I'm getting written up! (Very long)

Nurses General Nursing

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I'm getting written for an incident in which was completely misunderstood. Yesterday, I had a 20 year-old patient that was being induced for labor. On admission, she was asked what her plans were for pain control (part of our admission process). She stated " I don't want an epidural because I'm scared to get one". When I asked her what her concerns were, she stated she was afraid to be paralyzed and that the OB told her she may die if she gets one. I explained to her exactly how the procedure is done and although there are risks, these would be explained to her by anesthesia and the risk of paralysis or death were extremely low and that I've personally never seen either occur in 13 years of OB experience at 3 differant hospitals. I also told her that IV medication certainly was also an option and she could "play it by ear" and to just let me know what she decides when the time comes. Well, after several hours of increasing pain, the IV pain medication was becoming ineffective. She asked me at one point if she could have an epidural and I explained to her the the doctor only allows his patients to have epidurals once they are 5CM. Several exams later, she was finally 5 CM. When I told her the result of the exam, she stated "Can I have my epidural now?" So, I called anesthesia and she got her epidural without any difficulty and delivered a healthy baby girl 1 1/2 hours later with no complications. So here's the problem.. .......When the doctor showed up while the family was in the waiting room during the epidural, they complained to him that she was coerced into getting the epidural and that they didn't want her to have it The doctor was raving mad and complained to my charge nurse about this. 2 charge nurses talked to the patient and she told them that she was not coerced in any way and that she asked for the epidural and all I did was answer her questions and explain the procedure. She also told them that was embarassed by the behavior of her family regarding this. The S/O told them that he didn't want her to have it and since she was only 20 years old she couldn't make the decision for herself (he proudly announced he was 37 years old). On rounds the next day, our clinical coordinator asked the patient and family if they were happy with their experience and they never mentioned anything about this. However, the doctor is still insisting that I get written up! I've never had any issues with him but he is VERY anti-epidural and always tells his patients they WILL end up with a c-section, they WILL be paralyzed and MAY very possibly die from it rather than explains the risks. I merely was answering my patients questions and educating her and the family. And yes, there was a written as well as a verbal order from the doc allowing here to have it. I have a perfect 12 year attendance record at this facility and have never been reprimanded for anything and always get excellent evaluations. This is not fair! Sorry so long but I need some advice!

BTW...I'm proud of the OP for being a wonderful educator and patient advocate. Bravo!!

Specializes in L&D, PP, Nursery.

I want to thank EVERYONE for their encouragement and support! From what I understand, it has to be written up simply because it was a complaint whether it be family or patient. The family did not complain to any of the staff, just the doctor. He's known to be a jerk. Everything else went beautifully during labor every vag exam matched his, he was happy with her progress, etc. I actually was blindsided by this because I actually liked the family and they gave me NO indication whatsoever that there were going to be any issues with the care I was giving. As a matter of fact, the S/O thanked me all day for various things I did and information I gave them.

I've never heard that before and I don't buy it at all especially about a family complaint. There is no way everyone writes up every family and pateint complaint. They'd run out of paper. Just make sure you document well here.

The patient doesn't have a problem with their treatment and that's the person that matters here. How the family feels is insignificant in this situation. I think they might be giving you a bunch of bunk. It sounds like the doctor wants the write up and they are using this as their excuse which is totally spineless. If he wants the write up make him do it. If they bend to him knowing he's wrong I'd be good and ticked. I also wouldn't sign it as you disagree with it. You might even want to think of looking for a job where your superiors will defend you in a situation where no defense should even be needed.

Specializes in ER.

You sound like an amazing nurse! very inspiring and a role model to the students. Try to keep your chin up and stay positive. You know the guy is a jerk so go with your gut!

:heartbeat:heartbeat:heartbeat

Specializes in ICU, CVICU.
I want to thank EVERYONE for their encouragement and support! From what I understand, it has to be written up simply because it was a complaint whether it be family or patient.

In the write-up, I hope they remember to list the anesthesiologist who is responsible for obtaining consent and performing the procedure. I mean, isn't it ultimately up to the doc to make sure that the patient understands and consents? Isn't that the person with whom the OB has the REAL problem?

Specializes in Maternal - Child Health.

The physician is bleeping with your excellent work record.

Turnabout is fair play.

Call the State Board of Medicine and let them know how he "educates" young, vulnerable women in need of prenatal and delivery care..

Specializes in L&D, PP, Nursery.
In the write-up, I hope they remember to list the anesthesiologist who is responsible for obtaining consent and performing the procedure. I mean, isn't it ultimately up to the doc to make sure that the patient understands and consents? Isn't that the person with whom the OB has the REAL problem?

This all occurred while the family was in the waiting room while the pt. was getting the epidural. I was with the patient so I had no idea. Our hospital policy is that ALL family must leave during the procedure. The patient was also unaware that her family was making a fuss until the charge nurses questioned her (it was shift change so there were 2 charges there). They told me she was very embarrassed that the family was doing this and she was totally happy with my care and the epidural and wasn't coerced in any way by me. I was stopped in the hallway by the charges on the way to get the family. I ended up leaving my shift not even getting to say goodbye to the patient like I usually do because the family was now in the room and I was advised not to! I think what upsets me the most is that my work record will be blemished for the first time just because of an egotistical, lying OB!

Everyone, including the unit director agrees that I did nothing wrong especially since the patient herself said she asked for the epidural when the pain got too intense for the IV medication.

i agree that doc nastypants should be the one who writes you up...

no one else.

if the ud and cn's support you, the unit dir should respond to the writeup, w/a ltr of support, emphasizing you were being pt advocate and how you appropriately followed p&p.

then have ud and charge nurses sign.

definitely stand your ground, and handle it like the class act you are.

let us know what happens?

leslie

Who needs written up is the obgyn with his ignorant attitude on epidurals and the incertion of his opinions that are totally false and unsubstantiated.

Specializes in anesthesia, nursing labor research, philosophy.

I wish someone would explain men to me. (Or explain things to men.)

Belittling men, classy. Yes, men are nurses too and read nursing websites.

Welcome to the 21st century.

Well, your comment is moot regardless. The SO had no legal say in whether or not a 20y/o female gets an epidural or not. If the order is written and the pt (over 18 or emancipated) requests the drug, it's their body and their call.

To the OP: I'm confused, if the original doc was so anti-epidural, why did he have an order for it signed? How can you get written-up for something that follows hospital policy (which the rights and responsibilities of you, the doctor) to a tee??? You clearly didn't practice medicine without a license, abandon the pt, assault the pt, or anything else I can think of. I think that the doctor is the one who is courting a malpractice suit for intentionally deceiving his pts.

What does your nurse mgr. say? Somebody there must see this objectively.

Specializes in L&D, PP, Nursery.
Belittling men, classy. Yes, men are nurses too and read nursing websites.

Welcome to the 21st century.

Well, your comment is moot regardless. The SO had no legal say in whether or not a 20y/o female gets an epidural or not. If the order is written and the pt (over 18 or emancipated) requests the drug, it's their body and their call.

To the OP: I'm confused, if the original doc was so anti-epidural, why did he have an order for it signed? How can you get written-up for something that follows hospital policy (which http://images.allnurses.com/icons/bad.pnggoverns the rights and responsibilities of you, the doctor) to a tee??? You clearly didn't practice medicine without a license, abandon the pt, assault the pt, or anything else I can think of. I think that the doctor is the one who is courting a malpractice suit for intentionally deceiving his pts.

What does your nurse mgr. say? Somebody there must see this objectively.

He has a preprinted induction order sheet which says "May have epidural when 5CM, prn" He also gave me a verbal order earlier in the day stating the same thing. What he does to ALL his patients is try to scare them into NOT getting one. The standing order is for those who have already educated themselves on the subject, want an epidural anyway and thus it prevents us from us calling him to obtain it. This was a sweet little prime that thinks her doc walks on water. As a matter of fact, it is a unit joke that he must like to see women suffer because he doesn't want them to have epidurals and orders vag exams every 15-30 minutes despite their progression of labor.

As for my unit director, I have to talk to her tomorrow. I spoke on the phone today with our clinical coordinator and she told me that the UD agreed there was no wrongdoing on my part but it still has to be written up as a complaint. She's the one that made rounds today and said the family told her they were satisfied with everything and didn't mention it.

Specializes in ER.

every 15-30 minutes? I am the mother of two and I would have HATED you for that! lol

As for the epidural, his ideals are laudable as my own research and experience suggest that the pain is better then the alternatives. (Mine slowed down my labor, spaced my contractions, the whole slide, etc.) OTOH, and it is a big one, this is EVERY SINGLE person's individual choice. The patient had every right to ask for relief and to receive it.

Seriously, try not to let it worry you too much.

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