What would you have done in this situation?

[samaletta]

I am a senior nursing student with one semester left (woohoo). I recently finished my maternity nursing rotation. During this rotation I had the privilege of observing in the labor and delivery room. I helped to care for a single woman giving birth to her 3rd child. She had NO support person with her, which really got to me. I told her that if she wanted me to, I would stay with her.

She had a history of delivering fast. The doc came in and broke her water, and she started to dialate and efface rather quickly. The anesthesiologist was paged to do her epidural. She began to progress in the first stage, (maybe late active). She was in PAIN and asked the anesthetist to please hurry.

He stated in a cocky manner "Hurry? You want me to Hurry? I am dealing with you spinal cord and you want me to Hurry? We can't hurry in situations like this."

She was quiet for a few more minutes, while the doctor continued to mumble "she wants me to hurry". Her pain escalated and she was crying. She began to get impatient again, She was crying while asking him to hurry please. (I didn't see her as being impatient, but the doc did, thats what I meant)

The doctor said in a stern voice, "Oh you want me to hurry. Maybe if you were a little bit smaller I would be able to go faster, but you're not. You want me to hurry, but if I hurry and we have an accident, who are you going to sue? Are you going to sue her?" Then he pointed at the RN in the room. "Are you going to sue Me?" Meaning himself

The patient was crying and said "no" in a small voice.

The epidural was finally complete, (yet ineffective for pain relief D/T her being so far progressed).

The RN never said anything to the doctor during this entire situation. I didn't say anything during this situation. I was in the background "observing". I felt intimidated by this doctor. I can't imagine how the patient felt. I NEVER want this to happen again, whether I am a student nurse, or a working RN. I realize it is my duty to be a patient advocate, who else will be? But what could I have said or done in this situation?

I hope that assertivness and confidence comes to me soon, because I obviously had none during this situation.

What would you have done?

Please don't tear me apart for not doing what I should have done. I feel bad enough for letting him put her down the way he did. I'm looking for some constructive criticism. Please?

[arizonanurse]

I remember when I was a CNA student I was allowed to observe a lady partsl birth. They tried to get the epidural in for an hour - must have been five or six tries. The poor lady kept asking them if it was almost done, and the snotty doctor would say, "You need to hold still. No, we are not done. Do you want us not to do it?" in the most even, cold voice I had ever heard. She finally cussed them out, told them to leave and delivered the baby naturally, go girl! And I stood in the corner and did nothing because there was nothing I could do

If I was in the situation again, though, I would just ignore him. Don't give him so much as eye contact. As a student nurse, if you speak up or get confrontational, you're just going to be kicked out. Instead, I would have just talked to the patient - held her hand, told her "hang in there, just a few more contractions, you can do this, you will be holding your baby soon," you get the drift. Keep talking, telling her to breathe and how great she's doing. And then cry in the car all the way home at how poorly she was treated (at least this is what I did ).

I hate when I see this happen. Thankfully most docs aren't like this.

[GardenDove]

You are there as a student and I believe you did the right thing. You learned from the experience. You can perhaps role play in your mind how you will handle this situation when you are the nurse. It's a very delicate one.

In OB the nurses work very directly with the docs. There might be a pattern of behaviour with this doc. They know the territory, they can bounce it off of their collegues and get ideas. I think for you to intervene would have been inappropriate, esp in front of the pt. That's my opinion.

[scribblerpnp]

As a student, I think you did what would be expected of you. Hopefully the nurse had a talk with the doctor out of the room and not in-sight or hearing of the patient- which would be the most professional action. And hopefully it would go something like how that it is not appropriate to speak to a loboring woman in that manner (or any one). I've said this to MD's in similar situations (respectfully, of course, and NOT where someone else could hear me.) Whether they still do it to these poor people, I don't know, but they sure don't do it when I'm around) Some small lecture about how people in labor are in PAIN and want it to be over quickly would be a good start. Totally uncool of the doc.

Unfortunately, as is the case with most doctors, even if the nurse were to formally complain and even if the patient were to formally complain, nothing would change.

Sometimes all you can do at the moment is give the Look of Sympathy at the patient and the Death Stare to the MD.

[samaletta]

Thank you all for your responses. I tried to think of what i could have done both as a student nurse, and as an actual nurse, and I could not come up with an answer. I did consider what arizonanurse said about holding her hand and talking to her. I wish I would of been able to do that for this woman, but I felt pretty much helpless. I am relieved to hear all of you pretty much say, there was nothing I could have done to intervene in THIS situation, but it was quite a learning experience! Thank you all!! :nuke:

[TazziRN, RN]

Not much you can do as a student. You are a guest of the hospital, so you're very limited in what you can do or say. As her nurse, I would have either started talking to the pt ("Hang on, he's almost there. You're doing great, hang on") or asked the student to do so. Later I would have either cornered the doc and reamed him out or written him up. Nobody talks to my pts like that!!