Dangerous Unit?

Dixielee, BSN, RN · May 7, 2007

I have never worked L&D, but I have been a nurse for a long time. It sounds like you are in a disaster waiting to happen place. I would write letters to everyone who will listen, including all the docs who DO come in. I would write up each and every situation as it happens, including all phone calls and to whom.

Your immediate supervisor of the unit as well as house supervisor needs to be notified in person and in writing. The medical director needs to be notified in writing.

All of this will probably lead to your being fired, so be prepared for another job, but you will be doing the right thing as a patient advocate.

In any case, I would not plan to stick around a place who placed so little value in safe patient care and their nurses.

You are NOT in a good position. CYA the best you can.

avery · May 7, 2007

I am sorry you are in an unsafe situation and I think that based on the questions that you posed in your post, you know what you need to do.

Best of luck to you,

Avery

imenid37 · May 7, 2007

These are all OB docs? Usually they are really liability crazy. I work in approx. same sized unit. They often fuss and moan when called at night, but come promptly when called. Wow. 2 abruptions in 2 weeks waiting on doc? That is crazy. Why didn't midwife collaborate w/ doc immediately on a 31 weeker? She should manage healthy patients not a 31 weeker. How far away are you from your tetiary facility? Our docs don't sit on people who are preemie. We are having transport of the mom ASAP or are getting NICU to pick up babe or even be present for delivery, in some cases. I agree, it is a very bad situation!

Jolie, BSN · May 7, 2007

Wow! There are just too many problems to discuss in one post.

I have 2 suggestions: Go to Risk Management immediately, and give them objective, clearly documented evidence of inappropriate responses by your medical providers (MDs and CNMs) that have led to undesirable outcomes. Ask for their assistance in developing policies and procedures regarding contacting medical providers, parameters for them to respond, and the chain of command that staff nurses should follow if an attending fails to respond and report to the unit in a timely manner.

Go to your department/hospital's morbidity and mortality committee and do the same. This committee is comprised of docs who review the care of their peers. They are often able to put pressure on their colleagues that nursing and administration are unable or unwilling to do.

If these measures do not lead to prompt improvement in your unit, please dust off your resume and look for a safer place to work. You are of no use to any patient if you lack a license.

kmoonshine, RN · May 7, 2007

I'm not in L&D; never have been. But, here's some suggestions:

As far as the mother/baby nurses who refuse to work L&D: check their job description to see if it is part of their responsibilities. I think it's unfair to expect a nurse who isn't in L&D to function 100% on their own, but they can help with the basic nursing care all of us are trained to do. Perhaps you need to hire another L&D nurse?

For the MD's: document, document, document! When you call them with a pt's status and you know that the MD needs to come in but you hear "I'll come in after I take a shower", you need to say "No, you need to come in right now"; if that doesn't work, say "You need to come in right now, and you can shower after this baby is delivered...in the meantime, I'll be filling out an incident report". Don'tjust threaten to write them up; actually do it. This has to be done. You need to document the conversation and MD's response, along the pt's status. Work your way up the chain of command.

Do the same with the midwife; if you hear "I don't want to get out of bed", you need to say "well, you will get out of bed, and you'll come here to do your job"; if they take their time calling the MD's, say "this MD needs to be called now; if you can't do it, then I will". You're not being a brat, you're doing the right thing. It's hard, but I'd rather have a couple pissy coworkers than a dead mom and baby.

You need to seriously think about whether or not this job is worth the risk. Your unit manager should have taken care of this long ago. Perhaps they're doing their best and the problem is higher up; but regardless, this is a problem. If things don't change fast, find another job - you have a license with the state, not the hospital.

I know of someone who had a similar experience. They were an experienced L&D nurse, knew that a delivery was going to have a bad outcome if the MD didn't come in ASAP. When called, the MD said "I'll be there in an hour"; nurse said "no, you need to come in right now". The MD hung up, so the nurse called back; "You need to come in right now"; MD hung up again. So, the nurse called back again and said "you need to come in right now; in the meantime, I'm writting an incident report and I am calling both my supervisor and yours". MD came in 20 minutes later; the baby was delivered and had to be recusitated. Fortunately, both mom and baby survived; if this nurse wouldn't have spoken up, the outcome would have been much different.

Good luck, keep us updated.

lindarn · May 8, 2007

I'm not in L&D; never have been. But, here's some suggestions:
As far as the mother/baby nurses who refuse to work L&D: check their job description to see if it is part of their responsibilities. I think it's unfair to expect a nurse who isn't in L&D to function 100% on their own, but they can help with the basic nursing care all of us are trained to do. Perhaps you need to hire another L&D nurse?
For the MD's: document, document, document! When you call them with a pt's status and you know that the MD needs to come in but you hear "I'll come in after I take a shower", you need to say "No, you need to come in right now"; if that doesn't work, say "You need to come in right now, and you can shower after this baby is delivered...in the meantime, I'll be filling out an incident report". Don'tjust threaten to write them up; actually do it. This has to be done. You need to document the conversation and MD's response, along the pt's status. Work your way up the chain of command.
Do the same with the midwife; if you hear "I don't want to get out of bed", you need to say "well, you will get out of bed, and you'll come here to do your job"; if they take their time calling the MD's, say "this MD needs to be called now; if you can't do it, then I will". You're not being a brat, you're doing the right thing. It's hard, but I'd rather have a couple pissy coworkers than a dead mom and baby.
You need to seriously think about whether or not this job is worth the risk. Your unit manager should have taken care of this long ago. Perhaps they're doing their best and the problem is higher up; but regardless, this is a problem. If things don't change fast, find another job - you have a license with the state, not the hospital.
I know of someone who had a similar experience. They were an experienced L&D nurse, knew that a delivery was going to have a bad outcome if the MD didn't come in ASAP. When called, the MD said "I'll be there in an hour"; nurse said "no, you need to come in right now". The MD hung up, so the nurse called back; "You need to come in right now"; MD hung up again. So, the nurse called back again and said "you need to come in right now; in the meantime, I'm writting an incident report and I am calling both my supervisor and yours". MD came in 20 minutes later; the baby was delivered and had to be recusitated. Fortunately, both mom and baby survived; if this nurse wouldn't have spoken up, the outcome would have been much different.
Good luck, keep us updated.

I am a Legal Nurse Consultant. The two nursing negliegence cases that I have testified in for a deposition, both involved siltuations where a patient needed to be seen by a physician, and the nurses did not call, or insist, that the physician come in to see the patient now!

The first one, the nurse did not go in and assess the patient, and see if something was wrong, (I am sorry, but I don't want to go into any more specifics about the case). She did not call the doctor to see the patient because she had not assessed if something was wrong that the doctor needed to know. The second case, the nurses called the doctor, but this was a "problem physician", and was verbally abusive and bullying to the nurses, and did not want to come in the see the patient. She never wanted to come in after hours to see patients. The patient was harmed because she did not come in and see the patient, and get him the sugical care that he needed. The nurses all lost because they did not obtain care that they knew that the patient needed. They needed to go up the chain of command and obtain care for the patient. That is what the nurse practice act says. Reluctance to call a physician because you are not assertive, and don't like conflict, is not a defense against negligence. Period.

As I told the doctor's, and hospital's defense attorney, the physician gets paid big bucks to be a physician, and does not hesitate to collect insurance payments for treatments. They are not doing this out of the goodness and kindness of their heart. It is what they are being paid to do. Do not fall for the line, that you are "bothering them", when they need to see a patient. And document this as well:

Doctor So and So called to SEE PATIENT REGARDING XYZ symptoms, or v/s. Doctor So and So refused to come in to see the patient when requested. He/She stated, "blah blah". Doctor So and So informed that Nursing Supervisor and Dr. Medical Director will be called regarding the following situation, and an incident report will be sent to the hospital risk manager, and the Dewey & Cheatum Law Firm, who represents the hospital, will also be sent a copy. Therefore, Dr So and So, you can explain to Mr. Senior Partner of the hospital's law firm, why you are refusing to come in and see patients that the professional nursing staff has determined needed to be seen ASAP to PREVENT COMPLICATIONS THAT WILL LEAD THE HOSPITAL OPEN TO A LAW SUIT. Make sure that you make copies of all documents for yourself, including the Incident Report.

Lindarn, RN, BSN, CCRN

Spokane, Washington

smartynurse · May 8, 2007

I have never worked L&D, but I have been a nurse for a long time. It sounds like you are in a disaster waiting to happen place. I would write letters to everyone who will listen, including all the docs who DO come in. I would write up each and every situation as it happens, including all phone calls and to whom.
Your immediate supervisor of the unit as well as house supervisor needs to be notified in person and in writing. The medical director needs to be notified in writing.
All of this will probably lead to your being fired, so be prepared for another job, but you will be doing the right thing as a patient advocate.
In any case, I would not plan to stick around a place who placed so little value in safe patient care and their nurses.I agree, you need to: write incident reports, go up the chain of command, and document the heck out of this situation, keep copies of the incident reports,if you are able, document date/time/incident. If you go all the way up to the very top and still no response, you might even call JCAHO. Try and write down all the details of the last two weeks, patient initials, incidents, etc. You should also call risk management. You might need to contact a lawyer if this gets sticky. You have an ethical responsibility to react to this- babies and mothers could die!!!!!!!!!!!!!!!!!!!! good luck

bagladyrn, RN · May 8, 2007

My way of handling these kind of doctors is to inform them "Then I am charting that you have been informed of "whatever I have called them for" and informed that I need you in here now at (whatever time). Am I to chart that you state you will be in in one hour?" This generally results in a p.o.'d doctor showing up immediately. Also immediately inform your supervisor of the situation, request for the physician and their reply. If you do need to go up the chain of command, be sure to chart who was informed and what action they took (i.e. - if supervisor called physician back, or his higher up, etc.)

You will also want to follow up internally with incident reports, noting which physicians, time called and response time, and outcome for risk management. If you ever have a physician state they were not called, phone record of outgoing calls can be reviewed.

ShannonSRN · May 8, 2007

Thank you so much...to all of you.

I have written incident reports in every situation. Charted my rear off. it basically boils down to a group of physicians who plain don't care, unfortunately.

I spoke in length with my manager this morning after reading everyone's posts. (She has been here for all of 8 weeks) She is well aware of the problem, and we are working together now to fix it as best we can (or at least bring it to the attention of the hospital). I will be meeting with our President and Vice President of Nursing this week to go over all of my documentation as well as the incident reports re: RN deliveries, MD no shows, etc.

As for the MD's, I honestly am not expecting a great deal of change unless we deal with those above them. It would be great if we could go to the Director of the OB Department, unfortunately it is one of the MD's in question. So we are working on a strategy on how to proceed, and go above them.

I have requested a transfer to our sister hospital. I do not want to be responsible for a parents heartbreak...I absolutely refuse! I have a contract with this hospital for 1 more year, but I am not seeing this as a hurdle at this point. I believe they would let me walk out without question under the circumstances.

To LINDARN,

Thank you so much!! Getting the legal perspective of all this was a tremendous help. Fortunately I am very assertive, but the doctors do not respond, so legally, if it came down to deposition, I did what I had to do. In these cases, it boils down to negligence on their side. And now I know, after reading you post, that I will continue to be assertive. I just might have to be assertive elsewhere.

Anyone know of a hospital in need of an L&D nurse

tinyscrafts · May 9, 2007

wow.

can anyone say whistleblower TV?

magz53 · May 9, 2007

In NY, a delivery is considered "unattended" if the physician or midwife is not present and the event is state reportable. I would think the hospital could be sited for these incidences as they are less than the standard of care.

I would add to everyone elses' emphasis of document, document and document some more. But you can't stop there, you have to continue to try to get someone in there who actually has the license to deliver babies..........go right up the chain to and through the head of OB, right to the CEO if needed.