Thursday, September 25, 2008

Do I Really Know What I'm Doing?

So yesterday was the first time I really wondered if I'm ever going to be a Labor nurse like the nurses that I look up to. I worked with N yesterday, 'cuz I needed an extra day. The patient I walked into at change of shift was about 1 1/2 hours into pushing, and trust me, that's the worst time to switch patients. The first thing you see of them is them up in stirrups and you're supposed to go over and introduce yourself? Right...I wasn't too convinced that this gal was gonna be a great pusher, and we pushed and pushed in this position and that position for another hour and a half. I wasn't seeing much progress and I think we were both getting a little frustrated and poor girl was getting tired. Then Dr. M walked in and somehow put his hands on the head and made it happen. I love Dr. M, he did the first delivery I ever saw and I've always just thought he was a good doc. N came into the delivery, but she scrubbed in to help Dr. M so I really was kinda doing it on my own. That was the first time I actually had to think it all through and do all the pieces myself, and I don't think I was really prepared. I've decided that it's really hard to jump into the middle of someone else's delivery and then when the Dr. comes in and works magic and you're not expecting it, it's really easy to get behind.

Everything went pretty well until the end when he was repairing. She had a posterior vaginal laceration that seemed to just want to keep oozing no matter how many stitches he put in. He was already 30min late for his office so that didn't put him in the best mood, and then this laceration kept oozing. He wanted some vag packing so I went to go get it. I knew exactly what he wanted, but had no idea where to find it, it's not something that we use...ever on the unit, so it's not something I've gone looking for before. I learned a long time ago that it's usually better to just ask someone where something is if I'm in a hurry and don't have time to just stand around looking for it. So I asked one nurse where it was, she had no idea what I was talking about. So I asked another nurse, they handed me something they thought was it, took it back into the room, Dr. M said "that's not going to work. What were they thinking?" So I went out and found another nurse...still nothing. 3 items, 15 minutes, and a very frustrated Doctor later, we found one roll of packing and he was only an hour late for his office. Amid comments such as "does anyone know what's going around here anymore?" and "Where's the person in charge when we need them" he left without writing in the chart or clear orders. When he came back over for another delivery later, he was still upset about it and even asked me "How long exactly did we have to wait for the packing to get put in place?"

The one thing I didn't want to ever do is develop a bad reputation with doctors, because I've seen that once they don't trust you, it's nearly impossible to earn their trust again. I don't want to always be known as the "new nurse who doesn't know what's going on" but at the same time, I am new at this, and I don't know everything, but I still feel like I'm supposed to, especially around the doctors. I just hope that this one delivery isn't what Dr. M thinks of every time he sees me as a nurse.

The couple turned out to be fantastic, really sweet and the baby was beautiful. I went over and saw them again this afternoon after my wonderfully exciting basic dysrhythmia class...flashbacks to Critical Care class last semester. So I guess yesterday wasn't all bad, but it did frustrate me a little bit. Every time I feel my self-confidence level rise the littlest bit, something happens that sends it crashing back down. I'm waiting to make that one decision, at the right moment that proves to myself that I really can do this.

So things I learned yesterday:
1) Make sure that you're comfortable with the situation that you walk into. When I was nervous about what I was doing yesterday, and pushing with a patient all by myself I should have told N and not just pretended that I was perfectly fine with it; that's how I'm going to get myself in trouble.
2) Make sure that you're ready for delivery/procedure before it happens. I should have taken 5 minutes to really make sure that I had the room set up how I wanted it before I started pushing with the patient in the first place. Cord gases, pads, towels, etc, etc. That would have saved me from being flustered when the "magic" happened in the first place.
3) Deep breaths are a good start for any problem. I know (well, I think I know) that Dr. M wasn't necessarily upset at me personally for not being able to find the packing, but I shouldn't have let it get to me personally even if he was. I did make a right decision by asking someone, but when one person couldn't find it, I should have just gone straight to someone I KNEW could help me(central distribution) and then at least have been able to tell Dr. M that it was certainly coming.
4) Just like so many nurses have told me already, becoming natural at this takes time, and there's nothing I can do about that. The only reason they seem like they've been doing it forever is because they have been. I have to take it one shift at a time and learn what I can from that shift and apply it to the next one. That's just a rough lesson to learn.

Babies today: 1F
Babies total: 16M/14F = 30
Vag:10M/13F = 23
C/S: 6M1F

1 comment:

  1. I like how you keep "score" of your deliveries/births. I wish I had done that from the beginning! Don't be so hard on yourself about being prepared, and responding to the docs requests. It takes a good 1-2 years before you feel really confident and comfortable working in L&D. You're definitely well on your way though - you looked at the situation (afterwards) to see what you could learn from it, regarding better preparation. keep up the great work!