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Old 09-03-2007, 04:18 AM
L&DRN
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Default Anyone else relate to this....

First the background info-I worked at the hospital I am currently at (only hospital in a small town-average of 50 deliveries a month) for 7 yrs., from 1979 thru part of 1986 when I then moved to Las Vegas, NV. I worked in a 45 bed NICU for the first three yrs then took a couple of yrs off to be with my daughter. When I re-entered the nursing work force it was back to labor and delivery (had enuff of NICU stress) in a suburb of LV averaging 150 deliveries per month. In this hospital, the labor nurse was given total responsibility for their pt's care-ROM, applying scalp leads, giving pain meds., deciding when epidurals were appropriate, deciding to use Pitocin and managing that, etc. We called the physician with updates if that is what they desired and always knew we could call them for any problems that arose, otherwise they were called for the delivery when the delivery was imminent. This was a totally different situation compared to my experience "back home" where we worked as the doctor's flunky who made no decisions without their approval. At first I was intimidated and very unsure of myself-I couldn't believe that I would be the one who decided if the patient needed pain medication, how much and when she could have it. But after I got a few months under my belt, I couldn't believe the difference in the way I felt! I gradually got more confident in my decision-making capabilities, earned the respect of my coworkers and felt I was part of a team. With this came a respect for myself that I never had prior to this. I actually LIKED my job! To make a story that is getting pretty long, shorter-after 7 yrs working there, my husband, daughter and I moved "back home" and I had no choice but to return to the hospital I had worked in 13 yrs before. Nothing had changed in the OB dept. Nurses check your brain at the door because you won't be using them here! The docs would actually get upset with you if took it upon yourself to do even a vag exam! And therein lies my problem-how to deal with all these feelings of resentment that I have, such as when the doc presumes to tell me from his bed in the back whether my pt needs pain med. or not-or makes her wait until he wakes himself up and comes out to check her himself because you are not ALLOWED! Do any other OB nurses out there deal with a situation out of the dark ages such as I am in? Anyone else cope with being demoted to handmaiden after a period of increased responsility? There were more problems I had to deal with, but I've written a book now and so will stop. Thanks for sticking with it for me!
Connie
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Old 09-04-2007, 04:20 AM
KathiLDRN
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Default Reverse situation

I am an LD nurse in a community hospital. We are the last of the independent non-profit hospitals in town. We compete against the Cleveland Clinic and University Hosp. Our town's situation is a little different...If you are in the big hospitals you share duty with all the residents that need to get their hands into everything. Plus you have more staff. We do it all from admission thru recovery here. We have standing orders and you apply them using your own judgement. Some docs are very specific about when the pt receives an epidural but most leave it to the nurses opinion. I can see where you are feeling "demoted". But look at it this way...you are not shouldering so much of the responsibility.
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Old 09-04-2007, 06:11 AM
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KathiLDRN is right, however you wonder why you would employ qualified people if you don't actually to do the work of someone who is a qualified nurse. There is also the issue of accountability. I am not sure about your responsibilities in the US but in the UK I am responsible for my own actions. A Doctor can tell me to do something but if I do it without question and it is detrimental to the patient's wellbeing then I am going to liable for the consequences.
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Old 09-04-2007, 03:02 PM
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I'm wondering if there is any way to develop a "protocol" for the nursing staff - specific actions that can be taken for specific situations.

The advantage is the the doctor would not have to be interrupted so much and the nurses could use their expertise (or learn to for those who haven't).

Is it possible that the staff and doctors have been there so long they do not know what is done in other parts of the country?

Could you make it so that it was a win-win situation - everybody benefits: the patients, the doctors AND the nurses?
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Old 09-04-2007, 10:37 PM
L&DRN
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You have exactly gotten part of the situation right-these docs have been here for almost 30 yrs now and I wonder if any of them ever gets out of town for CEUS or anything where they discuss what is going on in the field! When I first came back here the docs were still doing their own epidurals and only one shot ones to boot! (Cath was not left in, BTW). Furthermore, if the pt. was "too far along" they wouldn't do another one becos then they were told they wouldn't be able to push the baby out! It was VERY hard for me to stand at my pt's bedside and listen to that when I knew differently. And imagine how it was for the patients! Here they are comfortable for an hour or two and then Wham! thrown back into what is usually transition labor by that time....I could hardly go to work and deal with that! I was almost to the point of not even suggesting an epidural to my pt's becos of this. Now the anesthesiologists or CRNAs do them and we have started using the epid pumps, thank goodness.
These same docs that will not allow us to check their pts, etc.-some of them fume at night when we call them to tell them the pt. wants something for pain cos they have to get up!
I want the responsibility! Bring it on! After all, who is actually WITH the patient at the bedside?
Connie
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