What is your opinion?

  1. In the afternoon that patient had significant fetal distress with fetal heart tones down in the 50's for a significant length of time (approximately 7-8 minutes). I feel that I cared for the patient and her fetus in an appropriate manner as stated in the OB policy and procedure manual. All steps were taken to insure a safe delivery. IV was at a bolus rate, O on per NRB mask, patient was in lithotomy position (which actually helps the patient not to push with the contractions and decreases the pressure on the fetal head), Pitocin was turned off, and betadine prepped for delivery which is basic routine -please refer to policy. Dr. XYZ had been called for delivery, which in turn took his 15-20 minutes to respond. No other doctor around. The fetus was crowning.
    My nurse manager walked in and I ask her if I should deliver the baby due to the decreased heart rate. She is an advanced pratice nurse. She turned and walked out of the room stating that the physician should be her in a little while and that I should turn her on her side. (2+ station remind you) On Monday I was fired by the same nurse manager who walked out on me and the patient the previous Friday. Her reasoning was falsifying documentation because I did not state I started pushing with the patient when the patient was complete. That is something I have never done, we document by exception and I document the betadine prep, lithotomy position and I assumed the pushing was a given, since it is labor and delivery. She also stated I was practicing outside my scope of practice since I ask if I should deliver the baby.
    I would like anyone who works labor and delivery to give me your opinion of my situation. I am still in shock. I was doing what was in the best interest of my patients.:innerconf :angryfire
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  2. 4 Comments

  3. by   babyktchr
    Ok. First, I really don't understand why you were fired? Maybe I am missing something. Did you start pushing with the patient, or was the decel occurring without pushing?

    I don't really see where you are acting outside your scope of practice. If a baby is crowning and there is significant reasons for the baby to be born (decels not compatible with a happy baby at birth), what can you do? It is very difficult to hold back a baby if mom is pushing and it is crowning. Everyone in L&D should be trained to deliver a baby, and we were taught by our chief of OB that we should never ask a woman to hold off pushing if delivery is that close. Just the other day I had to make the same call, as a baby was having terminal bradycardia...(60-70) mom tried her hardest not to push (and she wasn't) but the uterine contractions forced the baby onto perineum. We waited for MD, but with HR and position, I let the patient deliver. It was uncomplicated and the MD didn't arrive for another 10 mins. I talked to him about the delivery and he said he would've wanted me to do deliver, since the baby was having issues and there was really nothing you could do about keeping the baby from delivering.

    At best, you didn't falsfiy documentation, you ommitted documenting that you were pushing with patient (if that is what happened). As far as out of scope of practice...asking for advice is NOT going outside of scope of practice. As your manager, and an advanced practice nurse (in what I wonder), she should'n't have left you ALONE in this situation. If I were you, I would definitely fight this one. There really doesn't seem to be any justification here at all.

    Was there a bad outcome with this baby? I ask only that if there were, I wonder if they are looking to cover someone's butt, and hang someone else's out.
  4. by   nursejohio
    I only see a couple things I would have done differently. I would have turned mom side to side, or even to knee chest to try to get heart tones up, maybe with some scalp stim thrown in for good measure. If the heartbeat didn't come back up, I would have hit the staff assist button, delivered the baby and filled out the incident report for doc missing it. I will not prolong fetal distress because some doc feels like taking his good sweet time responding.

    I would definately ask a lawyer for advice, sooner rather than later, on the firing.
  5. by   L&D-RN-Mom of 4
    Quote from babyktchr
    Ok. First, I really don't understand why you were fired? Maybe I am missing something. Did you start pushing with the patient, or was the decel occurring without pushing?

    I don't really see where you are acting outside your scope of practice. If a baby is crowning and there is significant reasons for the baby to be born (decels not compatible with a happy baby at birth), what can you do? It is very difficult to hold back a baby if mom is pushing and it is crowning. Everyone in L&D should be trained to deliver a baby, and we were taught by our chief of OB that we should never ask a woman to hold off pushing if delivery is that close. Just the other day I had to make the same call, as a baby was having terminal bradycardia...(60-70) mom tried her hardest not to push (and she wasn't) but the uterine contractions forced the baby onto perineum. We waited for MD, but with HR and position, I let the patient deliver. It was uncomplicated and the MD didn't arrive for another 10 mins. I talked to him about the delivery and he said he would've wanted me to do deliver, since the baby was having issues and there was really nothing you could do about keeping the baby from delivering.

    At best, you didn't falsfiy documentation, you ommitted documenting that you were pushing with patient (if that is what happened). As far as out of scope of practice...asking for advice is NOT going outside of scope of practice. As your manager, and an advanced practice nurse (in what I wonder), she should'n't have left you ALONE in this situation. If I were you, I would definitely fight this one. There really doesn't seem to be any justification here at all.

    Was there a bad outcome with this baby? I ask only that if there were, I wonder if they are looking to cover someone's butt, and hang someone else's out.
    To tell you the truth, I don't know why I was fired either. I have been doing this for a long time and I did nothing that I had not done in the past. I had been pushing with the patient prior to the decel but not once it started. Babies first apgar was 4 at one minute and 8 at 5 minutes. I did wait for the physician because I told to do so and it cost me my job. I would have turned her to her side but the baby only weighed 4# 10oz. She would have delivered. I have went through the grievance process at the hospital and no one knows anything about labor and delivery. Bad for my case. I have went in numerous times and talked with HR to no avail. I am so upset. I just want my job back.
  6. by   SmilingBluEyes
    I would contact a nurse-lawyer or my union rep (or both if you have them) about this. It's hardly likely anyone here can truly give you the advice you need to proceed, other than to seek legal counsel. I am so sorry this happened to you; you sound like a conscientious person who is dedicated to what you do. I hope you seek and gain redress as needed. Good luck to you!

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