Saturday, April 23, 2011

A short rant about communication skills.

In a hospital setting, good communication is crucial. It can literally be a life or death issue. And even in the cases where it is not, a lack of communication can seriously Fuck Up Your Night.

Last night I was assigned to work in the Overflow Unit, a section of rooms in Pediatrics where we put the Moms that don't fit on the main unit.

I was originally assigned 3 patients, but one of them was halfway out the door. I just had to finish the last of the discharge paperwork and snip off the baby's security tag. Okay, cool. Down to two.

The Break Relief nurse told me to get Room X ready, because I was going to get the next admission. Didn't tell me the name, or when she delivered. I had to do some sleuthing and guess-work to figure out who was the next likely candidate. Okay, fine. It happens.

Then I get a call from L&D asking if Room Y was clean for my new admission. I explained that X was clean and ready, because that's what I'd been told to set up. She said "Right, pt A is going into room X, but she's not ready yet. Pt B is going into room Y." Huh? Who is pt B? "Also, make sure room Z is clean as well." (apparently for the other nurse on overflow with me).

So we scramble to get Y ready, and call housekeeping to clean Z (where I'd DC'd my other patient from). I'm trying to read up on my incoming patients when all of a sudden I see the room number for incoming-patient-B switch from L&D to the Main Floor, not Overflow as expected. Huh?

Apparently one that *they* were expecting was not doing well, and being kept in L&D longer, so they decided to move my patient to the main unit and give me the next one that came along.

It's 0445 when Patient A shows up, strangely lacking her baby. Apparently he was cold and they kept him under the warmers for a bit? Her husband was strange, maybe Asperger's? Obsessed with taking photos ("the lighting in here is terrible, and the white sheets are washing out the picture") while mom was clearly exhausted. Got her settled (the other nurse's patient came in while this was happening) and finally got to go on my break at 0520.

Back from break at 0550, got a 10-minute head's up, and then my New Patient B came to the floor. Did I mention I had 6am meds to give on practically everyone? Got B settled, managed to pass my meds mostly on time and waited for the Day Shift to arrive and rescue me.

And not *once* did my Charge call us to let us know what was going on. I had to call her. I understand what it's like to be busy as Charge. I used to do it on Tele. It sucks when you've got admits on all sides. But I made *sure* to call my nurses and let them know "You've got Mr Smith coming in, he's going into room 1234" as soon as I figured it out. There is nothing more unsettling to me than getting a call from the other unit going "Is the room ready?" and you having to ask "Which room and for what patient?"

I cannot handle not being kept in the loop. And I know that the Charge Nurse knows that this stuff is going on; she's the one making the decisions about who goes where. She changes the information on the L&D "Chalkboard" on the computer, but I am not sitting in front of that screen all shift waiting for information to pop up.

It is *not* that hard to call me and say "Miss Jones delivered at 0100, she'll be going into room 4321" It takes 30 seconds, and makes my night run sooooo much smoother. I know it's doable.

Apparently word got to the Charge that I was not happy, and at the end of shift I got an apology/excuse but no reassurance that it won't happen again.

Looking at what I've just wrote, I realize this is not a short rant. It is a long rant, and for that I am sorry. I just value thorough communication :)

Monday, April 11, 2011

An overheard conversation....

As a fix for our staffing problems, the management has decided to cross-train L&D nurses to float to Mom/Baby if we are short. One of those L&D RNs was having her first orientation day on the unit. Our scene finds us sitting at the station; they are discussing the pertinent info for shift report, and I am charting about 10 feet away.

[a muffled scream filters down the hallway]

L&D RN: Um, what was that?
MB RN: Sounds like a natural childbirth to me. *grins*
L&D: You guys can hear that all the way down here....?
MB: Yep. Especially if it's one of the rooms at the end of our hallway here.
L&D: [looks concerned] We had no idea you guys could hear things over here. I'll make sure to close the doors next time I have a mom without an epidural.

I dunno why but this brief exchange made me giggle like crazy.

Thursday, April 7, 2011

I may have a problem....

Ok, so this might be kind of stupid.... I'm watching through all of Xena right now on Netflix, and I'm on the last episode of season one. One of the side characters is in labor, spending most of her time sitting off on the sidelines while the main action is occurring.

Cut to her lying on her back with her legs bent, and another character is telling her that the baby "hasn't come down at all" and I'm thinking, "Dammit, woman! You're an Amazon! Get off your back! You're better than this!" (also, since when did ancient greek warlords know anything about childbirth?)

And then they determine that the baby (apparently a half-centaur!) is breech and she has to have a C-section using candle-related hypnosis as a method of anaesthesia and the baby that comes out could *not* have fit inside that woman and then I realized I need to stop taking things so seriously.....