal distress/c/s - don't you think he (as well as a court of law & nursing board) would hold me responsible to know when it is appropriate to pit - regardless if that is the standing order. we don't just follow orders blindly. when i first put her on the monitor - she was contracting 2-3 minutes, in a pretty regular manner, and they were strong, and obviously her cervix was changing, so even though i mixed the pitocin, i didn't hang it immediately because of the fear of hyperstimulation. after about 20 minutes - they became a little irregular, and i was mixing the antibiotics/getting supplies for epidural because they want them ready when they arrive, plus helping with the pp patients on the floor, so i was going to hang it the next time i went into her room, but her family came to the desk, and said she was crying for pain medicine, so i called surgery and found out it was going to be about 30 minutes before the crna to come for epidural, so i ran to get her some pain meds, and that's what led up to my delay. it was certainly all about his convenience! absolutely! i just got an e-mail from the girl who relieved me - she said that she never turned the pit above the initial 6mu - and that the patient was complete by 10am! so, i mean the pit probably helped some, but does not deny the fact it's almost 99% certain that the patient would have easily progressed on her own - just wasn't even given the chance. there are many things this doc does that is questionable, and i have many times charted to the excess to cover by butt. the other ob is aware - and gripes about him also. but...nothings ever done about it!

Maybe so, but in a small town where everybody knows everybody, and this is the only hospital within an hours drive, I have to choose my battles wisely. I have to have a job, and most the times, I absolutely love it! Life in a small town can become difficult if you get on the bad side of people. I am not saying he would like get me fired, but he could make me dread coming to work because he would be short with me all the time, and I just don't want to work in that environment. It's sad but true.

You are oh so right in sooo many ways! I think you have hit the nail on the head!!!! THANKS!!!!!!!!!! You have just managed to put the whole situation in PERSPECTIVE!

I'm glad I'm not the only one like this - I sometimes wonder if I'm "normal". I've been to several funerals in the past month or so of friends/loved ones, etc... and although my heart aches for them, and everyone one I'm with is crying with them, I'm just sitting there, appearing like I'm not sad - I just don't always cry at appropriate times! It's not PMS stuff either - as I had a hysterectomy 7 years ago. I never know when it's going to happen, but like you say -it's more about when I'm extremely mad. Also, it's evidentallyl when my feelings have been hurt! Man I wish I had a switch to control it! Ha Ha

You made me literally Laugh out Loud!! THANKS! I only wish I had the b*lls to say that! (and I am female btw)

Oh ME TOO!!!! You have NO idea!!!!

This is not something I would do - and I KNOW it just lets him get by with this behaviour. BUT, we are a small hospital, this doctor is someone I have to deal with on a daily basis, and BECAUSE he "likes" me, this is the first time he's acted this way toward me. IF I ticked him off, he could make my life miserable. Our administration is a joke, and making a report would only make matters worse. From what I've heard - most everyone has experienced something similar to this at some point in their career in this department, and it's like - you just learn to pick up on his cue's when he's "in a mood", and to know when to be agressive getting a patient ready. I've been warned, I've just personally never experienced it. I have no desire to make him mad, I know if I did write him up, that it would only bite me, so my only option is to hang loose, and when I'm far removed from the incident - try to speak with him. I am not promoting his behaviour by not addressing it - I'm protecting my working evironment/working relationships - because I desire to stay in this department. Not that he would get me fired - he would just be unpleasant to work with, and I don't want to have to come into work dreading seeing him. I have to look at this fact that 90% of the time - he treats me totally awesome! I've actually enjoyed learning from him, he's very teaching, and usually very fun to labor with, but this dark side......ummmm, another story!

Well, as bad as I hate to admit it - you are probably right. My problem with having a talk with him - is I'm afraid that my emotions might pop back up, and I do not want to appear emotional in front of him. Now I am not a "crying" person - I barely cry at funerals - sometimes don't, some people think I'm non-emotional - most people think I'm a strong/tough person because I handle situations when others are falling apart - that I'm able to be strong, but it's weird that in situations such as this - I can't seem to control when unbidden tears will threaten to fall. I will have to be pretty far removed from the situation to where I am no longer emotionally affected - when it no longer seems like a big deal - to feel safe to do this. Guess I'll have to wait and see. I just HATE confrontations!

What makes me mad - is I have uttered these very words from my mouth (after witnessing what I did in nursing school) and WHAT did I do? Stand and look him in the eye, and apologize, and fight back tears. I'm mad at myself as much as I'm mad at him!!

Lets see... "what have I learned?" It doesn't pay to stay after your shift in order to help out...... and "what will I do next time" Contact mgr/DON for them to cover, Clock out after giving report, and let them deal with it. Seriously! I would NEVER do this - it is NOT in my nature. But that is what I'd LIKE to do. Basically I've learned what is perfectly fine one day is extremely wrong the next day. You are supposed to KNOW (by reading minds of course)that the doctor is going out of town, and needs a G1 delivered in less than 3 hrs. And despite the fact you are in the middle of shift change, and patient is still in triage, that when you've called the doc at 7:15 - you should have already had her admitted, and pit mixed, and ready to start at 7:16 - worry about her pain/consents/GBS + status/Labs later. I am very sorry........I am totally not trying to be disrespectful to you - I appreciate your comments, but it seems that I did the best I could given the circumstances I was under. My evil side is coming out!! LOL! Believe me - I'll try to avoid this happening again. You definately live and learn!

First let me say that I work in a L/D-PP-NSY unit in a rural hospital. We only have 2 OB's and I like them both very much. I had been warned about one of them - how he was practically bi-polar - and I have seen a few of his mood swings, but he has always been extremely nice to me - he's always joking - even when I call him in the middle of the night - so up to this point I have really loved my job! I've even commented that our low pay is compensated by a good working environment, and awesome physicians who treat us with respect. ...... well my little bubble was somewhat deflated this morning. Keep in mind - our unit is a combo unit, where I not only triage/labor - I also take care of PP, and assist in the nursery when needed. Last night I had a pt at 39 wk who was contracting somewhat irregular, with no cervical change after a couple of hrs, and so we sent her home Well, as I am giving report to my relief RN, she shows up with SROM. Because the RN that was relieving me was going to be the only one for OB/PP and her LPN was stuck in the Nsy with a baby on O2 - and had a scheduled C/S, I volunteered to stay and get the new patient admitted, orders done, etc... until the nurse we called in arrives. Well, I phoned the doc at 7:15 to inform him of patients return, and status and received the order to admit & pit & can start prepping her for epidural. So, as soon as I finish report - maybe less than 5 min, I started the process - which is alot - you know consents, Labs, IV starts, answering questions, etc.....Mixing antibiotics/pitocin/hyrating for epidural/giving pain meds, while anwering phone, dealing with the floor patients families questions, & had to give a few pain meds to floor patients while I am rushing to do all of this. Well.... to try to make a long story short - my relief shows up - it is now 8:20 - I am giving her report and in walks the doc. As I am telling her that he wants her to have pitocin - and was handing it to her - he lays into to me. Now we are standing at the nurses station which is about 12 ft from patients rooms, the cleaning lady is there, my relief nurse is there, and he chews me out thouroughly because I do not have the pit going - because he has to leave town at 10 am. Now this is a G1P1 who when she returned had progressed to 4/80/-1 on her own, and was ctx - although still somewhat irregular - q2-3 minutes. When he checked her a few minutes later she was 4.5/90/0 - so it wasn't like she was actually going to NEED pitocin to progress anyway. It was all about he needed her delivered before 10. He proceeded to state very loudly that the order was given at 7:15 am, and he expected me to start pit THEN, and he should not have to call the unit to see if I'm actually FOLLOWING his orders, because he just ASSUMED that I would do what he ordered - because he had REASONS he gives me orders, and It's my place to follow those orders, then he started blabbing about a study that shows if you admit a patient at 5cm, start pit 6x6, then they have blah blah blah (can't really remember what he said at this point) - then he said furthermore, I am the one with the DEGREE! (This last sentence is the one that got me!!) Then plopped the chart down walked off. OK now I am standing there - humiliated beyond all measure. My relief nurse had grabbed the bag of pit before he got done with his lecture, and promptly went to hang it - the cleaning lady was looking at me with sympathy - I was speechless. I sat down to chart everything that I had done for the patient so that I could actually go home, seeing how I had already stayed 1.5 hrs over to help - and he KNOWS I am staying late because our schedules are fixed - I am always on nights - and plus I had been the one to call him at 3 am. I had not sat down since that patient arrived, as I was rushing to get as much done as I could to help, and did not sit twiddling my thumbs saying, hmmm.....I don't think I'll start pit, because I don't think she needs it - because I am smarter than said doc - uh, NO. There is a process - that takes time. If he had said on the phone I am needing to leave town at 10am, so can you speed things along, then yes, maybe I would have been able to gotten things done a little faster by spending less time during consents explaining, and answering questions, etc... I just don't know! After he checked the patient, he comes back to the nurses station as I am charting, and asks me a few questions so he could fill in his progress notes, and as he gets up to leave, he pats me on the back and says "Thanks for your help - I'm not mad at you - I just needed you to really get this one going" - well, I could not even respond at this point because I have tears threatening to spill, and I'll be darned if I'm going to let him see me cry. I held it together by not talking to anyone - except to say goodbye at 9 am. I cried when I was in the privacy of my car. I cried when I was trying to go to sleep. I'm mad at him for being unprofessional, and repremanding me in front of my co-workers, and anyone else who walked by. I'm mad at myself for allowing him to humiliate me - I always swore I would walk away and if they had anything to say to me - they could come to me in private. I'm made that I could not control my tears, and speak back to him when he tried to half-A$$ apologize to me - believe me I had words I wanted to say. I'm mad that my skin is not tougher - that I have cried over this, and allowed it to upset me. I guess I am fortunate that this is my first chewing, but I feel that although he did have a legitimate complaint - that I was taking a little too long - the manner in which is handled it was totally inappropriate. Does it get easier? Does your skin ever grow thicker? I know the next time he sees me - he will be back to normal, and will act as if nothing ever happened, but I'm afraid I'm will not be so eager to resume our "friendly" conversations. I have decided in my mind that it will be business only - I will say what I need to say in regards to patient care, and refrain from carrying on with his constant joking, long conversations regarding his son's wakeboarding events, pretending interest in his rock-climbing stories. Ya know? Does this make me immature? I will not be rude or disrespectful, I just have no desire to be "personable" to him. Sorry this is sooo long! I am one of those people who need to VENT to get things off my chest. I am still hurt. When in nursing school, I witnessed a doc chewing out an ICU nurse - in FRONT of the patient, all of us nursing students as well as her co-workers - and saw her later in the hallway crying, and being consoled.... that made a huge impression on me, and I can't believe I endured the same thing this morning. Somehow - I think I need a raise - LOL. My lovely working environment now longer compensates for the poor wages ! LOL

wow, that's interesting!

Thanks for your response - it explained things very well, and I can totally understand "WHY" now. Your last part about families being present - I can see a positive and negative to this. Positive being - the family can actually SEE that everything was done for their loved one, and in the ill/elderly can see how traumatic chest compressions can be, and actually influence the family in letting the patient go in peace. But on the negative side - I can now see why emotions should not be involved in a code situation - and if a weeping family member were present - it might make it hard to stay focused, and might cause you to become emotionally involved - despite the need to stay detached!

Well, I appreciate your explanation. I totally understand what you are saying. I guess if the code team is able to "converse" then that is actually a good sign - they obviously know their stuff - if they can do it like some one said earlier "a well oiled machine". I'm just glad to know that just because they are chit-chatting - doesn't mean they don't care- I should have known better - but it just seemed odd to me. Also, because at this point in my career, I couldn't imagine being able to do anything but concentrate 100% on what I was doing in a code - because of my lack of experience - that is was hard for me to grasp. Thanks for your reply. It helped alot.

Thanks for your thoughts - I can see what you are saying. We've had two family friends die this week - cardiac related - unexpected, and I guess I have been thinking on these things. Nurses have to deal with so much sadness/grief - they would go crazy if they didn't find someway to deal with it. I know I feel drained emotionally when we have a devastating situation (which is unusual in my department), I can't imagine having to deal with such things everyday.

Well, no I certainly would not want the people running the code to be "sobbing" or acting hysterical, and it is comforting that they are able to do these codes as a second nature - because they are so experienced. I also totally understand the need to seperate yourself from the emotional aspect - not getting personal - lest you drive yourself insane. While I was watching or helping as needed, I wasn't standing there getting upset, or crying or anything, I was just realizing that a life was passing. I guess those that deal with it on a daily/weekly basis are accustomed to it, and like you say must deal with it in their own way. Of course I had to go back to my department once it was called, and did not talk to the nurses afterwards, so have no idea how it truly affected them. I do know I have heard ER nurses discussing disturbing codes they have done on children before. Anyway, thanks for your input. I guess I was looking at it wrong. I'm sure the nurses cared about their patient. Maybe that's why I gravitated toward OB - 99% of the time - our outcomes are good!

I agree with other who said - it's usually the same couple of people who are instigators. And not be sucked into it. Our department is unusual (small rural hospital) that most everyone in the department are friends/relatives that socialize outside of the workplace. Also - most of these women are in their 20's-30's so have the PMS thing going on - and BOY you can tell when they do. I've seen some VERY unprofessionalism at the job - where they have cursed one another, threw little tantrums, acted like jealous little brats, and conspired against each other. BUT because they are all friends/relatives, they soon get over it, and all is back to normal. Now I know that is not normal - in fact if someone treated me like they treated each other - I would be totally crushed, and probably never fully get over it - but then again - I don't treat people that way. It's all in the type of personalities involved. These women I am speaking of all work day shift - and are very immature at times. Now switch to night shift - we are a close knit group of women - we all usually work the same nights, so we spend alot of time together, and I cannot tell you ONE time that we have spoken hateful to each other. We just aren't that type. We work together, and pitch in to help each other when needed - afterall we are working toward to the same goal. Even though I hate nights sometimes, I don't think I would trade my work environment for anything. I love going to work, and we also socialize outside of work. If one of us have a night off, we usually call and check on the other ones to make sure everything is OK, and to seel how they are doing. We all volunteer to be on "emergency call" for each other - just out of respect of our friendship. Seeing as we work in OB/PP/NSY there can infact be very serious emergency in the middle of the night. So I said all that to say that YES there is alot of gossiping/backbiting in any job, and if you let yourself become involved, you will more than likely end up doing the same thing. It is not wrong to "gripe" about a situation in my opinion. But once you find out who the instigators are - just stay away from them. They can spoil a good attitude in no time. I've seen it happen to many people - who used to be happy, and now are disgruntled. It only takes a few bad apples........ Anyway - that's my story and I'm sticking to it! ;-)

First let me say, I am a labor and delivery nurse, so do not witness codes very often, in fact I've only been in on two - one in nursing school, and one in our ICU when we had enough RN's in our department for me to go and assist. My question is - what is mood/environment like during codes that you've experienced? The two that I witnessed, it was strange to me - the nurses and medical personnel were just chit-chatting about their week, etc... while they did CPR - of course there were orders of meds being given and administered - with great care - but no one seemed sad, upset, serious, etc...... Now I must say - both of these were older people who had been sick - so maybe it's because of that - they no-one seemed to care? Maybe it's because I've not been around that end of it much, and death still seems so devastating to me. I could not help but stare at the person, and think that this is someones loved one - the most dear person in the world to someone - and their life is slipping away - someone's daddy, husband, brother, son. How would I feel if that was my loved one laying there, and yes - protocol and ACLS guidelines were followed, and everything possible was done, BUT - there was no evidence of concern in the people who worked on them - like it didn't really matter the outcome - it's just a procedure. I just find this disturbing. I'm sure if was in ER, and someone came in and coded, there would be a sense of urgency and seriousness - I hope anyway. Maybe it's because the medical personnel knew these particular people were very ill, and it was better that they passed. I totally understand that. I guess I just can't understand how anything could seem funny or humerous, or trivial, when a life ends. All I know is when we have a bad baby - one that requires complete resucitation, It is the most important thing in the world to me in that moment. Everyone ounce of me is seriously doing everything I can for my patient. Even in a situation where you almost KNOW the baby has really no chance, or will have severe brain damage. I believe it my job to try 100%, and out of respect for the family/patient, I could not imagine talking about what party I attended last weekend, while I was doing compressions! Please, I am not trying to criticize anyone - I am just wanting to know how others feel about this, and what you have witnessed. Also when I re-read this - I realized I sort of implied that the nurses in the code weren't trying 100% - that is totally not what I mean. Like I said - I believe good appropriate medical care was given, it was just the atmosphere/attitudes that I was wondering about. - Just to clarify.

I took one semester off - to get accustomed to my new job. Because I still lacked a few general study pre-requisites - I started slowly, taking 2 classes a semester, including summer. Now I have just completed those, and will start the BSN online in January. I have felt a little stressed, but it was important for me to continue while I was still in the "study" mode. I feel it is helping me as a nurse - with the new things I have learned (I had to take pathopsyiology), and I feel good about myself also. It will all depend on how stressed out you are at work, and what your family dynamics are as to whether you can handle it or not. Everyone is different. I plan to eventually get my MSN, but may wait awhile. I do not want to spend all my children's young lives studying! That is a BIG negative. It would be nice just to have the weekends and days off doing things with them, as opposed to writing research papers. The positive thing is that most of your classes can be online. All of mine are - and I can set my own clinicals up. My advice is just to keep your goal in mind, and it doesn't matter if you do it immediately or not, just keep striving for your goal. You will eventually achieve those goals! Hope this helps Paula