Intrauterine Fetal Resuscitation

[SCB]

Hi Everyone,

Iv'e been working L&D for seven years. Most of the time has been in high risk. A few months ago I took a job part-time in a small hospital. My fear is court. Example, the other day a labor patient G1P0, 42 weeks, not other risk factors, was in labor and the fetus was in distress. Lates, deep variables. Pitocin was running. The midwife called the MD in and we all waited for the c-section to happen.

While we waited I went into the room to see if the patients nurse needed help with anything. My observation - no O2 was on the mother, no IVF bolus was being given, and the mother was on her back, and in much pain. The nurse said she didn't ned anything so I left. In my eyes this situation could have possibily been corrected. Looking back I wish I had stepped in and done something, but I would have not been supported if I had.

Same hospital 2-3 weeks ago. A post c-section was bleeding out in the PACU. The nurse(a different nurse from above)called out for methergine. I went to the room with the drug and drew it up. The patient was in shock and still bleeding. Pitocin IVF bolus was running, no O2 was on the patient. The nurse was running about the room looking for a MD order to give the drug. This nurse forbid me to give it without an order. The patient had no risk factors or contraindications to the methergine. I managed the patient while the other nurse call the MD for help. The patient recovered.

I want to quit this job.

Please tell me your thoughts.

[imenid37]

sounds like a bad situation. i work in a small hospital. no in-house docs. i'd say your license and conscience isn't worth it. imho, if you see something you know is wrong, though, fix it. don't ask. i work w/ mostly good people, but we have a couple of really stubborn people who tend to "forget" things in an emergency (even though they KNOW IT ALL under calm conditions and try to boss everyone else around), i just start "helping" them w/o asking. ie. put the o2 on the pt. open the iv, etc. if you don't and everyithing is not "fine" in terms of the outcome, at the very least, you'll feel really guilty. sounds though, like this job is not worth it.

[HazeK]

How about getting involved in inserviing the L&D staff?

Sounds like they all need the basic AWHON course that "BEATS" O2, iv bolus, repositioning into one's head!

Also, how about developing some standing orders with your medical OB committee for emergency care when MD is not there/reachable? Like, if pt presents w/ decels, OK to start IV & O2 w/o orders....Methergine, if not contraindicated....Lomotil with multiple administrations of Hemabate...AROM & FSE application (if OK in your state) for prolonged decels...etc.

Perhaps purchasing a "DESK COPY" of AWHON PERINATAL GUIDELINES would also be a good investment!

Hate to see you quit when obviously there is a tremendouls opportunity for you to be a 'change agent' and to save lives through education!

Hugs!

Haze

[SCB]

I would love to do just what you have said, but I'm in no position to do all this. I work there part-time, and they don't care for part-time nurses. It's a doctor run hospital and I believe they like to keep the nurses un-educated. The midwife and the doctor knew the patient was not receiving O2, IVF's, or position changes. Yet they did nothing. I feel like I just gotta get out of this place.

Thanks

[canoehead, BSN, RN]

You will be responsible for your own assignment and may be able to set a good example. However if you are not "allowed" to start the O2, IVF, etc it would be wise to just leave.

[mother/babyRN, RN]

Sounds like an awful situation. However small the hospital, the skills of the nurses need to be top notch.....

[SCB]

I have moved on to work in the PACU, at a different organization. I interviewed for jobs until I found the right fit. Documentation was forwarded to the right people who should be concerned, and have the power to change the situation. My view of nursing after this is not a good one, and I plan to work my way toward something different.