er vs. ob the battle goes on sort of - page 2

i truly don't know how to make this short, but i'll try. i work in ob in a small community hospital. we are a level one facility w/ no ob dr. in house after hours. if we need the dr we call him or... Read More

  1. by   mark_LD_RN
    Originally posted by bagladyrn
    deespoohbear - regarding the term stillborn delivery - it's not unusual for mothers who have lost a child to be moved off OB, especially if they express that preference. Sometimes being within hearing range of mothers and babies is just too much for them. However, I think your OB staff should have come over for fundal checks, etc. to help out.
    that how its been done at all the hospitals i have been at. If i send a pt to medical like that i make sure i show the nurse how to check the fundus and what to look for.also let them know they can call me for help anytime. i also go check on them occasionally myself
  2. by   deespoohbear
    Originally posted by bagladyrn
    deespoohbear - regarding the term stillborn delivery - it's not unusual for mothers who have lost a child to be moved off OB, especially if they express that preference. Sometimes being within hearing range of mothers and babies is just too much for them. However, I think your OB staff should have come over for fundal checks, etc. to help out.
    That's the problem though. The OB staff does NOT come and check them. The only time I did OB was during my clinical time during college which is close to 10 years ago. I agree that any woman who has lost a baby should not be put on an OB floor with crying babies but she needs to be somewhere in the facility where the nurses caring for her know what they are doing!! Our administration still has the mentality that a nurse is a nurse is a nurse....
  3. by   SmilingBluEyes
    Originally posted by deespoohbear
    That's the problem though. The OB staff does NOT come and check them. The only time I did OB was during my clinical time during college which is close to 10 years ago. I agree that any woman who has lost a baby should not be put on an OB floor with crying babies but she needs to be somewhere in the facility where the nurses caring for her know what they are doing!! Our administration still has the mentality that a nurse is a nurse is a nurse....
    Frustrating huh? I hear you, I do. See, when we (OB) are slow, we are being expected to take increasingly complex med/surg patients. The one we had yesterday had tubes all over. It frustrates us on our end when we are so out of practice and sync with such care. We are getting GI surgicals, (some of which get complicated, like the bowel herniation we had who was with us 10 days). It becomes particulary bad when we DO get labor patients and have to constantly shift nurses and priorities to meet all these demands. Mixing newborns/moms and med/surg patients on one floor can be a nightmare, I tell you. But the mentality is the same ... a nurse is a nurse is a nurse and a bed is a bed, just get one, any one, if she is female. I am certainly having to brush up on some long-forgotten med/surg cares and meds. Yep, frustrating.
  4. by   deespoohbear
    Gee, our OB department wouldn't even consider taking a med-surg patient....unless it is one of their own who is having a hysterctomy or some other female surgery....once they took the son of one their nurses when he had his tonsils out...I don't think they should be able to pick and choose who they get as patients and especially if it is non-OB....this has been a sore spot between our dept and OB as long as I have been at this hospital....
  5. by   nursenoelle
    Our policy (supposedly) is that we only get them if they are > 20 weeks with pg related sx. That is usually not the case I get called down alot to ER for triage and to check FHT's. We started triaging down there d/t the fact that they would send us every little thing.


    Regarding the med/surg issue the battle is between us and admin. We want the preggers with med surge related probs at least in PP so that they can be monitored properly. We are also a closed unit,not floating out due to potetial of cross- contamination of VRE,MRSA, etc. We go through that fight war about q 2 wks. There are solutions, we come to them , but never adhere to them.
  6. by   AlaskaKat
    I also work in a small community hospital OB department. We see almost all prego pts over 16 weeks. If they are there for something unrelated to pregnancy, we will sometimes go to the ER to "clear her OBwise", or sometimes she will come here first to get evaluated and then sent to the ER for treatment. But, they never sit in the ER if they have any pregnancy related symptoms. The ER nurses wouldn't have it and neither would we! It is crazy to have ER nurses triaging OB patients for ptl and such unless they also have OB training!
  7. by   cindyln
    Originally posted by deespoohbear
    I also work in a small hospital, except I work med/surg, not OB. Over the weekend we had a situation where a mother delivered a full term stillborn infant at home but the placenta never delivered. She was brought to the hospital and into surgery for removal of the placenta. By the time surgery is over, she is about 6 hours post-partum. Guess what floor got her? Med/surg. Not OB. Why? I have no freakin' idea but I wouldn't know where the fundus was suppose to be if it came up and slapped me. Our facility is just the opposite. Unless the patient is full term and ready to go, OB doesn't want them. (they will take pre-term labors). Otherwise our floor gets them. One time we had a woman who was pregnant with twins 34 weeks along. She was having abd pain but the pain wasn't contractions. We begged the doctor to put her in OB for EFM monitoring. His reply was, her problem isn't OB related. Maybe not, but sure as hell could be real quick. Ended up having the woman transfered to a facility with a NICU-the woman had an acute appendicitis.....go figure. And another time we had a lady who delivered at home and ruptured her uterus during delivery. Guess what department got her? Med/Surg.

    My theory is if the woman is far enough along that the baby is viable and she is not contagious she should go to OB (unless it is something critical such as the MI mentioned in a previous post). Just as an OB nurse doesn't know what to do with an MI patient, I sure don't know diddly about OB....just my .02 worth....
    That patient would have been admitted to our Med/Surg floor also. The last place a woman who has just delivered a stillborn wants to be is on a floor where she will be hearing new healthy babies crying and seeing happy new families.We admit all miscarriages and stillbirths women to med/surg floor.
  8. by   mother/babyRN
    Guess it happens everywhere...
  9. by   ShandyLynnRN
    We don't put our IUFD's on a different floor. We try to move them as far away from the postpartum occupied rooms as possible, but our docs want them on our unit, where we know how to care for them. Also, in a way it is nice for them to be cared for by staff that has dealt with IUFD's instead of on a busy med/surg floor where they probably can't get as much one on one with the nurses just because of staffing issues.

    I'm sure if they would want to be moved off the OB unit, the docs wouldn't have a prob with it, but I do agree that the nurses on the med/surg floors are not comfortable dealing with OB patients. Just as I am not comfortable when I get floated to ICU or ER.
  10. by   winewinn
    From another standpoint, since the woman just delivered a stillborn infant, it could have been easier on her emotionally at the time to not be around other women with newborns or near the nursery...



    Quote from deespoohbear
    I also work in a small hospital, except I work med/surg, not OB. Over the weekend we had a situation where a mother delivered a full term stillborn infant at home but the placenta never delivered. She was brought to the hospital and into surgery for removal of the placenta. By the time surgery is over, she is about 6 hours post-partum. Guess what floor got her? Med/surg. Not OB. Why? I have no freakin' idea but I wouldn't know where the fundus was suppose to be if it came up and slapped me. Our facility is just the opposite. Unless the patient is full term and ready to go, OB doesn't want them. (they will take pre-term labors). Otherwise our floor gets them. One time we had a woman who was pregnant with twins 34 weeks along. She was having abd pain but the pain wasn't contractions. We begged the doctor to put her in OB for EFM monitoring. His reply was, her problem isn't OB related. Maybe not, but sure as hell could be real quick. Ended up having the woman transfered to a facility with a NICU-the woman had an acute appendicitis.....go figure. And another time we had a lady who delivered at home and ruptured her uterus during delivery. Guess what department got her? Med/Surg.

    My theory is if the woman is far enough along that the baby is viable and she is not contagious she should go to OB (unless it is something critical such as the MI mentioned in a previous post). Just as an OB nurse doesn't know what to do with an MI patient, I sure don't know diddly about OB....just my .02 worth....
  11. by   SmilingBluEyes
    Quote from winewinn
    From another standpoint, since the woman just delivered a stillborn infant, it could have been easier on her emotionally at the time to not be around other women with newborns or near the nursery...
    that would depend on the individual. We care for woman who have lost pregnancies often. Often Mother/baby nurses do this cause it's one of the things we are best trained to do, and in a more conducive environment, than, say, ED. We are trained in helping with the grieving process unique to parents losing their unborn babies or newborns. It's what we do.

    But if a person absolutely refuses to go to OB, it's understood and respected. It seems many choose to come to our unit, anyhow.
  12. by   winewinn
    I delivered a stillborn (36 wks), and was actually given a choice between an OB floor or another floor as we were leaving the birthing suite. I don't know which type of nurse would have been assigned had I chosen a different floor, but I opted for the OB floor anyway. I was in a quieter, c/s area, and that was fine.

    I just wanted to say that it was a nice "administrative" move on the hospital's part in considering the emotional needs of the patient and giving the patient that choice during my stay. Probably not every hospital is always willing or really able to volunteer such an option. From a patient's perspective, though, it was a class act on the nurse's/hospital's part to give that choice, and the hospital really made me feel valued as a patient because of that consideration. They acted proactive rather than reactive to the circumstances. (I didn't think to request a different floor, but it was nice to have been offered.)

    I think the OB floor was just fine, and I agree -- it's nice to have the nursing expertise from that area in such a situation. The nurses were super during my stay!

    Quote from SmilingBluEyes
    that would depend on the individual. We care for woman who have lost pregnancies often. Often Mother/baby nurses do this cause it's one of the things we are best trained to do, and in a more conducive environment, than, say, ED. We are trained in helping with the grieving process unique to parents losing their unborn babies or newborns. It's what we do.

    But if a person absolutely refuses to go to OB, it's understood and respected. It seems many choose to come to our unit, anyhow.
  13. by   SmilingBluEyes
    Quote from winewinn
    I delivered a stillborn (36 wks), and was actually given a choice between an OB floor or another floor as we were leaving the birthing suite. I don't know which type of nurse would have been assigned had I chosen a different floor, but I opted for the OB floor anyway. I was in a quieter, c/s area, and that was fine.

    I just wanted to say that it was a nice "administrative" move on the hospital's part in considering the emotional needs of the patient and giving the patient that choice during my stay. Probably not every hospital is always willing or really able to volunteer such an option. From a patient's perspective, though, it was a class act on the nurse's/hospital's part to give that choice, and the hospital really made me feel valued as a patient because of that consideration. They acted proactive rather than reactive to the circumstances. (I didn't think to request a different floor, but it was nice to have been offered.)

    I think the OB floor was just fine, and I agree -- it's nice to have the nursing expertise from that area in such a situation. The nurses were super during my stay!

    It was a great move. Where I work, our med-surg unit is way too busy and sometimes understaffed to deal with women who have experienced such losses, so most of the time they are better off on our unit. And fortunately, the way our unit is designed, they go to rooms (GYN/surgical) that are fairly far-removed from the LDRP suites and the nursery. There really is no "good" place to go when we have experienced pregnancy loss. Speaking from a patient's perspective myself (having had 5 first and 2nd trimester losses), I preferred the care I received on OB versus med-surg. It's individual, like I said. I was not given a choice and when I went to med-surg I was treated as a med-surg patient, not one who had experienced a painful loss of a pregnancy. Can't put everyone in the same box, I guess, is the lesson here.
    Last edit by SmilingBluEyes on Feb 20, '05

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