Emergency contraception in the ER

  1. I am considering going back into ER nursing after being out of it for many years. I have a concern about emergency contraception being given out in ERs nowadays, and I have moral and religious objections to this practice. I could in no way participate in this practice.

    The questions I have for all of you are:

    1. Does anybody else feel the same way I do, and if so how do you handle it?

    2. If you work with anybody who feels the same way that I do, how do you handle it? Do you give the patient to someone else and respect the nurse's beliefs? Do you tell the nurse he/she has to do it no matter what his/her beliefs are?

    I thank all of you in advance who will respond to my questions. I am trying to get a feel for what ERs are doing nowadays, and would really appreciate your input.

    If I am granted an interview, I will ask these questions to the nurse manager and be upfront with him/her regarding my beliefs.

    Thank you all!
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  2. 14 Comments

  3. by   cmggriff
    So I guess you won't be using the Norplant blowgun? Gary
  4. by   ERNurse752
    The only people I can think of who would be eligible to receive emergency contraception are the sexual assault victims. In my ER, sexual assault nurse examiners (SANE) are the nurses who see these patients and write/carry out all orders for them...so if your hospital has a similar setup, you would not be required to give it.
  5. by   fergus51
    Ou ER doesn't even carry it. Even sexual assault victims who want the morning after pill have to go to the pharmacy themselves.
  6. by   Nittlebug
    Squirrel, if you don't believe in contraception you should just work for a Catholic Institution and don't train to be a SANE nurse. Or don't be a nurse at all if you want to impose your religious beliefs on every patient that comes in the door. ER patients are often less than the christian ideal of moral. You might not be at peace with yourself having to work around them constantly.

    cmggriff, Where can we get that Norplant Blowgun???? And what is the range on that thing? does it come with a scope ? with nightvision???
  7. by   cmggriff
    Norplant blowgun, wt - 14 oz empty, 18 oz fully loaded. Has an effective range of 3 to 21 feet depending on lungs of bearer. Safety atomatically engages once target passes tha doors of the ER. With practice an experienced RN can fire at a rate of 6 shots per minute. It is also available in a semi-auto version. Some assembly and training required. Cannot be shipped to Ca. Soon to be available with Depo. Gary
  8. by   Nittlebug
    Gary - I work nights so I really need night vision goggles or something so I can hit 'em from the parking lot.

    Squirrel - I am a SANE nurse and so I give Ovral to prevent pregnancy in a patient who alledges sexual assault. We do not provide that medication other patients even though we have it. We are a Catholic institution and are allowed to give it based on the theology of Double Effect which assumes ovulation has not taken place. I doubt that whole theory is going to change anyones minds. It's the Nuns way of justifying birth control which we all know the Catholic church does not approve of yet. I think it's a load of hippocritical crap myself. I give it because I would rather not see these (mostly college age kids) get pregnant because they had a few drinks and made the biggest mistake of their lives.

    If it's just a matter of handing the person the birth control I think you could find another nurse on the unit to do that little task hopefully without too much resentment.
  9. by   Squirrel
    Thank you for your replies!

    Nittlebug: Thank you for providing your point of view. The biggest problem I have with the morning after pill is that if ovulation had already occured, then there is a chance of fertilization and creation of a zygote. I am one who believes that life begins at conception, so if conception had occured prior to taking the pill the effect would be to prevent implantation of the fertilized egg (which I believe is a living human being).

    The way I see it, by preventing implantation of the fertilized egg, the morning after pill causes an abortion. The birth control pill works the same way by either preventing ovulation or preventing implantation if fertilization occured. I am not sure about Norplant, but I think it works by preventing implantation of the fertilized egg and if so, to me is the same as an abortion.

    I understand that this is a very polarizing issue, and I am not trying to generate heated debates concerning differences of opinion. I am just explaining to you some of my objections to this practice. I agree with you that it is tragic when somebody has been sexually assulted regardless of the setting (date rape or in an alley), and that they need a great deal of support. Not only the emotional impact, but the physical pain and fear of STDs and pregnancy.

    If a child is conceived during this violent attack, I believe it is a victim also and think it would be even more tragic of an event if it was not given a chance to live. And yes, I do understand this is asking alot of someone who was sexually assulted especially since the entire pregnancy will be a reminder of the horrific violent act, and that this person will need tremendous support.

    Regarding the Catholic Church and birth control, if you read the encyclical Humanae Vitae by Pope Paul VI, you will find the church's explanation on the consequences of birth control and see that it is not hippocritical at all. I am not trying to impose my religious beliefs on you or anyone, I am just trying to explain that the church has practical reasons for not permitting birth control and not permitting sex outside of marriage. Many people including Catholics do not understand the church's teaching on this topic, and think the church is being very restrictive and out-dated on this teaching, but this encyclical is very instructive.

    Again, I am not trying to stir up heated debates or impose my religion on anyone, but when I express my view on this topic I usually get responses that seem to assume that I am closed minded, a religious freak, and not compassionate to others. I am just trying to explain my point of view on this subject and why I believe what I do.

    Thank you all!
  10. by   cmggriff
    Nittlebug,
    Scope and NVG sold separately. Keep the faith.
    Squirrel, we will agree to diagree on the whole soul and religion thing. You are entitled to your world view just like the rest of us.
    But if you work the ER long you may also want to become part of the "Thanks you for not breeding" network. Gary
  11. by   gvar
    Squirrel:

    No problem with your choices, however, deciding for all sexually assaulted women who concieve that they have to carry the pregnancy is like playing god. That is not your decision and they are the onces who have to live with which ever decision they make. Give them medical care and emotional support but it is still there decision.
  12. by   MollyJ
    Serious subject and I think you would do well to let your supervisor to be know your stance. Saddest thing I ever saw was a mom who wanted emergency contraception for her daughter who had been raped; doc said, "If you don't 'want' to get pregnant, you shouldn't have sex." I wanted to hit him. Rape is enough of a lifestyle crisis without health care providers turning it into an ethical arena where they hold all the cards.

    RE; the blow gun: can you get them by the case, with attachments?
  13. by   semstr
    A few years ago I volunteered in a refugeecamp one day a week.

    This was during the Balkanwar. A lot of women were raped and assaulted, on both sides.
    These were mostly moslem women though, very religious and normally not into abortion or preventing pregnancy.

    Normally I am not the one to say, ok let's do an abortion, cause you didn't take precautions. No!

    But after my experiences in that camp, with these battered women, I was glad to help in th OR and assist the doctors!!
    Never did that before, though working in the OR, I always refused to instrument the abortions.

    But this was something entirely different!!
    Refusing a woman help, in the way of morning after pills or abortion, after a rape, is as bad as it can get!! Not human at all!!

    Take care, Renee
  14. by   NRSKarenRN
    Found on Medscape 2/14/02

    Emergency Contraception
    from Seminars in Reproductive Medicine

    Abstract
    Emergency contraceptives are methods that prevent pregnancy when used shortly after unprotected sex. Three different emergency contraceptive methods are safe, simple, and widely available in the United States. These are: (1) ordinary combined oral contraceptives containing ethinyl estradiol and levonorgestrel taken in a higher dose for a short period of time and started within a few days after unprotected intercourse; (2) levonorgestrel-only tablets used similarly; and (3) copper-bearing intrauterine devices inserted within approximately 1 week after unprotected intercourse. Emergency contraceptive use is best known for women who have been raped, but the methods are also appropriate for women who have experienced condom breaks, women who did not use any method because they were not planning on having sex, or women who had unprotected intercourse for any other reason. Unfortunately, few women know about emergency contraceptives, and few clinicians think to inform their patients routinely about the option. A nationwide toll-free hotline (1-888-NOT-2-LATE) and a website (http://not-2-late.com) can help women learn about these options. Sharing "family planning's best-kept secret" widely with women could prevent as many as a million unwanted pregnancies annually in the United States.

    Full article (free registration required) at:
    http://www.medscape.com/viewarticle/...rcmp=ms-020802

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