Patient assignments during pregnancy - page 5
by ProfRN4 9,437 Views | 43 Comments
i'm sure some may not agree with me, but hear me out. we have a pregnant nurse on our floor. it's an oncology unit- full of pts that need chemo. many of the others have some kind of infection (mrsa, vre, cmv, whatever). ... Read More
- 0Jul 5, '10 by caroladybelleQuote from diane227IF PROPER PRECAUTIONS are taken, chemo can be safely administered by pregnant nurses and can handle chemo pts.I don't have any experience with chemo but is it not the standard that pregnant women should not be administering chemo. Clarify please!! Thanks
The big issue is , in most places, nurse are either slack about using proper chemo PPE or administration is slack about providing it.
On my Hemo floor, roughly at least a third of the pts are getting chemo at any given time, with quite a few over that on post chemo fluid precautions. And at least one time last year, we had at least 7 pregnant nurses. There would have been virtually no way to function like that and avoid chemo pts.
Fortunately, my facility is much more careful regarding chemo precautions and provides adequate care.
When chemo is given, the nurse should have a mask on, a waterproof gown THAT IS NOT REUSED, and two pairs of chemo gloves, one that folds under the gown wrist and one that folds over. Nurses should not be open priming chemo - a closed system must be used. The chemo product should have seals on it that can be spiked without aerosolization. And antileak, antireflux, safety seals should be used on connectors. When working where any bodily fluids (even several days post administration) may be leaked or sprayed, wear a mask and gown w/cloves, so you aren't being contaminated. And when dumping and flushing urine or vomit, wear a mask and gown with gloves, to keep from aerosolizing contaminants unto clothes or breathing it in - fluids should be flushed twice.
The nurse should have a pt to nurse ratio that supports this.
Many places provide gowns, but so few as to they get reused. They don't carefully glove, or they don't mask and gown to prevent contamination when flushing urine. And while they are getting better with having tubing preprimed or usable closed systems, most do not have the safety seals.
Please note that very few places actually provide the proper safety products or the ratio needed. I am lucky in that mine does. There have been no problem pregnancy cases that were related to chemo that I know of among them with these precautions in place.
While we do try to limit pregnant nurses to less problematic chemo, most still take chemo pts and post treatment pts and adhere strictly to precautions. We do not permit them to take care of active flu pts, especially H1N1 and resistant H1N1, CMV or Shingles pts, or RSV pts getting ribavirin or for thalidomide cases, etc.
- 0Jul 5, '10 by TDCHIMQuote from kloneWow. I'm a big fan of playing through pain, but that story just gave me chills! I can't believe your manager let you keep working in that condition, just from a liability standpoint.I work in an OB unit. When I was pregnant, I requested to stop doing L&D and just be assigned to postpartum or nursery, once I was about 6-7 months along (L&D was very strenuous, lots of bending and lifting). I was accommodated with no problems. I also requested not to be assigned pts that had things like active influenza (which didn't happen too often). Otherwise, I actually had to FIGHT for the right to do my normal job. I remember one nurse wanted help getting a s/p C-section out of bed for the first time, and I got up to walk to the room and the nurse said "No, not you! Go sit down!" Seriously, they were very protective of their largely pregnant nurses in that unit. If I went in to help with a delivery, they'd freak out if I tried to break down the bed.
One night I was charge and I had a postpartum pt assignment, and I was in early labor that night. I'd be walking to a pt's room and would have to stop and lean against the wall and breathe through a contraction. The other nurses were FREAKING OUT, telling me to go home. I had an OB appointment the following morning, so I didn't see any point in going home and then having to drive all the way back the next morning. I remember bending down and emptying a pt's foley catheter and she asked when I was due. I said that I thought I was in labor now, and she freaked out too. Finally, around 3am I asked if someone else could watch my pts while I go lay down for a bit. They all said "Yes, thank G-d. Go lie down!"
I ended up working through the rest of my shift, punched out, and went right into a labor room, where I was 6cm. I delivered by noon.
- 0Jul 5, '10 by kloneQuote from TDCHIMMy manager didn't know anything about it. It was 7p-7a, and she wasn't there at any time during the shift.Wow. I'm a big fan of playing through pain, but that story just gave me chills! I can't believe your manager let you keep working in that condition, just from a liability standpoint.
What would be the liability with working through early labor, as long as I wasn't bleeding, in inordinate amounts of pain, and my baby was active?
- 0Jul 5, '10 by Tina, RNQuote from BILLIE39Awww! Your time will come, and you will enjoy every moment of it. *hugs!*A friend of mine is about to give birth in 1 weeks time - I am so envious I wish I could meet MR right and settle down and have children. Ahhh nurses who are mothers you are truly blessed x