Labor & Delivery - highly litigated field

[SaraKay76]

Hi All, I am calling out to Labor & Delivery nurses. What is the culture in your work environment about the high nature of litigation in the field? I work in a hospital LDR unit in which the threat of litigation is constantly reminded to us.

Example: "Make sure you chart that...if you get called in by the lawyers..." "Chart everything you do...a lawyer would chew you up..." "If I had that strip, I would do XYZ because you have to be able to CIYA yourself in court..." "Make sure you do XYZ...because the provider isn't going to stand up for you if this goes to court...?

These types of statements are made ALL THE TIME. Is that the norm for this field? How do you cope with the looming idea that you could be called in for deposition? It's nerve-wracking. I understand the importance of charting. I am curious as to how it is for other LDR nurses.

[klone, MSN, RN]

I think it's an excellent idea to defensively chart, to chart per AWHONN recommendations, and to use approved NICHD nomenclature.

If you're doing those things correctly, you shouldn't have to worry about litigation. It's when you're NOT charting appropriately that you need to worry about it.

Honestly, legal defensibility drives much of what I do as an OB nurse/OB manager. Whenever I'm not sure, I ask myself three things: Is it the right thing for the patient or what the patient wants (or the staff, in the case of managerial decisions)? Is it something that a prudent nurse would do? Can I defend my actions to an attorney?

If you ever get a chance to go to a seminar hosted by Lisa Miller, I STRONGLY recommend it.

[Horseshoe, BSN, RN]

I have always charted with litigation in mind, and I've never worked L & D. It's the world we live in, sad to say.

[amoLucia]

1 hour ago, klone said:

" Whenever I'm not sure, I ask myself three things: Is it the right thing for the patient or what the patient wants (or the staff, in the case of managerial decisions)? Is it something that a prudent nurse would do? Can I defend my actions to an attorney?"

This mindset is what pretty much guided my many years of practice before retirement.

And it guided my practice in LTC/NH. I would imagine that it also directs nurses everywhere else. Like in the OR, neuro, peds, especially.

Folks enter into a system where they expect good outcome, but we all know that's not always the case. POOR outcome does occur whether or not expected. And when it does, the other parties left behind sue.

So yes, it is a litiginous system that so many work under. Not just L&D.

[SaraKay76]

Thanks for the response. Because I am new, I chart to "tell a story" on the strip about what I am doing, basically, every time I enter the room. ? I use NICHD nomenclature too.

[MidwifeyToBe MSN RN, BSN, MSN, RN, CNS]

On 4/24/2019 at 2:00 PM, SaraKay76 said:

Thanks for the response. Because I am new, I chart to "tell a story" on the strip about what I am doing, basically, every time I enter the room. ? I use NICHD nomenclature too.

I am an L&D RN and find that this 'fear' is always at the center of documentation on our unit. We also have chart auditors in our facility as we are a high reliability organization so often times if you are making an error or forgetting to chart something, it is brought to your attention to be fixed for the future. This is really helpful I have found. Additionally we use the NICHD nomenclature as well in our Epic Stork charting. This is very helpful as it paints a clear and concise picture of the FHR strip whilst having to minimally enter details i.e. Category 1/2 or 3.

[canoehead, BSN, RN]

When I did labor and delivery I found it LESS anxiety producing because ACOG had specific recommendations for almost every situation. I just followed along their algorithms and documented physician and patient decisions that took me off plan. It took time to learn them all and keep up with changes. I was low risk, so I imagine high risk units have a harder time.