The Secret Work of Nurses

The last day I worked, I admitted a patient in early labor and the first thing she asked me was when her doctor would be there.  In my head, I laughed.  I had not seen her physician all day, even though I thought they would make rounds in the morning.  I knew there was a laundry list of reasons why they had probably not made it in by then: they had lucked out, and not a single one of their patients had delivered that morning, which would have forced them to come in.  They had been unlucky before seven a.m. and had six deliveries in the middle of the night, including a STAT section (it was their turn to be on call).  Their daughter had called the unit at least three separate times asking if we had seen them, because they were waiting at volleyball practice to be picked up.  I vaguely remembered a unit clerk mentioning earlier in the day that they had a couple of gyn cases in the big OR, off of our unit.  Someone from medical records had called looking for them multiple times, wanting signatures on a few unsigned orders.  And of course, they had a busy clinic day, because it was Friday and everyone wanted to be seen before the weekend. Needless to say, there were a handful of people trying to hunt them down.  Instead of laughing at my patient’s question of where was her doctor, or trying to predict when her physician would be there, I put on a sterile glove and told her to relax her knees.  Because the patient had a beautiful strip and nothing bad to report, I would not talk to her physician or see her physician until she was complete and ready to push.  She was contracting adequately and making cervical change, so I didn’t need augmentation orders.  She was GBS positive, so we treated her.  I finally called her physician when it was time to deliver.  She pushed two times and required no repair (but I can’t really take credit for that, she was a multip).  And as soon as her doctor delivered her, they were gone again, off to see other patients.  I controlled her pain, I provided breastfeeding support and encouragement, and I tidied up her room before her guests arrived.  I’m like a professional mother!

nurse-jackie-glove

After the hundredth time I was asked by a recently-admitted patient “is my doctor coming now” I started to realize that no one knows what we do, as nurses.  I don’t think patients realize how much influence we have over when they will deliver, how they will deliver, and everything else in between. Doctors can’t be on the unit all the time, so they rely on us to tell them if we think something is wrong, if the strip looks bad, or if we notice any “changes.”  If we mess up, or are lazy, or do not pay attention, it could mean the difference between a mother who has a vaginal delivery or a cesarean delivery, a mother who has a stable delivery or unstable delivery, or a baby who has a healthy birth or a traumatic one. Labor nurses are always watching their strips, and everyone else’s—because in a matter of minutes a mom or a baby can deteriorate and the outcome can have life-long consequences.

I remember when I was still on orientation, my preceptor and I were laboring someone who had previously had a cesarean delivery. Her water was broken, she had a great epidural, and she had the most beautiful strip.  As we walked back to her room, my preceptor was watching her strip from each computer that we passed. I was talking and laughing and really not paying attention. I mean, we were 20 steps away from her room and less than 5 minutes before she had a textbook perfect strip. I remember my preceptor telling me as we got closer to the room, “Oh look, there goes a late decel. And there goes another one.” By the third contraction her baby’s heartbeat was 40bpm and would never come back up. It was the first time I had ever seen a prolonged deceleration. My preceptor walked calmly into her room, but my adrenaline had started to pump. Everything in me was freaking out. She was complaining of severe shoulder pain. She had one of those epidurals where she couldn’t even move her toes, so my preceptor grabbed the pad beneath her, rolled her to her side, and threw oxygen on her.  Of course, other nurses flooded the room.  My preceptor told the OR tech to open up the back, she took the IV fluids off of the pump, capped off her epidural, and started pulling monitor cables out so that they could transfer the patient in her bed to the OR. Then my preceptor looked at me and told me to go tell her physician that the patient’s uterus was rupturing, and we would meet them in the back.

When the physician opened up the patient’s abdomen, the baby’s hand was sticking straight out of her uterus. I wanted to shout out in the OR: My preceptor was right! It was a uterine rupture!!! But instead, I watched as she brought the baby to the warmer, limp, quiet, and blue. The baby was born so quickly that the neonatologist was not even there yet, but the nursery nurses knew what to do. Someone grabbed the base of the baby’s umbilical cord, they stimulated him, they gave the baby some PPV and by the time I walked out of the OR the baby was pink and crying and the father was smiling and taking pictures of his new baby. I distinctly remember thinking that if a few more minutes had gone by, he wouldn’t have been holding a camera.

I left the OR, and my heart pounded so hard I could feel it in my throat. What if my preceptor had not been looking at the patient’s strip while we were walking down the hallway? I mean, I was talking about what I was going to eat for lunch. What if she had not turned her to her side and put oxygen on her? Did that buy us those few precious minutes? What if we had called the physician first, and waited for her to get there before determining that the patient needed to be taken to the OR? What if the nursery nurses did not know how to pink up that baby and make him breathe, bringing him back to life? The outcome could have been devastating for that family. In just a few delayed minutes, that baby could have died before even getting to the operating room.

So if you a nurse, don’t ever forget that every single moment of every day that we work, we hold our patient’s lives in our hands. We have to keep watching, we have to be aware, we have to keep getting better, because we want the very best outcome for our patients and their babies.  What we say to our physicians is crucial, and how we say these things is just as important…but this is something that we all already know.

If you are a patient, know that your nurse leaves their own house before their family wakes up. If we eat breakfast or lunch, it’s based on what you are doing at any given point in time, and even then, we are watching you. We go to work and never know what our day is going to be like, or what kind of patient we are going to have. We are on constant guard, protecting you and your baby and trying to give you the healthiest delivery possible. We know it’s just a matter of minutes that have the potential to change everything. We’re telling your doctor everything we see and what we think, and we’re careful in how we tell them these things, because this too has the potential to change everything.

If you were the patient that heard your baby’s heartbeat plummet, if you were the patient that found herself with an oxygen mask on her face, or if you were the patient that had to be rushed to the OR for a quick delivery, know that your nurse has to know what to do even before your physician gets there. Your doctor is usually responding to information that we are providing them.  What we say and how we say it has the ability to alter every outcome.  That’s the secret work of nurses that no one ever talks about 😃

and p.s. I never just pass a computer monitor with a fetal monitor strip without watching it now 😉

 

Until my next delivery ❤


48 thoughts on “The Secret Work of Nurses

  • July 20, 2014 at 4:00 am
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    I absolutely love your posts. They are so true and we’ll written. I’m a labor and delivery nurse in a small hospital and how been in a lot of similar situations and you describe them exactly. Thanks and keep writing some of the best stories I’ve seen. From 1 L&D nurse to another.

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    • July 24, 2014 at 3:49 pm
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      Thank you to all the nurses out there! I know you do everything!!! My sister is an L&D nurse & my 15 yr old told me she wants to be an L&D nurse??

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  • July 20, 2014 at 5:19 am
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    Yes Labor nurses need to know what to do if their patients are hallucinating! I wish you were my nurse when my blood sugar dropped to 13! :)

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  • July 20, 2014 at 2:10 pm
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    I just stumbled on your blog a few weeks ago. I have been in LD for ten yrs now and have enjoyed reading your posts.

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  • July 20, 2014 at 2:43 pm
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    As the doctor, I always tell my patients that they won’t see me until there is something for me to do, LIKE CATCH THE BABY. They know the value of the nurses because I share it. It takes the whole team.

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    • July 20, 2014 at 2:49 pm
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      lol AND YOU SEW!!! It does take the whole team :) I’m very fortunate to work with some amazing physicians. Thanks for reading the post! <3

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  • July 20, 2014 at 2:58 pm
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    And I appreciate all y’all do EVERY day. We put complete trust in you. And you’ve earned it!

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  • July 20, 2014 at 4:30 pm
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    Actually, what I remember most about my stay at the hospital were how awesome my nurses were. I saw the doctors for, like, . 2 seconds.

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  • July 20, 2014 at 4:51 pm
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    Must be the same every where. The good doctors know to trust the good nurses and vice versa. I loved being the labor nurse, supporting Mom and baby, getting them through to the point of calling the doc to come and catch the baby.
    Your posts bring such wonderful memories to an old retired nurse. Thank you so much!

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  • July 20, 2014 at 5:01 pm
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    I love your posts! Thank you for being so inspirational. I Have been mother baby nurse for 8 years and thinking on going to L&D. If I do, I want to grow up to be like you.

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  • July 20, 2014 at 5:06 pm
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    My whole labor consisted of decels and oxygen masks, and almost a C-section, followed by a blue, not crying baby. It was really scary. My nurses were amazing though, and sprung into action, knowing what to do and without hesitation. I remember feeling kind of bad that they had to keep helping me onto my side because the epidural made it hard to move. They were awesome! You nurses definitely work hard and are a huge part of our labor experience.

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  • July 20, 2014 at 8:19 pm
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    I stand with you on this! Nurses are precious miracle workers who just not do jobs according to description but do everything with passion. I am a nurse from the Philippines and I hope that someday, the entire world would realize the true value of nurses.

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  • July 20, 2014 at 8:22 pm
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    Reblogged this on on hiatus. and commented:
    Some people think that nurses are just next in line before the doctors. I hope this could help enlighten everyone. I can’t help but be proud of my chosen profession after reading this.

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  • July 21, 2014 at 1:04 am
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    So, so true. We, as L & D RNs, must NEVER take any any moment for granted. I love OB.

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  • July 21, 2014 at 2:42 am
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    You are an amazing and gifted writer.

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  • July 21, 2014 at 4:59 pm
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    I’ve been doing L&D for almost a year now…I was lucky to have an amazing preceptor that taught me everything….nothing is worse than having ur baby decelerate into the 60s after an epidural…or after a foley is placed….yikes! Everyday is a learning experience and I’m proud to be an L&D nurse. No one really knows how much we do, but sometimes I get those patients that thank me for helping their baby come safely….and it makes all the work we do worth it…

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  • July 21, 2014 at 5:40 pm
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    Totally had a relatable experience: I had a really Type-A primip the other night. Didn’t realize she had the anxiety of not being able to be in control until she started hurting (SROM before labor started). Her mother had anxiety about the doctor not being there the whole time from the very beginning, but the patient went from zero to sixty in 2.2 seconds when contractions became real.
    Labor progressed well with only a few incidents of extreme wide-eyed, rapid, shallow breathing episodes. Then we set up to push. She freaked out about the doctor not being there (already called her BACK in at 0430 for her fourth delivery of the night…one we expected to wait until the OBs changed in the am, but flew through active labor in four hours. She was a few minutes out). Had to calm her three times in ten minutes. She was still getting the hang of pushing, but I knew she wouldn’t push but a few minutes once she got it. She was making a little bit of progress with a few slight variables.
    Finally got a great push out of her to almost crowning & the heart rate crashed to the sixties. Luckily, I realized that it wasn’t coming up within a minute, and rushed around to do my interventions, gather the troops, and thankfully, the OB was walking onto the unit & saw it two minutes in. The crowd doubled in size, but we got the baby out within a couple of minutes….through a tight triple nuchal cord.

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  • July 21, 2014 at 10:41 pm
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    Thank you for your latest delivery, Shelly. It was a truly wonderful read!

    Blessings,
    Dani

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  • July 22, 2014 at 1:46 am
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    I just told my very pregnant sister in law her L&D nurses would be more important than her doctor!

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      • July 22, 2014 at 1:51 am
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        My nurses are the ones who convinced me I could deliver my son after 27 hours of labor. My doctor was important since she stopped the crazy bleeding, but I wouldn’t have gotten there with out my nurses ( and I was there for several shifts. I still remember my favorite nurses smile and cringe when I think if the less kind nurse). Nurses made such an impact on my experience.

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  • July 23, 2014 at 4:12 am
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    I work on a surgical floor but I can relate. I wish patients knew their doctor is only going to come and see them ONCE that day, no I don’t know when when. Please ask your questions when they are there, don’t ask me hours later – and no I can’t “call them back so they can chat with you” – they already SAW you. Unless there is an urgent matter or a change in your status, they are DONE with you for the day. If at all possible I like to round with the doctors so I can prompt the patient to ask the doc questions then and go over the plan of care together.

    I love that the doctors get to know and trust us to take care of their patients for them. I love the doctors I work with so much and it feels good to all work together as a team.

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  • July 24, 2014 at 7:20 pm
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    SO funny that you used Lucy Hale as your top gif for this article. Her mother worked with mine as a labor and delivery nurse for years at Baptist women’s hospital in Memphis, before Lucy got her big break.

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  • July 24, 2014 at 7:46 pm
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    I am so proud of my daughter Tracey. Nurse

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  • July 26, 2014 at 1:36 pm
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    Have worked L&D for 23 years… You summed it up perfectly. Thanks!

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  • August 17, 2014 at 11:11 am
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    Your article is so good to read. Great!!
    Thank you for sharing, I will post it on my LinkedIn to share with my friends?

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  • August 19, 2014 at 3:02 pm
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    You say the baby was born so quickly that the neonatologist wasn’t there…..most places, the nicu NURSES (and RTs) attend cesarean/emergent deliveries and a neo only comes when requested by the high-risk delivery team whe additional help is needed.

    Great article, but I feel a little left out for an article that’s applauding nurses’ hard work vs doctors’ recognition!

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    • August 19, 2014 at 3:07 pm
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      At this particular hospital, the nursery nurses are the NICU nurses… and most hospitals don’t have RT cone to deliveries. Our neo intubates and all that jazz. I don’t know how you felt left out. I guess I don’t understand if you are a doctor or an RT… But I can only write about what I know, and I’ve never had an RT in a delivery. :( lol but it sounds nice!

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  • September 6, 2014 at 12:37 am
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    Too bad you don’t have midwives at your hospital – not only are we there making the tough decisions during labor, supporting mom, and through pushing…but we ALSO catch the baby! I always feel bad for women who have the expectation that their doc will be there during labor (or really, during most of pushing) – you should get a midwife!

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    • September 6, 2014 at 12:46 am
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      It’s funny that you say that, because I’ve worked at one hospital where the midwife totally acted like a physician, only coming in at the delivery when the baby was crowning. At the hospital I’m at now, it was so funny, because when I started working there I went in and talked to the patient about skin-to-skin and how labor would go and then I found out that the woman next to her was her midwife! lol I thought it was her mom. She stayed at the bedside. It was totally different!!! One of the best women I’ve ever met is a midwife! lol Shout out to Stefanie Clingon! <3

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  • March 17, 2016 at 6:24 pm
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    My mother worked in NICU, in part because of her I wanted to be either an OBGYN or a L&D nurse. How many male L&D nurse’s have you heard from?

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  • March 17, 2016 at 6:32 pm
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    I do work in a small hospital in Oxford Ohio. I remember growing up wanting to be a nurse in OB and nothing else but a nurse. You have put what we OB nurses do down in words! And wonderful words they are. Couldn’t be more true. I’ll share with my co-workers.

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  • March 17, 2016 at 7:37 pm
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    With my first baby I checked into the hospital at 9 am and around 2 pm my doctor came in and said if this baby doesn’t come by 5 we will have to give you a c-section. Luckily my nurse was sitting in the room when my doctor said that. After my doctor left I started crying and freaking out to my husband. My nurse came to me and said “That is completely not true, this is your first baby and everything is going great. If 5 pm comes around and you are still doing this great I will be your advocate and you will not get a C-section.” I was so relieved and happy that she was there for me and knew what she was doing. If it wasn’t for her I would have had a very un-necessary C-section. I have absolutely loved my nurses with both of my deliveries. I think Labor and Delivery nurses are special chosen angels who deserve all of the credit. Thank you!

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  • March 17, 2016 at 10:36 pm
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    Having been an L&D nurse for nearly 31 years now, I must say this is one of the best articles I have read about L&D nurses.

    Reply

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