Can OB's override hospital protocols?

L&DRN03 · Sep 29, 2008

In my hospital they can to an extent override hospital protocols but they will stand alone if something goes wrong. For ex. our hospital policy says we are not allowed to go above 20mu/min of Pitocin. If the OB wants to go above that they physically have to change it themselves on the pump and your job as the nurse is to well document that this OB is managing the pt's pitocin alone. In your case with the oxygen I would simply let the OB know that he/she can remove it from the patient themselves because it goes against hospital policy. If they do you make sure that it is well documented.

JaneyW · Sep 29, 2008

This isn't so much about hospital protocols as standard of practice. It is your standard of practice as an OB nurse per AWHONN standards to administer oxygen in that situation based on EBP. If the MD wants to remove it or order you to remove it, it is also your responsibility to argue for both your patients (mother and fetus) that this order is inappropriate. Having said that, I understand that this is a situation that makes you feel bad and upset. This doc has put you in a bad place. What do the more experienced nurses have to say about this group? Do they take the oxygen off? Welcome to OB. The best and sometimes the worst place to practice!

chicagrl · Sep 29, 2008

as someone who recently had a baby and is also a nursing student

i say . ewww it is too bad you have to documuent all this crap ...ewww

mom having baby ...let her be ...nursing dx...not trying to be smart

NurseNora, BSN, RN · Sep 29, 2008

Often we do all the steps of intrauterine resuscitation and they work. Once it's worked, you can stop doing the steps. If the baby has improved, lates gone, variability moderate, accelerations, you can remove the oxygen. Once we start the oxygen it often stays on, even once it's no longer needed.

Perhaps he looked at the strip and decided that you had misread the strip and she wasn't having lates, so didn't need the O2.

After one month, you're probably still on orientation, and you did say "we". What did your preceptor say about the situation? Did you follow the doctor out of the room and ask why he/she wanted the O2 removed when it's the hospital protocol to use it in the case of repetative lates?

If you're uncomfortable with this kind of thing, go to your preceptor. If no satisfaction, go to your charge nurse. Look at the Chain of Command that is posted somewhere in your unit and if no one gives you an answer you are comfortable with and you believe your patient really needs the O2, use the Chain of Command. It won't be the last time you use it.

rn/writer, RN · Sep 29, 2008

After one month, you're probably still on orientation, and you did say "we". What did your preceptor say about the situation? Did you follow the doctor out of the room and ask why he/she wanted the O2 removed when it's the hospital protocol to use it in the case of repetative lates?
If you're uncomfortable with this kind of thing, go to your preceptor. If no satisfaction, go to your charge nurse. Look at the Chain of Command that is posted somewhere in your unit and if no one gives you an answer you are comfortable with and you believe your patient really needs the O2, use the Chain of Command. It won't be the last time you use it.

NurseNora brings up some important points. Your best bet at this point is to seek out others--your preceptor(s), charge nurse, unit manager, etc.--for their perspective and advice. Are they aware of certain docs who bend or break the rules more than others? How do they handle such situations? What are some diplomatic ways to express disagreement (out of patient's hearing, of course)?

justme1972 · Sep 29, 2008

sorry...edited.

bagladyrn, RN · Sep 29, 2008

Lines I might have used with the doctor:

"I'm really not comfortable with that". "Could you come out here and look at this strip before I do that?" (This to get them out of the room where we can discuss it) "The hospital protocol and AWHONN standards call for this. If you want to do otherwise will you write me an order for it?" Then hand them the chart. It's unlikely that they will be willing to write this as an order in their handwriting with their signature - liability issues. If this doesn't resolve the issue, I'd then call the charge nurse/supervisor and start up the chain of command. If it is a really vital issue I would have ( and have) stated that I'm unable to follow the order and ask the supervisor to find another nurse who would be comfortable taking over the patient. I've only had to do this last part once (in 20 years in OB), the doctor had a hissy fit, the supervisor backed me, other nurses stated they would not be willing to comply with those orders, and the patient ended up being treated according to hospital standards and protocols. Only do this though if you are ready to deal with the consequences.

cassioo, RN · Sep 29, 2008

As somebody said if the lates resolved take it off if not and he told you to I wouldn't tell him to write the order I'd just say ok I'm going to write that as an order and write it if he doesn't say never mind and chart Dr Jones here, strip reviewed order for O2 to be removed received.

Our docs really don't care too much what we do. We do have one that is still newer that says up the pit up the pit just have to tell him nope been doing it longer then you.

bagladyrn, RN · Sep 29, 2008

As somebody said if the lates resolved take it off if not and he told you to I wouldn't tell him to write the order I'd just say ok I'm going to write that as an order and write it if he doesn't say never mind and chart Dr Jones here, strip reviewed order for O2 to be removed received.
Our docs really don't care too much what we do. We do have one that is still newer that says up the pit up the pit just have to tell him nope been doing it longer then you.

Cassioo - there is a reason I said to tell the doc to write the order him/herself. If you write it as a verbal order there is nothing to prevent the doctor from later claiming that "I never gave that order". If it comes to legal matters that is very likely. If you ask them to write it themself, it can make them rethink whether or not this is the wisest course of action.

cassioo, RN · Sep 29, 2008

Cassioo - there is a reason I said to tell the doc to write the order him/herself. If you write it as a verbal order there is nothing to prevent the doctor from later claiming that "I never gave that order". If it comes to legal matters that is very likely. If you ask them to write it themself, it can make them rethink whether or not this is the wisest course of action.

We're lucky to get ours to write anything at all because they are busy and we aren't as busy as they are we play lots of babysit the doctors that's why our really do let us do about anything but as long as you've documented all along what was going on that shouldn't be a problem....and if a doctor said to take off the O2 because it made them look funny I'd also be explaining to the patient why they should leave it on. Everything you say and do some doctor or patient can always say they didn't tell me that so the documentation along the way matters.

zahryia, LPN · Sep 29, 2008

I agree with the ladies. Go up chain of command and/or have doc write an order.

On another note, I thought I read somewhere that O2 is the least effective of the intrauterine resusitations. Have anyone else read or heard this?