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Discussion in 'Anesthesiology' started by ncdoc1974, Dec 17, 2008.
Please share your thoughts If your nurses are worse than mine, it may make me feel better.
Most of ours are excellent. Problem is that they tend to play by one script. And, when the patient deviates from that script, all hell breaks loose and they don't know what to do.
L&D nursing has its own niche culture, similar to how OR and NICU nurses are completely separate from the rest of "nursing".
And because they are somewhat isolated, certain beliefs or perspectives tend to persist without much outside influence (or checking).
X2 on following "the script".
Just to help you feel better (and to vent a little)
Nurse with prep stick for C-section belly- Me holding the uterus off of the vena cava with my hand while resident gives pressors for 50s SBP after spinal- "are you doing anything important or can I start prepping".
Another-As we are about to slide a crash c/s over to the table, my resident asks the pt to open her mouth (airway exam) and the OB nurse yells "we don't have time for that!" I got written up for my reaction to that one.
When asked to do a saddle block spinal in the labor room for an episiotomy repair I said we have to have standard ASA monitors and OB nurse says incredulously "you need all that for THIS?"
L&D nurses demanding that our residents put morphine in our c/s spinals even though there are contra-indications in a given patient. And then talking to their head nurse when my resident didn't do it.
I have several more, but you get the picture why I am happy that I no longer have to go up there.
My favorite L&D nursing call was in the middle of the night as a resident:
"The patient in room 4 won't agree to an epidural. Can you please go and talk her into one?"
We have some very, well pretty good ones as far as OB nurses go. But the other morning (3am to be exact) I'm walking out of a labor room after placing an epidural and this nurse that I don't know very well says to me "you need to put an epidural in my pt." I smiled (sort of) and said I don't know anything about that. After talking to the midwife I said where is the paper work for your pt. She tells me, "I don't do paper work" to which I said "I don't do epidurals without paper work".
I sometimes find that too, Noy. They tend to treat us like 2nd-rate technicians up and until the doo-doo starts to hit the fan. That's why I make it a point to smile, coddle them, get to know them, and b.s. around with them when I get the chance. Even for the few minutes. It pays off. If they call me to start a tough IV, I'll do it (if I'm not in the middle of something else).
Fact is, most of them don't know us by name our reputation. They know me. And, that pays off. You tend to get treated a little better. I don't get the "hey, anesthesia" when I go on that unit. Problem is, so many of my colleagues can't get off of that unit fast enough. That's our fault, not their's.
Why do you think it is this way?
Our OB nurses know all of our names. We never get the "Hey Anesthesia".
I think I can safely assume that your marriage to one of these evil nurses did not have a happy ending?
Who got the condo??
Here is how it goes usually in residency:
The anesthesia residents have a reputation of being lazy, not a type personalities and less respected than other specialties because their attendings are lazy, not type A and not respected.
Nurses are sharks that are constantly looking for victims.
Nurses find out that anesthesia residents have a reputation of being lazy, not type A, and not well respected so their natural reaction is to devour them alive.
The devoured residents respond to the aggression by developing a passive aggressive attitude that in turn confirms the assumption that they are lazy, not type A and not well respected.
The result is residents who hate OB nurses and OB nurses who are convinced they can do anything to anesthesia residents and get away with it.
Well thats one way of looking at it.
I agree. At the first sign of disrespect, you pull said nurse aside and tell them you won't deal with their crap (away from the patient, of course). Been there already and put the brakes on it the first time it happened. Now, I am introduced by them to the patient as "the anesthesiologist is here to put your epidural". I give them their due respect but also demand they do likewise.
Or alternatively they are primarilly composed of know it all, passive-aggressive, unhappy, angry, loud-mouth women who are attracted to that environment just like anesthesia people are generally attracted to the opposite...or at least i like to think so . But youre probably right
I think it is because most anesthesiologists find that working on L&D is not rewarding, for some reason. Personally, I really enjoy it. All the L&D nurses know my name, they generally (except for one or two, who have their own issues) respect me and what I can offer the patient, and they know that I'm helpful without "pushing my agenda" (at least as they perceive it) on the patient.
We're seen as outsiders, I think, and we work to perpetuate that. Rarely is anyone "assigned" to L&D (by that I mean stays there and actually hangs around on the unit, not just having to cover the patients). We show up, put an epidural in, and generally leave - maybe periodically checking on the patient or only coming when called.
When that's your service track - that they are "secondary" to other things you have going on in the hospital - I believe that they start to think you don't really care about them or their patients. It's amazing how much just listening to the concerns, and correcting their misconceptions, can help. Having a dialogue does wonders.
When's the last time you actually sat down and had a dialogue with an OB nurse that didn't consist of complaining about why a pump wasn't set-up, why they called you first before getting the patient to the bathroom, why they didn't call you when the patient first hit the unit and now they're at 9 cm... etc.
I frequently talk with the OB nurses during the regular business hours. I don't talk much at 3 am. If I do t ain't pretty.
you have to be careful with that one tough. Although i agree with pulling them aside and talkign to them.. just have a witness when you are doing it.. If you dont feel like having a confrontation just write a letter to the vp of nursing and the ceo of the hospital stating your concerns about said nurse. you dont have to mention anything to her. or if you dont wanna write a letter.. just give the vp of nursing (every hospital has one) a call and chat with him/her.
they eat at the desk, they gossip, they are usually overweight and they think they know everything. you ask for fentanyl they say why not dilaudid, you ask for dilaudid they say why not fentanyl you ask can i have some cricoid and they say which cabinet do i get it at? these are the same nurses who truly believe they know whats best for the patient medically. i trained for 4 years and i still wrestle with myself trying to figure out what is best.. that is whats most vexxing. the best way to deal with it is.. limit your exposure down there as much as possible.. easier on the coronaries.
if you wanna sit around have coffee and donuts with the l and d nurses thats your business. I go down there its all business. The things we complain about are vitally important for patient safety. They are not mild preferences. for example, I was called from home about 6 months ago to do a c section. I asked the nurse to make sure there was an 18 g iv in the patient. I came in. the patient was in the OR. the surgeon was scrubbing. The patient had a 20 g iv in. I told the head nurse call me when there is an 18 g iv in. Delayed the case like 30 minutes. I wrote a nice letter to the vp of nursing. you dont wanna mess arond with a positional 20 g when the uterus is not contracting.
You delayed a case for 30 minutes because of an IV? It was probably all the nurse could do to get a 20 gauge in.
Why didn't you start it yourself?
And what did you do for thirty minutes?
I have to imagine that if it took thirty minutes to start an 18 gauge IV by the nurses then she wasn't that easy of a stick.
i could have started it myself. what good would that do? I would just be having the same conversation sometime down the road. Thats HER job and I asked her to do it and she failed in her task. So i made the surgeon wait. and i wrote a letter to the vp of nursing. and you have to understand something. They have no concept of doing anything in a timely fashion.
i dont remember where i went. to the physician slounge to chill.
Sounds like the pot calling the kettle black.
You didn't like when I generalized about locums but you are generalizing about nurses. You can't have it both ways.
you are really starting to show our true colors.
Let me summarize just to make sure I have all of this straight.
The pt. is very close to being prepped and draped and ready to go. I assume you are going to do a general anesthetic since you never perform regional after 7 pm.
The nurses FAILED to start an 18 gauge IV and all they could get in was some little piddly 20 gauge.
You decided to pout and went to the physicians lounge.
It took another 30 minutes to get the case going.
You made some new friends that night
You wrote a letter to whine and cry over a FREAKING IV?
Can you not do a c/s w/ a 20 gauge, or was it a "matter of principle"?
This is unbelievable. Please permit me to make an assumption and that is to say that it seems as if there is an obvious reason that you do locums.
This is all kinds of WTF.
i dont do locums.. i have full time job. And I get along with everybody.
patient wasnt prepped and draped she was sitting up waitign for me to put in the spinal. ANd thats one exception. I do spinals for OB. There is no way i could get away with tubing all c/s. nor would i want to. and NO i cant do a cs with a 20. Have you ever been caught in a situation when you need a good iv and didnt have one? i learned the hard way so I secure my access prior to induction. and sometimes you have to make a point otherwise you will be walked all over. I could have started the iv in 2 secs.. but thats her job
the way I see it, the faster its done the faster Im back in my bed sleeping. So I would have had a discussion with the nurse, popped in the IV done the section and gone back home to bed 30 minutes earlier.
fonix is right, anything that gets the show on the road is good, however annoying...
i find that it makes a difference to give them positive feedback (wow, thats a big iv, thank you..), over the long run i noted quite a difference . ultimately we're all human and people just respond much better to praise than threats.
if things don't work out i will have a frank discussion , but make really sure that there is a witness, ideally their supervisor.
maceo - sometimes nurses are just not that good at iv's. If I need a better iv, I will start it. The nurses (in general - here we go again) are more likely to torture the patient with multiple sticks, then blow all the good veins. Some nurses are pretty good, but I will take my chances with my own skills any day. The patient is my first priority, and I would rather get a good iv myself. I will also do a section with a good 20 g any day of the week. You sound like you are trying to piss people off.
I can just about assure you that would have been your last case if you worked with my group. Absolutely pitiful and totally unprofessional. The patient suffers while you go pout in the corner.
You can't do a C/S with a 20? Puhleeeeze.
Yes. Hard to imagine. Even a Partner would be scolded for that behavior. Second offence would result in a severe, official reprimand. You can guess what would happen after the third time- even to a full partner of 20 years or more
In my group, you would receive a demerit. Three demerits and you'll receive a citation. Five citations and you're looking at a violation. Four of those and you'll receive a verbal warning. Keep it up, and you're looking at a written warning. Two of those, that'll land you in world of hurt. In the form of a disciplinary review, written up by me, and placed on the desk of my immediate superior.
The next step is a full disagulation...you don't wanna know what that is!
If only dwight were a doctor.
Dam nit, where did I put my abacus?
Good Office ref
I didn't know you worked for the United Nations.
i cant do a c section with a 20. that is correct.
She put the 18 g in and we moved on..
Why would it be my last case ? because im looking out for patient safety. How did the patient suffer?
i dont work at that kind of place where doctors reprimand other doctors
I'm not understanding how your actions here put the patient first and not your own agenda first. Perhaps it's still my starry eyed student-ness, but i'm still under the impression that the patient comes first in this biz? At the very least I imagine the OB who's ready to operate is not too happy with your conniption, so at the very least you're draining off some of that priceless interpersonal capital that Jet and others write about.
From the Office to Seinfeld...
I'm breaking up with you: ......(Hand is social and political capital)
George: But I've got hand....
Girlfriend: And your gonna need it.
I've read the thread.
Alotta s hit followed by alotta feel good stuff.
Heres my read on L&D nurses:
ALOTTA THEM HAVE PERSONALITY ISSUES YOU'D RATHER NOT DEAL WITH.
I'll leave it at that.
exactly. I couldnt have said it better. Im pretty certain that's the only person I was putting first . tell 'em jet.
Give Maceo a break here. It was obviously an elective C/S and pt/baby were super fine when he demanded a second IV.
You are seriously missing the issue here. Just as maceo has missed it all the long.
maceo is a ego maniac trying to push his weight around to a nurse.
The bottomline is if you want something done right, DO IT YOURSELF.
you think i' m an ego maniac because you have a low self esteem. I wasnt trying to throw my weight around, i seriously wanted an 18 g. I never ever ever. start a c section with anything less.. NEVER.. Do i have to go over all the reasons why NOT to?? the nurse knows that too. Every patient at first stick before induction of labor gets and 18 g. this nurse tried to get away with somthing by putting a 20 in cause she didnt wanna put an 18 g in. You havent done enough cases pal, maybe a mini fellowship is in order.
then i would be doing everything!!. sometimes you have to show them how to help you and how you want things done