Another OB Problem

[SCB]

I sware I've got to stop working at this hospital, or I will see the inside of a court room.

A G2P1, with 1st baby delivered by c-section, presented to L&D and had been ruptured for 14 hours, with clear fluid. She was placed on the monitor. Contractions were q10min and palpated mild. FHR was 140-150 baseline with good varitability, but did not meet the criteria for reactive. With contractions the FHR dipped down to 120's and (lates). The matermal temp was 99.1.

This patient was sent home by the CNM on duty with the hopes of spontanious labor so she could have a natural lady partsl delivery.

I showed the monitor strip to the CNM and my charge nurse. They didn't have a problem with it. The OB on call for the CNM group happened to walk in the door about 30 min later. I pulled him aside and let him view the strip. The CNM was directed to call the patient back to hospital for further evaluation,and it's a good thing. The fetus was in distress and the patient was sectioned and given a healthy, alive infant.

Now I'm on the poop list of the CNM. Too bad, she is on poop list as well.

Today I look for another job.

Susan

[legsmalone, RN]

Wow SBC, I can't even believe that, my Mom is also a nurse, worked L and D for 25 years and in the last few years per diem with CNM's and I have never heard anything like that from her. Her only complaint are the midwives who never were nurses or didn't work out in the clinical setting before becoming a midwife and have no frickin clue how to handle their patients.

I can't believe she was ruptured 14 hours, the hospital I am at for clinical right now won't let anyone walk out with ruptured membranes, longer then 12 hours they get ampicillin.....add the late decels and they are itching for a c section....they want that baby out of there......very sad the CNM messed up, this isn't the kind of thing that gets nurses as a whole more respect as a profession.

Good call SBC!

[jdomep]

Being a student All I can say is I'd want YOU in with me if I were having another one! You did good by your patient and that is what matters!!!

[Jolie, BSN]

I once worked as a nurse manager in a NICU, and stepped down to a staff position because I had 2 staff nurses whose judgement and performance I could not trust, and upper level administrators who refused to allow me to retrain, reassign, or fire these nurses. In short, I went to work every morning wondering what they might have done to cost me my license the night before. In a legal environment where s**t truly does roll uphill, a nurse manager can be held legally responsible for the actions of his or her staff. I can't, for the life of me, understand why any manager with 2 brain cells to rub together would let these incidents go unaddressed. But, since that appears to be the case, have you tried going to Risk Management?

Most hospital risk managers require the immediate reporting of certain "sentinel" events, such as unattended births, low apgars, un-diagnosed meconium staining, delays in establishing respirations of the newborn, etc. In short, anything that could potentially turn into a lawsuit in the future. It is helpful in determining whether any one staff member is consistently involved in such events, and helps ID areas of education needed by staff members.

The OBs and CNMs should also be participating in departmental reviews of questionable cases. Our hospital was able to remove one OB with a consistent track record of complications thru such reviews.

If I were you, I would high tail it out of there, but if you choose to stay, please consider pursuing some of these options. Good luck.

[cindyln]

First problem I see is sending home a patient that is ruptured.We never send anyone home ruptured.You did a good job standing up for the patient