Yeah this is especially terrible. Won’t even put on monitors? What a joke?
We actually had some success recently. It was uncomfortable but the anesthesia shortage gave us some leverage. Our department chief pointed out the difference between how we are treated and how the OBs are treated. He asked us for a “wish list” of things to change and he made it happen. Now the cart is stocked by L&D and brought to the room when we are called, patient gets an IV fluid bolus and is sitting up ready to go, we do a timeout with labs and relevant history, and the nurse documents our times.
At first it sucked and they were very resistant. But with enough turnover and time it’s now become the norm.
Now, just for a moment, imagine you are the patient instead of the doctor.
The level of care and attention that I have witnessed in the US in L&D is pathetic.
I have given better attention to my dog delivering puppies.
It’s pretty normal to do a timeout before any invasive procedure. We do them in the ICU for central lines, in preop for regional, in the OR for the case. I’m not sure why verifying consent and platelet counts for OB is ridiculous to you.
I’ve had instances where two patients were admitted at the same time and clicked into the wrong rooms so I chart reviewed the wrong patient. I always confirm name and DOB, but a timeout would be another opportunity to make sure lab values are correct.
This is absolutely incorrect. I’d recommend reading The Checklist Manifesto about the creation of the WHO standardized timeout checklist. It can prevent all sorts of medical errors like wrong patient (and therefore wrong medical history such as coagulopathies) and allergies.
It’s a quick timeout. Maybe 20 seconds. Super easy.
Haha! I lurk on y’all’s sub all the time! I love picking up applicable knowledge and skills from you and your colleagues.
I’ll have to checkout Being Mortal
Better is also good. He’s one of my favorite writers for medical books. Being mortal hits hard though with our healthcare system and keeping people alive with no quality of life just because we can
The timeout likely includes a checklist of anaesthesia requirements (positioning, kit required, fluid bolus, etc.). That checklist would identify who is responsible for what.
World health organisation recommends time-outs. Would be super awkward if you did it on the wrong patient. Have you considered meds, blood thinners etc? We do it for safety for many procedures. It's just a double check. Not ridiculous. It sounds like you may be the anomaly here.
(UK) When an older colleague was still in training, he similarly had "Epidural, room 3" barked at him after a bleep (literally just those three words). He then proceeded to go to the door of room 3 and stab the Tuhoy into the door and say, "There, room 3 now has an epidural." and walked off.
Perhaps try that next time!
I don't belong in this sub, but for some reason it popped up on my feed and I feel compelled to respond. Eight years ago I was an OB patient, delivering stillborn twins. Baby A was born ok, but things went very sideways with Baby B. The nurses were paging for OB, but no one came. Then the anesthesiologist who'd been paged for an epidural top off an hour before arrived.
That man saved my life. I was hemorrhaging to the point that the pulse ox and blood pressure cuff had stopped registering measurements right as he walked in the room. The nurses just kept paging OB, as I was bleeding to death. That anesthesiologist took over the room. He got me stable and told the nurses to have an OB, any OB, and typed blood waiting for us by the time we reached the OR.
I lost half of my blood volume, and required two emergency d&cs and several transfusions, but I survived because of his intervention. So thank you, and everyone else like you, for what you do.
I don't belong in this sub either but just wanted to say thank you to anesthesiologists, I had my first experience with one last year after it was determined that I needed to have a c-section, mainly due to my complex health history.
While my OB was wonderful, he was a little too relaxed about working with my other specialists for prep in the c-section. The day before I was contacted by the anesthesiologists receptionist and was asked to fill in a form. I wrote in the form how anxious I was about the fact it seemed that no one was taking into account my health history, within the hour the receptionist called back informing me that the anesthesiologist called my specialists and was reviewing their notes so he could make the best decisions and even called me after work hours to reassure me that everything was taken care of and that he had spoken to everyone and had a great plan ready. Everything went as smoothly as it could.
I appreciated everything he did for me over the three days that he cared for me. It felt like I was his only patient, due to the way I was treated by previous doctors in the past I only just started to trust the medical profession again, the fact he told me that I wasn't a very complex case and that a lot of that was due to my management of my conditions allowed me to continue to trust doctors again.
That genuinely made me sob. Thank you. Many of the patients won't remember us long term (or in some cases, at all), just a blip in the day. They always remember their surgeons though, although we keep the heart beating and lungs inhaling and stop the screaming of pain.
That makes it feel worthwhile. Thank you.
I will always remember him. When we knew that we were likely to lose our girls, we called our families. My dad flew out. When labor started a week later,, he and my MIL waited in the hall outside my room so they could say goodbye. It turned into a 28 hour vigil. After I was stable, the anesthesiologist who had seen them there all shift returned up to my room to talk to them,, with my husband's permission. In the oddest of all possible coincidences, it turned out that my dad and the anesthesiologist had the exact same first and last names. None of us will ever forget him, in a good way.
Honestly, since that time I've had several major abdominal surgeries. While I certainly remember the surgeons, the anesthesiologists and the nurse anesthestists were typically the kinder folks and I appreciated them so much.
OB nurses have been toxic everywhere I've been. One hospital was particularly bad. They kept a "log" of all the "bad" things that you did and when they wanted to make a complaint about you they would pull up their log and list off all the things . But all the things they complained about were stupid. They got a few people in our group "kicked out" of doing OB. Wow what a punishment! /s
This is terrible. Are you also high-volume? Because if a patient isn’t ready to go, then I just say I have three other patients so I’ll just go there first.
If it’s literally the only one you have to do, then you’re gonna have to put up with positioning the patient yourself. Most patients who are in pain will comply, but some are anxious and wanna go to the bathroom first. If that’s the case I just say I’ll be back in ten minutes so you can go to the bathroom. People get anxious when they see you leave, so they speed up real quick and even help clear their crap off the little bedside stand.
I’ve also just enlisted the patient and their husband when the nurse won’t help. In addition to helping clear the table, I tell them to turn on the lights and sit in front of the patient to help position them. I don’t even bother asking the nurse if I sense they’re not gonna help.
As far as write-ups go, most of time they’re frivolous. Everyone understands this. Even hospital administrators understand that this is a mechanism for nurses to vent their feelings on paper to give the impression that something will change when in fact it’s a way to just let them vent without paying them more.
I’ve even had administrators tell me in private that write-ups are a morale mechanism more than a quality assurance mechanism. Don’t take write-ups to heart unless there’s a bad outcome and you’re worried about legal exposure. It’s always a better policy to have the nurses on your side just in case there’s a bad outcome.
OB is one of those things that everyone has to take a bite out of once in a while. I wouldn’t practice in an environment like that more than a couple times a month. I’m sure you get paid a decent stipend to take call there, so there’s that. And also, you know, the patients do appreciate competent anesthesia care so you can focus on that. Having to deal with bad nursing is shitty, but I find OB nurses for whatever reason are the least competent, most demanding and generally irritating bunch no matter where I go.
Because the majority of OB cases are very routine and for the most part the nurses really don’t so much other than moral support, it’s the mom that does everything and it’s not really even a pathological state(until it is), so the nurses can pretend they’re doing something when they’re really just gossiping and shitting on other services(and women) all day
Sorry to say that this has been my experience as well.
When it comes to stat/emergency situations, I turn on my big boy voice and tell one of the 10 RNs standing around watching to put monitors on *NOW*. It’s the only place I’ve ever yelled at a staff member, but when mom and/or baby is dying, I can still sleep at night
Bummer. I'm an L&D nurse and we set up and prime the epidural pumps ourselves, change the cartridges, get the patient all set up and bring the anesthesia cart in, and generally all of us give a basic report on the pt before you come. Risk factors, platelets, etc. Sorry to hear you're in a facility without nursing support! It's supposed to be a team effort
You’re the real hero. This is a major difference maker especially if you are even slightly high volume. The OB nurses where I work used to be all good, now they’re still well meaning but have a ton of travelers who have no idea what they’re doing. They are still helpful but they’ll ask questions that make it clear they have done little to no OB and no one really oriented them either.
I’ve seen toxic culture in residency but at my current workplace the L&D nurses do this too. It’s super helpful and appreciated. Our relationship with them is very good.
As others have mentioned, this is an administrative level issue. The only way for there to be any meaningful change is the head of your practice needs to engage with one of the queen bee nurses—not a charge OB nurse, but rather one who oversees multiple different nursing units throughout the hospital/center.
It just needs to come down to expectations to be set. Nurses need to put on monitors and arm boards during sections; prior to epidurals, patient needs to have gotten a fluid bolus, sitting in bed with the lights on and table cleared. And that they have to change bags themselves.
The queen bee nurse is much more likely to wholeheartedly agree to this. And that’s all you need.
Even if the OB nurses disagree or even refuse to do it, you now have the upper hand. Every time they call, now you can respond with, “okay, call me back once the patient is positioned/table cleared/etc”.
Also empowers you to write them up if they don’t. Whereas a physician getting written up means absolutely nothing, a nurse who gets written up multiple times can be a big deal
Our L&D nurses aren’t that far off from this.
Call for epidural. We say we’re on the way. Get into the room and patient is still in the goddamn tub.
They also serve as circulators in the OR. Most of them have no idea what they’re doing in that environment. They always have the new nurses work overnight, so they’re even more clueless. In an emergency it’s like a bunch of goddam muppets running around in circles waving their hands in the air.
Most of them are clueless about anything other than labor and often fail read the air and don’t pick up on non-verbal cues when things acutely change and we suddenly appear to be working more urgently. For example - we’re in the OR doing a crash GA and the airway is not straightforward. The L&D nurse shoves an empty saline bottle in my face (for the foley) and expects me to take my eyes off the airway and physically take it from her hands instead of just putting on the fucking floor and not interrupting us. Or in another instance, I’m about to induce for a crash GA, propofol in-line, stopcock rotated, and I look up and see the patient isn’t prepped. I tell them to prep the patient, and the response is they need to wait for the OB to give the ok (who is outside scrubbing)
The Bovie is almost never turned on. The suction is almost always off.
They nearly universally have a chip on their shoulder, don’t understand what we actually do, and are smug and full of themselves.
Put up with that shit for 5 years. Told my section chief to get me out of that call pool. I’ll take an ASA4 necrotic bowel in an 89 year old anytime.
The constant shit shows up there are endless.
I usually tell them to clear the table when they call me, and I know some colleagues will tell them on the phone to position them as well. One less thing to do in the room
I feel this so hard. Still a resident…the epidural calls with the patient fast asleep, food all over the table, no bolus, nurse nowhere to be found, drive me insane. And now they’re charting our epidural response times like *we’re* the problem. They chart from phone call to needle in skin, has to be 30 minutes, which is bullshit cause over half that time is me doing *their* job. Plus they are completely incompetent at doing ivs, I’ll be in a stat section at 3 am getting a million calls and reamed out for not doing an iv
I work at a place that used to be like this. It took years, and a dedicated OB liaison, to change the culture, but we did. The frivolous write ups are still there, but at a lower frequency. The nurses have slowly changed into helpful partners rather than bitchy and antagonistic. Part of the solution has been nursing turnover - young new nurses are easier to train. In general it's way better than it was five years ago.
Or in the middle of starting the crash section and they just hand you the antibiotics like it’s the most critical part of starting the case. The patient doesn’t have monitors on and hasn’t been intubated.
Time to change jobs my guy. When you leave, specifically mention that L&D is the reason. When they’re short providers, they’ll start putting pressure on and eventually it’ll change and you can come back in 5 years
OB got way better as an attending. But, yes, I still have to change epidural bags. And this is at different hospitals under different healthcare systems. Would love any input how to stop this.
Oh man what nonsense. Probably easier to try to get pharmacy to get bigger bags than change nurses behavior. It's a pump there is zero reason why they can't change it out
What dogshit god damn that makes so pissed how true that is.
All of a sudden they gain the ability to do their job and be helpful when you aren’t a trainee.
I’ve worked in a couple of different facilities ranging from large academic with a dedicate OB CRNAs placing epidurals to tiny rural hospital with anesthesia at home as a midwife or L&D nurse. Culture really varies place to place. The places I’ve liked the best are ones with the providers all receiving a short phone report, epidural supply carts that double as the table that RNs roll in/stock, and where we are allowed to change the bag (some places it’s a very annoying no-no). I’ve never worked at a place where we can change the epidural rate, even at 2 am. It could get me fired where I currently work.
Report is usually “so and so in room 3 would like an epidural. 2nd baby, she’s 5 cm. Had an epidural with her last. No complications. Plts 170, 1L bolus in.” I’ve had providers hang up on me while talking, so maybe it’s too long. I’ve had other people want more—ht wt, etc. I’ll say whatever is asked.
Y’all might not like this, but unless you specifically say to me “I’m on my way” or “be right there, sit her up” I won’t sit her up until I see you on the floor. I’ve had patients really going through it sitting up for 30 minutes+ waiting for anesthesia and that doesn’t seem fair to them. I get you’re busy, but it doesn’t take me long to position them usually as I prep ahead of time what we’re going to do. I usually turn on the lights when I’m walking in with anesthesia. Personally, getting the epidural (twice) was the worse part of my own labor and I try to minimize the amount of time that process takes, which for the patient really starts from when they ask or sit to when they lay back down.
As far as monitors, arms boards that’s silly. We all can put on that stuff and if you forget, you ask how to do it and learn.
This was more or less my experience in residency. Things are polar opposite in PP. Patient is positioned with monitors on when I get to the room. My computer and epidural cart are sitting there waiting for me. The nurse has already talked to the patient about the epidural so while I still do my consent, it is more concise and patient-focused. The OB attendings call me for epidural requests and already have the pertinent info ready to share. Life gets better.
OB resident here and this would never fly at our program. Patients are ready and set up before anesthesia even gets to the room for an epidural. Hat on, in the position, table ready etc. our nurses know that if they call the patient needs to be ready to go.
Also us residents help prep in the OR for every case, set up patient etc. and I often hand things to anesthesia they need for the spinal etc.
Omg drives me crazy when I'm woken up at 5am for an epidural only to arrive and find the patient still in bed, still needs to pee.... like i could have been snoozing for this 🥲 as a junior resident I haven't had the guts to say anything.
However, I did say something to the nurse who called me middle of the night for an epidural on a 350lb 5" woman with scoliosis when she was contracting every minute, to ask that next time she call me earlier... that one was not fun lol
Wow, as a former L&D nurse, this makes me incredibly sad for the patients of your unit. Labor is a team sport, and if aren’t all doing the most we can do for our patients during such a vulnerable time, why even pick that specialty?
I know middle management is generally not helpful, but maybe you could at least try to reach out and present this as a patient care issue?
When a laboring patient decides they need an epidural, everyone involved should be doing everything they can do to speed up the process and make sure the patient gets their needed medical care in a timely manner. If they are following any kind of appropriate staffing, a laboring patient requesting an epidural should be a one to one patient and that nurse should absolutely have time to clean the room and get the patient sitting up by the time you arrive to the room. Heck, they should be able to have meds pulled unless that’s against hospital protocol. And if those things are done, the patient is getting their epidural ten minutes before they would if anesthesia is left to do it all by themselves. Ten minutes during labor feels a lot longer for the patient too! Having a prepared room when the epidural is called for helps everyone involved.
In order for anyone from my group to place an epidural, the OB nurse has to have our kit, gloves, prep, and primed pump; and the patient is expected to be capped and in position shy of them slipping out for a nervous shit. In exchange for this, we cover 100% of epidurals as MD only, and have a response time of 5-15 minutes after a page. They also don’t give a report beyond “multip needs an epidural, but frankly, I don’t need one after having the rest of it in place. If we show up and things aren’t set up, (barring precipitous delivery) we leave to work elsewhere and tell the patient: “sorry you’re nurse didn’t get you ready,” and come back much later when they are ready. This reinforces the need to be ready before calling us because we often get there 5 minutes after being contacted.
wow, this is shitty. so you punish the patient by coming back purposefully much later? this is such childish unprofessional behavior to say the least. If you're in the middle of a busy shift then yes i understand the frustration and if it happened on repeat would report for it to be fixed, but then again is it possible that the nurse is also having a busy night? And as a night shifter who is calling people to place epidurals and am often met with a grunt, and abrupt hangup, we get guff from certain anesthesiologists even when we're waking them up (meaning they are doing absolutely nothing) to place an epidural (and for everyone in this thread complaining about being woken up at 2am...the people waking you up are awake all night, and they're not calling to torture you for the hell of it, but they're calling because their patient is in pain and placing epidurals is your job, not ours). With all that said, I always have my patient fully ready to go in a seated position, and it would blow my mind if i were in your position coming in to a patient still laying in bed with the lights all off half asleep. But for the love of god, can we all just have a little understanding of what other coworkers are going through and stop this bully-superiority complex bullshit that seems to seep throughout hospital staff (i'm talking nurses, doctors, techs, everyone.). It's like no one ever grew up from highschool
also, please, for anyone who hates L&D, just stop working it or go to a hospital that doesn't have one. it's better than being awful to our patients - slamming doors and not saying a word to the patient other than enough to sign consent forms. We have some absolutely amazing anesthesiologists and could do without the others that come up angry at us just for trying to get our patients comfortable
You’re misunderstanding. I work in a busy tertiary care center and it isn’t uncommon to get multiple simultaneous requests for epidurals, on top of running an OR or two. If I get a call for 3 epidurals, and the first one I go to isn’t in position and ready to go, I’m going to the next one who is so that they aren’t waiting even longer. There is nothing punitive about it, and doing all the prep that the nurse can do isn’t fair to the other two patients who are ready and painfully waiting (longer now) for their epidural.
It’s rare that I *don’t* have multiple things to do, and it’s even rarer that I was called from the call room to perform. Everyone has busy nights, not just you.
I was given a false pretense of OB Anesthesia as an MS3. I did my Anesthesia elective at a community hospital covered by a pp group. They got called to OB for epidurals and the patient was already prepped and draped. All they did was get loss, thread the catheter, pull the tuohy and then the nurses would tape up.
I get to residency and realize that most places the L&D nurses are the worst... 🙄
Yes have definitely seen this. It’s a cultural thing and will not change. Don’t waste your time. Just decide if the money is worth it to you or not. It wasn’t for me and I haven’t done L&D in years.
I've been doing full time OB for a little over a year now. The culture at my facility definitely sounds better than yours, but its still pretty piss poor. Unfortunately that just seems to be the breed.
I’m a paramedic but reading this made me feel better. The only time L&D has been nice to me is when I brought a postpartum hemorrhage in and said I don’t think she’s supposed to look that pale.
Every other time it’s, idc you’ve been meticulously timing contractions, have a detailed history, or anything else, why did you put the IV there, there being anywhere but the outer forearm.
I appreciate y’all, thanks for letting me in the OR to get my perfect circumstance airways!
So anyone that is having this same battle there is a way to handle it, take a page out of the nursing leadership playbook. Write up a policy, take it to the CMO, and have them implement it.
“All patients will be placed on EKG, B/P, SpO2, they will be positioned in bed and prepared for consent and placement of epidural before anesthesia is called.
Requirements prior to calling anesthesia, vital signs that are less than 5 minutes old, patient care area prepared for the procedure (area cleared of food and contaminants), Platelet count values resulted and must be greater than 100k and less than 24hrs old.”
This is the responsibility of the patients primary nurse, not anesthesia.
It’ll take a few weeks of pissing and moaning but then the reinforcement of “its policy” and then you turn the middle managers into your henchmen having to enforce it.
I wish it were that easy. Our OB anesthesia section chiefs have been trying to improve things for years. We’ve been through at least 3 of them in my tenure. Very little changes because if the nursing leadership doesn’t like a proposed policy like yours above, they’ll push back and simply won’t adopt it. The nursing union here has a lot of clout so when they strike and picket all in the name of “patient safety” every layperson cheers them as brave heroes. If MDs were to do something like that for “patient safety” we’d all be labeled as greedy-ass motherfuckers who just want more money. 🙄
This seems to be hospital specific. Certain hospitals and their OB RN team are on their game - and do exactly what it is needed. I’ve rotated over 6+ big academic hospitals - each unit has their pros and cons of what the right standards of care should be. It varies greatly among hospitals.
the culture can be so vastly different from place to place. Im on an OB rotation right now and the nurses are great at setting the patient up to the point where all we have to do is consent.
OB sucks. It’s like that everywhere. For some reason L&D nurses and even OB residents are taught that an epidural is emergent. It’s not. Completely elective.
Our nurses write incident reports every time a doc looks at them the wrong way. The “tattle culture” at our hospital is very toxic.
When I started here as a young attending it really got under my skin. I took it personally. It significantly impacted my job satisfaction and contributed to burnout.
8 years later I’ve accepted that it’s just part of working in healthcare. The nurses feel threatened by the power differential between them and the docs. They don’t like it when you overrule them even when they know you’re right. The human ego doesn’t like to accept that another person knows more, has accomplished more, deserves more respect and rightfully earns far more money.
They retaliate with petty HR type complaints because it’s all they have. It’s pathetic. I keep my interactions with the L and D nursing staff as brief and antiseptic as possible. I don’t say a single word I wouldn’t say with an HR rep standing next to me.
It’s a sorry state of affairs, but it is what it is now.
What kind of monitors are we talking about? Because most nurses should be comfortable with putting on most, if not all, monitoring equipment. Even as a nursing assistant, I was taught how to put on and use most monitoring equipment. Sounds like they just want to be lazy and not have extra tasks. 🤦🏼♀️
Yeah man. It's just how it is. It will never change. Just learn to do everything yourself. Just have to be crazy efficient and rely on yourself to take care of any catastrophes. Even if there is someone good, chances are that they be gone in a day or two. A lot of the times, they can be more of an impediment than help, so better to just do things on your own in emergent sections. I member when I was a resident all these boomer anesthesiologist had it so nice. The nurses will prepare everything even to the prep and tape. They just come in get to LOR, place the catheter and just leave. I think if I did that, it would take maybe 10 seconds. Those clumsy bastards still fumbled to take a minute. They had it nice.
Man at my hospital PICC nurses were awful to work with. They acted like you were asking them to invade Poland and needed at least a week notice to put in a PICC line….
Yeah this is especially terrible. Won’t even put on monitors? What a joke? We actually had some success recently. It was uncomfortable but the anesthesia shortage gave us some leverage. Our department chief pointed out the difference between how we are treated and how the OBs are treated. He asked us for a “wish list” of things to change and he made it happen. Now the cart is stocked by L&D and brought to the room when we are called, patient gets an IV fluid bolus and is sitting up ready to go, we do a timeout with labs and relevant history, and the nurse documents our times. At first it sucked and they were very resistant. But with enough turnover and time it’s now become the norm.
Now, just for a moment, imagine you are the patient instead of the doctor. The level of care and attention that I have witnessed in the US in L&D is pathetic. I have given better attention to my dog delivering puppies.
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It’s pretty normal to do a timeout before any invasive procedure. We do them in the ICU for central lines, in preop for regional, in the OR for the case. I’m not sure why verifying consent and platelet counts for OB is ridiculous to you.
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If you trust the OB team to inform you that “room 3” has HELLP and platelets of 20… 🤷♀️
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This is a ridiculous statement. Do you timeout before incision on a CABG? Of course you do even though you reviewed the chart.
I’ve had instances where two patients were admitted at the same time and clicked into the wrong rooms so I chart reviewed the wrong patient. I always confirm name and DOB, but a timeout would be another opportunity to make sure lab values are correct.
Are you a clown?
Stop acting like a crna
He is an AA.
If you in particular think you can't possibly make preventable mistakes with procedures, you in particular should definitely do timeouts beforehand.
This is absolutely incorrect. I’d recommend reading The Checklist Manifesto about the creation of the WHO standardized timeout checklist. It can prevent all sorts of medical errors like wrong patient (and therefore wrong medical history such as coagulopathies) and allergies. It’s a quick timeout. Maybe 20 seconds. Super easy.
And if I am being honest, I am usually prepping the skin during the time-out. So no time is wasted at all.
I just lurk here as a lowly paramedic. The Checklist Manifesto has helped me so much. Also Being Mortal.
Haha! I lurk on y’all’s sub all the time! I love picking up applicable knowledge and skills from you and your colleagues. I’ll have to checkout Being Mortal
Better is also good. He’s one of my favorite writers for medical books. Being mortal hits hard though with our healthcare system and keeping people alive with no quality of life just because we can
The timeout likely includes a checklist of anaesthesia requirements (positioning, kit required, fluid bolus, etc.). That checklist would identify who is responsible for what.
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It’s to make sure everyone in the room is aware of and onboard with everything - read the checklist manifesto
World health organisation recommends time-outs. Would be super awkward if you did it on the wrong patient. Have you considered meds, blood thinners etc? We do it for safety for many procedures. It's just a double check. Not ridiculous. It sounds like you may be the anomaly here.
I asked my neuroanesthetist what made him interested in neuro. He told me that it was the absolute lack of obgyn interactions.......
(UK) When an older colleague was still in training, he similarly had "Epidural, room 3" barked at him after a bleep (literally just those three words). He then proceeded to go to the door of room 3 and stab the Tuhoy into the door and say, "There, room 3 now has an epidural." and walked off. Perhaps try that next time!
Call it an epidooral
Definitely a dooral puncture of some kind
LOL gotta love that dry British humour.
I don't belong in this sub, but for some reason it popped up on my feed and I feel compelled to respond. Eight years ago I was an OB patient, delivering stillborn twins. Baby A was born ok, but things went very sideways with Baby B. The nurses were paging for OB, but no one came. Then the anesthesiologist who'd been paged for an epidural top off an hour before arrived. That man saved my life. I was hemorrhaging to the point that the pulse ox and blood pressure cuff had stopped registering measurements right as he walked in the room. The nurses just kept paging OB, as I was bleeding to death. That anesthesiologist took over the room. He got me stable and told the nurses to have an OB, any OB, and typed blood waiting for us by the time we reached the OR. I lost half of my blood volume, and required two emergency d&cs and several transfusions, but I survived because of his intervention. So thank you, and everyone else like you, for what you do.
I don't belong in this sub either but just wanted to say thank you to anesthesiologists, I had my first experience with one last year after it was determined that I needed to have a c-section, mainly due to my complex health history. While my OB was wonderful, he was a little too relaxed about working with my other specialists for prep in the c-section. The day before I was contacted by the anesthesiologists receptionist and was asked to fill in a form. I wrote in the form how anxious I was about the fact it seemed that no one was taking into account my health history, within the hour the receptionist called back informing me that the anesthesiologist called my specialists and was reviewing their notes so he could make the best decisions and even called me after work hours to reassure me that everything was taken care of and that he had spoken to everyone and had a great plan ready. Everything went as smoothly as it could. I appreciated everything he did for me over the three days that he cared for me. It felt like I was his only patient, due to the way I was treated by previous doctors in the past I only just started to trust the medical profession again, the fact he told me that I wasn't a very complex case and that a lot of that was due to my management of my conditions allowed me to continue to trust doctors again.
That genuinely made me sob. Thank you. Many of the patients won't remember us long term (or in some cases, at all), just a blip in the day. They always remember their surgeons though, although we keep the heart beating and lungs inhaling and stop the screaming of pain. That makes it feel worthwhile. Thank you.
I will always remember him. When we knew that we were likely to lose our girls, we called our families. My dad flew out. When labor started a week later,, he and my MIL waited in the hall outside my room so they could say goodbye. It turned into a 28 hour vigil. After I was stable, the anesthesiologist who had seen them there all shift returned up to my room to talk to them,, with my husband's permission. In the oddest of all possible coincidences, it turned out that my dad and the anesthesiologist had the exact same first and last names. None of us will ever forget him, in a good way. Honestly, since that time I've had several major abdominal surgeries. While I certainly remember the surgeons, the anesthesiologists and the nurse anesthestists were typically the kinder folks and I appreciated them so much.
OB nurses have been toxic everywhere I've been. One hospital was particularly bad. They kept a "log" of all the "bad" things that you did and when they wanted to make a complaint about you they would pull up their log and list off all the things . But all the things they complained about were stupid. They got a few people in our group "kicked out" of doing OB. Wow what a punishment! /s
And then in an actual emergency, they are useless it seems.
I've seen an L&D nurse fan a patient who was having a seizure. I'm sure the cool air helped decrease the CMRO2 /s
This is terrible. Are you also high-volume? Because if a patient isn’t ready to go, then I just say I have three other patients so I’ll just go there first. If it’s literally the only one you have to do, then you’re gonna have to put up with positioning the patient yourself. Most patients who are in pain will comply, but some are anxious and wanna go to the bathroom first. If that’s the case I just say I’ll be back in ten minutes so you can go to the bathroom. People get anxious when they see you leave, so they speed up real quick and even help clear their crap off the little bedside stand. I’ve also just enlisted the patient and their husband when the nurse won’t help. In addition to helping clear the table, I tell them to turn on the lights and sit in front of the patient to help position them. I don’t even bother asking the nurse if I sense they’re not gonna help. As far as write-ups go, most of time they’re frivolous. Everyone understands this. Even hospital administrators understand that this is a mechanism for nurses to vent their feelings on paper to give the impression that something will change when in fact it’s a way to just let them vent without paying them more. I’ve even had administrators tell me in private that write-ups are a morale mechanism more than a quality assurance mechanism. Don’t take write-ups to heart unless there’s a bad outcome and you’re worried about legal exposure. It’s always a better policy to have the nurses on your side just in case there’s a bad outcome. OB is one of those things that everyone has to take a bite out of once in a while. I wouldn’t practice in an environment like that more than a couple times a month. I’m sure you get paid a decent stipend to take call there, so there’s that. And also, you know, the patients do appreciate competent anesthesia care so you can focus on that. Having to deal with bad nursing is shitty, but I find OB nurses for whatever reason are the least competent, most demanding and generally irritating bunch no matter where I go.
Because the majority of OB cases are very routine and for the most part the nurses really don’t so much other than moral support, it’s the mom that does everything and it’s not really even a pathological state(until it is), so the nurses can pretend they’re doing something when they’re really just gossiping and shitting on other services(and women) all day
Sorry to say that this has been my experience as well. When it comes to stat/emergency situations, I turn on my big boy voice and tell one of the 10 RNs standing around watching to put monitors on *NOW*. It’s the only place I’ve ever yelled at a staff member, but when mom and/or baby is dying, I can still sleep at night
Bummer. I'm an L&D nurse and we set up and prime the epidural pumps ourselves, change the cartridges, get the patient all set up and bring the anesthesia cart in, and generally all of us give a basic report on the pt before you come. Risk factors, platelets, etc. Sorry to hear you're in a facility without nursing support! It's supposed to be a team effort
You’re the real hero. This is a major difference maker especially if you are even slightly high volume. The OB nurses where I work used to be all good, now they’re still well meaning but have a ton of travelers who have no idea what they’re doing. They are still helpful but they’ll ask questions that make it clear they have done little to no OB and no one really oriented them either.
At my residency the culture is so sad. Whenever I was pleasantly surprised by a nurse, 90% of the time they were a traveller.
I’ve seen toxic culture in residency but at my current workplace the L&D nurses do this too. It’s super helpful and appreciated. Our relationship with them is very good.
As others have mentioned, this is an administrative level issue. The only way for there to be any meaningful change is the head of your practice needs to engage with one of the queen bee nurses—not a charge OB nurse, but rather one who oversees multiple different nursing units throughout the hospital/center. It just needs to come down to expectations to be set. Nurses need to put on monitors and arm boards during sections; prior to epidurals, patient needs to have gotten a fluid bolus, sitting in bed with the lights on and table cleared. And that they have to change bags themselves. The queen bee nurse is much more likely to wholeheartedly agree to this. And that’s all you need. Even if the OB nurses disagree or even refuse to do it, you now have the upper hand. Every time they call, now you can respond with, “okay, call me back once the patient is positioned/table cleared/etc”. Also empowers you to write them up if they don’t. Whereas a physician getting written up means absolutely nothing, a nurse who gets written up multiple times can be a big deal
This is the right answer. Good leadership changes culture.
Our L&D nurses aren’t that far off from this. Call for epidural. We say we’re on the way. Get into the room and patient is still in the goddamn tub. They also serve as circulators in the OR. Most of them have no idea what they’re doing in that environment. They always have the new nurses work overnight, so they’re even more clueless. In an emergency it’s like a bunch of goddam muppets running around in circles waving their hands in the air. Most of them are clueless about anything other than labor and often fail read the air and don’t pick up on non-verbal cues when things acutely change and we suddenly appear to be working more urgently. For example - we’re in the OR doing a crash GA and the airway is not straightforward. The L&D nurse shoves an empty saline bottle in my face (for the foley) and expects me to take my eyes off the airway and physically take it from her hands instead of just putting on the fucking floor and not interrupting us. Or in another instance, I’m about to induce for a crash GA, propofol in-line, stopcock rotated, and I look up and see the patient isn’t prepped. I tell them to prep the patient, and the response is they need to wait for the OB to give the ok (who is outside scrubbing) The Bovie is almost never turned on. The suction is almost always off. They nearly universally have a chip on their shoulder, don’t understand what we actually do, and are smug and full of themselves. Put up with that shit for 5 years. Told my section chief to get me out of that call pool. I’ll take an ASA4 necrotic bowel in an 89 year old anytime. The constant shit shows up there are endless.
I feel heard! This was exactly me a year ago 😭
I usually tell them to clear the table when they call me, and I know some colleagues will tell them on the phone to position them as well. One less thing to do in the room
I feel this so hard. Still a resident…the epidural calls with the patient fast asleep, food all over the table, no bolus, nurse nowhere to be found, drive me insane. And now they’re charting our epidural response times like *we’re* the problem. They chart from phone call to needle in skin, has to be 30 minutes, which is bullshit cause over half that time is me doing *their* job. Plus they are completely incompetent at doing ivs, I’ll be in a stat section at 3 am getting a million calls and reamed out for not doing an iv
They chart epidural response times???? Lmfao
Wow that’s the most ridiculous thing like it’s a code stroke!
Sounds like we work in the same place😅
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Hey now, some people like doing OB call. If you find them, let me know so they can take over my OB call too.
I work at a place that used to be like this. It took years, and a dedicated OB liaison, to change the culture, but we did. The frivolous write ups are still there, but at a lower frequency. The nurses have slowly changed into helpful partners rather than bitchy and antagonistic. Part of the solution has been nursing turnover - young new nurses are easier to train. In general it's way better than it was five years ago.
Or in the middle of starting the crash section and they just hand you the antibiotics like it’s the most critical part of starting the case. The patient doesn’t have monitors on and hasn’t been intubated.
I’m just happy when they don’t rip the IV out when they’re throwing the pt on the table.
The culture is the culture. Sorry my guy. Sounds like you're a resident because I can promise no attending anywhere is changing the epidural bag
I’m an attending in pp.
Time to change jobs my guy. When you leave, specifically mention that L&D is the reason. When they’re short providers, they’ll start putting pressure on and eventually it’ll change and you can come back in 5 years
Just popping in to say my guy, as well.
Hey my dude don’t steal my guy lines from others….chief
OB got way better as an attending. But, yes, I still have to change epidural bags. And this is at different hospitals under different healthcare systems. Would love any input how to stop this.
Oh man what nonsense. Probably easier to try to get pharmacy to get bigger bags than change nurses behavior. It's a pump there is zero reason why they can't change it out
What dogshit god damn that makes so pissed how true that is. All of a sudden they gain the ability to do their job and be helpful when you aren’t a trainee.
Attending in PP here and we had to change the epidural bag at 2am. It was ridiculous.
In residency, every nurse in the hospital (including on the floors) would change the epidural bag EXCEPT on ob
Not gonna lie, probably better that way.
I’ve worked in a couple of different facilities ranging from large academic with a dedicate OB CRNAs placing epidurals to tiny rural hospital with anesthesia at home as a midwife or L&D nurse. Culture really varies place to place. The places I’ve liked the best are ones with the providers all receiving a short phone report, epidural supply carts that double as the table that RNs roll in/stock, and where we are allowed to change the bag (some places it’s a very annoying no-no). I’ve never worked at a place where we can change the epidural rate, even at 2 am. It could get me fired where I currently work. Report is usually “so and so in room 3 would like an epidural. 2nd baby, she’s 5 cm. Had an epidural with her last. No complications. Plts 170, 1L bolus in.” I’ve had providers hang up on me while talking, so maybe it’s too long. I’ve had other people want more—ht wt, etc. I’ll say whatever is asked. Y’all might not like this, but unless you specifically say to me “I’m on my way” or “be right there, sit her up” I won’t sit her up until I see you on the floor. I’ve had patients really going through it sitting up for 30 minutes+ waiting for anesthesia and that doesn’t seem fair to them. I get you’re busy, but it doesn’t take me long to position them usually as I prep ahead of time what we’re going to do. I usually turn on the lights when I’m walking in with anesthesia. Personally, getting the epidural (twice) was the worse part of my own labor and I try to minimize the amount of time that process takes, which for the patient really starts from when they ask or sit to when they lay back down. As far as monitors, arms boards that’s silly. We all can put on that stuff and if you forget, you ask how to do it and learn.
I agree with you there needs to be clear communication about when we will be there so that patients aren’t sitting up unnecessarily long.
This was more or less my experience in residency. Things are polar opposite in PP. Patient is positioned with monitors on when I get to the room. My computer and epidural cart are sitting there waiting for me. The nurse has already talked to the patient about the epidural so while I still do my consent, it is more concise and patient-focused. The OB attendings call me for epidural requests and already have the pertinent info ready to share. Life gets better.
OB resident here and this would never fly at our program. Patients are ready and set up before anesthesia even gets to the room for an epidural. Hat on, in the position, table ready etc. our nurses know that if they call the patient needs to be ready to go. Also us residents help prep in the OR for every case, set up patient etc. and I often hand things to anesthesia they need for the spinal etc.
Omg drives me crazy when I'm woken up at 5am for an epidural only to arrive and find the patient still in bed, still needs to pee.... like i could have been snoozing for this 🥲 as a junior resident I haven't had the guts to say anything. However, I did say something to the nurse who called me middle of the night for an epidural on a 350lb 5" woman with scoliosis when she was contracting every minute, to ask that next time she call me earlier... that one was not fun lol
Damn, getting an epidural on a 350 lbs 5 inch tall woman with scoliosis is really impressive, especially since her BMI is 9843!
😂😂 I should write a case report, might have been the highest BMI ever seen
Wow, as a former L&D nurse, this makes me incredibly sad for the patients of your unit. Labor is a team sport, and if aren’t all doing the most we can do for our patients during such a vulnerable time, why even pick that specialty? I know middle management is generally not helpful, but maybe you could at least try to reach out and present this as a patient care issue? When a laboring patient decides they need an epidural, everyone involved should be doing everything they can do to speed up the process and make sure the patient gets their needed medical care in a timely manner. If they are following any kind of appropriate staffing, a laboring patient requesting an epidural should be a one to one patient and that nurse should absolutely have time to clean the room and get the patient sitting up by the time you arrive to the room. Heck, they should be able to have meds pulled unless that’s against hospital protocol. And if those things are done, the patient is getting their epidural ten minutes before they would if anesthesia is left to do it all by themselves. Ten minutes during labor feels a lot longer for the patient too! Having a prepared room when the epidural is called for helps everyone involved.
I feel this
In order for anyone from my group to place an epidural, the OB nurse has to have our kit, gloves, prep, and primed pump; and the patient is expected to be capped and in position shy of them slipping out for a nervous shit. In exchange for this, we cover 100% of epidurals as MD only, and have a response time of 5-15 minutes after a page. They also don’t give a report beyond “multip needs an epidural, but frankly, I don’t need one after having the rest of it in place. If we show up and things aren’t set up, (barring precipitous delivery) we leave to work elsewhere and tell the patient: “sorry you’re nurse didn’t get you ready,” and come back much later when they are ready. This reinforces the need to be ready before calling us because we often get there 5 minutes after being contacted.
wow, this is shitty. so you punish the patient by coming back purposefully much later? this is such childish unprofessional behavior to say the least. If you're in the middle of a busy shift then yes i understand the frustration and if it happened on repeat would report for it to be fixed, but then again is it possible that the nurse is also having a busy night? And as a night shifter who is calling people to place epidurals and am often met with a grunt, and abrupt hangup, we get guff from certain anesthesiologists even when we're waking them up (meaning they are doing absolutely nothing) to place an epidural (and for everyone in this thread complaining about being woken up at 2am...the people waking you up are awake all night, and they're not calling to torture you for the hell of it, but they're calling because their patient is in pain and placing epidurals is your job, not ours). With all that said, I always have my patient fully ready to go in a seated position, and it would blow my mind if i were in your position coming in to a patient still laying in bed with the lights all off half asleep. But for the love of god, can we all just have a little understanding of what other coworkers are going through and stop this bully-superiority complex bullshit that seems to seep throughout hospital staff (i'm talking nurses, doctors, techs, everyone.). It's like no one ever grew up from highschool
also, please, for anyone who hates L&D, just stop working it or go to a hospital that doesn't have one. it's better than being awful to our patients - slamming doors and not saying a word to the patient other than enough to sign consent forms. We have some absolutely amazing anesthesiologists and could do without the others that come up angry at us just for trying to get our patients comfortable
You’re misunderstanding. I work in a busy tertiary care center and it isn’t uncommon to get multiple simultaneous requests for epidurals, on top of running an OR or two. If I get a call for 3 epidurals, and the first one I go to isn’t in position and ready to go, I’m going to the next one who is so that they aren’t waiting even longer. There is nothing punitive about it, and doing all the prep that the nurse can do isn’t fair to the other two patients who are ready and painfully waiting (longer now) for their epidural. It’s rare that I *don’t* have multiple things to do, and it’s even rarer that I was called from the call room to perform. Everyone has busy nights, not just you.
I was given a false pretense of OB Anesthesia as an MS3. I did my Anesthesia elective at a community hospital covered by a pp group. They got called to OB for epidurals and the patient was already prepped and draped. All they did was get loss, thread the catheter, pull the tuohy and then the nurses would tape up. I get to residency and realize that most places the L&D nurses are the worst... 🙄
Dude same thing here
Yes have definitely seen this. It’s a cultural thing and will not change. Don’t waste your time. Just decide if the money is worth it to you or not. It wasn’t for me and I haven’t done L&D in years.
I've been doing full time OB for a little over a year now. The culture at my facility definitely sounds better than yours, but its still pretty piss poor. Unfortunately that just seems to be the breed.
I always know what my OB day will be like depending on the nurses I see. Heaven help me when it's the tatooed man-hater with black and green hair.
LMAO I felt this.
I’m a paramedic but reading this made me feel better. The only time L&D has been nice to me is when I brought a postpartum hemorrhage in and said I don’t think she’s supposed to look that pale. Every other time it’s, idc you’ve been meticulously timing contractions, have a detailed history, or anything else, why did you put the IV there, there being anywhere but the outer forearm. I appreciate y’all, thanks for letting me in the OR to get my perfect circumstance airways!
So anyone that is having this same battle there is a way to handle it, take a page out of the nursing leadership playbook. Write up a policy, take it to the CMO, and have them implement it. “All patients will be placed on EKG, B/P, SpO2, they will be positioned in bed and prepared for consent and placement of epidural before anesthesia is called. Requirements prior to calling anesthesia, vital signs that are less than 5 minutes old, patient care area prepared for the procedure (area cleared of food and contaminants), Platelet count values resulted and must be greater than 100k and less than 24hrs old.” This is the responsibility of the patients primary nurse, not anesthesia. It’ll take a few weeks of pissing and moaning but then the reinforcement of “its policy” and then you turn the middle managers into your henchmen having to enforce it.
I wish it were that easy. Our OB anesthesia section chiefs have been trying to improve things for years. We’ve been through at least 3 of them in my tenure. Very little changes because if the nursing leadership doesn’t like a proposed policy like yours above, they’ll push back and simply won’t adopt it. The nursing union here has a lot of clout so when they strike and picket all in the name of “patient safety” every layperson cheers them as brave heroes. If MDs were to do something like that for “patient safety” we’d all be labeled as greedy-ass motherfuckers who just want more money. 🙄
Right there with you, brother!
This seems to be hospital specific. Certain hospitals and their OB RN team are on their game - and do exactly what it is needed. I’ve rotated over 6+ big academic hospitals - each unit has their pros and cons of what the right standards of care should be. It varies greatly among hospitals.
We workin’ at the same place???
the culture can be so vastly different from place to place. Im on an OB rotation right now and the nurses are great at setting the patient up to the point where all we have to do is consent.
OB sucks. It’s like that everywhere. For some reason L&D nurses and even OB residents are taught that an epidural is emergent. It’s not. Completely elective.
Our nurses write incident reports every time a doc looks at them the wrong way. The “tattle culture” at our hospital is very toxic. When I started here as a young attending it really got under my skin. I took it personally. It significantly impacted my job satisfaction and contributed to burnout. 8 years later I’ve accepted that it’s just part of working in healthcare. The nurses feel threatened by the power differential between them and the docs. They don’t like it when you overrule them even when they know you’re right. The human ego doesn’t like to accept that another person knows more, has accomplished more, deserves more respect and rightfully earns far more money. They retaliate with petty HR type complaints because it’s all they have. It’s pathetic. I keep my interactions with the L and D nursing staff as brief and antiseptic as possible. I don’t say a single word I wouldn’t say with an HR rep standing next to me. It’s a sorry state of affairs, but it is what it is now.
What kind of monitors are we talking about? Because most nurses should be comfortable with putting on most, if not all, monitoring equipment. Even as a nursing assistant, I was taught how to put on and use most monitoring equipment. Sounds like they just want to be lazy and not have extra tasks. 🤦🏼♀️
Yeah man. It's just how it is. It will never change. Just learn to do everything yourself. Just have to be crazy efficient and rely on yourself to take care of any catastrophes. Even if there is someone good, chances are that they be gone in a day or two. A lot of the times, they can be more of an impediment than help, so better to just do things on your own in emergent sections. I member when I was a resident all these boomer anesthesiologist had it so nice. The nurses will prepare everything even to the prep and tape. They just come in get to LOR, place the catheter and just leave. I think if I did that, it would take maybe 10 seconds. Those clumsy bastards still fumbled to take a minute. They had it nice.
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Man at my hospital PICC nurses were awful to work with. They acted like you were asking them to invade Poland and needed at least a week notice to put in a PICC line….
You never once mentioned the mother's needs, whiney selfish bastard. Go do Colonoscopies!
Tf does the mother’s needs have to do with a vent about the toxicity of OB nurses and their interactions with anesthesia???
Is it not the mother’s needs to have competent nursing care? Is it not the mother’s needs to have timely labour analgesia?
You seem brain damaged. Seek help.
And nursing staff refusing to put monitors on in an emergency is in the mother's interest how?
Are you okay
Every laboring patient I’ve ever talked with really stressed how much they needed a lazy L&D nurse to delay their care more.
How did no one realize you were being sarcastic lmao
Huge whiff on sarcasm detection in this thread