Saturday, September 19, 2009

Birth with Nurse Crappy

I came in for a labor patient. She was 4cms and planning natural childbirth. This would be her first baby and we had met in the office a couple times.

The nurse assigned? Nurse Crappy. F*ck. I now can anticipate a long day of substandard nursing care. We start the day off with Nurse Crappy asking if she can give stadol to the patient. IV is already started with fluids going. Granted the patient came in just before I came on and the offgoing CNM gave pain med orders. I ask if the patient has tried the tub yet? Of course not. She was ready to jump start to meds. She had probably been in the room pushing an epidural already!

I got the patient in the tub, which she really liked. All is well for awhile. Then she gets out and wants to be checked. Now she's 5-6 cms with a bulgy bag. She wants to try pain meds...no problem. Gets her stadol and sleeps.

Time goes by and she wants more stadol...I suggest getting back in the tub, which she does. Then out again for a vag exam and stadol. She's 7cms with bag still intact.

Throughout this time, I only saw Nurse Crappy go in the room to immediately strap her on the monitor when the patient was back in bed. Otherwise, she sat at the desk. She gave up her other patient to another nurse. She starts asking me if I'm gonna break the patients' water. Umm, not at this point.

The patient would periodically vomit. Guess who's holding the bucket and doing clean-up? Me and the boyfriend. Now, I don't mind helping with these things but I kinda expect that the nurse will not assume that I will provide all nursing care! That's not my ultimate job. I also helped with intermittent auscultation. Also the nurses' responsibility.

Guess what else got done by me? Freshening up the linen and chux.
So anyway the patient ends up stalling at 7cms. I discuss various options with her (do nothing but positioning, ambulation,etc, add arom to the first option, or epidural then arom) and she opts for epidural and arom. I tell Nurse Crappy the plan and she says "oh ok, and then start pit?" We all start laughing and I tell her how about we see if the arom and epidural help...one intervention at a time! Geez.

So she gets her epidural and is comfy. I break her water and she's 8cms now. She throws up some more while Nurse Crappy convieniently disappears.

She progresses to complete after me reminding Nurse Crappy to flip her from side to side periodically. The end of the shift arrives but the patient isn't feeling pressure to push so the plan is to have her labor down and a new nurse (my BFF) will take over as well as the oncoming midwife.

Then the patient throws up some more and feels pressure. So I recheck her with the oncoming midwife to find the baby at +2 station. So I decide to stay and catch. We have a beautiful delivery after only pushing for half an hour, over an intact perineum (she had a nice healthy stretchy perineum).

I'm on my way home when I get a text from my BFF. She tells me that Nurse Crappy never checked a temp in the entire twelve hours!

3 comments:

Beetus said...

Nurse Crappy is very apropos. You had my ROTFL! Nurse Crappy!!!! I'm going to have trouble not using her new nickname. You watch..."report given to N. Crappy".

Did you know that one of the first things the pt said to me was that she "hated" the nurse she just had? I said..."Well, I'm nothing like her honey, so let's have us a baby." She giggled and we had this instant bond. It was cool. Plus, the fact that you were able to catch..well, it was an absolutely lovely delivery.

I had all three of them tucked in the bed later. The FOB, the new mom, and baby skin to skin. So sweet.

Joy said...

Oh geez! If I end up with Nurse Crappy at my hospital I'm going to be requesting a new nurse. Ugh!!! It just sucks that you won't know who you have until you're there. Sometimes you're in so much pain you don't care so long as someone gets that baby OUT.

Joy said...

PS I'm glad you were there to keep things running smoothly! She wanted to start Pit right after the AROM?! UGH!!!!!!!!!!!