Monday, June 09, 2008

Doctor's Orders

Many of our scheduled inductions come in at 0500. We change shifts at 0600 so I barely get a chance to know these women before handing them off. On a good day I can get her in and out of the bathroom, to bed, monitors on, vitals taken, consents signed, IV in and complete physical assessment complete before 0545 when report starts. If I don't then she ends up not getting her pitocin started until at least 0700 for one reason or another. (This is a whole other post that I'll address sometime.) So, I tend to try to be as efficient as possible. Everyone once in a while we'll get a real kink thrown in like someone wanting an enema, an extremely complicated medical history, tough IV start, etc. I do my best to get them going as quickly as possible without them knowing that I'm busting my ass to get their crap done!

I was starting an induction the other day and she asked me if she could have something to drink. I told her that her doctor usually preferred that patients just have ice chips but that I could probably get her a glass of water if she needed one.

Now, there are a couple reasons that I would go "against" doctor's orders in this case.
#1 One small glass of water is no different than ice chips; I wasn't offering her a Big Gulp :)
#2 She was having her third baby in 5 years, one of which was almost 9 pounds so she had a fairly significant proven pelvis as opposed to a first timer.
Now, if a mom is trying to VBAC, has a known risk factor such as history of shoulder dystocia, IUGR or diabetes, I would have refused her the water and just given her the ice chips. I promise I have a point. :)

A few minutes later I'm signing consents with them and we go to have her husband sign one of them and I find out they are under our hospital's I dumbly say "so where do you work?" And he tells me he is one of our hospital's a specialty we rarely if ever even consult with. Oops.

No doctor, we nurses don't ever offer your patients something against your orders. :)


pinky said...

I do that all the time. F them. It is not like you put up a morphine pump.

designed by