I am a month into L&D and have seen some scary things...such as OB's going against hospital protocols...my question is what is my responsibility as the nurse in cases such as these....?
Example: my patient is having repeated late decels...we flip her over to her side, increase IV fluids and administer oxygen per protocol. The OB comes in and says "take off the oxygen...makes her look sick"....ummmmm I know I am new but giving oxygen to a mom experience late decels is the norm...plus is scientifically proven to help by increasing O2 levels to the fetus. Apparently this group of OB's do not like to use oxygen.....for some reason their egos do not correlate to practice...this obviously bothers me...and I just want to know...what are my responsibilites to the OB, patient and hospital policy? I want the best care for my patient as well as to protect my license....Does this make sense??????
I would explain my rationale for putting O2 on the patient, and hold the strip in front of MDs face and force him to acknowledge the late decels. If he still wanted me to remove the O2 I would say "I will be charting in the patient's medical record that MD stated to remove O2 and is aware of late decels." Generally they don't like it when they know you will putting your concerns in the medical record. Then I would climb the chain of command if needed. And honestly, when the MD left the room I would be putting O2 back on. Maybe he thinks she "looks sick" with it on, but if there is any chance at all that it will help the baby, why not have it on. I also like the idea of making him write a written order to remove the O2, and explaining he needs to do this because he's going against hospital and ACOG guidelines and the standard of care which is what he is held to.
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
Hi Nora - I am responding to you post questions...She did know the patient was having lates...the baby's Heartrate dropped to 90's and she called a stat c/s and to take off O2....my preceptor told me that she documents everything the OB says and that that group is known for that kind of practice... Thing is..that group's head is the chairman of that dept...so go figure...I want to protect my license and even more importantly take care of a potentially hypoxic fetus...I mean it doesn't hurt and can only HELP...it is crazy....
cassioo, RN
92 Posts
yes it only works for a very short time.