Saturday, August 22, 2009

Slack Nursing Care

Ok, I'm sure I have ranted before about this topic...but it's boiling up again so here goes...

1. If a patient is there for pitocin for an induction - you have to turn the pitocin up from time to time. There's every reason to believe that if you would just increase the pitocin in a timely fashion, the patient would deliver before I go off call. That's what both myself and the patient want. But becuase the nurse doesn't want a delivery, because she's the f*cking laziest nurse I have ever met....not to mention scary and totally clueless, an hour and half will go by before she increases the pitocin. And I looked at the strip during that time....contractions were spaced out, baby looked reason not turn the damn pit up. The goal is to have a baby. But apparently just not on her shift.

2. The patient is there for induction due to preeclampsia, on mag. She had a foley bulb in through the night and pitocin started early in the morning. The day shift nurse checks her at 7:30am when the foley bulb falls out and her water breaks (the patients' not the nurse). I sit down to chart on the patient at 10:00 am. I look at vital signs....last temp was done at 9pm the night before! Uh hello, temp for baseline when her water breaks and then every two hours thereafter is the policy I believe?????

3. Pericare - if a woman is sitting in sh*t when she's pushing, do you think you might wanna clean it off from time to time? Or a puddle of fluid and blood-tinged mucusy stuff...maybe clean it up before I come in the room and start doing it myself? Hey nurse, if you were the patient, would you want to sit in that stuff for hours? If this was your family member, would you be ok with that? Clean the sh*t up then please...(literally)

4. So there's this sheet in the chart that says physician orders (I know, it irks me to, wish it said provider orders or something). It doesn't say physician suggestions. Orders. That means you have to read them and follow them. What a concept. If a provider orders labs for a certain time, maybe instead of just noting the orders off, you should read them first so as to not miss important information like mag levels and PIH labs. Hmmm...

I swear, I have to come in and be the nurse as well as the midwife. And please don't get me wrong, I like to help out but dayyyyummmm. Could you just do your job.

I used to think that it was because I am a CNM that some nurses felt like I would handle those things. I remember a nurse (lazy a$$ nurse mentioned in #1) telling me "oh I love midwife patients because then I don't have to do anything". Uh no. You still have to do your job.

Your job = basic nursing care
My job = labor support and management
You doing your job = priceless

But I really think that some of these nurses provide just as crappy care to doctor patients.


Labor Nurse, CNM said...

funny, I think we might have the same nursing staff. No seriously, many of the nurses I work with are very good, but just had a delivery recently where the patient was sitting in crap, blood, amniotic fluid, you name it. As a nurse, I would have been cleaning the patient b/t every push. So I was shocked when the nurse in the room just sat on the stool. Even the patient was commenting that she smelled like poop.

Prisca: said...

yeah, i can see where that would would piss you off!!

Anonymous said...

My ob delivered me when I had my daughter and the same crap happened to him. His orders were NOT followed. I was induced for pe. I had had severe pe twice before so he was inducing me at 36 weeks while it was still mild with a mature amnio. The MFM wanted to deliver me at 34 weeks and I refused with my ob's approval. Anyway, my labor nurse told me according to her I didn't have pe. My bp was skyhigh from a baseline of 110/70 to 160/110 with max ziac and procardia. I had had a headache for 2 weeks that would not go away but was dimmed by fiorinal. I had brisk reflexxes, and I had visual issues. My protein was near diagnostic a week before at 276 in a 24hr urine. According to her I was not preeclamptic. Umm, I think I pay my ob and peri for those decisions. Several nurses refused to give me fiorinal. I told them he ordered it and I wanted it. Being a pe patient, you would think actually doing my labs would have been important. Um, nope. Labs were never run the next morning. I asked for motrin after I had her for cramping. I was told it wasn't ordered. I got my medical records. Not only was it ordered but so was LORTAB up to 10mg for severe pain. Needless to say a long letter went to the nurse manager of OB. Now that I work in a hospital, I will be speaking up and requesting a different nurse next time.