I'm getting written up! (Very long)

[rn4babies63]

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!

[ghillbert, MSN, NP]

I would definitely write down your recollection of events, down to quotes if you remember. Then either get the mother to sign it, or get her to write a brief letter. Keep copies and get one put on file if a complaint is written up.

This is ridiculous and you didn't do anything wrong. I would not worry about it.

[Purple_Scrubs, BSN, RN]

If it is written up, I would NOT sign it, and instead write a rebuttal stating that part of your obligation as a nurse, per your state's nurse practice act (if true, from what I understand it is in most), is to be a patient advocate. You were acting in that capacity when you did what you did. A family member should not be allowed to dictate the kind of pain relief that a laboring woman recieves, that is just ridiculous! A complaint that the family member was not allowed to dictate this is just not a valid complaint! If the PATIENT said she was coerced or given misleading information, that would be different, but that is clearly not the case. Good luck to you!

[Karen1984]

You did absolutely nothing wrong and should make certain you get statements from everyone involved in case the doc decides to be an a**. I had natural *shudders* childbirth with my first child and an epidural with my other two.

The first time I was only twenty and my family and mother in law wanted me to do natural. Luckily it went fast but I did get in a lucky shot at my mother-in-law's face when I was yelling at her to leave. They were the ones that shoved me into natural labor. Sounds the same way with the family you were describing.

And let me guess...the doc is male and over fifty?

[azhiker96, BSN, RN]

If it has to be written, just make sure it's written accurately. It may be on a "complaint" form or whatever they call it but it should read like a commendation. For example:

List the error: RN educated pt on pain relief options. RN monitored pt's pain and treated with IV medication per orders. Pt. requested epidural for pain relief. When pt. reached 5cm contacted anesthesiologist for epidural per doctor's orders.

List Adverse outcome: Pt's pain maintained less than 5/10. Pt. delivered a healthy baby with no complications. Pt. thanked me for my care during her labor and delivery.

Just make sure it's factual and complete. The doctor may not be happy with the epidural but he can't argue with the facts.

[pers]

Is the family complaining about your care or complaining she got an epidural? I guess I'm confused about the amount of choice you had in this matter since the patient requested the epidural and the doctor wrote for her to get one (and if he doesn't like it, he shouldn't write for it). Family complaint or no, what choice did you have here? Unless she wasn't capable of making her own decisions it wasn't up to her family any more than it was up to you.

[FireStarterRN, BSN, RN]

That is the most ridiculous thing I've read in awhile! These people are a bunch of control freaks. It sounds like you did an excellent job with this young woman, informing her and respecting her individual autonomy. Meanwhile, she's surrounded by a bunch of controlling family members and a husband who sounds like a total male chauvinistic pig who is too insecure to marry a woman his own age, but needs a young girl to boss around.

[FireStarterRN, BSN, RN]

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..

Good advise! This young woman is an adult, and even if she isn't an adult she deserves the pain relief she wants during labor!

[FireStarterRN, BSN, RN]

The irony in all this is, even if this woman had been 14 years of age, if she were seeking out an abortion, she would have easily been provided one, free of cost, no parental consent required, no need to notify the father of the baby.

[Wicked Wahine]

The physician is having a hissy fit, but he is not your boss. You need to hold your head high because you know you gave good care to your patient and you were an excellent patient advocate. Dr. Whiny Pants can stomp his feet and make a complaint but I would definitely not sign it because you clearly did nothing wrong.

[vaughanmk]

I feel horrible for you. I cannot imagine working on a unit that requires every single complaint by anyone to go into your employee record. I would check with administration to make sure that this is correct. I would understand that the dept wants to address all complaints but they should not go into your employee file.

[GadgetRN71, ASN, RN]

This whole situation is bogus..If they write you up for this, I wouldn't sign it, plain and simple.

[David13, MSN, RN]

This is yet another example of hospitals allowing physicians to dictate their own personal policy in regard to how nurses are managed. There are policies and procedures in place in all hospitals, and as long as you did not violate them, you should not be "written up". This physician does not get to dictate policy and procedure per his whim, and any nurse manager who rolls over and allows it is doing ALL nurses a great disservice. Fight this injustice with all you are worth. Document, document, document. And save a copy of everything.