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Is this considered safe practice?

Ob/Gyn   (1,498 Views 5 Comments)
by rkmoyers rkmoyers (New Member) New Member

600 Profile Views; 4 Posts

I'm new to L&D so my concern may be related to anxiety and being unsure of myself.

At my hospital, c-sections are done with one RN in the OR. The one RN is responsible for:

assisting with epidurals

preparing the patient (shave, foley, FHT)

documention of various times (cut, close, placenta, etc)

intervals of instruments/gauze count

obtaining needed supplies (has to leave the OR to obtain items)

making phone calls if additional staff is needed (peds)

assessing/caring for the infant

I think the RN is stretched too thin. Especially having to care for the baby in addition to circulating. What is your opinion of this practice?

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NPinWCH has 15 years experience and specializes in Family NP, OB Nursing.

374 Posts; 6,523 Profile Views

Awhonn standards clearly state that there should be 1 person in the delivery room who's sole responsibility is the care of the newborn. Where I work the OR staff is responsible for circulating and scrubbing in and 1 or sometimes even 2 (if it is an emergency c/s) OB RNs are present to care for the baby.

The OR has refused to do a c/s until someone with NRP certification is available to do baby care(non emergent cases), of course all the OR staff is NRP certified as well, and during the day they often do baby care for routine c/s. In an emergency we call anyone available to assist. Our house supervisors and respiratory therapist/techs are also NRP certified and will respond in that case.

It's not only unsafe,but unwise as well. If something were to happen you and the hospital don't have a legal leg to stand on...bring it up with your risk manager. I've found that once they know what the standard is they can usually get things changed, after all it's their job to keep the hospital as safe from lawsuits as possible.

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6,372 Posts; 34,523 Profile Views

rninwch summed it up very well.

I just have one more question. Do you have a second staff member present to provide baby care during vaginal deliveries? That is an AWHONN and AAP standard as well. There need to be 2 persons present at ANY delivery who are capable of carrying out neonatal resuscitation, at least one of whom is skilled in intubation. In some facilities, RT provides baby care, which is fine, as long as they are NRP certified. But one RN attending both mother and baby alone is NEVER acceptable.

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SmilingBluEyes has 20 years experience.

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As states above, you are violating standard of care here. Make sure you and your manager are aware of this and do what you can to change. it.

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29 Posts; 1,106 Profile Views

Where I work, one RN goes back to circulate, which we always have the foley and the shave already done in the room. When we go back there is always a CRNA and anesthesia doc at the pt's head giving meds, documenting times, etc. We (the circulator) listens for fht and then preps the abdomen, straps the legs down, connects suction, etc. The two LPN's we have on the floor go back to scrub and we ALWAYS have an RN and a Respitory Therapists go back for the baby in a C-Section.

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