Assistance needed: Could the nurse have done more for this ethical dilemma?

calivianya, BSN, RN · Nov 30, 2013

I'm sure that in some textbook it says we could do more... but in reality, the physician has the final say on what is and isn't done, and that nurse is going to have to work with that physician again. So, the options are to either go with the flow, recruit the patient to ask about the tests, or move up the chain of command. Going with the flow means there will be no hard feelings between the nurse and the physician, but if the nurse goes to her charge nurse and tries to start something, or tries to talk the patient into asking for those tests, the relationship with that physician might be damaged. One thing I hardly ever heard about it nursing school is how important it is to maintain a good relationship with the physicians you work with. They are much more receptive to you telling them what you need if you have to call at 3 AM for a change in the patient's condition if they trust you. If they don't, and think you're a little backstabbing nurse who is going to undermine their authority at every turn, your life is going to be REALLY difficult when you need their help.

I would personally let it go. 37 weeks isn't that early for a baby to be delivered. I don't remember enough about OB to make the judgment of when I would push it, but it would have to be a serious, obvious error on the physician's part for me to go behind his/her back and risk the bad feelings that would engender.

Esme12, ASN, BSN, RN · Nov 30, 2013

Hi, Im a student nurse currently in the labor and delivery unit. I want to find out if the nurse assigned to the nurse could have done more for the patient after getting turned down by the doctor.
Scenario: A mother at 37 weeks was having a c/sec. At 37 weeks we're worried about fetal lung maturity. Nurse told the physician about possibly running tests to test fetal lungs but the physician shot her request down and told the nurse that she's just following policies and procedures on getting this baby delivered. With that answer from the physician, could the nurse inform the patient that lung maturity could be an issue (just in case patient didnt get the whole run down of risks in surgery) or should the nurse just stay quiet and listen to what the physician said? Or could the nurse have gone to the charge nurse?

I will be honest....there are times you should fight and times you don't. If this MD has a history of bad decisions, or the baby is earlier, I'd probably be more verbal or pro active. Depending on the situation as well....was this a planned section? was the baby in distress making it a real emergency to get the baby out? Was the sex of the baby known? I would not circumvent the MD and tell the patient anything...... I would discuss it with the charge nurse/supervision/administration and possible the medical director of the department if I felt that strongly...but go in and tell the patient their MD is not doing things right? no I wouldn't...that is over stepping your boundaries.

There was a cardiac surgeon once that came in for an emergency surgery and he was intoxicated to the point he was dangerous. I stuck my neck out called admin and other MD's in the group...got him into the back room and proceeded to let him know he was going no where near the patient. It wasn't a pleasant exchange.... eventually he realized the wisdom of my words and ceased threatening to removed me from his path. He apologized the next day...he had NEVER been an issue EVER and was an excellent MD...he was having a bad moment.

However the patient nor the family EVER knew what had transpired that night.

yellowmamba · Dec 1, 2013

Thank you to the both of you for you comments and knowledge!

KelRN215, BSN, RN · Dec 1, 2013

37 weeks is considered full-term. Why is this woman having a C-section? There must be some reason why this was scheduled at 37 weeks as opposed to 39 or 40. In many women who have complications such as pre-eclampsia or severe hyperemesis, they take the baby at 37 weeks because the benefit of delivery outweighs the risk to the mother. I know several people who delivered precisely at 37 weeks for this reason. The odds of respiratory distress syndrome in a 37 week old are still small (something like 5% from what I've read) and based on the information given in the OP, I can't say whether or not the nurse could have or should have done more. And I'm not so sure this is an "ethical dilemma."

nurseprnRN, BSN, RN · Dec 2, 2013

Yeah, that was my first thought. Where's the ethical dilemma? Not everything that is confusing is.

4boysmama · Dec 3, 2013

At 37 weeks we're worried about fetal lung maturity. Nurse told the physician about possibly running tests to test fetal lungs but the physician shot her request down and told the nurse that she's just following policies and procedures on getting this baby delivered.

This makes me think that there's some pathology going on with mom and/or baby. Yes, there's always concern for lung maturity in a late term premature baby (and 37 weeks is technically a late termer, because 38 weeks is considered full term) However, 37 weekers typically do quite well with little to no intervention needed. So - what's the policy/protocol that the physician needed to follow to get this baby delivered? Yes, lung maturity is something to be concerned about, but there are bigger fish to fry...Was mom pre-eclamptic? Was baby IUGR? There has to be a reason for the c/s at that point.

(also, it's worth considering that assessing fetal lung maturity carries it's own risks - amniocentesis is generally low risk, but it's not risk free. It would be an interesting study to compare the risks of c/s at 37 weeks versus the risks of amnio at 37 weeks) Finally, there's potentially relevant info that you weren't privvy to...for example, was betamethasone on board? (2 shots, 24 hours apart, with maximum efficacy kicking in 24h after 2nd shot) If it was, then lung maturity is no longer a big concern...