What is up with L&D nurses?

[ggidgetzz]

So I've only had experience with 2 institutions now, but both places the l&d nurses were mean and had a major attitude. Here they are downright unprofessional, speaking loudly and rudely about how much they disagree with calls made by attendings (it was the right call, they just didn't understand the situation and were basing these opinions on secondhand information - none of these nurses were involved in the care of the patient in question). Is this normal? I've never experienced that anywhere outside of L&D. What gives?

As a new resident I realize they have way more experience than I do but I feel awkward when they make comments like the one above while I'm sitting right next to them. They also question my decisions and imply how bad they are (ordering labwork and stuff, nothing involving patient safety or anything) loudly amongst themselves while I'm sitting right next to them, instead of talking to me directly. They were right in the end and I told them so, but I feel like they could just tell me instead of being so passive aggressive and rude. How would you handle a situation like that?

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[deleted480308]

Until I stopped being wrong, I would just let them talk.....nothing will shut them up until then. Just keep learning and get better at what you do as you gain experience

 

[22031 Alum]

There are great L&D nurses out there, I promise!!

Depending on the culture of the unit, a lot of L&D RNs become very accustomed to managing labor almost independently, from cervical checks to adjusting pitocin to deciding on and placing internal monitors to coaching pushing. With a doc just coming in only at the exact moment of baby catching. With precip deliveries nurses often do the catching as well. I've seen many nurses take pride in that independence, to the point that they get bitter about having to yield that autonomy-- especially to residents. Nurses that have a long history of working with trainees tend to be better about it overall. Younger nurses or those used to community hospitals tend to be the worst.

I agree with the advice above. You certainly don't have to suck up to anyone, but laying low until you've proven yourself is usually the best way to go. The interns I've seen have the most trouble are the ones who refuse to acknowledge that they might not be the best at tough cervical checks, or at realizing when minimal variability isn't just a sleep cycle, etc. I wasn't that intern because I was terrified and asked for validation on every little thing- so I ended up as the intern who got walked all over by nursing (through my first two blocks of OB). You want to be somewhere in the middle of that spectrum. Depending on your program's volume it will take a while for your practical knowledge to outstrip the more experienced nurses' - but it eventually will.

 

[anonperson]

This is not uncommon. L and D nurses are some of the most irritating nurses out there. At some crappy places, they get a lot of autonomy which I have issues with. They make the mistake of thinking experience as being equivalent to a residency or something. It's not uncommon for them to be completely behind the times regarding the most up to date literature.

You just have to pick and choose your battles. Don't get lulled into a false sense of security by an over confident nurse. Learn some stuff from them but eventually your knowledge will surpass them. And it's not uncommon for them to have issues with females residents either.

 

[Gastrapathy]

You are an OB? Don't worry, you'll be more bitter and mean than they could ever be soon enough. 😉

 

[FutureInternist]

They have to put up with L&D doctors 🙂

 

[SLC]

I've seen this one or twice on my OB rotation right now. I or one of the other residents make an order, they go off ranting about how "insane" it is.

But they still follow the order...

 

[ggidgetzz]

You are an OB? Don't worry, you'll be more bitter and mean than they could ever be soon enough. 😉

Not an OB! I might have been, but the personalities on my OB rotation turned me off so much that I decided I couldn't do it...

 

[22031 Alum]

Not an OB! I might have been, but the personalities on my OB rotation turned me off so much that I decided I couldn't do it...

Oh, then why are you even worried about it? Your time with those nurses is limited. Just survive the rotation.

 

[Crayola227]

just wait until there's an abruption, the belly is rock hard and purple, and the patient loses consciousness, all within like 5 min..... right in front of that damn nurse
and that L & D nurse is going to be white as a sheet and come a-RUNNING to any OB they can get their hands on
it's easy to get cocky with all your normal vaginal births and take your OB for granted
bit when sh8t hits the fan -
what you really want is a good OB with a sharp knife
there will always come a time when the nurse or midwife is not cutting it (pun intended)'

the OB is without question the least expendable profession
if all other doctors died they would keep the human race going
unless the zombies ate everybody too fast

it's odd because Mother-Baby Unit is the happiest place in the hospital.... and L&D is the most stressful

 

[22031 Alum]

it's odd because Mother-Baby Unit is the happiest place in the hospital.... and L&D is the most stressful

Mother-Baby is only the happiest place in the hospital if you're clueless about the significance of those pictures of roses or other markings on the doors of the quiet rooms. Or if the hospital is able to place those patients on a different unit.

 

[Crayola227]

Mother-Baby is only the happiest place in the hospital if you're clueless about the significance of those pictures of roses or other markings on the doors of the quiet rooms. Or if the hospital is able to place those patients on a different unit.

"only the happiest place in the hospital if" I'm clueless?
Why imply this belief means I am clueless?
is it just really fun or important to pick out one thing you can contradict, and not only do so, but in a condescending manner?

Why not just highlight the tragedies on that floor in a manner that does not make comment on or imply anything about someone else's intelligence or knowledge base?
Yes, thank you for reminding us of the tragedies on the MBU floor
that should not go unnoted

we keep having some black and white thinking on here

OK, so tell me, which ward of the hospital are patients in general happiest?
the morgue?
the cafeteria?
the gen floor?
the onc floor?
post plastic surgery PACU?
transplant unit? (they could be pretty glad post-transplant, but on the whole greatest percentage of them are waiting on the edge of death)
derm clinic? (contrary to popular belief usually old people, psoriasis, eczema, acne is bread and butter not botox)
NICU?
PICU?
MICU?
CICU?
Gen peds ward?
Dialysis?
Inpt psych?
parking lot?
giftshop?
ED?
anywhere you like
Let's take a poll

I think it is the happiest place in the hospital
pretty low mortality rate
mostly healthy young patients who did not come in with illness
unless we want to define pregnancy as illness as all the anti-OB detractors would accuse, I assumed we would not
vast majority came in healthy, leave healthy
vast majority leave with bundles of joy

is there death on that ward and it's sad? yes, but that's the hospital baby, there are more wards with more grieving parents than MBU
MBU's joy rises above the baseline level of misery that is the hospital

not the case for any other part of the hospital except for maybe your elective surgeries, but then again, those imply a problem is being addressed surgically

OB can have the worst outcomes, but the good outcomes more common and easily could be lauded as some of the best in the whole damn complex of general misery

 

[22031 Alum]

"only the happiest place in the hospital if" I'm clueless?
Why imply this belief means I am clueless?

Easy tiger. I only meant that it's the happiest place if you aren't aware of all the losses. "Clueless" was a way to say that succinctly. My philosophy when posting is generally the opposite of yours- I try to get my point across in as few words as I can. No offense was meant.

I think it is the happiest place in the hospital

And I was giving a different perspective. Just like L&D nurses/staff, postpartum nurses/staff can have a very emotionally devastating job, which is only compounded by the fact that the average person expects them to feel nothing but sunshine and joy. I can't tell you how many friends I've had recount somebody telling them "Stop looking so sad, you just got to hang out with babies all day!!" after a shift spent helping with stillbirth photos or finding funeral homes. (Or calling security to break up fights over custody, or trying to comfort an inconsolable baby going through withdrawal.) I felt your statement compounds that misconception so I was countering it.

OK, so tell me, which ward of the hospital are patients in general happiest?

If the participants and target audience of this forum were patients, your statement may make more sense. But I was writing from the perspective of a medical professional. Where patients are the happiest does not necessarily equal the happiest place in the hospital for staff. Otherwise we'd be declaring the OR, where many of us like to spend time, the most dreaded/scary place.

 

[Crayola227]

Easy tiger. I only meant that it's the happiest place if you aren't aware of all the losses. "Clueless" was a way to say that succinctly. My philosophy when posting is generally the opposite of yours- I try to get my point across in as few words as I can. No offense was meant.

Ah, thanks for that.

And I was giving a different perspective. Just like L&D nurses/staff, postpartum nurses/staff can have a very emotionally devastating job, which is only compounded by the fact that the average person expects them to feel nothing but sunshine and joy. I can't tell you how many friends I've had recount somebody telling them "Stop looking so sad, you just got to hang out with babies all day!!" after a shift spent helping with stillbirth photos or finding funeral homes. (Or calling security to break up fights over custody, or trying to comfort an inconsolable baby going through withdrawal.) I felt your statement compounds that misconception so I was countering it.

Ah, thanks for that insight too.
Yeah, that's BS, no one working in any part of the hospital should be expected to feel joy, even in MBU. I don't mean that in a snarky way to you or MBU, but as a joke about working in a hospital.

If the participants and target audience of this forum were patients, your statement may make more sense. But I was writing from the perspective of a medical professional. Where patients are the happiest does not necessarily equal the happiest place in the hospital for staff. Otherwise we'd be declaring the OR, where many of us like to spend time, the most dreaded/scary place.

But the OR is the most dreaded/scary place. I kid.
Maybe it isn't so much a statement for patients, but could be true about other medical professionals being outside looking in. Someone in IM hanging out with GOMERs, the drain circlers, and as my signature suggests, people who lost what made them people but have been kept alive through modern medicine, may find a workstation near the MBU to work on their notes and remember that rotation fondly, especially given that in IM that is now one of the few places in the hospital where you never have any business going to despite it having some of the healthiest patients, but then, if one went into IM made they made their bed on a pile of old bones like a masochist. Watching the little car seats parade past in the corner of their eye, and that Elton John song playing in their head about the circle of life while writing nursing home d/c orders. I've always thought MBU floor of the hospital was pretty peaceful. That and the onc floor, but I probably attach different feelings to the atmospheres to each.

However, as I've always said, MUCH bigger stakes and having anything medical to do with babies or pre-babies (I think there's a word for that, fetus?) I would not ever suggest is easy, in fact, I think it may be one of the most stressful. So probably a case of the view is better from the outside.

I have nothing but enormous respect for OBs and L&D nurses, and those on MBU

Kudos

 

[Fajardo04]

just wait until there's an abruption, the belly is rock hard and purple, and the patient loses consciousness, all within like 5 min..... right in front of that damn nurse
and that L & D nurse is going to be white as a sheet and come a-RUNNING to any OB they can get their hands on

This right here. Nurses in every specialty (but especially L&D) tend to get confused about the difference between the number of years spent TRAINING vs the number of years spent WORKING. They somehow think that since they've worked more years than you have, they have an equivalent knowledge base. It's only when the crap hits the fan that the true value of a physician is realized. Just remember that at the moment of truth, you don't rise to the occasion, you fall to the level of your training.