I'm getting written up! (Very long)

Nurses General Nursing

Published

Specializes in L&D, PP, Nursery.

I'm getting written for an incident in which was completely misunderstood. Yesterday, I had a 20 year-old patient that was being induced for labor. On admission, she was asked what her plans were for pain control (part of our admission process). She stated " I don't want an epidural because I'm scared to get one". When I asked her what her concerns were, she stated she was afraid to be paralyzed and that the OB told her she may die if she gets one. I explained to her exactly how the procedure is done and although there are risks, these would be explained to her by anesthesia and the risk of paralysis or death were extremely low and that I've personally never seen either occur in 13 years of OB experience at 3 differant hospitals. I also told her that IV medication certainly was also an option and she could "play it by ear" and to just let me know what she decides when the time comes. Well, after several hours of increasing pain, the IV pain medication was becoming ineffective. She asked me at one point if she could have an epidural and I explained to her the the doctor only allows his patients to have epidurals once they are 5CM. Several exams later, she was finally 5 CM. When I told her the result of the exam, she stated "Can I have my epidural now?" So, I called anesthesia and she got her epidural without any difficulty and delivered a healthy baby girl 1 1/2 hours later with no complications. So here's the problem.. .......When the doctor showed up while the family was in the waiting room during the epidural, they complained to him that she was coerced into getting the epidural and that they didn't want her to have it The doctor was raving mad and complained to my charge nurse about this. 2 charge nurses talked to the patient and she told them that she was not coerced in any way and that she asked for the epidural and all I did was answer her questions and explain the procedure. She also told them that was embarassed by the behavior of her family regarding this. The S/O told them that he didn't want her to have it and since she was only 20 years old she couldn't make the decision for herself (he proudly announced he was 37 years old). On rounds the next day, our clinical coordinator asked the patient and family if they were happy with their experience and they never mentioned anything about this. However, the doctor is still insisting that I get written up! I've never had any issues with him but he is VERY anti-epidural and always tells his patients they WILL end up with a c-section, they WILL be paralyzed and MAY very possibly die from it rather than explains the risks. I merely was answering my patients questions and educating her and the family. And yes, there was a written as well as a verbal order from the doc allowing here to have it. I have a perfect 12 year attendance record at this facility and have never been reprimanded for anything and always get excellent evaluations. This is not fair! Sorry so long but I need some advice!

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I would definitely stick up for myself. Is there a union? Go to your union rep and make sure they are present if you get the write up. Since you most likely can't avoid that doctor in the future, you might want to consider a transfer if you can't convince the powers that be that you did nothing wrong.

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Specializes in L&D, PP, Nursery.

We do not have a union. Everyone, including the unit director agrees that I did nothing wrong especially since the patient herself said she asked for the epidural when the pain got too intense for the IV medication. It's just the S/O and family that were upset because THEY didn't want her to have it.

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Specializes in Med/Surg, Acute Rehab.

This is a perfect example of a nurse trying to be a great pt advocate and a doctor who doesn't want to be bothered with anything more than his routine deliveries! Your manager should support you in this; a doctor cannot insist that a nurse be written up if she did not do anything against his orders, and clearly you did not. Does your facility have a Midas system where the nurses can write up reports on doctors? A hospital that truly cares about its nurses will not let doctors like this get away with such behavior. I am sorry this happened to you.:heartbeat

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Specializes in LTC.

As for the SO, it's been my understanding that once a woman becomes pregnant, no matter her age, she is no longer considered a minor.

The doc is letting his prejudice against epidurals get in the way of good practice and wanting you to pay for it. Grrrr.

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Specializes in Trauma, Teaching.

You don't work for that doctor, you work for the hospital. As long as your director doesn't have a problem, I think nothing will come of it. If the doc writes a complaint himself (he can't force your boss to do so), then you can also include your written defense, and get those who interviewed the girl, as well as get the girl herself to write a letter of support for you. Then the whole packet may be in your file, but it will be quite clear that you did nothing wrong.

If S/O won't bother to marry her, I don't see how he has any say in the matter at all. Last I heard, 18 was the age of adulthood and making one's own decisions! In my state, even minors are considered emancipated if they are pregnant, with all decisions about the baby and care belonging to the girl. (Can you tell we have lots of teen pregnancies?:crying2:)

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Specializes in nursing family members with rare disease.

Is it really true that a 20 year old in labor can't decide if she gets an epidural? And family members who are NOT in labor get to decide?

What kind of doctor would tell the patient that an epidural WILL kill her? What is wrong with these people?

I too started into labor hoping for natural childbirth, but by the time I was 5cm I think I would have done violence to anyone who nixed my epidural! (kidding)

I hope this turns out all right for you.

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Specializes in Mental and Behavioral Health.

You did everything correctly as far as I can see. This doctor is being unfair. You should write all of this up very objectively, make yourself a copy, give one to the DON, and one to your charge nurse. I hope someone takes up for you. They should.

What is this doctor's deal? He hates for the labor process to slow down. He wants done with it. That's why he's ready to jump straight to C-section. It sounds to me like this doctor and family had a conversation about this, and that perhaps this patients confidentiality was comprimised in the process.

I remember how very irritated I was in L+D when the very young wife was crying for pain medicine, and the older husband was coldly insisting that she didn't need it. I wish someone would explain men to me. (Or explain things to men.)

What business is it of this family's anyway? FOR CRYING OUT LOUD!

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It doesn't matter what the S/O and family members think and want. The woman was conscious and of sound mind and can decide for herself. Case clased on that one.

You superior doesn't need to write you up because the doctor wants it done especially as patient and your boss both agree you handed things spot on. If the doctor persists your manager can tell him if he wants write up he has to do it himself. That is proper protocol anyway. Chances are if she puts it on him he will be too lazy to do it himself.

If he does do it you NEVER sign it as you disagree. You can however write up your side and ask it to be attached to the write up. If your superior has a backbone she won't do the write up and will advise the doctor that the patient has no complaint about epi or care. The doctor seems to have very little respect for his own patients and the staff.

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Specializes in ICU/Critical Care.

You didn't do anything wrong. You gave the patient the options. It's was her decison. Not the doc's, Not the S/O. Stay strong and stand up for yourself. He does not control whether or not you are written up. And if management does so to appease him, then I'd look to work elsewhere.

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I'll bet Mr. 37 y.o. S/O would have been BEGGING for an epidural if HE had been the one going through labor pains. I'm always amazed by family members who think they know better than the patient how much pain their loved one is in. It steams me.

I am sorry you are having to go through this. You sound like a wonderful nurse.

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Is it really true that a 20 year old in labor can't decide if she gets an epidural? And family members who are NOT in labor get to decide?

It's not even remotely true. They clearly are out to bully the poor pregnant patient and the staff. The woman was conscious and of sound mind so she decides. What a shame that they did this first to the poor patient and secondly to the nurse. People should mind their own damn business sometimes.

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