Can someone offer an ante nurse some insight?

[KellNY, RN]

I work at a level IV large teaching hospital. I work on the antepartum unit, and we get anything from gestational diabetics at 30wks, to hyperemesis at 8wks.

We also unfortunately get a lot of incompetant cervixes, PPROMs and run of the mill preterm labors at 25 weeks and earlier. Each pt over 21 weeks gets a NICU consult--basically a NICU resident comes in and gives a rushed "What if your baby is born now. What about next week" speech, then an RN from NICU comes in and answers other questions.

There is one RN who comes up frequently, and she gets on my nerves. She always complains about being there-meanwhile they are paid extra (and volunteer) to do this. That's not my issue.

My issue with her is she implants false hopes, IMO. I completely understand the importance of maintaining a positive outlook on life, but...not to the point of misleading patients who may very well not survive, or suvive with multiple problems...let me give you an example of what she's told Pts in the past

~21.3 weeks who PPROMed at 20wks--severe oligo (has no pockets of fluid). Was told that if she makes it to 22 or 23 weeks, her baby will live, get help breathing and then go home.

~24weeker with inc. cervix. Told by this RN that the average NICU stay for a 25weeker is one month. Not true.

~23.3wks Twin gestation with IUGR of baby B. Told that since she passed the 22 week mark, and this is a "great hospital" she's "pretty much out of the clear for the babies".

And this is an experienced nurse, not a hopeful new grad. I just can't understand why she's telling our patients this. Now, I've never heard it from her mouth, BUT, my patients only mention this crud after she's vistied them. I work nights, so I rarely see her, but when I ask my Pt's "How'd the NICU consult go?" and they smile and gush about how the nurse explained that the baby's going to be fine, I can see it's her who signed the consult papers.

Not that other NICU nurses are all doom and gloom, but they paint a more realistic picture, according to my patients, who tell me things like "Well, she said that the baby will most likely have trouble breathing and may need to be on one of those breathing machines for a while, and he probably won't be able to eat for a few weeks, he might need a tube to feed him in his nose. And if he makes it, he'll be in here probably 2-4 months" Or "Well, she has a good chance of surviving delivery, but will probably need 2 or 3 risky surgeries before she turns one. We have a long road ahead, but she's a fighter" or something like that.

Thanks....

[BittyBabyGrower, MSN, RN]

Where I work only the fellows go and speak to the moms...this is an offical consult that has documentation. They also get permits signed for various things at that time if the parents want everything done. You need to go to the unit managers and say that any conversations need to be documented, which I would think for legality reasons, should be. One our consult sheets what is said to the parents and what the parents verbalize is right there. Usually the antepartum nurse stays in the room also.

I wish I had better advice than to go to your unit manager and go up the chain from there, but I don't really think that there is much you can do until you do that.

[llg, PhD, RN]

I don't think it is appropriate for a staff nurse to be giving this type of information (accurate or not) to the expectant moms. That's the phyisician's job. The nursing visit should focus on the environment of the NICU, the visiting policies, programs for parents, etc. Giving a medical prognosis is simply not within the staff nurse's role. Period.

I would take the issue up the chain of command ... and use this particular nurse's inaccurate portrayal of the facts as an illustration as to why your hospital should take a look at the whole situation.

llg -- (16 NICU experience. 14 in CNS/staff development roles. Several different hospitals.)

[RainDreamer, BSN, RN]

I agree with the 2 previous posts in that an RN should not be consulting with these patients. Only our neos speak with the mothers, an RN doesn't go with them or anything. Thankfully most or our neos are straightforward and tell the facts ..... if your baby is this gestation, this is the chance of survival, and if they survive this is the chance of long term complications, etc. Everything needs to be documented.

[cocco]

I agree with the other posts. Only our neos go to consult and get consent and then they document a full page of their consult for the chart. It is not the rn's place to consult it is our place to educate about the environment and like pp said the visiting policies.

[KellNY, RN]

Let me clarify a little, I think I wasn't clear:

The NICU attendings do make the consult. (I mistakenly said resident in my OP). Everything is well documented on a triplicate carbon copy forms and kept in the chart. Consents are signed if applicable.

The staff RN (who is present when the attending talks tothe pt) is supposed to talk about the visiting hours, equipment they might see/hear/etc, that they can get help for medicaid/disability/etc. They're also supposed to kind of fill in the blanks-you know how doctors (esp attendings) sometimes can talk to Pts...they might say "Assistive breathing devices, CPAP, ng-tube insertion blah blah blah" and the staff RN is there also for if the Pt asks "What did he mean by 'ng-tube'"? and the RN can explain what one is, and some different reasons it is inserted, etc. For the most part, from what I can tell, the other RNs do a great job at explainig the services, explaining what to expect (as far as translucent skin, lanugo, etc), and all that.

But this one RN is where the problem is. It's like she counters what the NICU doc said--she must be, because I can't see them telling the pt nonsense like that! And her documentation looks just like the other RN's (basically "Educated this 25y/o Pt. and spouse Re: social support available, NICU policies Re: visiting and EBM storage. Emotional support offered. Pt verbalized understanding")

[prmenrs, RN]

Stay w/the mother when the nurse is in there, and if she's saying what seems to be inappropriate, document it to your nurse manager.