Induction craze

SmilingBluEyes · Dec 28, 2003

yes it can and does get out of control. My unit sounds like yours, but add in GYN surgical patients in the mix!! THEY really can bog us down on top of all that......all I can say is...

hope you have a strong manager!!! needs to be a meeting w/her/him and the doctors and a solution worked out.....

dr's will say "staffing is not their problem, but a nursing issue." they only are part right. ya see, safety is EVERYONE's issue.

I would have a meeting w/the manager ASAP and try to come up with a fair plan to deal with this situation soon. GOOD LUCK...it's hard and since doctors make so much $$$ for the hospitals, they usually get their way.

maybe the answer would also be to have a nurse or two on call each shift. that was what we have had to do to deal with the increased workloads.....it sucks to be oncall but then the money is sweet and we usually can get someone to take call during really busy times. Agency nurses can fill in gaps, too.

I doubt you are gonna get much done about the induction rates. They know how to play the games to get their way, really.

try to be creative and open-minded, whatever come up.

best wishes.

BarbPick · Dec 28, 2003

We are in a society demanding immediate gratification. We invented a term "snail mail" because of this. People used to wait till the weekend when long distance rates were cheaper to make phone calls, now text messaging. Doctors also want it over with just to have a night off, no delievreries.

I had a teenaged boyfriend who went to Europe with his family one summer, The letters came about once a week, now we find internet cafe's.

Mimi2RN, ASN, RN · Dec 28, 2003

Do you also have too many scheduled c/s? Sometimes we will have 5 or more scheduled for day shift. Add in an unscheduled one or two, and that's an extra labor nurse or two, and an ICN nurse for the baby.

Our other irritation: shift change c/s. They know when we have report, but decide to do one for FTP, or CPD........it could wait another half hour. They don't care about staffing.

acuteobrn · Dec 28, 2003

Happening here too, happens every year between 12/26-12/31, end of year tax break inductions & sections. EVERY DAMN YEAR and guess what, we don't have the staffing, they won't cancell and you still have mom's coming in in acutual labor. Now I don't mean to hold off a 38 wkr w/ PIH, but come on 38 wks w/ "history of fast labor" which was 7 hours or "pelvic discomfort" COME ON!!!!! I personally won't crank the pit if I can't properly care for my pt. I got into it w/ an attending asking why I didn't keep going up on the pit, my responce was that the unit was crazy 4 admits in 20 min. and that I couldn't care for that pt properly if something were to happen, the UCs were q 3 minutes, she will be ok for an hour or two w/ that, that attending couldn't say anything....UGH!!!!!!!!!!

TiffyRN, BSN, PhD · Dec 29, 2003

My husband who also works NICU says his hospital had a run on C-sections on Christmas Eve which he was told (I know, just rumors among the NICU nurses) that this happens every year on Christmas Eve for women that are very close to term or in labor not progressing quick enough to keep the docs from having to come in the night before Christmas and Christmas Day.

Dayray, RN · Dec 29, 2003

yep happens on my unit too. In fact it feels like we have more inductions then we do women in spontaneous labor.

It's almost the norm to be induced around 38 weeks. Sometimes the docs make up reasons . PIH seems to be the favorite.

It's sad because inductions can be so grueling for the patient. I've seen primagravidas be induced for 48 hours. can you imagine? being woken up every 3 hours to get a suppository shoved up you with no lubrication and then having to push out a baby after 48 hours with little sleep and nothing to eat?

have also seen duc's rupture membranes at like 1 cm, thick and way way high. Never mind the risks can you imagine having someone reach up that high with 2 hands and then having to labor down from like -5 with pit? I wrote the doc up but am doubtful it will change anything.

Sometimes you ask the patient why they are being induced and they don't even know why. "because my doctor told me to come in" isn't a good reason.

Some blame can be placed on patients that don't want to be pregnant anymore but I place most of the blame on the doctors for not educating them.

USC2001 · Dec 29, 2003

I made a comment to one my (non-nursing) friends the other day about how busy we are becuase everybody wants to have their little "tax deduction" before the new year. She couldn't believe that some pts use that as a reason to be induced. When I asked an induction the other day why she was being induced (I always like to ask) she told me "well.. I wanted to just get it over with before the new year and we'll get a tax cut this way". I couldn't believe it! :eek: I'm glad I was leaving at 7a.

I also love when they are being induced for "PIH" and they are not on any meds and the starting BP is like 118/62. OK.... whatever.

We have also had a rash lately of "I don't why the doctor won't induce me at 35 weeks. I'm tired of being pregnant. My last baby was born at 32 weeks and she's fine." With no medical reason, no PIH or GDM, nothing. Uh... NO! One of the nurses actually had a triage that was saying something similar while her first child was sitting there being fed through a feeding tube and is mentally handicapped. She told the pt that obviously her first child was not fine if she had a feeding tube and was mentally handicapped and that she should be thankful that the current pregancy was progressing without the complications of the first one. Some people!

Anyway... had to vent a little.

HazeK · Jan 7, 2004

Originally posted by Blizzard
My unit is being overwhelmed by inductions. ... Most days there just are not enough of us to go around. We find ourselves spread dangerously thin and inductions really push us over the edge. We have tried putting policies in place to cancel and reschedule inductions that are not medically necessary but now the doctors give diagnosis to make all of them medically necessary by claiming oligo, macrosomia, and early PIH. Are other units finding this to be a problem?

AB-SO-LUTE-LY!!!

How about requiring the physician to fax documentation to validated the medical necessity? Like BPP results? AFI measurements? Labs? etc.?

we do > 400 deliveries a month...

we are a tertiary center...

and we limit "bookings" to 6-8 per day, depending on staffing!!!

good luck!

Haze

fourbirds4me · Jan 7, 2004

We have policy of 3 scheduled deliveries/day (c-sections or inductions) There is a list of guidelines for induction and sometimes are doctors will fudge on the medical reasons to get a pt induced but absolutely no more than 3/day. If something happens that we get busy or have to squeeze in another induction because of medical reason then someone gets bumped. This is usually worked out between the charge nurse and the doctors concerned.

L&D_RN_OH · Jan 7, 2004

We actually don't do a whole lot of scheduled inductions. Maybe a few a week. But if we are real busy and there is not a significant medical indication, they get rescheduled.

studentdeb · Jan 7, 2004

Not a nurse yet, but with both my kids (3 & 5), I was scheduled to be induced at 41 weeks but with the first I started on my own before I got to the hospital but was still put on the pit several hours later because I was not progressing and with my son I was induced and had my water broke, but at least I was 41 weeks with both of them.

My doctor would not induce any earlier than 41 weeks though because at 40 weeks with my first, I asked her if we could and she said no and to wait another week because there was not a good reason to do it earlier.

We do live in a convenience society, it seems. I hope it doesn't eventually end up hurting someone.