I love working with donkeys

I just want to start by saying that I really don't have a problem with doctors. I enjoy working with most all of them. Some are more difficult than others, but I'm sure they feel the same about nurses. That being said, this weekend was a pain in the butt because of a jerk doctor. The same MD who was being 'difficult' Sat. night was on the rampage all weekend. The patient I was taking care of that night of course, had a huge fetal heart rate deceleration right at shift change. After trying all interventions, like O2, turning, etc, it stayed in the 70's. . Anyway, I call this ass and he tells me in a very condescending tone to "give her o2, turn her and make it happy". No shit doc, already did that, that's why I'm on the phone with you. Sunday night, he refused to listen to report on a patient and told me to call the patients primary doc, who he was on call for. She didn't answer, because she wasn't on call, and we call him back. Still said to keep trying. Eventually we got the hospital supervisor to call him to take report on this 34 week twin mom who's babies were transverse. It's time like that that I wonder why I went into nursing. Last night was much better. I had nice docs, nice patients, and had good report with them.
I noticed another small, but pleasant, effect of being pregnant. My nails are a good length and look good. I was not blessed with nice nails. And being a nurse doesn't help. They're always dry and brittle and break as soon as they get past the nail beds. And with the last two pregnancies, they didn't get any better, but this time they look great. They go great with an expanding belly that looks huge right now, thanks to the wonderfully slow gastric motility of pregnancy and the gas that builds up as a result. So I look about 28 weeks instead of 18. Well, I guess not that bad. The little critter has been letting me know he/she's in there. It's so nice to be at the point where you can feel that there's something in there. Well, I'm off to bed so I can dream about what I can do my 4 days off.

Why?

I had a patient last night come in, 1st baby, contracting every 3 minutes, dilated 3cm 100% effaced. She wanted to try without an epidural and thought that the birthing tub would be great. Call the on call doc, who is notorious for being an ass about pain control in labor, and he of course said no tub and to call back if she makes cervical change. Patient is very uncomfortable despite efflurage, birthing ball and rocking chair. Short time later, she's 4 cm. Call him back. Can she get in the tub? No. How about IV pain medication? No, but she can have an epidural if she's making good change. This doc usually gives IV pain meds, and there was NO reason why he wouldn't give it to this patient. Patient decides she'll get the epidural for some relief, even though all she wanted was something to take the edge off for a bit. After her epidural was placed, she asked me why he wouldn't allow her to get IV meds. I was professional, but I had to tell her that I had no idea. Maybe she would have gotten an epidural anyway, but now she'll always wonder if she would have been able to do it. I just don't understand what happened here. He has been frustrated with some staff for different things, some things that were out of everyone's control, but it isn't right to make the patients suffer for it. And that's how it seems to me. If anyone has any insight as to why, that would be great. Because none of us here can figure it out.

Not much new

I had a much needed 4 days off in a row. I was actually able to get caught up on thing around the house. And I was able to get away from work for awhile. I keep dreaming about what it would be like to work with plenty of staff for all the patients. The last night I worked, we had so many people coming in that we ended up running out of labor rooms and our last admission delivered in our recovery room. Not a real great place to deliver. Lucky for her she came in at 8 cm and delivered within 10 minutes, so a real bed probably wouldn't have been any more comfortable than the recovery cart she was on. Here was the morning RN:patient ratio (all patients actually were laboring. 3 RNs: 9 ACTIVE labor patients. Luckily, we didn't have any emergencies.
Over the weekend I worked with my least favorite nurse. I'm sure everyone works with someone like her: little experience, big attitude and thinks she knows all. I can usually deal with her but this weekend she crossed the line. She has little or no compassion for people. For example, she was taking care of an induction. The patient was contracting every 2-3 minutes and asked for something for pain at 5a.m. (she had come in at midnight). She came out to the desk and told me her patient asked for pain medication and here's what she told her "I told her to wait until dayshift gets her at 7a.m. and we'll re-evaluate your pain then." I then asked her if she ever takes motrin for menstrual cramps. She said yes. So I then explained the difference between the pain of cramps and contractions and told her she needed to give the poor woman some pain meds. Back to this weekend though. They had a woman come in 25 weeks by ambulance with feet hanging out her vagina last week. THey couldn't hear the heartbeat because of the positition so they took her back to the OR to deliver the baby by c-section if they determined by sono that the baby was still alive. Unfortunately, the baby was dead. They went ahead and gave her a spinal because they had to go in and deliver the baby and they needed to make sure the placenta came out completely. This nurse, I'll call her Jane, was telling me about this Saturday. Very sad. But what made me want to strangle Jane was when she started saying that it took 2 people to hold the mom down after they told her that her baby died. She seemed to think it was inappropriate behavior. And the tone of voice and other things she said about this mom just pushed me over the edge. I told her that it would probably take 2 people to hold me down had I been told my baby had died. I understand that this mom used cocaine and thats what led to the unfortunate events, but I doubt she wanted to kill her baby. I just was floored at Melissa's attitude toward this mom. I'm sure she was rude and inappropriate with this mom judging by the things she told me. Luckily, there aren't that many Janes out there.
On to happier topics, I felt the little bean move for the first time. I had felt things earlier that I thought might be the baby, but this was definately baby. I had forgotten how cool it was. It's a little reassurance. We also decided not to wait until birth to find out sex. It's just too tempting and I'm too much of a control freak not to know. I want to have the baby's room set up with clothes and blankets, that aren't all yellow and green. This weekend we played with the sono machine trying to see if there are dingle berries or not. Now we don't really know what we're doing, but I think, 60% boy. But the bean wasn't really cooperating. At first it looked like girl parts, but then we thought we saw boy parts. But we could see where the umbilical cord was and what we were looking at looked too big to be the genitals at this stage. So, really, we dont know. We may get to find out on 8-9 when I have a professional sono, if he/she cooperates.

Its all worth it

There's nothing sweeter than seeing my 2 preschoolers who were wild and unruly all day curled up with their "luvies" sleeping, and knowing that the miracle of a new life is developing right now. If that doesn't speak of God's love and perfection, I don't know what does.

The outlaws strike again

My oldest turned 4 last Friday. It's amazing how quickly the time goes. Everyone tells you that, but I didn't really get it until he was born. It doesn't seem like he should be 4 already. We got him a little bike and man he loves that thing. We had family down this weekend for cake and ice cream for his b-day. This of course involves my out-laws coming into town, not just for a day, but for the whole flippin weekend. All day Saturday they were at their finest. MIL drunk, acting stupid and wanting the kids' constant attention. I suggested cake and she immediately said "how bout we go watch a movie". It goes on all day like that. Unbelievable. She also pushed my kids faces into the ice cream and cake and encouraged them to act like dogs by eating with their faces in their plates. I had finally gotten them to stop doing stuff like this, seriously just last week. I could go on and on about her classy behavior, but I'll restrain myself. My FIL, also just as classy with his Modelo beer in his hand at all hour of the day, told my daughter "you're too young for beer yet, but we'll talk when you're 12". Yeah, I catch anyone giving my kids alcohol, they will wish they hadn't. As a side note, my husband and BIL had kegs of beer at their 8th grade graduation parties that they were allowed to drink from. They allow my kids to do a lot of things they aren't allowed to do usually. They just dont get it that when they act like that, it makes my and my husbands job harder. Some things, fine, let them have an extra cookie or whatever, but when it comes to behavior issues, it's unacceptable. "Meema" and "Boompa" (names they picked out themselves) wonder why we dont allow the kids to stay with them overnight like they do with my parents. Gee, I wonder. I try to hold my tongue to avoid problems b/c they are my husbands parents, but one of these days I wont be able to, either I'll lose all restraint or if it's a matter of safety.
Anyway, work this weekend wasn't too bad. During a weak moment, I agreed to work extra last night. Had a twin delivery. It was her 5 and 6th kids. All others were vaginal deliveries. The first twin delivered very easily, but the 2nd decided to come down back first. The doc didn't really try very hard to turn the baby either. So we went back for her first c-section. At least she delivered the first baby with an intact perineum.
I also think I might have felt the little bean move, but it's so hard to tell this early if its the baby or gas. It's funny how you can't wait for each pregnancy milestone, but eventually you tire of them. While I'm dying to feel movement, I know at the end of the pregnancy there will be a time when I'm trying to sleep and the bean won't quit moving, and it will do head-butts with my bladder to see if he/she can make me pee my pants. A couple coworkers offered to play with the sono to see if we could see boy or girl parts like we did with my daughter, but I had the strength to say no. So maybe I can wait until delivery day. We'll see.

Hospital-Grade Toilet Paper Issues

One of the things I've recently learned involves the high quality toilet paper that hospitals and offices use. You know, that see-through thin, single-ply stuff that falls apart when wet? Let me explain. A couple months ago, I was admitting a patient for ruptured membranes. She was obviously ruptured and had just come out of the bathroom from changing into her stylish gown. I finish the admission, and when I go to check her cervix, there is toilet paper stuck to her labia. A few weeks later, I'm taking care of someone in for possible labor, and again I have to check her cervix. Again, I find toilet paper. And not just a little, but several shards on the labia and one pretty good size wad right in the middle of her vagina. Without thinking, I remove the wad and proceed with my exam. Then I realize that she had to have felt me do that and was probably embarrassed. In my defense, it had to be removed otherwise it would have traveled with my fingers to her cerivx. And I would never do anything purposely to embarrass any of my patients. These haven't been the only women with TP stuck to their genitals, and they were very clean women. Now that gets me thinking...how many times have I gone to the ob-gyn and had TP stuck to me? Everytime you go, don't you always either pee or give a urine sample? So ever since then, I have to make sure that I don't have any toilet paper stuck to me, which I realize will be a bit difficult when I start really getting big. So I have this conversation with my sister and it progresses into an experience she had at the gyn. (she's in med school and we pretty much have no boundaries when it comes to things we'll talk about) The MD was able to feel stool in her rectum when he did the manual exam and said to her "Feels like you need to go to the bathroom." Who would ever say that to someone who has their butt hanging off the bed with their feet in stirrups? Of course then I wonder if at some time, I went to the doc, with TP stuck to my labia and stool in my rectum. Maybe that's why my ob-gyn chuckled a bit the last time I called her in for a 3am delivery...
On to another subject, pregnancy is going fine. I'm still enjoying 3 trips to the toilet in the middle of the night, and Tums and I are again bonded. Nausea gone, heartburn in. It's not all that bad as 1 Tums will do the trick. There are also 4 of us at work who are due within 4 weeks of each other, 2 of us on nights. She is one week behind me. It's her first baby, and she is dying to start to show and wear maternity clothes. It's my 3rd baby, have outgrown most of my regular clothes and I know that while it's nice to finally look pregnant and not just fat, that you'll grow very tired of maternity fashion by the end. But, there is at least someone to commiserate with.

Short-staffed

I'm sure that I'm not working at the only hospital in the world that's having problems with having enough staff, but man does it suck. About 6 months ago. the administrative board decided to look at ways to try and help with the budget. They considered closing the pediactric unit, which is part of OB (nursery, Peds, L&D and mother-baby) and putting the few peds patients we have on the medical unit. Our average census in peds is 2, but in the winter it's usually about 6. The other hospital across town had done this, and the pediatricians now send most of their kids to my hospital, unless it's an insurance matter. Anyway, there was a huge backlash from the MD's, staff and the community, and the board then said that it was just a rumor and that they were'nt closing peds. That was all fine and dandy, but by the time they said it was just a rumor, we had lost several nurses. (our nurses work 2 areas, so not only did we lose peds RNs, they also worked nursery and mother-baby). At that time, we were in Feb-March and people who hadn't worked in peds for years were forced to work peds b/c of the short staff. Then they quit. Then we became even more short staffed with some nights RN's having 3 or more patients than the supposed max patient load, and more people quit. I'm sure the patients noticed when it takes us 30 minutes to bring pain medication when we have 3 people calling ahead of them and no one to help. Then to help with the big loss of staff, they went to mandatory 12 hour call every 3 weeks, regardless of how many hours a week you usually work, or if you just work prn. Then more people quit. Even the MD's comment on ask how we are going to take care of their patients with no staff. One night, I had 3 active labor patients, and an unstable pretermer on Mag. One of the midwives came in and said, man you guys need more staff and she stayed for awhile to help keep an eye on the monitor strips. All in all, we lost 26 nurses in the last 6 months. 26. Well, Sunday night I had a chance to chat with the hospital's medical director. once a month, the admin will walk through the units at night to 'make themselves visible', something they started when they tried to get magnet status. I was in the wrong place at the wrong time and had to talk with him. He asked me if I had everything I needed to do my job, if there was anything we needed. I told him staff and explained that we've lost so many people, some with 10, 20 even 30 years of experience. He then said "I know of 4". I thought, dont argue with me dude, these are my co-workers and I know how many are gone. He tried to say, well, people go to offices for a different lifestyle, try different areas with better hours. I then said that the majority wouldn't have looked for something else had all this crap not gone on. I then got that usual line of BS that you get from administration (sorry if I offend anyone) about how nurses aren't appreciated, his wife is a RN, blah, blah, blah. Basically changing the subject. He did say he would talk with our director about the issue and I e-mailed him the list of names of all the staff that left with the approx number of years they worked on the unit. We'll see what happens.

Another busy night

Another glorioius weekend shift at work. Saturday was pretty busy, but man did the 12 hours go by quickly! I started out working on Mother-baby and was called back to admit a patient who was 23 weeks, no prenatal care, and cramping. Assessed her, found out she was not cramping but coughing. Just goes to show you how fast ER is at getting pregnant women off their unit. "Oh, you're pregnant, you must have some cramping...great, up to OB you go. I had just about finished triaging her when another nurse called me out of the room. We had another patient that they decided I should also admit come in. She had been transferred from a small town hospital that doesn't have maternity services. She was in active labor with her 2nd kid, no prenatal care and 6 cm according to the speculum exam the MD there had done. We were quite surprised she didn't deliver in the ambulance. Anyway, i'm a little peeved because I hadn't called the doc on admit #1 and there was no reason this other nurse could have done the new one. So I check her cervix, expecting to be close to delivery, but no, she is 8 cm and I don't feel head, I feel scrotum. Crap, crap, crap. The nurse who rode over with the patient asked if she was in position for delivery, and I said, well, in position for a c-section as the baby is breech. Then, finally the patient says, "Yeah, I didn't figure he had flipped". First, that's important info that she should have given the first hospital. Second, and most importantly, the MD who examined her should have been able to tell that she was not vertex (head down) as it was very obvious. And to top off all things, she stated she saw Dr. T when in fact she saw Dr. D. After 39 weeks, usually you know your MD. So off to caesar we go, baby born, dad didn't make it in time. He comes strolling in 20 minutes after we've been in recovery and asks "So you getting ready to have the baby". Oh, he was wasted, and the reason he missed it was because the police who went to his house couldn't wake him up. So we talked about time, weight and all the birth stuff. I sent him to the nursery to see his son. He comes back, after our conversation about how he missed the birth and says to his girlfriend "So you had him not long after I got here, huh". I thought she was going to come off that bed and strangle him, even with dead numb legs. All in all, the patient was very sweet and the baby was beautiful. So I get her settled on mother-baby, decide to sit down and chart and get a call that a 24 weeker, 10th baby, is coming in bleeding by ambulance. She arrives, has blood caked all the way down her legs, and is only 22. 3 weeks. No active bleeding at that point. She had bled like this a week ago and they found she had a hematoma behind her placenta. Her and her pregnant 14 yo daughter were laughing, talking about how they hoped he was coming today, how he just wanted to be born, etc. The dad of this baby also kept leaving and coming back, smelling strangely like he'd been smoking some pot in the car. Finally, I had to tell them that we would do all we could to keep her pregnant, that this was serious, and that if he was born today that he would not have a chance. Man, I felt like the grim reeper, but I had to let them know the seriousness of the situation. The tone did change and they were no longer worried about their 4a.m card game they left and were more appropriate. We got her stabilized and safety helicoptered to a hospital with a NICU at 7:00. I would have kicked my husbands backside had he acted like any one of the dads that were with the 3 patients I took care of. At least they did come in, which is more that some. I was able to finish about 7 hours of charting on three patients by 8:00. What I wouldn't give fore a nice, normal labor and vaginal delivery and a night where I can actually chart at least half of what I need to chart before the end of my shift.

Happy (belated) 4th of July

Hope everyone had a happy 4th of July. We spent some time with our friends from college who set us up, watched some fireworks and had a pretty good time. My last weekend shift was really busy. I work Sat and Sun nights from 7p-7a. Sunday afternoon, work called and wanted me to come in early, at 4:30. I like extra hours from time to time, but not added on a 12 hours shift during a pregnancy. After a little negotiation, the charge RN agreed to change my shift from 5p-5a that day. I knew that when 5a.m rolled around that I wouldn't get out of there. It was a pretty slow night. I was taking care of a former co-worker and she was progressing a bit slow, but not unusual for first baby. At 4:30 a.m., 3 patients came through the door at the same time. We also had a schedule c/s patient who would arrive at 5:00a.m. We had 3 labor RNs on at the time and one on call. She got called in, but of course, with a total of 4 admissions and the great timing of my patient going to complete dilatation, I didn't get out of there at 5a.m. Even after I had reported off on my patients and every patient had a RN, the charge RN was reluctant to let me leave. I clocked out at usual time of 7:15 a.m. And to top off a long night, I was spotting a bit when I got home. Everything is fine, baby's great, cervix long closed and hard as a rock. Just too much activity, I guess. Doc said no more 14+ hours shifts and I readily agreed. Got a sono scheduled in 5 weeks and I'm starting to waver when it comes to finding out the sex. We plan on waiting since I could end up with a scheduled c-section and we want some surprise if we know date and approx. time. But it's SO tempting to just find out. We'll see if we can hold out.