Preterm Childbirth Redefined.

[iStater]

^{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).}

No guidelines are not the law. But, even now we do not know the full story. Was this RN part of the L&D team or the NICU delivery team? The NICU delivery team usually works directly per the neonatologist which trumps a resident. They are highly educated and trained which is why they are called to the bedside of some deliveries even if a cardiac arrest or mec is not present. Did the resident not get the full details of the delivery? Did he not know how to operate the O2 equipment properly and rigged by tearing up something else? That makes me grind my teeth and I will not hesitate to correct. Was this a CHD? Mec? Was any drying or stimulation done before the O2? Did the resident ignore the guidelines or just feel he did not want to follow them with a good reason or with an attitude of being in control regardless of how the situation dictated? Was this resident already known to be a shithead in the unit?

The chewing out also was not done at the bedside. That does demonstrate professionalism by the RN. By MSN, would this be for NNP?

Sometimes the RNs do know more about the surroundings they are in than a new resident. The resident who fails to use their knowledge and experience in that environment will have a very difficult time and make many mistakes which could easily be avoided. The NICU and L&D situations have RNs and others in that area who are much more aware of their environment and will be more observant of what is happening or doing whatever to the baby. I doubt if many residents have held very many 23 week infants prior to their first rotation in the NICU. Hopefully the RN took the matter to the attending for the delivery or the Neonatologist if it was serious enough.

[ERDoc]

I think scuba's last post pretty much summed up the nurse's lack of professionalism.

[iStater]

I think scuba's last post pretty much summed up the nurse's lack of professionalism.

I don't see anything unprofessional by talking to a physician in private. We still do not know the specifics of the situation. Don't just assume the RN is always wrong especially if it is in an area where you lack certain expertise. This was in L&D and not the ER where things might be more lax. Residents are not always right even if they have MD after their name. It is the responsibility of everyone to see the patient gets quality and the correct care even of some egos get bruised. This nurse might even have done the resident a favor by correcting him rather than getting his attending involved. That is the nice thing about the teaching hospital I work at. The attendings want to hear about all the screwups the residents make but that can also go badly for the resident.

Edited October 29, 2013 by iStater

[ERDoc]

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,

I guess you missed this part, which pretty much explains the unprofessionalism. I will give her a point for not doing it in front of the pt. No one should be berating anyone else, we are all on the same team. I never said that residents can't be wrong (there is a reason we have residency) but the way the nurse handled it was almost completely wrong. As I said before, based on scuba's first post it sounds like this nurse yelled at the resident for allowing oxygen to blow into the babies eyes. My assumption is that she doesn't understand the pathophysiology of ROP, based on the description. No I wasn't there, but that is the beauty of having internet forums, we can have discussions, that will not affect anyone, even if we do not have all of the information. I have my opinion and you have yours. Just because I am just an ER doc doesn't mean I haven't worked in plenty of other places in the hospital, so I do know how they function, especially L&D since I almost went into OB/Gyn.

[Just Plain Ruff]

. This nurse might even have done the resident a favor by correcting him rather than getting his attending involved.

A favor after chastising him like Scuba said she did, with it being pretty embarassing for everyone involved. That's pretty rich.

I guess you missed this part, which pretty much explains the unprofessionalism. I will give her a point for not doing it in front of the pt. No one should be berating anyone else, we are all on the same team. I never said that residents can't be wrong (there is a reason we have residency) but the way the nurse handled it was almost completely wrong. As I said before, based on scuba's first post it sounds like this nurse yelled at the resident for allowing oxygen to blow into the babies eyes. My assumption is that she doesn't understand the pathophysiology of ROP, based on the description. No I wasn't there, but that is the beauty of having internet forums, we can have discussions, that will not affect anyone, even if we do not have all of the information. I have my opinion and you have yours. Just because I am just an ER doc doesn't mean I haven't worked in plenty of other places in the hospital, so I do know how they function, especially L&D since I almost went into OB/Gyn.

You're just an ER Doc, doc, "You don't know nothin bout birthin no babies"

Edited October 29, 2013 by Captain ToHellWithItAll

[Eydawn]

Yeah... mutual respect and communication is important. Hugely important. Perhaps the MOST important thing that contributes to patient safety and accurate care...

I'm a newer nurse, but the docs I work with know me and know that I'm keeping good eyes on their patients. When I ask a question or suggest a treatment route, it's a back and forth discussion with my impression, their big picture, and a treatment decision moving forward... Do I ask dumb questions sometimes? Oh hell yes. I have blonde moments, just like anyone else. Fortunately, the providers I work with just laugh, educate me, and we all move forward.

I would never berate or belittle someone. Asking if they're qualified to be who they are and where they went to school is an ad hominem lateral violence tactic and it is not excusable. Asking what their treatment decision rationale was and if they were aware of XYZ is appropriate, and can even be done intensely "Did you realize this, this and that? Did you consider this before you attempted that?" while still remaining professional and appropriate. If you got so scared or freaked out that you feel like all you can do is scream at the person "are you a moron?" you need a time out before you attempt to discuss it with them. Also, if your nursing student sees you chew on a doc, it wasn't in private. It was just not in front of a patient/family, which is only *marginally* better. Students are students- not to be exposed to the bullshit and dirty laundry.

Trust me, I know all about certain areas or care teams doing certain things. I know about the "this doc trumps that doc and therefore his/her PA overrides this other doc's order" game. At the end of the day, raised hackles and peevish behavior do nothing but create an environment where the patient is at greater risk of harm. What about the next time that resident is working the delivery/resus? Will he be distracted, wondering if this nurse is going to jump him? Will he be less aggressive and miss nuances? Lots to consider here. We can mess each other up psychologically and affect care pretty badly if we're not careful. We already have enough emotional trauma to deal with.... why add to it when there are other alternatives?

Wendy

CO EMT-B

[iStater]

A favor after chastising him like Scuba said she did, with it being pretty embarassing for everyone involved. That's pretty rich.

You're just an ER Doc, doc, "You don't know nothin bout birthin no babies"

It was stated earlier that the nurse and doctor were not in public but in a room aside.

Attendings can blast a resident for very little things and often in rounds where there are a dozen people from several disciplines to hear all about it. Some residents deserve it and some don't. It is not all butt slapping and hugs like on TV shows.

"Birthin' babies is something women have been doing since the beginning of whatever theory you believe. But when a baby gets into trouble at birth we like to know there are highly skilled personnel at the bedside. If your intent was to belittle the importance of neonatal resuscitation and the staff who works in these specialized areas you have clearly succeeded. At no time did I question the ability of an ER physician to perform at their level of expertise in emergency medicine. When it comes to neonatal resuscitation I hope an ER physician does not put ego in front of calling the NICU team.

As far as this topic goes, all we have is hearsay from a student nurse. At some point new nurses will learn doctors also make mistakes. It is also this petty gossip on the unit which gets stories spread out of proportion. Then when someone offers a differing opinion which goes against whatever the intent of original gossip, they get criticized. Student nurses need to distance themselves from gossip or discuss it with their mentors to see a broader picture with more angles. This discussion has made a villain out of an RN without getting the full picture. For all we know the RN and resident were also in a sexual relationship and personal issues were present.

It might just be "birthin babies" but if they are in a hospital giving birth they deserve to have quality care.

[MariB]

Oh boy

[scubanurse]

First off, I'm not a student nurse, second off, I know doctors make mistakes. If you read the posts, I was just confused about O2 in the eyes of neonates and that question was long ago answered and I now better understand it. So get over it. The original situation that caused confusion has been resolved.

[ERDoc]

It was stated earlier that the nurse and doctor were not in public but in a room aside.

Attendings can blast a resident for very little things and often in rounds where there are a dozen people from several disciplines to hear all about it. Some residents deserve it and some don't. It is not all butt slapping and hugs like on TV shows.

"Birthin' babies is something women have been doing since the beginning of whatever theory you believe. But when a baby gets into trouble at birth we like to know there are highly skilled personnel at the bedside. If your intent was to belittle the importance of neonatal resuscitation and the staff who works in these specialized areas you have clearly succeeded. At no time did I question the ability of an ER physician to perform at their level of expertise in emergency medicine. When it comes to neonatal resuscitation I hope an ER physician does not put ego in front of calling the NICU team.

As far as this topic goes, all we have is hearsay from a student nurse. At some point new nurses will learn doctors also make mistakes. It is also this petty gossip on the unit which gets stories spread out of proportion. Then when someone offers a differing opinion which goes against whatever the intent of original gossip, they get criticized. Student nurses need to distance themselves from gossip or discuss it with their mentors to see a broader picture with more angles. This discussion has made a villain out of an RN without getting the full picture. For all we know the RN and resident were also in a sexual relationship and personal issues were present.

It might just be "birthin babies" but if they are in a hospital giving birth they deserve to have quality care.

Wow, just wow. Putting aside insulting several of our more prominent members and a colleague of yours (no wonder nurses are stereotyped as eating their young), you are wrong. No attending should be blasting any resident, especially in front of others. That is a disgusting lack of professionalism. As for the ego of the ER doc deciding to call the NICU, who else is he going to call? It's hard to care for a baby for days in the ER. Remember though, not every hospital is an ivory tower with a NICU team and every specialist you could want. The closest NICU team for me, when I work at my rural hospital, is over an hour away. If I'm lucky, the hospitalist who is on will be med/peds but not likely. Until the NICU teams arrives in their golden chariot, guess who manages that baby. Yup, that egotistical ER doc And unlike the NICU team, he has to manage the mother also (hopefully she's not hemorrhaging from undiagnosed placenta previa due to a lack of prenatal care. yeah, that was a lot of fun). Luckily I work with a bunch of awesome nurses who don't have huge egos and feel the need to berate and belittle someone to feel better about themselves.