"Pit to distress..." (Rant) - page 4

I'm gonna try to make a very long story short... I had the chief resident today give me an a** chewing because I had turned off the Pitocin of a pt who had persistent episodes of... Read More

  1. by   lauriesalRNC
    You cannot up the pitocin when there is hyperstim....regardless. If the doc wants to give you any lip, look up use of Pitocin in your policy and procedure manual and show him the policy. No doubt it says that once contractions are every 2 minutes you do not increase the Pitocin, regardless if there is fetal distress or not. If anything happened to that baby as a result of fetal distress, you would be held liable for misuse of Pitocin. That doc is definitely wrong, you cannot wait until the fetus had distress to back the Pitocin down. Tell that to the mother when her baby has hearts in the toilet! It takes a while to be able to stand up to the docs when you know you are right and they are wrong. if you do not feel comfortable doing this, ask your charge nurse to handle the situation. Remember, as a nurse you have to protect the patient so if you carry out orders that you know could result in harm to the patient you are just as liable as the doc who orders it.

    What ever happened to this patient? what was the outcome?


    Quote from camay1221_RN
    I'm gonna try to make a very long story short...


    I had the chief resident today give me an a** chewing because I had turned off the Pitocin of a pt who had persistent episodes of hyperstimulation. I had only turned it down a few minutes before he came in, so I had not informed him of this. He asked why I turned it off, and I showed him on the strip the pts ctx pattern. He looked at it and said, "Well, there's no fetal distress." I told him I understood that, but the pts uterus was not getting any rest between ctx. He then proceeds to tell me, "You need to call me before you do anything like this again, this is my pt." It took everything I had to keep from saying, "No, she isn't your pt, she's our pt, and it is my license on the line should something happen at your wanting to misuse the Pit." I didn't say anything though. So, I restarted the Pit, but only after I saw the pt had resting tone, and I started from the beginning, 2mu/min. She handled that okay, but when I got up to 6mu/min, she started having the ctx one on top of the other again. I pointed this out to the resident and he said, "Keep upping the Pit until there is distress, then you can back down on it." OMG, my tongue was almost bleeding by this time! Well, lucky for me, but not for the RN who followed me, this was right at change of shift, so I'm not the one having to deal with the aftermath. Which hopefully, there won't be one.

    You know, I know I am new to this whole L&D experience, but when I have my preceptor and my RN educator agreeing with the actions I took, I can't help but think my actions weren't that far fetched.

    I'm sure I left tons out, but I think I covered what I wanted to.

    Thanks for letting me rant!
  2. by   fergus51
    Quote from SmilingBluEyes
    Lord, so glad I dont' work in a teaching hospital. I avoided it due to things like this. Yes, residents NEED to learn, but many are very stubborn in their newness and ignorance, and nurses are NOT allowed to manage their patients. Like pointed out, I thought that WAS nursing's job. I feel for you who work in situations like this.
    I actually prefer teaching hospitals because you can just go over the resident's head to the attending if you feel strongly about something. Working in a non-teaching hospital there is no one else to go to if the doc is an a$$. Seen a lot of problems with that!
  3. by   SmilingBluEyes
    It depends on the hospital ferg. There is ONE I know of where "going over their heads" is like pulling hen's teeth. And I have just as much backup where I work as I would in a teaching hospital. My supervisors are VERY strong and will back us up as needed. As will the Chief of OB.
  4. by   Spidey's mom
    Quote from SmilingBluEyes
    It depends on the hospital ferg. There is ONE I know of where "going over their heads" is like pulling hen's teeth. And I have just as much backup where I work as I would in a teaching hospital. My supervisors are VERY strong and will back us up as needed. As will the Chief of OB.

    Hen's have teeth? :chuckle

    I've never had a doc "pit to distress" . . .the nurses usually manage the laboring woman.

    I've been a nurse for 6 1/2 years at a rural hospital . .. . I'd probably never last at a big hospital although my supervisor today said rural nursing makes you well-rounded because you are flexible and do many jobs. I work ER, OB, med-surg, post-op, pre-op, I'm the baby nurse in cesareans, etc. I'd be scared though . . . I sometimes feel like I know a little about alot.

    Having a resident to answer to . . . that would be weird.

    steph
  5. by   SmilingBluEyes
    Quote from stevielynn
    Hen's have teeth? :chuckle

    steph
    Yea that would be my point, rofl, Steph.

    How ARE you? have not seen you around in a couple days...
  6. by   SmilingBluEyes
    And yes, rural nursing DOES make you well-rounded....it presents its own amazingly unique challenges, that much I know.
  7. by   obnursesteff
    Quote from SmilingBluEyes
    Kev said it. I will NOT ever turn up or leave pit on when it's clear hyperstim or distress are happening. Hyperstim to distress is opening yourself up to a non-defensible and vulnerable position. Not to mention how would you feel if you caused a poor outcome? I could not sleep at night, myself.
    We have a doc here that says it is not hyperstim, unless there is fetal distress to go along with the all too frequent ctxs!!! Not in my book. He's been upset with me several times. S***s to be him.
  8. by   BETSRN
    Quote from fergus51
    I actually prefer teaching hospitals because you can just go over the resident's head to the attending if you feel strongly about something. Working in a non-teaching hospital there is no one else to go to if the doc is an a$$. Seen a lot of problems with that!
    You can always go OVER the docs head to the chief of OB or to the chief of the medical staff. :chuckle
  9. by   SmilingBluEyes
    Quote from BETSRN
    You can always go OVER the docs head to the chief of OB or to the chief of the medical staff. :chuckle
    which is easy enough to do in our hospital.
  10. by   Mermaid4
    I have had docs upset with me too and then turn around and turn up their own pit...On those occasions when there is little or no resting tone I have and do turn it off and if they turn it on, I will document that I turned it off, exactly what I informed him or her of, and that they turned it back on themselves....You know these same docs will not be on your side in a court of law when the uterus ruptures and someone is irreparably injured or dies...And, usually it is not your peers who are judging you..You are judged by what you did and didn't do according to standards. I have found that many nurses think just because the doc disagreed with them and ordered the incorrect or problematic care, that they are covered. Wrongo!

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