Saturday, December 12, 2009

Fired

I know, 3 weeks is a long time to go without blogging...but 3 weeks is a long time to go without a baby too!! We've all been running our tails off at work the last several weeks, but I've seen no fruits of my labor. I keep getting antes, cervidils or getting a labor patient started and then leaving them blocked, comfy and well on their way in the morning...just to let someone else get the fun of delivering :( Even worse are the nights I've come in and had 3 recoveries to move...that's just the dirty work!! Oh well...I guess it's all a part of the process, so I'll do it anyway.

I did get "fired" for the first time by a patient this week. I was more than a little upset and hurt by it...until I found out that there hadn't been a nurse yet that she'd gotten along with...including the "reverend mother" of the unit (the sweetest, most caring, gentle, knowledgeable nurse on the unit). The first words out this woman's mouth were "how old are you, how long have you been a nurse and do you have any kids?" I guess my answers of "23, 2 years and no" weren't good enough for her. I didn't mention the fact that I've helped/observed with birthing a baby many more times than she has. I know, it's no replacement for actually doing it myself, but it has to count for something, right? She wasn't happy with the fact that since she was already being induced early for PIH and really high pressures that I said that an epidural might be something to think about, simply because as labor progressed and her pain got worse her BP's were going to naturally keep getting higher...and wasn't really what we wanted (hence the fact we were delivering her early). She did go on to deliver unblocked, so I guess that showed me. From here on out I will no longer be asking someone if they would "like" me to check their cervix to see how far they're dilated...since I'm the nurse and supposed to be managing them. Good grief. I felt bad for the nurse I handed her off to...

Since Thanksgiving I have yet to work another 3 in-a-row. I've been using up some of my required PDO time, so I've only been working 2 scheduled days, plus whatever extra I pick up. This next week I go back to my 3 nights...and I hope I survive!!

3 comments:

  1. I've never "fired" a nurse though I should have. Not having babies does not make you a bad L&D nurse, and neither does having had babies make you a good L&D nurse.

    I wouldn't be afraid to ask to check a cervix. I personally plan to refuse most checks because I had way too many last time (every 20 mintues means I had at least 3 checks an hour plus the ones the OB did...at least 15 if not 18 checks....I felt violated).

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  2. You can't win with the 'ask if pt would like _____' vs. just kinda plunging into it... someone's not going to like it either way. Maybe a sort of middle ground would be "I would like to _____ now" and let them take it from there?

    I tend to ask, though, or say "The MD wants me to _______ (usually in the case of getting specimens/doing labs, etc.)". Some patients think you're crazy because they're thinking (or outright say it), that "YOU'RE supposed to be telling ME what to do (i.e. you are the professional that I'm paying for here- just do your thing because I don't know!)"; but more often I think that patients like to feel that things are their choice (which they are) and have a better feeling of control that way.

    And I have also been known to tell preeclamptic patients not to feel bad if they are considering an epidural (not that they should anyway), because it can help to lower their pressures and that is what is most important for a preeclamptic patient after all.

    But yep... some people you just can't win with, no matter what.

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  3. Yeah, you're not going to find a "one size fits all" approach to vaginal exams. I think the most respectful way to do it (and if you're going to have a single approach) would be to continue to ask and get their permission before proceeding. I've read many birth stories in which women felt violated (particularly abuse survivors) or as if they were a lump of meat based on how they were treated during VEs. I would not like for anyone to just stick their hands up me, and I don't think it follows "informed consent" to just tell a woman *as you're doing it* what you're doing, and not giving her a chance to say no.

    Perhaps a better thing to do is to say, "I'm supposed to check your dilation every X hours, and it's that time now. Is it okay with you if I start now?"

    Perhaps when you become their nurse (either on admittance, or if you come on shift mid-labor), you can discuss this issue or any others, find out what they would like and what they're expecting, and see if you can alter your behavior to match their expectations. Some people are going to be more comfortable with a "take charge" sort of nurse, while others are going to have problems with that attitude. You can give them a run-down of what you're supposed to do (and why), and feel out their comfort level at the onset. In this instance, you can say, "I'm supposed to come in every hour and ask you to rate your level of pain/discomfort, check your dilation, ask how you're doing, take your blood pressure..." and whatever else you're supposed to do every 15 minutes, hour, three hours, etc. Ask if she has any questions, tell her her options ("if you don't want me to interrupt you while you're laboring, I can just write down the 'pain assessment' based on how you're acting"; or "if you want to minimize vaginal exams, I can write down that you declined a VE, but I'll get in trouble if I don't check you every 3 hours"), ask if she's planning on going natural or having an epidural, etc.

    You're not going to be able to have a "one size fits all" sure-fire method for anything, because there is a wide range of thoughts, feelings, desires, etc. in women -- including the range of elective C-section for no medical reason to planned undrugged birth with a request of no vaginal exams, no AROM, intermittent auscultation, etc.

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