Order for EFM (!)

  1. At the last OB committee our hospital held the head of the department proposed requiring an order before nurses could place a pregnant mom on the fetal monitor. Currently we use auscultation for low risk moms and EFM for high risk, or at nursing discretion.

    Nursing does not want to lose their autonomy in this area, and by times this is the only way they have to assur themselves of the baby's well being when docs are doing office hours, in bed, or just are blowing us off.

    I would appreciate any information or opinions you can give us to strengthen our case at the next meeting.
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    About canoehead, BSN

    Joined: Oct '00; Posts: 8,712; Likes: 8,354


  3. by   JennieBSN
    How is that LEGAL??? I'm sorry, but it smacks of something shady to me. There's no way in hell our docs would get away with that. I just don't think they can LEGALLY restrict a nurse from doing something like monitoring. That's like saying you can't take someone's blood pressure. I'd come at them from the standpoint of fetal distress...you don't need an order to stop pit, put on O2, give an IV bolus, etc., when you see a pathologic FHR tracing. If they want to be such arrognant A**HOLES as to presume the nurses have to be 'told' when they can and can't use the fetal monitor, then they need to be prepared to have their butts at the bedside with every patient 24/7 so they can write their precious orders for what is routine nursing care. Tell them fine, no EFM without an order, but from that point on, the MD MUST be present and at the bedside to make basic clinical judgements that you (the nurses) are so incapable of doing.

    What a bunch of crap. I'd be out of that unit so fast you'd see smoke coming from my heels. Our nurses just flat out would tell that doc to go blow him/herself. There's no way such a policy would be tolerated. There was a doc who used to raise hell when nurses called peds to a delivery in the event of a baby that needed much more resusc. than anticipated. Well, several nurses just told him where to shove it, that it was their license on the line, and that they had not only the brains but the authority as well to make the decision to call the peds team with or without his blessing. Geez. You all need to protest as a group. Everybody call in sick. Tell your spineless nurse manager (who I must assume isn't defending you guys, or else you wouldn't be posting this problem here) to get the almighty doctors to play nurse for the day, since the nurses on your unit are far too stupid to make basic clinical judgements.

    Bleah! Man, I am so p***ed off for you all...

    E-mail AWHONN and see what they think, and e-mail Michelle Murray and see what she thinks.
  4. by   2ndCareerRN
    You may not like or agree with the AWHONN policy on this, but, it seems as though your
    department head has read it and has interpeted it their own way. Read the statement and perhaps you can gain some insight into why this decision is being discussed.


    We live in an age that if you order a pizza delivered to your house and call 911 at the same time to report a life or death situation....my money is on the pizza arriving first! Learn to protect yourself, become a wolf among the sheep!
  5. by   judy ann
    You might also touch base with risk management in your hospital. A 20 minute strip on adm and at regular intervals (that varies with the facility) is the standard and both you and the doc might very well be put at malpractice risk with out monitoring in this day and age. This is true even if there is a policy that there must be an order, or if the hospital policy does not demand it. It is the national standard.
  6. by   Q.
    I agree with the above posts. Monitoring, at least intermittently, is a nursing assessment.

    I once had docs who didn't want me to do vaginal exams before starting an induction. I didn't feel comfortable doing so, but, I wrote it as an order: "No vaginal checks prior to induction, V.O. Dr So and So/Susy K RN"
    I then left the hospital.

    Policy or not, if your hospital initiates that, I would always write it as an order to CYA until you can leave.
  7. by   canoehead
    Well, that was about a year ago I think.

    The other docs would not agree to the change in policy aand the NM backed us up in classifying EFM as a nursing decision.

    This does not stop the doc in question from saying "take her off the moniter" but we know that we can write the order, and that we can disregard the order prn if we feel strongly enough to keep her on.