Nursing Voices

Friday, March 09, 2007

Driving to Work in the Dark

Snow drifts on the ground.

My breath hangs uncertainly in the frigid air.

Winter still. Stubborn.

But as I drove to work in the warm cocoon of my car, I was transformed by a vision of bright rows of lights, shining festively through the transparent walls of a greenhouse at one of the nurseries I pass by.

Instantly invigorated!

I imagine the vibrant lights perched above tiny seedlings, coaxing them to grow despite the lingering reality of winter outside their sheltered walls.

And as the birdsongs further testify this morning, spring is coming.

They know it.

And I am hopeful again.

******

I enjoy working at a teaching hospital. Really.

However.

It can be extremely, astoundingly, incomprehensibly frustrating when the team of residents on call are a bunch of indecisive know-it-alls. Sounds contradictory, right? Maybe that's why the plan of care for my clinic patient (whose care is overseen by the residents) changed every 5 minutes or so last night. They all know it ALL and are ALL making the decision.

Draw labs at 0500.

(talk to senior resident)

Cancel that, let's recheck them stat.

Straight cath her.

(discuss with attending)

Actually, now that you just cath'd her, I think we're gonna need a foley.

Let's hold off on the Mag.

(enter senior resident)

Pressure's up but we'll just keep a close eye on it. And better draw those labs again.

(update chief again)

Now we are starting Mag. And antibiotics.

And some rectal Tylenol.

And I think she's gonna need a section.

(review with attending)

Yeah, let's just do the C-section now.

Hold that thought, the other clinic patient needs a section, too. This one can wait an hour.

*** hour goes by while I furiously try to catch up with meds and charting and explain to family why, despite the fact that the decision has been made, we can't do the C-section right now***

(re-enter senior resident)

Let's go, we're ready NOW!

Intersperse numerous cervical exams by whichever resident is around at the time, and you may have a potential cause for the chorio.

Argh.

Baby did great, and the patient came through it all okay.

The nurse, on the other hand, feels defeated and sad. For the patient, for herself, and for a system that could clearly be better.

4 comments:

Labor Nurse said...

I feel your frustration. I find the patients who end up in this situation are the clinic patients. The attending MD's at my hospital don't get paid as much for these patients and so they step back accordingly. I had one doctor actually get mad when she realized that the patient she spent X amount of time with was a clinic patient and not a private insurance patient. She said something like, "Oh, great! Had I known I was going to get paid 28 cents for this I would have been faster!"

AtYourCervix said...

Ahhh, the joys of working with residents and attendings. They do an absurd about of vag exams (and "double checking" behind the less experienced med students/interns/residents), that it's no wonder the patients end up with fevers and/or chorio.

I know they need to learn, but common sense should really dictate things.

I agree with you on the change in plans every 5 minutes - it's VERY frustrating.

Nurse M said...

Oh.. I so understand exactly what you are talking about. The only difference is that in our case the few residents going through are directly under the attending. There are no senior residents.
They round and discuss what to do. Write the order a bit later, then the doc comes by much later in the day to check it. Most of the time.. well how you say they know it ALL... in the NICU, they know nothing! (seriously... nada and will admit to it).
The one thing that is a big pain in the neck is that they do write orders ALL day long. Over and over.. different orders, more labs.
When we pass off report and the nurse is asking.. why are we drawing this agggaiiin."Resident baby." "Ah, got it."
They do need to learn and eventually they will get there. I can't speak for other units but in the nicu you can see the fear in their eyes. Afraid to touch the baby or turn it over (which.. weren't we all at first?! It takes time for anyone to get comfortable.. - myself included). A new resident (only on the unit a few days) was assessing the baby while on it's belly. As much as I REALLY appreciate this (thank you for not really disturbing my baby) they need to learn. Turn it over and examine- bellies are too important not to examine in your first assessment. The res just wanted the go ahead and I can appreciate that.

JustCallMeJo said...

Hey apgaRN...My best friend over at justanotherloveletter.blogspot.com is considering going back to work (as boyos start kindergarten) as a dula. Do you have dulas at your hospital?

She loves the pregnant moms. Not sure she's up for switching to become a nurse (yet, I tell her), so she's thinkin dula.

Love to hear your $0.02 at some point, if you have thoughts on them. My hospital doesn't even have L&D or peds, so I'm at a loss.
/jo