Liability of not assessing fetal heart tones

[dusky1228]

Hello all! I hope you all have a Happy Easter or Passover.

To try to make a very long story much shorter, I need to give those of you who don't know me a little background.

I have been an RN for almost 30 years (since 1980). My specialty since the beginning has always been OB, though I did my fair share of med-surg and multiple other specialties as a float nurse or agency nurse since the beginning because I wanted to get and keep experience in other areas. I worked in a Level III regional perinatal center for over 15 years. In that time frame, I was charge nurse on the high risk antepartum unit, and we did inpatient and outpatient NST's in our NST room.

I hold my Inpatient Obstetrics Certification from NCC (it was AWHONN when I was first certified) in 1989, and have maintained it since.

I currently work in home care, and have done so since 1991. My caseload is maternal-child health, which may include high-risk pregnant women.

However, I now have a new manager (again), and problems have arisen not only for me, but my coworkers as well. :angryfire

I have just been told that I can no longer do fetal heart rates by Doppler for our patients (even with a doctor's order) because she "can't verify" my "competency" in it. She also told me that the agency never provided an agency Doppler. I pointed out that I *DO* have an agency-assigned Doppler, but that it malfunctioned several years ago, so I bought my own from a medical supplier because the agency never ordered a new one for me. I also pointed out that it would be a liability if we accept high risk pregnant patients and then did not do fetal heart assessment, because we would not be fully assessing a pregnant patient if we didn't. I consider that part of vital signs.

Does anyone have documentation about whether a certification in Inpatient Obstetrics should be sufficient documentation of competency with fetal heart assessment? It seems that it may, because the eligibility requirements include fetal heart monitoring and assessment.

Also, would there be liability in NOT doing a fetal heart assessment in these high risk pregnant women?

Are fetal heart tones considered a "vital sign"?

Any written documentation would be appreciated. Anything would be of help.

In the meantime, my next "requirement" is being told I need to go to the local clinic to have someone supervise me in checking a fetal heart by Doppler, which just seems comical to me because I have been a nurse in the specialty for almost 30 years, and I can do it in my sleep, but if that it what is required to satisfy someone's "rule, then so be it.

Thank you all!

[GilaRRT]

A few thoughts:

1) You may be taking on additional liability by using your own doppler. Let the agency get one and deal with maintenance, inspections, and bio-medical issues. This is less liability for you.

2) Certification in a specialty area may not indicate competence. I am a certified emergency nurse. One of the many concepts tested includes interpretation of XII lead ECG's. So, simply having CEN after my name makes me competent at XII lead interpretation? Not at all, and every quarter, I am tested to ensure I have competency in this area IAW my employer's policy/procedure guidelines.

While you may take offense, do the observation and have your "competency" officially documented. This reduces liability and demonstrates ongoing and continued competency. Who knows, you may even learn something from the clinic nurse?

3) I agree that not documenting FHT's creates additional liability; however, I do not see your manager's expectations as unreasonable. I would be more upset if the agency refused to buy and maintain their own doppler however.

[dusky1228]

Thank you for your quick response GilaRN. I can't say that I am offended at all, I understand her point. What I objected to was her *way* of telling me. It was presented in such as way that *no* manager should do. It was actually me that suggested going to the clinic or to one of my community contacts where FHR is done routinely so that whatever skills checklist is needed can be performed. Obviously all the details can't be presented here, but I can tell you that I was being told "We have never done this at the Agency", when I have been at the agency for 18 years, and have done them since day 1 there, *with* evaluation and being signed off on a skills list. But since it is so long ago, that skills list is no longer there, so I was trying to find something that is still documented somewhere that would cover the new requirement.

We all understand that when new managers come in that there are changes (remember, I have been there through 13 or more manager changes) but it seems wiser to let us know that some new policies or procedures are going to be instituted, rather than just saying "We have never done this at this agency" when I know we have, and they have *not* been there to know it. I have previously had outside contracts arranged between my agency and another agency to do specialized care for extremely high risk pregnant women, and have completed a skills list for those agencies as well in cooperation with my agency.

As for providing my own doppler, I did that at the time because when the one that was provided went belly-up, I asked for a replacement and kept getting told "it's on order", but it never got done, so I bought my own-medical grade doppler. I did the same thing when my infant scale died. Maybe I shouldn't have to, but I did because the agency was primarily an adult agency and my MCH program (I was hired for it, and deevloped it over the years there) sometimes got left out when it came to ordering supplies that were unfamiliar to them.

Thanks for your input-I really appreciate it.