Saturday, August 11, 2007

Who does she think she's talking to?

I was taking care of a patient who was having twins and singleton patient. One in active labor, the other a pitocin induction. My twins mother was a primipara pitocin induction, but I hadn't started the pitocin yet because she was contracting just fine. Her blood pressures were higher than normal and since she was a G5P0, I had the doctor review her pressures and labs were ordered to check her for preeclampsia. The other was a multiparous patient who was real uncomfortable. Nurse B was in the same nurses station taking care of a chronically hypertensive mother on hydralazine because her pressures were sky high. The shift had just started. I hung my medication for the twin mother when I happened to look up at my singleton mother and noticed that her tracing was looking kind of strange. I went to visit my singleton mother and she was looking like her butt was about to explode. So I put on a sterile glove to check her and the baby was crowning. I run to the intercom and call for assistance immediately. No one came. So then I ran out to the desk and called two more times. Finally many people come into the room and the mother pushed out a healthy baby boy. In the meantime, Nurse B took care of my patient. I gave Nurse B a quick report and she watched my patient for two hours.

During that time, Nurse B knew the situation with the elevated pressures on the twin mother. She knew that labs were ordered, she didn't draw them because her tracing was bad on her chronic hypertension mother. I didn't hold it against her because I knew she had the more difficult patient. As soon as I finished my delivery, I got all of the charting caught up and got the labs together to assess her elevated pressures. Nurse B was aware. The whole time I took care of my twins, the mother was throwing up, violently. Her labs came back normal and the MDs decided not to treat her with magnesium sulfate. Despite all that, I had a foley placed for her comfort. In the meantime, I talked to Nurse B and we were having a pretty nice time working to gether. Her chronic hypertension mother delivered vaginally, which was quite a feat considering her tracing and all the drama with the Doula. During her delivery, I got a new patient that was Spanish speaking and 6cm dilated. Not a problem for the DiVa because I speak Spanish. I knew this patient was going to go very quickly and it was no suprise when she was completely dilated within two hours of being brought to the room. By that time Nurse B finished her recovery and had to take over my twins...Again! Let me put emphasis on AGAIN.

The tracing for my spanish speaker was not looking good and it was time to push. Nurse B asked me who was watching the twins. Obviously, no one because all this happened rather quickly. She was done with her delivery so she knew that she was going to be watching her again. We are holding legs and pushing with my mother when she says something like, "So are you gonna give me report?" Meanwhile the chief resident is yelling at me and the first year like we were idiots. This is amazing to me because the chief was quite inept just last year and now she is shot callin like she really knows what time it is. Any reasonable human being could see that it was an inappropriate time to ask for report because I am running crowd control, trying to find a fetal heartrate, keeping the mother calm, trying to remember how to conjugate Spanish verbs and accomodating doctor's requests. I ignore Nurse B and give all of my attention to the delivery. The baby comes out limp, purple and barely breathing. I am FREAKING out. I run the baby over to the warmer and call out for the charge nurse. I run back over to the warmer and rub the baby really hard. I bag for a few seconds so that the baby has a little extra oxygen before I start suctioning.

Just as I am doing that the charge nurse turns the corner and of course the baby is crying. He's juicy, but crying which is a good thing. The charge nurse says, "You're alright and if you need help just call Nurse B." So once the baby starts crying the requests start rolling in, "I need Vicryl." "I need lidocaine." "I need more lidocaine." Here comes Nurse B, "Are the doctors aware of her blood pressures?" She knows about this patient, at least as much as I know so why is she asking me these stupid questions?


Vixen said...

I get the vibe she really didn't want to watch your patient and was irritated you asked her to do it again. That's why she kept getting on you for stuff, being in your face trying to get you all frustrated so you would say "never Mind" and take the patient back before you were even done there. It sounds like on your shift you don't have that much support.

Nurse Diva Extraordinaire said...

you are absolutely correct. There is very little support in our unit...PERIOD!