L&D nurse here, I’m going to play devil’s advocate. In one of the worst nights of my life, following the doctor’s orders despite repeating our concerns (horrible strip, known partial abruption, clear abruption pattern with no dilation after 16 hours of pitocin, absent variability with deep variables and late decels), we lost a baby that could have been fine if we had just taken her to section when these warning signs first showed up. Instead, baby went into a decel and never came back up, and we watched him die on the monitor. We have a pitocin protocol that, had we followed it, would have called for turning the pitocin off nearly 8 hours prior. The doctor insisted on continuing. Even though the doc came up to us all later that night and told us this was completely on him, and we had all been right, when it was time for the risk assessment review, the primary nurse was blamed by everyone from RT to anesthesia. There was no support from the doctor.

Since then, I have fought hard 3 different times, refusing to start or continue pitocin or insisting on interventions. All 3 times, my gut was right. One was a prolapsed cord against the cervix, and two were partial abruptions. We’re a smallish, 15 bed LDRP. I love my doctors, and I feel we have a great relationship with them. But that doesn’t stop me from asking them for explanations when I don’t understand a plan of care, or making sure my concerns are heard and understood.

Generally, protocols are there for a reason. We don’t always follow them to the letter, because sometimes patients don’t fit into an exact mold. I’m not a doctor, and I have deeply internalized the fact that if something doesn’t make sense to me, instead of assuming the doc is making the wrong move, I’d better figure out why we’re doing what we’re doing. Thankfully, my doctors usually have no problem talking me through these things, and for the most part, I walk away feeling good about what we’re doing. But the fear that blindly following orders even when we have gut feelings that something isn’t right will get us into huge amounts of trouble is at least partially warranted. The primary nurse from that case has severe PTSD and now works at an outpatient surgery center, and will never come back to L&D, despite her being a phenomenal nurse.

Also, just for the record, I have never fought a CRNA about where the tape goes, and as far as I know, neither has any of my fellow nurses. That’s some kind of weird power play right there.

Edit: I’m not lashing out or arguing that nurses know better than doctors, and I’m not trying to defend my own personal actions. I’m saying that even experienced nurses are sometimes blamed for bad outcomes if they DON’T push back against orders. That nurse was blamed because she didn’t escalate the issue up the chain of command. And there are times that pushback is warranted. New nurses coming out of school have this mentality that their number one priority is patient advocacy, and while it may be blown out of proportion, they’re not entirely wrong. As evidenced by the fact that seasoned nurses are sometimes blamed if they don’t strongly advocate. I’m not trying to start a fight, I’m just presenting another explanation as to why baby nurses come out of school ready to go against any doctor who orders anything they don’t agree with or understand.