Nurses as patient advocates

I had a multip mom laboring beautifully and spontaneously. She progressed quickly to 10 cm dilated, and was fairly comfortable with her epidural. She had a history of short pushing stages, and the baby looked fabulous on the monitor.

The doc wants to teach the resident how to apply forceps.

(Umm, hello? You want to do what??)

When I heard this, I approached the doc and said to him "there is no medical reason why you need to apply forceps -- this is just a teaching time? Um, no."

He looked at me like he couldn't believe I would go up against him like that.

I stated the same thing again - "There is no medical indication for forceps. The baby is tracing beautifully on EFM. And the fetal head is presenting at the vaginal introitus. This patient is not a teaching patient to "practice" forceps on. Now, are you going to put some gloves on and come catch this baby, or what?"

End result? Spontaneous vaginal birth in under 2 minutes of maternal pushing. No forceps. No vaginal or perineal lacerations.

Now, I understand that there are times that residents need to learn new procedures, etc. However, this was totally NOT the right time, nor the right patient to do this.

And this was totally the wrong nurse to try to pull this crap on.

Do you have some personality to go with that chocolate?

Short answer: yes.

Just what the heck am I talking about? I'm talking about the new baby docs that are starting their rotation with us at Big City Hospital. When I refer to new baby docs, I'm not talking about pediatricians. I'm talking about those newly minted MDs that have just graduated from medical school in the past year.

New Baby Doc: (noun) - A physician which has just graduated from medical school within the past year. This is also referred to as the intern or first year resident. These newly graduated physicians have book smarts, but not necessarily clinical smarts.

Ahhh, breaking in the new doctors of tomorrow. What a fun job for nurses! What everyone should know is that these new doctors do not always start their first clinical rotations in July: they sometimes start in the dead of winter. Typically, July 1st is the changeover time for all med students and residents. However, we receive students/residents that share time with another local hospital, so we tend to get newbies all year 'round.

I had the 'pleasure' of meeting several newbies recently. There are good newbies, and there are not so good newbies. (I'm trying to be positive here.)

Good newbies: eager to learn, introduce themselves to the nursing and medical staff, ask questions, treat the nurses like co-workers, bring in yummy chocolate.



Not so good newbies: think they know it all, don't bother looking you in the eye when they need you to come in with them to examine a patient, don't introduce themselves to you, treat nurses like they are lower than them, order tests for no rhyme or reason, and where-the-freaking-heck-is-the-chocolate???

Ya'll understand where I'm going with this, right?

Yeah, of course you do!

Newbie #1: no personality, no introduction to nursing staff, very brusque and abrupt. Has no clue when ordering tests/treatment. Very slow to warm up to the nurses. How you gonna learn medicine without the nurses on your side??? This one might not last long in OB.

Newbie #2: looks you in the eye, introduces themself, smiles, presents nurses with yummy chocolate brownies, asks questions, very laid back, talks about their children, sits down with nurses at the nurses' station. Shows basic knowledge of OB when discussing particulars of a patient situation with the nursing staff. This one is a keeper.

Rule #1: Smile. Introduce yourself.
Rule #2: If you don't know, ask questions. Don't just guess.
Rule #3: Know the basics of OB before you walk in the door. We can help you build from that.
Rule #4: The nurses are your friends, not your enemies, and certainly not your subordinates. Respect is mutual.
Rule #5: You chose this specialty. If you don't like it, it shows.
Rule #6: Bring food. Especially chocolate. And often. We will share our food with you too.