Appropriate patient discussion

[amtisdale]

So I'm just asking for an opinion. I work in a small hospital on a women's unit (ob/gyn/postpartum and level 1 newborn nursery) . We average about 30 deliveries a month. We usually have 1-2 Labor nurses and 1 newborn nursery nurse on the floor per shift. No secretary and no tech. Here lately they have been sending us medical patient's. The problem is some of us do not have medsurg experience. They are sending us male pts, we have started heparin drips, we had a positive troponin the other night that had to be transferred out due to o2 sats going into the 70s. Plus we have to take care of anyone coming in in labor. They tell us we can't refuse to take care of the medical pts and this is the new normal. I just feel it is very unsafe saying we are not trained with medical pts and also we only have 3 staff members on the floor. Most of us went into this specialty because we didn't want to do medsurg. Then they send us these complicated with all different comorbidities etc. Just wondering others opinions or if you work somewhere similar

[Sour Lemon]

In med surg, we occasionally get post partum patients or even children. The children can be scary, but they're usually admitted for emergency surgeries with no time to transfer somewhere with a children's ward.

Male med surg patients in labor and delivery sounds a bit odd. People are sometimes required to cross train and float, though.

[Munch]

In med surg, we occasionally get post partum patients or even children. The children can be scary, but they're usually admitted for emergency surgeries with no time to transfer somewhere with a children's ward.

Male med surg patients in labor and delivery sounds a bit odd. People are sometimes required to cross train and float, though.

Yeah I was thinking the same thing about the male patients in labor and delivery...sounds strange. I work on a Neuro floor and get med-surg overflow all the time. Actually we usually have more med-surg patients than Neuro patients on my floor. Luckily we have a huge labor and delivery floor(actually ob/gyn has their own separate building for patients in labor as well as patients that aren't pregnant but have gyn issues).

It actually doesn't sound safe OP to have only a few staff members needing to tend to not just the labor and delivery patients but the med-surg overflow. If that is going to be the norm they should hire someone else to care for those patients.

[KelRN215, BSN, RN]

I imagine that this is a small hospital? I can't imagine anything like this happening at any of the adult hospitals I ever did clinical at in school (I've only worked pedi my entire career) because said hospitals have multiple floors in the realm of maternity (antepartum, L&D and postpartum) and nurses would only float between those units, patients would only be overflow from one of the other units. Said hospitals also have MANY other medical or surgical specialty units that overflow med/surg patients could be placed.

This is not appropriate but if you don't have a union and you're a small hospital/the powers that be have decided that since your unit isn't full, you need to take overflow patients, I don't know what the next step would be. You could always speak with your feet and find a job at a hospital where this doesn't happen, though.

[smf0903]

I can't imagine this in a post-partum/nursery area. What the heck do they do about security?? I'm at a small community hospital and you have to just about have to hand over a DNA sample along with FBI clearance to even get into the ward.

[amtisdale]

We are a locked unit. Visitors have to leave their ids at the desk and we give them a room pass

[Crush]

Although you may not be able to stop the powers that be from doing this, especially if at a smaller hospital you can contact the education person(s). Ask for at the very least to be checked off on new equipment you may need, etc. You can also ask to be cross trained and do bring up any security concerns with your manager.

[TriciaJ, RN]

Although you may not be able to stop the powers that be from doing this, especially if at a smaller hospital you can contact the education person(s). Ask for at the very least to be checked off on new equipment you may need, etc. You can also ask to be cross trained and do bring up any security concerns with your manager.

I agree with this. Complaining will just get you blown off. Make a comprehensive list of every new skill and piece of equipment you are now using. Request a thorough orientation to everything that's been previously outside your usual scope of duties. Until this happens, every time you are forced to accept a med-surg patient, fill out a form stating you are accepting the assignment under protest because you have not yet received the requested training. (You can design the form and make copies.) Keep a copy of the completed form for your own records.

Every time there is a staff meeting, someone should ask about when the trainings are scheduled. If you all become a complete PIA for management, hopefully they will abandon this practice or at least provide you with some orientation.

Good luck.

[Nurse Beth, MSN]

i agree with the previous posters.

Ask your manager what kind of training will be provided so that your skills match the patient's needs.

You are uncomfortable operating equipment and devices without training and wonder if this is placing the facility in a vulnerable position.

[Wuzzie]

I would imagine all of you are smart enough to be able to take care of med-surg patients with some orientation although it's always scary to be forced out of yor comfort zone. However, if I was a laboring or recovering mom I would not be happy to have male patients on the floor. Yes, I know there are male visitors but for some reason the idea of male patients on an LDRP floor just seems really intrusive to me.

[Katillac, RN]

Your manager may want to talk with your loss prevention/ risk management people. Every hospital, even small ones, should have somebody managing the liability exposure of the organization. If something goes very wrong and you have not had proper orientation and training to take care of the population you're working with - ESPECIALLY if there are discoverable records of your having asked for it - the hospital is setting themselves up for astronomical damages. As a former legal nurse consultant, I think very possibly a med/surg float or a per diem called in would be seen as an actuarial advantage over the liability exposure.

Also, and I hate to say this because it's of course true in a right to work state you could be fired for refusing to take even an unsafe assignment, taking report on a patient you aren't qualified to take care of puts you at financial risk as well if something goes bad. Make sure your malpractice insurance is in effect, a million dollars in coverage costs only a few hundred a year.

[chacha82, ADN, BSN]

You're right, doesn't sound safe at all. But I feel like working inpatient anywhere = potential for "not our service" patients.