Jackass OBs and their little friends too

I haven't spent a ton of my nursing career in labor and delivery, but I have spent enough time dealing with egotistical OBs as well as my own experience as a patient and a support team member to other moms to offer this rant:

Dear Labor and Deliver Staff:

1) Please stop saying "you're not in labor" when a mom is having palpable contractions every 6-3 minutes.
2) Please don't be the ass who asks the mom in labor with contractions every 4 minutes, "Do you have a low pain tolerance?"  --- here's a clue if the person is having repeated contractions--- of course its painful- if its their first birth chances are it's going to be very uncomfortable.  If you have a penis ask yourself how would that feel if your penis was contracting every 4 minutes!!  If you can't imagine it please come closer and I will find a way to make you uncomfortable every 4 minutes and follow it up with "do you have a low pain tolerance?".
3) Please don't tell the mom in labor that although the monitor shows a contraction of 75, it really doesn't matter, because the numbers on the monitor are only really valid when the internal transducer is in place---  moms in pain don't give a crap about that, and it doesn't reduce their pain.
4) Please don't tell moms who are having a difficult time pushing because of an epidural that they "aren't trying hard enough".
5) Please don't tell the mom who is 37 weeks, bleeding, having strong contractions every 4 minutes and was on bed rest at 22 weeks for preterm contractions and an incompetent cervix that they can go home because there are not in labor and they shouldn't be having pain because they aren't in labor because their cervix is only 3 cm dilated.
6) Please put an IV in and hydrate the mom when she has not been able to eat or drink appropriate amounts due to pain and vomiting, within 2 hours of being at the hospital, and not 10 hours later!
7) Please do not blame the dehydrated, pregnant, scared mom who is in pain with contractions for not having plump veins.
8)  Please do the right thing for dehydrated moms in pain and find the best vein for the time being--- if its an AC vein so be it-- hydrate them, manage them with an antiemetic and pain meds, find a more suitable vein in the lower arm later after they are hydrated--- don't stick the patient 7 times when you could have inserted an IV the first time!  Take care of the patient first! find the vein that suits you better later when they are comfortable!
9)  Don't ask the support team and husband to leave the room because your IV skills, and the skill of the nursing team suck!
10)  After essentially blaming the patient for "not being in labor" and taking up a bed with symptoms of labor in a high risk pregnancy, don't try to shove them off to home or an antepartum unit, re-check the patient.  And by the way you look like a complete ass when the patient dilates to 4 from the 3 they were at and now all of a sudden they are in labor!  And when you say "I've never seen this before"… you are a liar…  it happens all of the time!  Women can be slow to dilate and have close strong contractions!  It happens all of the time!
11) To the L&D staff.  A mom that is "not in labor" is no different than another patient in the hospital..   they need to be assessed and monitored!  Waiting hours to check a set of vital signs is not appropriate!  You have that ability on your fetal monitor!  Put the cuff on!
12) L&D nurses: Advocate for your patients!
13)  Don't leave narcotic pain meds drawn up in a syringe sitting for 2 hours at the bedside until the anesthesiologist can come start the AC IV---  waste or return your meds!  Bad practice!  Very bad!
14) When a mom has been pushing for 3 hours and things are not progressing, change the approach, because when that baby is born and isn't breathing, has to be placed on a vent with a cooling cap, its hell on the family and the nice ER nurse friend is now your worst enemy!
15) When you see the meconium come out when the bag was ruptured, you need to explain to the family the significance of it right then and there, not wait  hours until the very troubled birth!  Because that C-section they requested before they fully dilated might have been a better idea than the chain of events that unfolded!

Stop Bit@hing And Do Something

The ER I work in has 4 areas.  The area I was assigned to the other day is pretty detached from the main ER.  This particular part of the ER has 10 urgent care beds for the not so sick folks and then another 12 beds for level 3 and 2 patients.  The 12 bed area gets its fair share of stroke and septic patients.  Unfortunately it is a logistical nightmare.  Not only is it minimally stocked with meds, the new flavor of the month is not to have insulin stocked in a medication refrigerator because there were issues with vials not being properly labeled with "use by" dates.  Needless to say trekking through the ER to the main ER's med room is time consuming.  Upon getting to the med room and finding no insulin one might find themselves extremely annoyed… not because they walked all the way to the main ER, but because it was a complete waste of time  when they are otherwise running around cleaning up the mess from the prior shift.

Having had this issue of no insulin in the ER in the past I called the pharmacy and offered to pick up a bottle of each type of insulin in order to restock the ER!  During my conversation with the pharmacy tech I asked why when they restocked the refrigerator they didn't check to see if we had insulin.  The tech informed me that it wasn't something they did.  Knowing that they stock the refrigerator with other refrigerated meds it just seemed like a simple request…. but I wasn't getting anywhere.  The only explanation I was given was that someone must have been stealing the meds.

After hanging up the phone on of my managers said that I was "mean" for calling them as telling them that it was unacceptable that the ER didn't have insulin.  Well I do find it completely unacceptable to not have insulin stocked in an ER.  I then pointed out to the manager and the charge nurse that this was a chronic issue, which it has been, and that we needed a solution.  She quickly stated that pharmacy wouldn't perform a check and restock twice a day.  I then suggested that the charge nurse at the beginning of the shift check the refrigerator to ensure that insulin was stocked as well as checking our stock levels for vital things like liter bags of normal saline.  I was then told by the charge nurse that I "complain too much".

Maybe I do complain.  But I think that I am right to complain and offer a few suggestions on how to fix this problem we have.

Its interesting how identifying a problem and offering a solution is met with such resistance.

I have decided to turn a new leaf.  I'm not one of my apathetic coworkers, I refuse to give into that mentality.  If there is an issue I will absolutely point it out but I will now offer no less than three solutions.

Compassion and Caring

"Love and compassion are necessities, not luxuries.  Without them humanity cannot survive." ~ Dalai Lama

Compassion is something that one would thing is a given with nursing and the medical system.  Compassion is the one thing that is not delivered in a pill, an IV push in a manufactured way.  Compassion is genuine.  Compassion is ignited from within.  Compassion in the one thing that we can give of ourselves to comfort those who are suffering, as we give it, we also receive great benefits in return.

Why is it in our field there is a lack of compassion.  In order to provide compassionate care we must have received compassion. As we care for our patients and provide compassion it is equally important that we treat the members of our hospital teams with compassion.

http://www.ted.com/talks/view/lang///id/1216

Joan Halifax highlights this concept in a short Ted Talks episode.

2013 ENA President-Elect Deena Brecher speaks at 2013 ENA General Assembly

Incarceritis And New Onset Suicidal Thoughts at Time of Discharge

There is this amazing phenomenon  in the emergency room that results when a patient arrives in the ER while in custody of law enforcement with a new onset of incarceritits.  The symptoms of incarceritis include chest pain, shortness of breath and syncope.  Upon a full medical work up, which often includes lab tests, EKG and x-rays medical findings are usually negative for MI or other life threatening emergencies.  As the patient is discharged they miraculously develop new onset suicidal thoughts.  

Lucky for them they are usually handcuffed to a stretcher and have no personal belongings.  

Thankfully there is a cure for this!  Swift discharge and a bail bonds business card.  

The Waiting Room---- Why do you wait to be seen in the ER?

I have to give PBS props for airing what has to be the most honest look into life in the ER, for the patients that wait to the team that works to care for what is an endless stream of pictures.

If you haven't had a chance to view this gem, I encourage you to click on this link and give it a view!

http://video.pbs.org/video/2365092060/

While MTV shows the party life of nurses on their new show, essentially Jersey Shoring nursing, this is PBS docu is a real look, the real deal!

Who Dat?

I ran into a former manager today and it was an interesting experience.  I hadn't seen her in a while.  When I worked under her she was always well dressed, poised, professional in appearance....  when I saw her today in my former ED I hardly recognized her.  At first I thought she was one of the girls from the hood.  Then I thought she was a visitor.  Maybe it was the bad wig, the overly tight attire, the lab coat the unprofessional lab coat or the fact that she was literally hanging on some guy in the ED.  This was not the same former manager who was well dressed, professional and poised that I once knew.  I stand by my earlier post, leadership is lost!