Urgent Csection

brownbook · May 15, 2015

Yuck....I feel your pain. I have been there done that. I have the horrible way of handling stuff like this of not talking about it. I know I feel terrible inside but completely deny mentioning it to any co-workers, my boss, etc., for fear they will find out, realize, what a terrible nurse I am. I know that is a crazy exaggeration but that is how I feel inside!

I wish I wouldn't react this way and what I would tell my rational self is you need to talk to someone. I don't mean get a psychiatrist. Talk your charge nurse or unit manager or even someone in nursing education (whomever you think might be supportive, helpful, sympathetic). Find your own words...but tell them you feel "out of your element" in OR. It is affecting your ability to function...you are starting to doubt your self....I don't know, I am not good at words (probably why I keep quiet!) but anyway just talking helps a lot.

Ask if you can shadow a co-worker (or even an OR nurse if they do scheduled C/sections in the OR) a few more times because you are loosing it....again, my words are not well thought out...and I am trying to leave for work! But I do know how your feel....you might find co-workers, your boss, say..."yeah...I know exactly how you feel...I felt that way a lot when I started doing C/sections!"

tsm007 · May 15, 2015

I am a new nurse (eventually I'll stop saying that), but since I'm new I'm making mistakes that are embarrassing. It sounds like you are feeling embarrassed to face your coworkers. Shake it off. Take a look at the things you do know. You're new to the OR and mistakes happen. You learned from that mistake. I'll bet that every c-section going forward now you will count those stitches right. This is how people learn. Nobody was harmed. You're human. Don't even bat an eye at your coworkers if they make you feel dumb. Eventually they'll stop. If you think you are still struggling with OR see if you can shadow or see if you can get some resources on policies and such. But stop beating yourself up. I am quickly learning nurses are a tough crowd. Eventually you'll get the hang of this and you'll be able to tell someone new "I remember when I first started doing c-sections...." Anyways, I hope you have a wonderful rest of your day and you find something nice to think about besides this :)

Red Kryptonite · May 15, 2015

From the patient side, as I've had two cesareans, I would appreciate that you sent me for xray if you weren't sure, rather than CYA and keep your mouth shut, letting me go septic and possibly die because something was left behind. Next time you want to be embarrassed, think of that. You exposed yourself to embarrassment instead of risking someone's life, and that shows character. You're new, you'll make mistakes, it is what it is. In a year, you'll hardly remember this.

CBlover, BSN, RN · May 15, 2015

I know how you feel. However, even though the count was wrong on your part, it is OKAY. You did the right thing for your patient and in our profession, you have to learn to get over the times when you feel silly for steeping up to "be safe rather than sorry." It happens a lot. I can think of times when I told the MD, "Something seems odd about my pt..." when it turns out that everything was ok. Again, it's better to be safe than sorry. Think about if you HAD counted right and they hadn't and what the outcome would've been had you not advocated for the xray? You are still new to L&D and understandably nervous. Feels like new grad days all over again I'm sure. Don't let the next shifters getcha down. Hold your head up high friend.

Elvish, BSN, DNP, RN, NP · May 15, 2015

This sort of thing happens, no matter how many years' experience you have. Fortunately it isn't common and it isn't likely to be for you, either. Urgent C/sections can be crazy when a dozen things have to happen at once and you're responsible for about half of them. BUT, you absolutely did the right thing WRT the count.

We HAVE had people come back septic with laps etc. still inside them. That is obviously a Very Bad Thing. It is always better to be safe than sorry when it comes to wrong counts. It happens after lady partsl deliveries too sometimes. Never ever feel bad about insisting on safety. If your coworkers say they have never gotten a count wrong or perhaps been what we'd call 'overcautious in retrospect', they're either lying, they're not conscientious, or they haven't been a nurse for very long.

Tink1987 · May 16, 2015

Your kind words and advice are beyond appreciated! Practicing good self care and luckily have a few days before I need to GI back in.

IDeliverRN · May 18, 2015

I feel your pain! I started in L&D in January as well. I had an urgent c-sect friday night too, that didn't go as smoothly as I would have liked. We use McKesson which I am new to and I hate it. I couldn't find the correct orders, there were missing orders, and wrong orders. On top of that, mom had critical range b/p's and low blood sugar with decreased kidney function and on mag. It was a chaotic episode but we got through it and mom and baby did great! Other nurses came to help me and they reassured me that I did great and that it was the situation not me. However I still felt incompetent and as if I did't give good pt care. I actually just talked to my educator about it and she also said that I did all I could. She gave me a few tips for next time and told me to forget about it. She blames my pregnancy hormones.

I say all of that to say you are not alone and you did the right thing! I agree with the previous posters, talk to someone about it and ask for the next c-sect so you can get right back in to it! God bless!

USA987, MSN, RN, NP · May 20, 2015

You did the right thing by calling for an xray. That is the policy in every OR I have ever worked in. Don't beat yourself up. You are still new at this and things will come with time. My heart still races when we go back for an emergent section...and I have been doing this long enough!

melmarie23, MSN, RN · May 20, 2015

As the circulator you did your job in pointing out an incorrect count and calling for an X-ray to ensure no instruments were left in the patient. Do not let anyone make you feel inadequate for doing your job correctly.

As far as it being hectic prepping the patient for an urgent c/s, where was your charge? Ours is usually in there. As is a nursery RN/someone responsible for baby when it comes out. They could easily grab the heart tones and strap mom to table etc while you are doing your counts with the scrub tech.

NurseNora, BSN, RN · May 21, 2015

If the counts don't agree, you get an X Ray. That's all there is to it. Since you were doing it for bradycardia, the doc could have called it an emergency and done it without counts at all, and then gotten an x Ray. One suggestion, the primary job of the Circulator so to wait on the scrub tech. You do need to listen for tones in the room after anesthesia (if regional), but if you already have Brady, you don't have to listen long. Tell the doc "it's still down" (listen for six seconds and multiply by ten), or "I can't find it." Either way, he knows he needs to get in fast and not tie and Bovie every little bleeder on the way in. If the rate is in the normal range, you can listen longer to be sure, knowing that there isn't a big hurry and there's time to do the counts to your satisfaction. If you have any question, ask for another count, sometimes everyone gets in a big hurry, especially if they start off that way, and seen irritated with your request. That's their problem. You took responsibility for your patient's safety. You did the right thing.

You out could ask to do a few more scheduled sections if you feel you need more practice. But just know that you will always feel like a one armed paper hanger in any emergency section. Keep your priorities in mind and it will get easier with experience. Remember--you did the right thing!

FurBabyMom, MSN, RN · May 23, 2015

I would read your facility policy. That will tell you exactly how to handle it, and give you your leg to stand on. Blame the policy, not you/coworkers. It's easier to blame the institution/policy than people and it makes it less personal. I'd imagine you already followed your policy - which is great! :) You did the right thing. Even if unpopular!

Talk to your former preceptor and/or other more seasoned coworkers (or your boss/educator) about how your experience and how they handle their urgent/emergent sections. Know when to call for help (if available) and do it before you need it. Grab your charge nurse and delegate something. You can delegate counting or getting heart tones. Can you ask for some more experience with scheduled c-sections? As you build a routine to every case you will feel more comfortable in emergencies - you will know what is most important and what can wait.

I work in the OR (Level 1 trauma center) and just now (three years) have started to feel comfortable in emergency situations outside of my usual service line (I've done countless emergencies on my service line). I called for help during an emergency recently, my boss and one of our charge nurses came to help and I was telling them what to do for me. The way that scenario played out felt a little backwards but yet it wasn't - I was the primary and they were the help.

I do not work in L&D/OB, but I work in the Main OR of a Level 1 trauma center. We do have a L&D floor with several ORs up there. Sometimes at night OR staff/call staff are sent up to help with stat sections, and sometimes we do sections in the Main OR. If mom was in a MVC and has a head injury (ex epidural/subdural hematoma) and baby is (or is potentially) unstable, she's likely going to the Main OR for a crani for decompression and we're going to set up for a section as well. We're going to call the NICU team, they will send the fellow/NP and a nurse down, and we're going to make it work. With my specialty - we've had a few occasions of a patient who was pregnant and needed surgery - we set up in the Main OR for the procedure they needed plus fetal monitoring, plus the table for if we did a c-section and the NICU stuff was in the room too.

I agree with the others - if it's an emergency and your policy allows you don't have to count but you do have to get an x-ray (and whatever else the policy says). Ultimately, you have to do the right thing and what you can live with being responsible for. Part of being in the OR (L&D or otherwise) is that you HAVE to advocate for your patients when they are unable to. You did that. Don't feel like less of a person. Other people can only make you feel like less of a person if you let them.

As for your coworker defending their position by what they opened? I've also seen suture packages, blade packages, and laps/rays/patties come with the incorrect number - so you really can't go off of what was opened. We use "custom packs" for specific procedures - and there are tons of times that we've had packs come with the wrong number of supplies. In our facility these instances are written up as an incident report (as a near miss for an incorrect count) and any item and lot with more than one instance the entire lot is pulled from use. You can acknowledge how your coworker feels and still stand your ground ex "More than likely, it was a recoding error, but to be sure - we are going to get the x-ray because that is safest."

I am lucky - the attendings of the group I primarily work with are very patient safety conscious. They know the policies we most commonly have some issue with, and are agreeable to following them. You could have written the physician up for not only refusing to follow the policy but suggesting you just change your numbers so it'd be correct. THAT is the thing that concerns me the most about your situation - suggesting you just ignore it and change it? No. That would NEVER hold up in court or in front of the Board of Nursing. Protect yourself so you can protect your patient.

Also along with the physician's behavior - look at your facility's policy for chain of command (ie who you take concerns to when they are dismissed by the attending/charge nurse etc). I had a situation where I was floated off service once, we had an incorrect count, and everyone else (OR staff) in the room tried to dismiss it - until I called one of the charge nurses in the room to help look for the item. The more people you can get involved, the more likely people are to cooperate.

Don't feel like less of a person - you did the right thing. Mistakes happen - I know that my coworkers had count errors like that. It happens. Just be the type of nurse you'd want caring for you and your family. You don't have to be loved by your coworkers to work well with them.