In your opinion, was this an inappropriate assignment?

[klone, MSN, RN]

I just started working part time for OB float pool for a hospital organization that has several hospitals. I float around to a handful of hospitals. The first shift at any new hospital is strictly orientation. This was my second shift at this particular hospital, so only my FIRST shift on my own, taking my own patient assignment. I was assigned to M/B, along with one or two of their regular staff nurses.

Along with a couple couplets, the charge nurse assigned me a postpartum IUFD. 95% of the paperwork involved was already completed, and she was on day 2 of a NSVD.

However, to me that just seemed like really poor judgment. I've taken care of plenty of IUFDs, both during labor and PP. But as a regular staff nurse, where the charge knows me, knows my abilities and my temperament.

As a charge nurse, I would NEVER give a float pool nurse, on her first shift off orientation, an IUFD. IMO, that's just wrong for so many reasons.

Am I way off base or blowing this out of proportion?

[JaneyW]

Maybe, maybe not. Maybe the charge nurse had regular staff on that day that she knows are not good with IUFDs and you were the best choice. When I was working registry, I found that I often got the toughest assignment. I wonder if they think that since we do registry we are better/more experienced? I don't know. Maybe it is just giving us what no one else wants to do. Was it a place that has a lot of IUFDs? Maybe the other nurses had had their share recently. I have worked in high risk where that was the case. As long as the paperwork was done, I didn't mind taking care of IUFDs. It is very difficult, though, and I still am haunted by some that I didn't handle as well as I could have.

[klone, MSN, RN]

It was a small low-risk facility, so no more IUFDs than any other small low-risk facility.

I don't mind taking care of them, and I'm good at my job. But the charge nurse didn't know that. She didn't know me from Adam (or Eve, I guess).

I'm just thinking from a charge nurse's perspective - there's no way I would give a float nurse whom I've never met, fresh off orientation, an IUFD. It just seems wrong to me. It's unfair to the patient and to the nurse. Also as a charge nurse, I would always ASK the nurse if she was okay taking the IUFD. It's just such a sensitive situation.

At another facility I float to, they have an IUFD team - only the nurses on that team take IUFDs, and they have special training and classes that they have to take before they go on the team.

[Mike A. Fungin RN]

Interesting thread... not my practice area btw. I guess it's hard for me to understand why an IUFD would be so sensitive and challenging that it might not be an appropriate assignment for a certain nurses (i.e. a new traveler).

But then... I guess tragedy and death are more the norm where I work so we're all "used" to dealing with it. I imagine (hope) it's the exception to the rule in L&D... is that why some nurses in your practice area have a tough time with it?

[klone, MSN, RN]

But then... I guess tragedy and death are more the norm where I work so we're all "used" to dealing with it. I imagine (hope) it's the exception to the rule in L&D... is that why some nurses in your practice area have a tough time with it?

To give you some context, the place I used to work (a smallish low risk community hospital that did about 100 births/month) might have 1-2 IUFDs a month.

And yes, it's always a sad, tragic event, especially when it's unexpected. When you have a woman who has had a normal healthy pregnancy come into triage at 36 weeks due to decreased fetal movement, and then discover no heartbeat on the monitor, it's awful. And for many nurses, it brings back painful memories of their own. It's just a very sensitive situation that needs to be handled delicately. When I had a late miscarriage a few years ago, I was not assigned to any IUFDs for several months, and the charge nurse asked me when/if I was ready to take one.

[JP2011]

It just seems that you are more uncomfortable with that assignment. Outside of emotional support (which should mainly be provided by a support person) You are taking care of a normal delivered patient. I wasn't in your position but I don't think it was inappropriate unless you had recently suffered the same fate. Float nurses at my facility have a lot of experience. I think the charge nurse may have figured since paperwork was done and you are highly experienced that you could handle it.

[klone, MSN, RN]

Generally speaking, I am not uncomfortable taking care of a PP IUFD. In fact, at my old facility I would often volunteer to take these pts because I know that they need to be treated delicately and with sensitivity and I'm good at that. On this particular occasion, I was completely unsure of how that facility handles things like caring for the body, when to call the morgue, who takes the baby down to the morgue and when, but I figured things out as I went along.

I was speaking more from a charge nurse's standpoint and her decision to give that patient to a brand new float nurse, rather than a staff nurse who is experienced with how their facility handles it, and whose temperament the charge nurse is familiar with, and knows would be a good nurse to take care of an IUFD pt.

Perhaps the facility I've worked at for the previous 4 years just handled it extra-sensitively, and most facilities treat an IUFD just like any other routine PP patient. Dunno.

[guest2210]

Is it possible that the charge nurse knew of your previous work experience and felt comfortable giving you that particular assignment? Generally speaking, to join a float pool the nurse must have the experience for the areas she will be assigned to. I worked as a float for 6 months when my regular med/surg floor closed d/t low census. I gladly went wherever the nursing office scheduled me, but if they want ed me to do something I wasn't comfortable with, I would let them know and it was never a problem. By the end of those 6 months, there wasn't much I couldn't do on any unit.

[JP2011]

She was postpartum day 2 with the fetus still in the room? Our IUFDs are allowed bonding time and then the baby is transferred to the morgue (they are not rushed at all) and mom is transferred to a GYN unit.

[klone, MSN, RN]

She had delivered around midnight the previous night. So at the beginning of my shift, the infant was about 20 hours old.

At this facility, the infant is kept on the unit until the pt is discharged in case she changes her mind and wants to see the baby again.

[JP2011]

Oh I see. I'm just curious how is the infant stored? Just in room or in a refrigerator? I know our IUFDs always look pretty bad after a few hours at room temp (not trying to be insensitive).

[klone, MSN, RN]

When I was there that night, the infant was wrapped and in the procedure room when not in the parents' room. They said there was a fridge on some other floor where I could store the infant if I wanted to. Since they had family in and out of the room all night and there was a possibility they'd want the infant back in the room at some point, I opted to keep the infant on the unit.

Yes, they do look pretty bad after a few hours, especially the younger ones. But I was told that I absolutely cannot send the infant to the morgue until discharge, in case they want to see it again.