I am on orientation to a small community hospital OB unit. I have almost 30 years of experience in OB - both hospital L&D, Post Partum, Nursery, Antepartum, high risk and low risk and clinic settings. I don't claim to know everything in the world and learn something new each shift, but I KNOW WHAT I KNOW.
Orientation at this hospital is tough. The regular OB nurses have been getting paid full wages to stay home on call if there are no mothers or babies in hospital. My orientation meant I was at the hospital BY MYSELF for 12 hour shifts with NO ONE to teach me the system unless patients were there. One day - while there alone - a doctor's office nurse called and stated that the doctor she worked for was unable to get fetal heart tones on a 22 week gestation patient. She said the doctor would like to have the patient come to the hospital so she could be put on the fetal monitor. Since there had been quite a flap between ER and OB recently at this hospital the OB head nurse and the director of OB MD decided we would not put anyone under 24 weeks on the fetal monitor. The head nurse had just sent out an e-mail to that effect to all OB staff. I told the office nurse that if the MD could not get fetal heart tones ACOG Standards of Care recommends an Ultrasound. She put the doctor on the line (which is how it should have been to begin with since he was standing right next to her). He told me he thought it would be 'REASSURING" to the mother to be on a fetal monitor. I'm thinking that 1) if the MD couldn't get fetal heart tones at 22 weeks gestation with a doppler, either the MD was a problem or there were no heart tones to be heard. 2) I told him that our Head Nurse had just sent out an e-mail to the OB staff telling us that we should not put anyone under 24 weeks gestation on the fetal monitor. 3) Since I was new and he had no idea who I was (I had never met him) I started to tell him that I had about 30 yrs experience when he simiply hung up on me. I knew I had told the doctor the right information - 1) ACOG Standards 2) the most definitive answer to the question of whether the fetus was alive or not and 3) the instructions of my head nurse as in NEW POLICY.
Immediately after the MD hung up on me I tried to telephone my head nurse - no answer and message not returned. I called the RN who was on call at home and she agreed with my advice to the MD but stated she probably wouldn't have "had the nerve" to tell him that since he "doesn't like women". I then called the Director of Nursing to tell him what had occurred. I told him I knew the correct information to tell the MD and felt I was correct in doing so. He told me "there's a way to take care of people like you".
I am now being charged in a CORRECTIVE ACTION for refusing the doctor's order. Not only that, but in the wording of the charges it states that the doctor ordered a STRESS TEST on the patient. That was never ordered. Who on earth would do a STRESS TEST on a 22 week gestation pregnancy??? The Director of Nursing has no idea what he is talking about. What seems to actually be the problem (as I see it) is that I disagreed with the DON's idea that an RN can NEVER refuse an order. Of course we can. Jehovah Witness RN's don't give blood even if it's ordered. They have to assign another RN. That's refusing an order. Just reading your state's Nurse Practice Acts also tells RNs that we can not do anything that would cause "Mental Stress" for the patient. Surely trying to trace a little 22 week fetus around with a monitor meant for TERM infants would delay her assurance of her baby's well being.
How do I defend myself. My probation period has been extended for one month beyond my "orientation".
Dog gone it. I know what is the right thing to do and I tried to tell the MD in the best way I could. I never REFUSED an order. He "requested" I put her on the monitor. And my head nurse should be baking me up that I did the right thing.
Any ideas out there? I refused to sign the Corrective Action paper and stated that I wanted to write my own response. One of the things I am being charged with is not following the hospital policies - two of which are to show Empathy and Compassion. I certainly belive that I was doing just that by advocating for the fastest way to show that mother that her fetus was indeed ok (and the baby was okay according to the US done that day).
Noor - OB RN
Apr 23, '09
I know next to nothing about OB, but I had a similar thing happen to me in the SICU. The difference in my situation was that the ICU manager actually backed me up when the MD wrongly accused me of not following an order.
Frankly, I think your DON is a weenie and the MD is just an ***. Doesn't like women? What the hell is he doing in OB?
Sounds like you followed the prescribed policy, which unfortunately was not what Dr. Compassion wanted to hear. I would want to know from the charge nurse, manager, DON, whoever, why you're in corrective action for following their policy.
Kudos to you for not signing the CA form. Have you considered seeking employment elsewhere?
Good luck to you.
Last edit by ElvishDNP on Apr 27, '09
: Reason: TOS
Apr 23, '09
Sounds to me that they are all threatened by your knowledge and years of experience. When I was a traveller years ago, I saw this in some small rural hospitals. Hang in there and stand tough. Good luck and please keep us posted! :clphnds:
Apr 23, '09
I really don't see why you would want to continue working in a facility where you are treated like this. With 30 years experience, surely you can find employment elsewhere.
Apr 23, '09
Can you print the email that stated you were not to place anyone under 24 weeks on the monitor? Can you also print out the ACOG standards of care in this situation to use as evidence in backing yourself up? Do you have a union? If so I would go to the union for some assistance. I would also consider requesting a meeting with your director and the DON with your evidence in hand to face them with. Include a copy of the policies on file. Good Luck! I don't know that i'd want to work with a doctor like that.
Apr 23, '09
I appreciate your problem. If the physician was really pushing for the patient to come over to be monitored and you told him it was not your unit's policy he should have called the house nursing supervisor and let them handle it. That is the appropriate chain of command.
You were not refusing an order, you were simply stating your unit's policy and proceedures.
At my small hospital, we see all kinds over from the office for EFM, including 18 weekers. Yikes, I know. Most of the time you can't get it without a doppler anyways.
I also agree. Ultrasound would be the indication on the 24 gestation with no FHR in the office.
Apr 24, '09
Oh my word, where do I start. So many issues here....why are you by yourself while you are in orientation? Who is responsible for patient care since your status is orientee?? If they are paying the nurse full wages to be on call at home (which is just ludicris), why not have her there with you teaching you things? NO ONE should ever be alone on a labor and delivery unit. What if a patient came in in active labor and precipitously delivered? Guidelines clearly state that TWO NRP certified professionals be in a delivery. Who would call the second nurse in while you were dealing with that? I don't care how small the hospital is, you still have to maintain standard of care. This situation you are in is just plain unacceptable.
Ultrasound is standard of care here, not NST. A patient would've been reassured by seeing a picture, not being tortured while a fetal monitor was trying to find FHT's. Sounds to me like the physician was just being lazy.
This is not what you need. This is just dangerous. It really bothers me that you are not being oriented properly, despite your experience. JCAHO would have a field day with your file if they visited.
Please consider getting out of there. I know jobs are tight, but you did nothing wrong, and you certainly don't deserve this. It will NOT get better. The DON has already shown she does not have nursing's back here. By the way, was there an reprocussion from the nurse manager not calling you back? She is an integral part of the chain of command (that you initiated). That is also unacceptable.
My heart goes out to you. Good luck.
Apr 24, '09
if that is a direct quote from your DON, you might consider a hostile work environment.......best thing would be new job.....find one and walk
Apr 24, '09
Thanks to EVERYONE for replying to my call for help. Yes, another job would be best. I am almost 64, do you have any idea what it is like to interview for a job with a 25-y-o who asks if you think you could "handle the strain of hospital nursing?" Yes, I know, that's against EEOC - I've already submitted that one. I am definitely looking for another placement. Yes, no RN to orient me was ludicrous and crazy. As for a patient coming in to deliver, I've done that so many times over the years I can't count them. New standards state 2 NRP certified personnel must be present. We didn't have that in "the olden days" (as the young nurses refer to my experience). Although it sounds arrogant, I know that there is no emergency that would come to OB that I haven't learned to handle. Doing it all alone is no fun. At least the House Supervisor shows up when a patient comes in unexpectedly. My Head Nurse (Nursing Supervisor - whatever) is so non confrontational that she doesn't speak up for us at all. In fact, she was the one who handed me the Corrective Action form and didn't seem to notice that the DON kept referring to the fact that I had refused to do a STRESS test on a 22 weeker. Who on earth would put a 22 weeker on Pit????? He has no idea what he's talking about. As for people having their noses out of joint because of the experience I have had, you are right. Not a single OB RN has worked anywhere else. This hospital has about 30 births a year. I have worked at huge facilities with multiple births every shift. I'm not scared of anything there except the incompetency of the administration. I am formulating my reply. There is NO union there or I wouldn't be having this problem. One of the MD's told me today that if the administration tried to do anything about this they would be shot down immediately. Head nurse says "just sign it and forget it - it's no big deal". The HELL it isn't. Yes, I'm still hopping mad but instead of leaving in what some would think was disgrace, I will fight this to the wall.
Thank you all - You have really given me a boost.
Apr 25, '09
GOOD FOR YOU!!!
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