Liability of threatened AB on M/S unit?

[new_nurse_2006]

I'm a new LPN (8 months) on a med/surg floor and would love to hear from experienced nurses about this situation.

Management wanted to place a threatening abortion on our med/surg floor from ER. US showed viable intra-uterine pregnancy between 16-18 weeks; placenta intact. Minimal spotting and some cramping. L/D said they don't take

Supposed to be my admit, but I stated I was not comfortable taking this patient. I'm a new nurse, minimal L/D experience, no fetal or tele monitors on our floor. (Doesn't a mag drip need a tele monitor?)

The charge nurse had numerous conversations with the coordinator and unit manager, but the patient was brought to our unit. By then, the admit fell to the next shift. The patient ended up transferring to L/D on that next shift. I don't know the outcome of the baby, unfortunately.

Was I right to refuse the patient? All I could think of was losing the baby (or the mom!) because we didn't have the knowledge, skills or equipment to identify and prevent such a loss.

[TexasGrrl]

There is one big downside that must be evaluated.

If this patient would have gone to L&D with a threatened AB, is it really good for her to listen to babies crying all day and night?

[tntrn, ASN, RN]

I'll be brief: this pt should have gone to Antepartum, L/D, or GYN. From the perspective of an ER nurse, she did not necessarily need continuous fetal monitoring, but should have had "spot" FHT's obtained. IMHO it would have been preferable to leave her in the ED until L/D could get its act together. At least the ED could go through the pretense of "having a doctor there" for the pt.

In our Birthing unit, we do not have doctors on the premises all the time. Again, in our hospital, after she was seen, evaluated and diagnosed in the ER (or sometimes in the office) she would have come to our floor. FHT's would be done along with regular V/S (q 4) and that's about it. Once verified to be absent, FHT's would no longer be done. Why put her through all of that muliple times? If the threatened AB becomes a reality, a doctor may or may not be present when it occurs. Sometimes there's no time. Once the fetus is delivered, if the doc is not there, we call to report. More often than not the patient will require a D & C afterwards.

I don't see more of a liability of putting this patient on a med-surg floor if the antepartum area is wild than floating an L & D nurse to med-surg to take care of 8-10 patients with diagnoses she's never seen or heard of. But that is routinely done where I work. Except when the actual "birth" occurs, this patient would not require 1:1 care and this kind of thing can take hours.