For Kelsey Smith, RNC-OB, Wildwood Hospital was becoming a complicated combination of opportunity and frustration. Wildwood’s staff and facilities were top-notch; the equipment she worked with were the best available. She saw a wider variety of maternal ages, conditions and complications in a shorter time than ever before in her career.
Working hard and drawing on her fifteen years of experience she’d mostly overcome the initial awkwardness involved in learning a new workplace, but not without challenges along the way. Yet now she had new struggles—personality conflicts, with some of them sharp.
It seemed while the high expectations that everyone had for the hospital and for each other were what the profession demanded and supported excellent care, they also produced tension—some of it to be expected, some of it excessive. There were the physicians who condescended to nurses; there were long-resident nurses who resented the travelers on staff; there were feuds. Lainie Mazotta, the senior nurse who had helped with Kelsey’s onboarding, seemed to have an ongoing one with another veteran, an LPN named Ruth Regan. For Lainie, it seemed, Ruth’s EMR entries always fell short and she never came quickly enough when Lainie called for her help.
Kelsey had experienced these types of tensions before, but at Wildwood they seemed to have sharper edges. There was one traveling nurse, Karine Collins, who regularly got on Kelsey’s nerves. When Karine came to the bedside with a physician at the beginning of labor, she would pepper Kelsey with questions—had Kelsey been monitoring her blood pressure? Was Kelsey sure about the patient’s dilation when she told her to start pushing? Of course I had been and of course I was, Kelsey replied quietly.
On the other hand, to Kelsey’s surprise Dr. Amelia Morton had become a friend and mentor. During onboarding Lainie warned her that Dr. Morton could be prickly, but she and Kelsey bonded over what Dr. Morton called “our OCD tendencies” and their mutual love of tennis.
Once, after Karine had asked Kelsey if she “was keeping her eye on the monitor while she was chatting with the patient,” Kelsey asked Dr. Morton if they could meet after work for an early, quick dinner at The Great Wave, a sushi place in a nearby mall.
When they’d been seated at the rotating, floating sushi server, Kelsey spewed her bottled-up thoughts.
“I don’t know what she thinks nursing is!” she said, loudly enough to be heard several tables away. Then, lowering her voice, she went on. “What I have done my whole career is what I think nursing is—balancing the technical and the human. Her constant questioning of my process and abilities is exasperating. I’m there to reassure this new mom that she’s not going through this revolution in her life alone, and Karine’s comments and questions undermine my position in the room.”
“I know,” said Dr. Morton. “I’ve worked with Karine for a while and she can be kind of…acerbic. But she’s dedicated.”
“We’re all dedicated, aren’t we?” Kelsey snapped. “Or else we’d be doing something completely different!”
“The only advice I can offer is to hold tight to your knowledge about yourself,” said Dr. Morton. “You know you’re good at what you do. People who observe you are going to be who they are, right?”
“I suppose so,” said Kelsey, with the intonation she’d use if she were saying “I know, but it’s still hard!”
Next morning Kelsey had what felt like an emotional hangover from the previous day. A very nervous new mom named Elise was admitted at 10am. Kelsey connected the fetal monitor and found that the fetus’ heartbeat was normal. She inquired about the mom’s health, the course of her pregnancy and her medical history, sounding to herself less compassionate than usual and began charting away. She notified Dr. Veena Prakash, who would be attending the delivery as Elise’s contractions began again.
“How are you doing?” Kelsey asked, with Elise between grimaces responding, “Not so great.”
She was now dilated five centimeters and Kelsey gave her five milligrams of Nubain IV for the pain. “This will help you for a little while,” she said, “but an epidural might help you relax more.”
Elise nodded and Kelsey helped her breathe through several more contractions. Kelsey started to feel better and confident in her approach to nursing—using her knowledge and skills to help bring life into the world in the most compassionate ways that she knew.
Another big contraction came.
“An epidural would be great,” said Elise.
So, Kelsey notified anesthesia, gathered the equipment for the epidural and began to explain to Elise how she needed to sit and what she could expect from the procedure. Midway through her explanation the anesthetist appeared—Dr. Luke Ward, with whom Kelsey had had a pretty tense relationship from her first day. He waved his hand and said, curtly, “I’ll take it from here Kelsey.”
Later, as the epidural was taking effect, Dr. Ward motioned Kelsey into the corridor.
“I think we’ve been through this, Kelsey. Here at Wildwood, the anesthesiologist does the explaining. So that there isn’t a slip-up or a miscommunication.”
“You mean a slip-up or a miscommunication from me?” Kelsey said, feeling her face flush.
“Just to keep things clear,” he said. “That’s all.”
Kelsey left the interaction feeling uncertain about her abilities and ashamed of being reprimanded for the approach she’s had so much success in—balancing the technical with compassion.
That night at dinner, the encounter was all she could talk about with Kyle.
“Of course he explains the process he’s going to do. But to demand I don’t give a set-up to the patient is unreasonable.”
“But the delivery was okay you said. The mom was fine and the baby was healthy. So, it was really okay,” said Kyle.
“Yes, of course that’s the part I deeply care about the most. But the interaction with Dr. Ward was so unsettling. I’m not looking for a solution from you, just an ear and an opportunity to vent, don’t you get that?” said Kelsey.
“Honey, of course I get that. I was just trying to help you look at the bright side. I’ve been noticing you’re not your typical optimistic self; it feels like something is wrong. Is there?”
Tell me something I don’t know, Kelsey thought, and her anger turned into sadness.
Continue with part 3 of the story.
