Unlucky Ob Nurse

[moon25]

I don't know if I have rotten luck or if i'm just in the wrong field. I've been an OB nurse for about 2 yrs now. I started right out of nursing school. It seems as if everytime I start to feel like i'm beginning to function like a real nurse, something happens to knock me down on my butt. about a year ago after taking care of a pt in ob-pacu, she was stable, but she was to remain on pulse ox for an additional 12 hrs. Her baby was in the NICU and she had not had a chance to see him yet. So after giving report to the nurse that was to assume care in on the postpartum floor, i took her (on a stretcher) to see her newborn. I told her to call when she was ready to leave. I told the nurse who was going to assume care, that she was in NICU and since i currently had no pt's I would be glad to transport her to the room when pt was ready to leave and to call me. the nurse said ok. I assumed that my role as caregiver was over and I would only be acting as transporter. well i got a pt, and became very busy. 10 hours later the NICU called to say the pt is still there. I was written up, I accepted responsibility, according to nurse manager although I gave report the pt was my responsibility till she was physically transported to new nurse. I moved on. several wks ago, an md (who has never liked me)- complains about me because i told him that a fhr variable decel was positional and happened right after lady partsl exam, so pt was flat on her back. so he complains to nurse manager because the pt told him the decel occured several mins after V.E. not right after like I said. Now never mind that it was only one variable lasting about 60 secs and never re-curred after pt was repositioned, and the strip was beautifully reactive for the entire time she was being monitored - the nurse manager complies and requested that i be reprimanded without even discussing the situation with me. He ended up sectioning someone less than 36 wks with premature contractions, without attempting to stop contractions and with a beautiful strip because the pt had a Bad feeling, needless to say baby ended up with problems. though I do not feel like i was wrong in this scenario, it is still a black cloud hanging over me. then just recently after an ultrasound was ordered for a pt for weights and presentation, ultrasound tech gave myself and md who was physically present a verbal report of results. i wrote it down, but i did not then afterward call dictation line to get official radiologist report. so offcourse baby had undiagnosed problem that was traumatized during lady partsl delivery and required immediate surgery. I accept responsibility, because usually i will call to get dictated results so I may give md report, but this time since ob was already there and got results himself, it was an oversight not to call dictation line. I am wondering, are these obstacles that nurses meet from time to time that we must learn from and move on. Or is there something wrong with me, am i not in the right field or do I need some serious retraining. what do you guys think. these things hit me hard and significantly decreases my confidence. I don't know what to think of myself anymore as a nursing professional..... sorry for the long thread.

[Liddle Noodnik]

I don't know if I have rotten luck or if i'm just in the wrong field. I've been an OB nurse for about 2 yrs now. I started right out of nursing school. It seems as if everytime I start to feel like i'm beginning to function like a real nurse, something happens to knock me down on my butt.... what do you guys think. these things hit me hard and significantly decreases my confidence. I don't know what to think of myself anymore as a nursing professional..... sorry for the long thread.

Have you heard the expression that "poop" flows downhill? Sounds like you are being made a scapegoat. For example, the doc that received the verbal report - shouldn't ultrasound have made a dictation or shouldn't the doc have documented it somewhere?

Document everything you've been told/disciplined about, and what your side of the story is. Then you can be clear when/if you are asked later. This stinks!

Have you had a recent performance evaluation? Sometimes they just warn you verbally because they "have to" but it doesn't necessarily mean they agree with the doc or whatever.

I'm not an OB nurse but I can certainly empathize! Take care ...

[gonzo1, ASN, RN]

sounds like you have not yet learned the golden rule of covering your own butt. for example with the ob pt I would have checked back to see if she got to her room because you can never trust anyone to do their job. You always need to follow up. Don't ever leave any loose ends, like the dictation. The things you have mention sound like they are not career ending problems, but you always have to practice with an eye to protecting your patients and your license. Don't take anything for granted. I probably wouldn't have told the doctor that the decel was positional. I would have let him make the decision as to what it was. Some doctors don't want nurses giving any input. They want to make all the decisions.

I would just be more careful about tying up loose ends and not taking any short cuts ever. Perhaps it is time for a change to another unit or hospital. You sound very conscientous and caring. There is a book called from "Novice to Expert" and it talks about how many years it takes to become competent in your area. At two years you are still very much just learning. It takes five years or more to become an "expert" so don't be ashamed that you do not know it all yet.

[moon25]

thanks for your input, i will certainly look for that book.

[nurse79]

ohh i can definitely vouch for that: "Some doctors don't want nurses giving any input. They want to make all the decisions."

there is this one OB on our floor..he gets livid if you say the pt is "hyperstiming" because he feels that is deemed a DIAGNOSIS, and nurses DONT diagnose. Another scenario with this MD was that he wanted HIGH DOSE pitocin for his pt. She was a nulliparous woman, so she started at 6 mmu/s and increased by 6 milliunits q 20 mins. OF COURSE he DID NOT want an IUPC. He denied my request, but said that i could place a FSE. (Pt was GBS neg). His rationale was that IUPCS are pathways for infection and that within 6 hours she would have a NURSE induced fever if it was placed. Has anyone else heard of such a thing (the fever part). I mean i know we try to limit our VEs but a pt on HIGH DOSE pitocin needs an IUPC!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! right ??

[Liddle Noodnik]

...I mean i know we try to limit our VEs but a pt on HIGH DOSE pitocin needs an IUPC!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! right ??

What's an IUPC?

[moon25]

an IUPC stands for intrauterine pressure catheter, it is placed inside uterus and gives accurate measurements of uterine resting tone after contractions and also tells us accurately what a contractions intensity is. Most times we use external monitors placed on the belly, but they are not used to determine intensity or resting tone, they basically only tell us when pt is having contraction. then we feel the belly to see if it is relaxing between contractions.

At my hospital we on we go all the way up to 30 mu without an IUPCall the time, we really only place one if pt is having recurrent decels and we want to determine for sure if they are really late decels, we may also place them if we have trouble monitoring contractions with an external monitor (this is usually with or larger pts). usally when we place them the pt is at least 4cm dilated and in active labor to decrease length of time iupc is in uterus thus decreasing risk of infection, was this nulliparous woman in labor. This doc does sound like a real jerk though, i've never heard of a "nurse induced fever"

[HappyNurse2005, RN]

diagnose. Another scenario with this MD was that he wanted HIGH DOSE pitocin for his pt. She was a nulliparous woman, so she started at 6 mmu/s and increased by 6 milliunits q 20 mins.

he coulda kissed my orifice. a few docs will try to order the pit for start at 6, go up by 6, and i still do 2 by 2. none of the nurses like 6 by 6. some will start it at 6, but only go up by 2.

[dawngloves, BSN, RN]

So you gave report to PP, the pt was d/c'd from PACU to PP and NICU called you? I would have told them it was not your pt and to call so and so on PP. I don't know how you got chewed out for that.

You learn from expereince. You are going to have to eat some sh#t every now and again until you learn how things get done in the real world and stand up for yourself and cover your butt. It's hard lessons to learn, but at least you remember the second time.