Preterm Childbirth Redefined.

[iStater]

Or it could be the resident was trying to practice medicine while the nurse was following a protocol.

Then the resident may have ignored the basic principle of communication which is stressed in any infant resuscitation. It is imperative for the resuscitation team to work as a team especially if they want to be the doctor and at the head of the bed of a resuscitation. L&D and the NICUs are not as forgiving as the EDs. A totally different world where a miscommunication can more easily produce a very bad event.

[ERDoc]

I guess I missed the part about this being a resuscitation and not just a normal delivery. Or the nurse could have overstepped her bounds by "chewing out" the resident. Yeah, it's a team but all teams have a captain that has the ultimate responsibility and the resident is there to learn how to be the captain but he's not perfect. If there is a NICU team involved, then there was an attending in the room who was watching everything the resident did like a hawk, who probably would have had no problem correcting the resident if needed. It sounds like this nurse was overstepping her bounds and did it for the wrong reason.

[iStater]

I guess I missed the part about this being a resuscitation and not just a normal delivery. Or the nurse could have overstepped her bounds by "chewing out" the resident. Yeah, it's a team but all teams have a captain that has the ultimate responsibility and the resident is there to learn how to be the captain but he's not perfect. If there is a NICU team involved, then there was an attending in the room who was watching everything the resident did like a hawk, who probably would have had no problem correcting the resident if needed. It sounds like this nurse was overstepping her bounds and did it for the wrong reason.

I think the key work here was "oxygen". With the new guidelines that takes it up a level where as before oxygen was a given for many "normal" births first thing.

There is not always an attending watching the resident. Some attendings who have trained the nursing staff as well will trust them to show them the correct way. You will see this if a resident accompanies the transport team as an observer or is placed in L&D to "observe" a mec delivery. There are usually many residents for one attending and it is difficult for them to be everywhere. There probably was an attending with the mother but that is usually another service.

If the resident is to learn, he first must know the basics. That includes the guidelines of the unit or department and how to communicate. I don't know what actually happened here but if the RN was to allow the resident to do something which could have harmed the infant, it would also have been the RNs butt hung out for the attendings and the BON. If an ER doctor orders the wrong dose or is about to give the wrong med or do the wrong procedure, would you expect the RNs to allow this to happen?

In this case "chewing out" might also be a strong term for what might actually have been "why are you doing that" and expecting an answer so more prep can be done or to just know "why". If the resident can not explain "why" then maybe a further chewing out should be done by the attending. I will tell you that in the NICU and L&D we have high standards and there are expectations for all professionals.

[ERDoc]

Only scuba can tell us what the "chewing out" involved but chewing out a resident during patient care hardly meets the high standards of professionalism. I've worked in 3 different L&D settings at hospitals that had NICUs and at every single one the attending was required to be present at a delivery if the NICU team was asked to be present, anything less should be considered substandard care when you are dealing with patients and situations that are "not as forgiving." Guidelines are just that, they are to guide you. They are not laws set in stone. It is being able to work outside of pretty, one-size-does-not-fit-all protocols that makes the practice of medicine an art. To answer your question, no the nurse should not let the resident to do something that would hurt the pt. I expect my nurses to speak up if something doesn't seem right, but there is going to be a long talk afterwards if one of them thinks they are going to chew me out and it will not involve nursing admin. I do not chew out nurses or residents and the nurses should give the residents the same respect. Just because they are residents does not mean they should be treated like shit. Again, it doesn't sound like this nurse in question understands the thing she is worried about (but I will concede that we are working with limited information).

[Just Plain Ruff]

You know doc, I dated a medical student for a long time in the early 90's and she became a resident at the tail end of our relationship and I can't begin to tell you the horror stories of what nurses in some of the departments felt they could say to the residents. Usually Kristie(that was her name) would usually nip the nurses behaviour in the bud without the involvement of anyone else but there were times where she did have to involve Nursing administration and often times, that nurse would be out looking for another job.

I know hundreds of nurses and I don't know any of them who would feel comfortable or powerhungry enough to "chew out" a resident. I know Scuba and believe you me, if she said it was a chewing out, then by golly, I'd take that to the bank.

[ERDoc]

I don't doubt her at all. After working all of these years in academia, it just amazes me that this still happens. The same goes for attendings/residents doing the same thing to the nursing/tech staff.

[scubanurse]

The nurse pulled the resident into one of the charting nooks and proceeded to ask where they went to medical school and if they were even qualified to be a doctor. It was pretty embarrassing for everyone, the only saving grace was that it was pretty private and no family members could witness it. She wasn't a bad nurse, she was pretty young and was in an MSN program, so I'm guessing she thought she knew more than the doctor.

I've seen it happen on all of my rotations, the nurse thinks because they have been a nurse for x many years, they can tell the doctors what to do. My opinion is that we're called a care team for a reason and communication should be a two way street between MD, RN, PT, OT, ST and the whole care team. I've had doctors ask what my opinion is of the patient and I respect them for that since I'm with that patient for much longer than the doctors can be and we'll sometimes see more of the picture than the doc.

I would never consider chewing out a doctor, resident or otherwise, unless they were actively trying to kill a patient but I don't foresee that happening with the group I work with.

[Just Plain Ruff]

I don't doubt her at all. After working all of these years in academia, it just amazes me that this still happens. The same goes for attendings/residents doing the same thing to the nursing/tech staff.

I actually told a doctor one day after we had been chastised up and down by him for being idiots and jerks and the like, we stabilized the patient and when we were out of the room he proceeded to yell at us for making him look incompetent, and then he asked me for help on his computer. I then said "When you can talk to us here like professionals and not treat us like dirt, I would consider helping you, but until then, you are on your own, good luck with your charting, and by the way, the only one making you look incompetent in there was you yelling at us in front of the patient and the family" and I walked away.

[ERDoc]

Yeah, some doctors can be jerks.

[Just Plain Ruff]

Yeah, some doctors can be jerks.

yeah, actually we can all be jerks at times. I'm not immune either, just ask my wife or kids.