Nurse Observation

On my first shift in labor and delivery at Massachusetts General Hospital, the patient to whom my preceptor and I were assigned was a 30-year-old primiparous female from Germany who was in the first stage of labor, though not yet actively laboring. The patient was admitted for induction of labor post-expected date of delivery. She experienced some increases in the frequency and duration of contractions over the first few hours of our shift, but these changes were not clinically significant.
After a few hours of gradually increasing the level of Pitocin being administered to our patient, the fellow told my preceptor that she was unsatisfied with the progress of our patient’s labor and desired, instead, to intervene. Several times, the fellow

In my analysis of the situation, the value of beneficence prevailed in the fellow’s mind, whereas the principle of nonmaleficence informed the nurse’s standpoint. In my mind, the fellow did not want to simply do good for the patient; she wanted to do better: she wanted to do something that would improve, enhance, or – literally – augment the mother’s labor. In my nurse’s reaction to the fellow’s itching to do something, I am reminded of the maxim, “leave well enough alone”. The idea of this phrase relative to the conflict at hand, and the idea that I believe to have informed my nurse’s response, is that normal progress of labor is better for the patient than a risky, uncertain, and – hence – unnecessary attempt at improvement. “There is nothing wrong with the way things are going right now,” my preceptor informed me. Thus, we may do no better, she implied; at the least, we do no

My nurse first acknowledged the doctor’s perspective, suggestions, and frustration. “I understand where you were coming from and I know that my response was not what you anticipated,” my nurse said. She then synthesized her own assessment with the doctor’s and suggested a compromise: “we can do a pelvic exam on our patient, so long as you promise not to rupture her membranes unless it’s necessary.” My preceptor was neither asking nor demanding; rather, she evidenced to the fellow that she had considered the fellow’s perspective, combined with a risk-benefit analysis, and arrived at a course of action about which the two could agree. Performing a pelvic exam would allow the fellow to assess the mother’s progress through labor and obtain data to revise or tweak the plan of care, with the risk of infection and with minimal medical intervention in the childbearing experience. The way in which my preceptor presented the compromise implied mutual benefit for doctor, nurse, and patients. The fellow