Summer in Labor & Delivery: New Babies and New Doctors

Something much lighter after a super heavy two part blog post about childhood trauma. I recently thought, I have been struggling to find my ‘why’ for continuing to be a labor & delivery nurse… I am hoping that writing about it and posting about it will give me a little excitement and inspiration. Share with any of your fellow nurses or residents; that may give me a nice hit of dopamine.

In Light of Current Events…

So, today (as writing this) is the day after the SCOTUS decided to overturn Roe V Wade. I started drafting this post a while ago, and I need to stick to my topic. I need to use this blog for it’s original purpose: a project to work on when I need to be creative and productive for my mental health. Taking a break from doom scrolling on Instagram is a must.

What is a Resident?

You Might have Learned that Term from Grey’s Anatomy

Are you a nurse? Or are you a healthcare provider in a teaching facility? End of June and beginning of July can be an interesting time in a teaching hospital. I am talking about one reason in particular: brand new residents. These are when new doctors, who just graduated from med school, become doctors. They have MD (or DO) added to the end of their name. Residency is a period for learning and guidance. Depending on specialty chosen, residency is 3 to 5 years working and training in your field under other doctors. When you finish that residency, you can go into an even more specialized training, or you can start in your field as a “real doctor”? That doesn’t sound right. A “full doctor”? Well you get what I mean, you can work technically without anyone over you checking your work and signing off on decisions you have made.

In my facility, brand new doctors are called interns during their first year. They are supposed to be our first line call, and provide the most hands on care with the patients. We not only get interns doing OB as their specialty, but also family medicine and emergency medicine interns. Babies do sometimes like to make their grand entrance in places other than the labor unit or birth center.

Do you Take a Class in Your Second Year of Residency where you Learn that you Now Know Everything?

Then when these interns complete their first full year of residency, they become an upper level resident, and that’s our next step in the chain of command for the patients. Also, the upper level residents handle our more complex antepartum patients managing their care when not in labor and are the ones to respond to OB consults called from the main emergency department. Being a second or third year resident at my hospital is exhausting. From helping guide a brand new doctor fresh out of med school, being the main provider for our complex and often sick antepartum patients, responding to God knows how many consult calls, and responding to every emergency and delivery. They sure do learn a lot in that time!

Over all of the residents are the attending doctors. These are doctors who have completed their OB residency, have the most experience, and are kind of the final say or top resource for our patients healthcare. Speaking of Grey’s Anatomy, I want to work at that hospital. Their residents are giving the meds, ambulating patients in the hall, and transport the patient themselves to surgery. I don’t really want to walk in on any of the doctors I work with having sex in the supply room though.

Summer is Baby Season

July can be a tough time in a hospital like mine, and if you’re an experienced nurse, you understand my pain. Especially in labor and delivery. Every labor and delivery nurse knows, summer is the busy season. Somehow, across both states I have worked in and multiple others where I have good friends working, more babies are born in the summer. We usually get a slow down in December and January. Unfortunately, this year we never really got that break. I am not sure if continued Covid threw the pattern off, or if we just felt busier because we got so short staffed. My unit lost a lot of nurses from covid burn out and high paying travel nurse positions. All I do know is, we never got a break.

And now comes summer. Brand new doctors, fresh out of medical school, some in their early 20’s and they are supposed to be making decisions for and taking care of patients in labor; a very critical time in healthcare and a vulnerable time in a woman’s life. And our hospital is very high risk, so there can be some sick patients that need critical decisions making. Of course, they have their upper level resident to lean on. Funny thing about that, that doctor was considered an intern a month ago and has barely gotten their feet wet. I am not going to lie, I sure wouldn’t want to be getting sick or having a baby in a teaching hospital over the summer. 

The Nurse Vs. The Doctor: Why is there War?

For some reason, the past year or two, the nurses and resident doctors at my facility have had a lot of conflict. Much more than I have ever seen in my 13 years of a labor and delivery nurse, and 7 years at this hospital. I honestly cannot pinpoint the reason for the change. Most likely a combination of things: covid burn out and stress, a different generation (OMG I sound old AF) coming in and becoming doctors and nurses, not willing to accept some of the norms of the past. And a lot of imposter syndrome.

These new doctors know they don’t know shit. But they have to appear confident to the patient, because that patient is relying on them to make decisions about their childbirth and unborn baby. So sometimes these new doctors can get pretty defensive when the nurse, who knows they have no clue what they are doing, call an upper level doctor to come help out. I am sure its not an easy place for them to be.

The Advocate

As nurses, we are taught to be the advocate for our patient. And I am sorry, just because this patient got her healthcare at the county health department and now has to deliver at the high risk center with residents and medical students does not mean she gets to be poked and prodded multiple times while you are learning and don’t want to ask for help while you try to appear competent. Nurses would much rather you admit you need help, and even ask our advice. As a nurse with 13 years L&D experience, I definitely have much more experience than you, and most likely your upper level resident you are asking for help from. We are a valuable resource to you, and a little courtesy and asking for advice would go a long way. 

Our conflict got so toxic that we were made to start a “task force” compiled of our nurse manager, nurses from the unit, a couple of the residents, and an attending doctor. This task force was meant to discuss our problems, learn from each other, and brain storm ways to improve. When it effects the care we are giving to our patients, we have to find a way to fix it.

In one of these meetings, I spoke up and said “you know what, the new residents should get some sort of nurse orientation,”. The response: great idea Ashley, so what do you want to do? 😑🤦🏼‍♀️

Ask and you Shall Receive

This past week, I got the opportunity to take our new OB interns that will start working in the hospital this week for a “tour” of the unit. During this tour I got to chat with them and give them my nurse orientation of sorts. I made a list in the notes section on my phone, top 10 things your nurses wants you to know. I decided to use it as a guide, versus writing it down or listing them out. Didn’t want my words in print to be misconstrued or taken as a rule book. In the words of one of my favorite real housewives…

Say it, forget it

Write it, regret it

Dorina Medley, The Real Housewives of New York

It felt more productive than I thought it was going to be. And I got a really good first impression of this group. Let’s hope that impression lasts.

What the Labor & Delivery Nurses Want the Residents to Know

1. Clean up after yourself in the patients room. Don’t leave your glove wrapper on the counter, or even worse, a bloody glove
2. Ask the nurses advice and opinions, we bring so much experience
3. Get to know the nurses and surgical techs. We welcome you to hang around the nurses station to chart and chat. A lot of my co-workers did not want me to put that in there…
4. On the note of communication: speak to the patient a few minutes before performing invasive exams. We know you have a to-do list and sometimes can’t see outside of the task at hand, but a lot of L&D is hands in the vagina, and to most people…thats not common in their day
5. On the note of vaginas and cervical exams: you have 30 seconds to find the cervix, maybe one minute to try and break water
6. It’s a good idea to make a plan outside of the patients room. If you don’t feel comfortable with a task or a conversation you have to bring up to the patient, we can help believe it or not. We can also talk about where the limit is and warn you we might be calling your upper level resident to come in
7. Wait for the nurse to come to you when a patient first arrives, in OBED or for an induction for example, that way you don’t repeat all the questions we just asked
8. After you see the patient, might be a good idea to touch base with the nurse and try to inform us of the orders you are about to put in
9. Just because you want us to start or increase Pitocin, we can’t always do that. Per our policies and what we could be asked in a deposition or court of law, “but the doctor said to do it,” is usually not a good defense
10. Here is where the ultrasounds are kept, here is where the speculums are, along with the lights, consent forms, and ice. Getting some of the supplies yourself shows respect for our time and step-count and can go a long way

What else would you have included in your list or nurse orientation for the doctors you work with? Our attendings and private OB/GYN’s could definitely use some remediation too!

Another Oprah “ah ha” Moment

The day I gave these brand new baby doctors my tour, we also arranged a lunch on the unit to welcome them and our nurse new grads that will also start on our unit next week. This year we have 4 new grads starting on our unit. That feels like a lot, especially when you need to find nurses to precept them. Do you take new grads on your unit?

We don’t often plan anything that include both the nurses and the doctors. This plan for lunch was met with mixed reviews. If we could include some alcohol, maybe it would be better received. Stupid rules.

Can I take you on a random ADHD thought tangent for a sec? Alcohol or other herbs and pharmaceuticals would make a lot of things in the hospital better received. Staff would be better retained and much happier if we could start the shift off with a mimosa. Another idea I had was a mid day marijuana micro dose edible; help you get through the rest of your shift with a little less anxiety. What about a benzodiazepine salt lick? I know some might not be able to function with full dosage, but just a little lick or chunk as you walk out of your patient room after getting cussed out, vomited on, or meconium fluid in your shoes. Just a little something something to take the edge off when things calm down after a STAT c-section isn’t too much to ask for is it?

Click here to read more if you are thinking of choosing L&D as your nursing specialty

Ok, Back to My Point

What was my point? Oh, “ah ha” moment, yes. The new grad nurses we hire get a 6 month orientation before taking care of patients completely on their own. I’m pretty sure that is much longer than a lot of new grads get straight our of nursing school. I think it’s fair. Our new grad nurses have to learn to become a labor & delivery nurse, an antepartum nurse, an OR nurse, and neonatal resuscitation. Plus, the hospital puts them in all sorts of classes and trainings, taking away their time from patient care.

When I was using my therapeutic communication skills during my tour with the new residents, and showing empathy for having imposter syndrome and being thrown into the trenches right out of med school, I realized, they don’t get an orientation process. I could not imagine throwing a new grad nurse onto the floor alone to care for and make decisions for patients by themselves. Telling them they do at least have a resource in more experienced nurses. Feel free to call if you have any questions! Can you even fathom how stressful that must be? True on the job training, except this job is bringing new life into the world and dealing with complex emergencies. We have a whole human patient that we cannot see, talk to, or even touch really. Not something you can really fuck around and find out with.

Why is Communication Always the Right Answer?

I know that some of our nurses can come off as real bitches, but they usually mean well. Just like some of the doctors come off as condescending a-holes, but I am sure they mean well… but at the end of the day, we want the same thing. To take the best possible care of our patients and make it through the shift without anyone getting hurt or dying. And quite importantly, our hospital is nationally ranked with a remarkably low c-sections rate, and we don’t want anyone coming in and jacking that up.

If we improved our communication, our relationships would improve. I don’t care as much about this relationship as my marriage, but if you think about it, I am with these humans as much if not more than my husband. How you say it is always more important than what you say. I usually live by the philosophy, you catch more flies with honey than vinegar. (In all seriousness, I would never want to actually do anything to lure flies to me). You can usually get what you want by leading them to the right decision, maybe even making them feel it was their idea, offering alternatives acceptable to you rather than demanding rudely. We should also extend some grace on both sides and give each other the benefit of the doubt.

Will this be Another Summer of Insanity?

So far, the summer isn’t starting off too crazy busy…yet. I’ve been pretty anxious about it, because we are much shorter staffed than our unit is used to, we have many more inexperienced nurses and travel nurses. Raleigh, NC has been continually advertised as a great place to move, especially for young families, which I think definitely increased our patient population. Maybe the area is so saturated now that no one else can come here. I should be happy with job security. Ever since Covid started, I am just a bit burned out being a nurse.

Do other specialties in a teaching hospital struggle during the summer like this? I’ve always done labor and delivery and women’s health, so I don’t have much of a clue on how other areas of the hospital run.

Are you a med student or doctor that happened upon my page? I’d love feedback. I am hopeful for an improved relationship between the nurses and doctors on my unit this year. The negativity is way too toxic. If the hospital won’t approve morning mimosas, mid shift edibles, or a Xanax salt lick, then maybe a good ole’ happy hour mixer should be put on the schedule! Cheers!

ashley, RN

Mental Mommy Nurse