Pt refused to leave!

Specialties Ob/Gyn

Published

Specializes in LTC, Home Health, L&D, Nsy, PP.

I tried posting this earlier, but it got eaten somehow, so I'm trying again. Excuse me if the other post shows up from cyberspace, lol.

At any rate ... I am laughing now about the whole thing, but it wasn't so funny when the whole thing was taking place last night!

At 0300 this morning, I had a 14 yo present to L&D c/o pain rated 9/10 in her lower abd. She was laughing with her best friend and mother and demanding that I get her a tray because the was hungry. I told her that I couldn't feed her until I knew what was going on with her and she became very upset with me ... almost throwing a tantrum. I proceeded to place her on the monitor and start my assessment. 1cm, very thick, very posterior. She had some mild contractions that were irregular - 20 minutes apart at one point. Her UA came back clear. Since she was 39+ weeks. I waited an hour, checked her again - no change. So I called the MD. He gave orders for a hydrocodone and to send her home with labor precautions.

When I went into her room to D/C her, her mother blew up like a rocket! WHAT! WITH HER CONTRACTING AND HURTING LIKE THIS! (The pt was asleep when I came into the room.) The mother then proceeded to ask why in the H--- the Dr hadn't even bothered to check on her. HER Dr came in to check on HER when SHE was in labor!

I told the mother that, had her daughter BEEN in labor, which she wasn't, the Dr WOULD have been there at some point to check in on her.

Then the mother informed me that she wasn't comfortable at ALL with some NURSE assessing her child and judging whether or not to send her home and that she was NOT leaving until they saw he DR! (The mother was also a nurse - or so she said.)

I called the MD back and he told me to just leave her there until he made rounds this AM, but to tell her that this didn't mean that he would be keeping her.

Like I said, I am laughing now, but I was so angry last night that I had to call the PP nurse to sit at my station while I went outside to cool off! :angryfire

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Too bad "mom" wasn't so attentive BEFORE her teenager got pregnant!

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Specializes in ICU, ED, Transport, Home Care, Mgmnt.

Since Mom thought she was in labor maybe you should have had them walk to stimulate contractions, all night.:idea: :rotfl:

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Specializes in Emergency Room.

i try as much as possible to look at things from the patient's point of view. when people go to the hospital they ultimately expect for a physician to give the last call. i would too. everyone does not understand what nurses do and the level of our knowledge. sorry, but i kind of agree with the patient. a doctor should be there to confirm diagnoses/prognosis. i also think that because the patient was young it also makes the situation appear less threatening than if it had been a nice married couple or a mature woman. scenarios like this makes it very easy to understand why patient education is so important.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

Where's this pt.s other parent. :stone

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Specializes in Pediatrics Only.
Too bad "mom" wasn't so attentive BEFORE her teenager got pregnant!

I completely agree.

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Specializes in Psychiatry.
Too bad "mom" wasn't so attentive BEFORE her teenager got pregnant!

:yeahthat:

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This is completely within the nurse's role. She did her assessment and got a doctor's order based on that. Doctors don't need to come in and reassess a patient every time a nurse assesses them or nurses would be completely useless.

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Specializes in LTC, Home Health, L&D, Nsy, PP.
i try as much as possible to look at things from the patient's point of view. when people go to the hospital they ultimately expect for a physician to give the last call. i would too. everyone does not understand what nurses do and the level of our knowledge. sorry, but i kind of agree with the patient. a doctor should be there to confirm diagnoses/prognosis. i also think that because the patient was young it also makes the situation appear less threatening than if it had been a nice married couple or a mature woman. scenarios like this makes it very easy to understand why patient education is so important.

I do see your point of view, but believe me, the first hour this patient was there was spent trying to educate her - but her mother kept reminding me that SHE was also a nurse. Nevertheless, I educated the patient as to what was going on with her body, the labor process, what to expect, even to the extent of telling her that occasional contractions do not mean that she is on labor. I even pulled her strip to assure them that the baby was looking great and explained to them what everything on the strip meant.

L&D is one of the only areas that nurses ARE allowed to triage patients and be the eyes and ears for the MD, then to take orders from the Dr without them ever seeing the pt. We have protocols in place which allow us to do exactly this. I work in a small hospital in which there are primarily three Dr's who deliver. It would be physically impossible for them to be there everytime a pt presents. More than that, it would be dangerous to them, us and most importantly the patients to keep the kind of hours that would allow them to do this. Of course there is always an ER Dr in house, but even they call us down to the ER when an OB patient presents with non-pregnancy related problem just to check on the mother and baby's status.

Angel, what is sad though is the fact that our hospital offers classes on infant CPR, breastfeeding, epidurals and the labor process and newborn care, but only a fraction of these mothers will agree to attend the classes.

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Specializes in Pediatrics.

14 years old? Oh man! I was still playing with Barbies. This young girl is probably tired of being pregnant, but she is probably really scared too. You handled the situation nicely, though. Do you know if the MD ultimately admitted her and induced labor?

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Specializes in LTC, Home Health, L&D, Nsy, PP.

I called back to check just now and he did induce her. Thank GOODNESS it's over! :balloons:

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Specializes in OB.

I allways wonder how these pt's will handle being parents. We have had several of these "I refuse to leave" pt's lately and for the most part the dr's are firm in treating the pain, letting them rest and then if no change and as long as baby looks fine they go home. I had one last week that was only 35 weeks and insisting that we induce her. Well needless to say no doc was going to induce a 35 weeker for no reason, so we gave her lots of pain meds and let her sleep through the night then sent her home. She and her boyfriend were irrate with the MD, and I think left with the intention of finding another MD.

We even had one pt induced for insomnia.....having a newborn baby should help the insomnia!:lol2: Pepole just don't get it!!!!

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