I would like some honest input from my peers. I live in an area that has only two major hospitals. I switched from the bigger of the two to the smaller hospital due to schedule changes - my former hospital did not offer evening shift, only 12's and I could no longer work night shift for various reasons. For the most part, I like my new job very much. The pace is a little slower most nights (a looooot slower) and I just love what I do, so i'm adjusting. It is hard at times because they do a lot of things differantly but I'm getting used to it. Oftentimes my new co-workers talk about my old place of employment in a very negative manner - basically that "they" are a bunch of idiots....I don't recall any of my old co-workers ever mentioning my current place of employment as we were usually to busy running our tails off....Last night I was working with one other nurse who is fairly new (6 months of experience). There are always two nurses per 3-11 and 11-7 shift. She is really quite good and a pleasure to work with. I got a call from the ER and they told me that we had a patient of Dr. _____'s coming in (this doc works at both hospitals so I know him.) They gave me the following info: Pt is 24 weeks, states her water broke, is having contractions, states she has the urge to push, is in a lot of pain. I tell my coworker to set up a room, to get IV supplies ready, I call the nursery to give them a heads' up. I page the Doc so I can give him a heads up as ER told me she would be arriving any minute and coming straight to me. There was a lot of confusion as to who was on call with the group that I called - there are three groups, the one that I called happens to be the only one that also worked at my old hospital, so the all know me, and I've never had a problem with them. Anyway, during the phone calls to get to the correct on-call doc, the patient is brought up via stretcher accompanied by the paramedics. She is screaming, crying, scared to death. I follow them into the room, help transfer her to the bed. Take off her pants, tell Marcy to establish IV access and to draw labs. Put oxygen via face mask on her, try to calm her down (she's crying and telling us that she's hurting and feels pressure). I note no bleeding -ask her if she thinks her water broke, she says she felt something come out earlier. She then says she fell. I palpate her abdomen and it feels moderately firm. Is she bleeding internally? I look at vital signs...fine for now. She looks about 24 weeks, but we have no prenatal records on her. Whole other story... Within minutes, we have labs drawn, an IV going, we've position her in left lat trend, oxygen per face mask, and thankfully get fetal heart tones that sound great. We establish a history. During all this I got word that the MD was on his way. As he walked into the room and recognized the patient. He privately told me that she has done this "act" before and hoped that was the case this time. He performs a pelvic exam with speculum, orders IV pain meds, performs ultrasound. Everything looks fine. He tells me, good job..at least my new nurse coworker will know what to do in case something happens for real. We'll watch her overnight. He was very pleasant and acted relieved that the patient was ok and left after about 10-15 minutes. Signed the orders and left. The new shift comes in and I give report. They tell me that I better be lucky that this patient didn't belong to the other group (the group that I don't have a lot of experience with) because they would have chewed my a--. They tried to make me feel like a complete idiot for calling the doc before the patient was in-house and I should have done a complete assessment on her before calling him. They say this isn't like my other hospital and we have a lot of "princesses" here. They say, "well, you know that group (the one I called) better then we do (the group i called rarely delivers at our hospital and prefers my old one. This new hospital is private by the way, the old one is not. Should I have not called the doc? Normally, I would always completely assess the patient, but she came up via ambulance and with what the ER was telling me I figured the doc would have to come in anyway....Did I over react? As I left, my new co-worker was very angry. She told me that she was proud of the way we handled the situation. I had tears in my eyes in the parking lot because they were so critical of my actions...what would you have done?
I read your post this morning before anyone applied, but didn't answer because I'm not yet a nurse, but I am a mother who delivered at 24 weeks. Granted, in your situation, it seems that the patient thankfully wasn't about to deliver, but in these siuations you can't take chances. I know how quickly the situation can change - I also delivered fairly recently at 28 weeks. If you had been my nurse, I would have been grateful. As has been said, what if she HAD delivered and you hadn't called the doctor? What if her situation was such that she needed an emergency c-section, as I did?
You absolutely did the right thing.
Now I just hope that woman never has to know what it's like to deliver extremely prematurely.
Thanks - Your situation is the very reason that I did what I did - in my mind I thought, ...24 weeks - this baby has a chance - I told the nurse that I was working with, "What if this was your sister...or you.?" Wouldn't you want us to do everything in our power to help?!!?
I gotta tell you, when I was a new nurse (a long,long time ago) I was terrified to call docs at night then one night I thought that it was just plain stupid to be so afraid. I am there for the patient and that patient trusts me to let the doctor know if something is amiss. The doctors knew when they became a doctor that people get sick 24 hours a day not just in the daylight hours. If they yell at you, big deal. Thats why they get the big bucks. After 28 yrs of nursing, I have never been yelled at for calling any doc for any reason. They may get testy when you wake them up, but then so do I. You are just doing your job. I always think for the patient not for someone elses B.S.
Good call. I'm sure you know it doesn't take much for a 24 weeker to be coming out. Better the doc lose some sleep and be there if needed. Screw what your new coworkers think. You did what was right, and I hope you'll continue to do so.
Don't doubt yourself- you DID the RIGHT thing. You are there for your patients, they are our priority.I had a md yell at me this weekend, and then come in and apolgize. He was upset because he is always on call when his partner's patients are crashing. He hugged me and said sorry. But when he yelled at me over the phone, I hung up crying. Then I received a STAR for a fellow coworker for doing the right thing. That other nurse doesn't know what she is talking about and obviously is more worried about upsetting the md's then taking good care of her patient.
I would have done the exact same thing. We have a small hospital and only 3 ob/gyn docs. We all know them very well, I would of called any of them if they were on call.
You did the right thing considering the info you got from the ER doc.
You were absolutely correct in calling the doc. You are the patient's advocate - their voice. The nurse response makes me think of a current thread "why are nurses so catty?" Maybe you should reference that thread for ideas to the temperment of your fellow staff.
I couldnt have said it better myself ( now I know what catty means).
It could have been an abruption or anything-I dont believe you can take chances with pregnant women because at the end of the day i would rather be safe than sorry.
What would you say if you didnt make the call, Sorry!!!!!!!!!!!! Try saying that to a woman who has lost her baby and you know you did not do all you could, it is bad enough saying sorry when you know you did do everything possible.
I agree with everyone. You did exactly the correct thing. What would have happened if the OB was 30 mins away and she came in complete with the urge to push??? You were acting as any reasonably prudent nurse would have!
#1 you knew the doc and new what he would want you to do.
#2 this pateint needs a spec exam and it doesent sound like you have an OB in house. You had to get one there to properly assess the pateint.
#3 I would much rather have a doc mad at me then a patint have a bad outcome. Even if it had been an error to call him you would have errored on the right side.
This would have been a differnt situation if the pateint was'nt reporting SROM. You could have assessed them and then called but nurses dont do spec exams so how could you assess her?
Every place does things differntly but I think this was a case of your cowrokers wanting to show you they know more then you. Its nurses eating their young again. Even though your not a new nurse you are new to the hospital and they want to establish dominance.
Dont let them get you down. It sounds liek you have been a nurse for a while so I'm sure you can take a doctor yelling at you and I know you would rather that then have a bad outcome.
#1 you knew the doc and new what he would want you to do.
#2 this pateint needs a spec exam and it doesent sound like you have an OB in house. You had to get one there to properly assess the pateint.
#3 I would much rather have a doc mad at me then a patint have a bad outcome. Even if it had been an error to call him you would have errored on the right side.
This would have been a differnt situation if the pateint was'nt reporting SROM. You could have assessed them and then called but nurses dont do spec exams so how could you assess her?
Every place does things differntly but I think this was a case of your cowrokers wanting to show you they know more then you. Its nurses eating their young again. Even though your not a new nurse you are new to the hospital and they want to establish dominance.
Dont let them get you down. It sounds liek you have been a nurse for a while so I'm sure you can take a doctor yelling at you and I know you would rather that then have a bad outcome.
You did the right thing.
I do spec exams all of the time to assess SROM and dilitation on possible PTLs. I am in CA. Is this a hospital to hospital thing???
I do spec exams all of the time to assess SROM and dilitation on possible PTLs. I am in CA. Is this a hospital to hospital thing???
Yes, definitely, (perhaps a state to state BON thing as well? I'm not sure). I'm in NH. Shortly after I was hired, but before I began orienting to labor (LDRP floor), what had become a muddled issue was clarified and our policy changed to reflect that nurses do not do spec exams on patients under 34 weeks, the provider must come in and do them.
As for the OP- you bet I would have called a provider when you did. If we had a patient coming in by ambulance for any reason, the provider on call needs to be notified. They can choose whether or not to wait until we have assessed the patient to come in, but we do notify them as soon as we know something is coming in.
Why would any coworker be annoyed with those choices? Ridiculous.
Because they're not upset because they feel she handled the situation poorly, but because they're jealous she handled it so well. She's probably been handling a lot of situations well and they're beginning to look for little ways of bringing her down.
fmrnicumom
374 Posts
I read your post this morning before anyone applied, but didn't answer because I'm not yet a nurse, but I am a mother who delivered at 24 weeks. Granted, in your situation, it seems that the patient thankfully wasn't about to deliver, but in these siuations you can't take chances. I know how quickly the situation can change - I also delivered fairly recently at 28 weeks. If you had been my nurse, I would have been grateful. As has been said, what if she HAD delivered and you hadn't called the doctor? What if her situation was such that she needed an emergency c-section, as I did?
You absolutely did the right thing.
Now I just hope that woman never has to know what it's like to deliver extremely prematurely.
Tiffany