OK, I need your take.
Last week I saw an OB/post-partum pt with a history of pyschosis. I was sent b/c she had wound care for her C-sec incision. A well-mom-baby visit was first conducted by the peds nurse, so I was told I only needed to see the pt for wound care. I have never been asked to see a post-partum pt before, and we only have one peds nurse in our HH agency, so if I didn't do her Sunday visit, she would have to work on her day off. I was very nervous about it, not so much for the OB, which BTW I HATE OB nursing, only slightly more than I hate psych nursing, but I was nervous b/c the pt repeatedly asked me on the phone if I was coming alone. It gave me the willies. What was going through her head? I was thinking she would answer the door with a knife in her hand. I found out later that 2 nurses went the first visit, b/c our agency is doing a inter-rater reliability QI to see if 2 diff nurses would assess pt the same way. So, that apparently had made this psych pt paranoid. BUT, I figured, this is a rare occurance, so I agreed. Found out the day after my visit, pt checked herself into the mental health crisis center. I did not peg her as so close to a crisis. Maybe I missed something, since I am not a psych nurse? Or, maybe just being 40 yo w/ new infant and h/o psychosis was a bad combo, who knows?
Now, today, I find out, I am seeing another OB pt for a C-sec wound. I protested, saying I am not an OB nurse. They said, you have good assessment skills, you're a good nurse, you can do wound care! I said, I do not see such a pt as a wound to care for, I do a comprehensive assessment on my pt's, and I am unprepared to properly assess a post-partum pt. They acted like I was a bit*h, prima donna. TOUGH!
It's not so much that I couldn't handle this pt, b/c I think I could have, but I see this as their first step into forcing me to do something and see pt's whom I do not wish to see. I have ZERO desire to be a OB nurse, and I would not take a public health job b/c it is mostly well-mom baby visits and child abuse cases (from what I have heard, in my geographical area.) I see them as sending me to well-mom baby next "since you did so well with the others and their wounds." Next it would be peds, you get my drift. Our present peds nurse agreed to do one peds case, then another, now she is the only peds nurse, works all hours, since parents may work and kids may attend school, so she has to make visits in the winter in the dark to some very bad neighborhoods...forget it! She hasn't seen an adult in the last 2 years since she agreed to see one kid, and I am not getting swindled into this.
Now I don't like psych at all either, but the difference in taking a psych case with a wound is that I do assess psych/emotional status to some degree in every pt I see. I may not be the best nurse to talk a pt out of a delusion, or know the correct med to get the pt back on track again, but I can assess suicidal ideation, depression, and anxiety. I do NOT however, routinely assess fundi, breasts, lochia, blah blah blah to any degree on every pt. I am not an expert on post-partum depression or knowing how to identify it.
So, you tell me, am I making something out of nothing? Should I have not refused to do the visit? Another nurse volunteered to do it, so why force me? We swapped assignments. I am planning to write a letter to my supervisor to tell her of my concerns and my lack of experience and confidence in these pts. What do you think?