I have just attended the first day of M. Murray's Advanced Fetal Monitoring class and I am scared to return to work. I am nauseated and unable to sleep tonight. I am new to L&D and have been on my own since August. Practices that I thought were scary; she has confirmed my suspicions. I work in a hospital that does 120 deliveries per month and that number has been rising. We are responsible for triage, antepartum, c-sections, recovery and sometimes pp if our pp floor is full. We have a room that we put PTL and PIH pt's on MgSO4 that doesn't have central monitoring. Then we are expected to manage them and a second pt who may be actively laboring or second stage. I have had these pt's and sometimes not been able to go into the room for 1 or more hours to view the strip!
Our Docs don't stay in house and live 30 or more minutes away. We run pit on people at night without a doc immediately available. Docs miss deliveries and then tell us to deliver the placenta and write pp orders, and don't come to see the patient until the next day. Docs don't come to fetal demise deliveries unless fetus is term. We are the baby nurse and the mom nurse at delivery; sometimes we have a tech at delivery. The other day I had a mom hemorrhaging and a baby not crying and me and the secretary. The secretary can't hang my pit in the bag of LR or resus the baby so what good is she you say? She can dial the phone while I PPV the baby. The doc leaves the room to find help. I call help and don't leave either pt. He should have stayed. Our nurse manager is a pp nurse by training and a WHNP. I feel these docs get away with murder because she hasn't a clue as to how to labor a pt and how much staff is really needed. I work nights and hate the fact that I have to beg and plead for a doc to come in and they still don't.
One night I had a patient who started having early decels at 6 cm, down to the 80's, on pit. Started calling first doc at 2300, care transferred to different doc at 0100. Called him all night and he didn't come. Convinced 16yo pt to get an epidural in prep for c-section. Pt doesn't progress past 7, doc finally comes at 0600 and sections her and then teases me for calling him all night. Doc speculates CPD at delivery.
I called my the person who precepted me and she told me that there are hospitals that are worse then ours. I felt like she was telling me life is tough and then you die. I need to know that there are hospitals that support there nurses and practice within ACOG guidelines.
Thanks for listening! Any suggestions are greatly appreciated.
Mother-baby, Do you work at a community hospital or do you work at a tertiary care centre and have a certain perception about the community hospital setting? If you have experience working at numerous communty facilities, then I will say, I am sorry you have worked at some pretty lame facilities. If not, I'd ask you to please shorten the distance you are looking down your nose at those of us who do and adjust the old specs. Although my hospital is not perfect, it is far superior to the 2 teaching facilities I had previously worked at in terms of staffing and enforcement of policies/procedures. Pt's are afforded a far better birth experience because of our ability to provide more personal attention. My co-workers (for the most part, we have several loafers, they do everywhere) are knowledgeable and highly skilled. We have only 5 OB physicians and they know us and we know them. Rarely, are we asked to do something we should not. If we are, we refuse knowing that nursing admin. (again not perfect, but this is a strong point) will back us up. I find it sad that you had such an arrogant tone to your posting because anthing else I have ever seen you write is sensitive and thoughtful. I can only think you must be ill-informed in this case. If you have had this experience, be sure it is not universally true.
Well said imenid, sad that someone is so misinformed to assume all community facilities are bad. I've worked in both tertiary and community settings and have been fortunate to have good experiences in both. Once again, ignorance is obvious in this case, as with most people who make broad generalizations.
Since you are taking Michelle Murrary's course take her advice. You know when she says, "You don't want to take a single passanger car to a law suit, you want to take a bus." I would start calling my chain of command starting with charge nurse, house supervisor, unit director, director of nurses and document everyones name in the chart. You can also file Safe Harbor in my state and at least let it be known you thought conditions were unsafe even if everyone else went along. Also go to the AWOHHN site and get a copy of their standards of care and give to your unit director. Let her know she can be held liable if she does not make sure her unit is run according to the standards. It doesn't matter if you do one or one hundred deliveries a month. We all have to practice the same. If after all this things do not change, get out and don't look back.
I have worked in three community hospitals and I would never work in a tiertiary care center. I love the personal attention we can give our patients and the birth experience our patients can have far exceeds most larger more impersonal hospitals. While I would love to have the experience of diversity in a large facility, I am very happy to be able to give the quality of care we give.l In fact, most people who come to us having had babies at larger facilities, tell us that our small hospital far exceeds anythingt they have found elsewhere. Large facilities often (not always) overuse technology, and medicalize birth to the point where the mother nad baby don;t have a snowball's chance in H--- of having a nice low tech birth. Birth is not always an accident waiting to happen which is how most teaching facilities view it.
I work at a teaching hospital where we have a lot of high risk patients. We have residents and attendings and peds that are in house for emergencies and deliveries. I would be scared out of my mind if we didn't have that kind of backup! We have several area community hospitals that do well for themselves, but I feel more comfortable with the resources we have at our fingertips.
I am especially grateful after giving birth to my son here. He had a 7 minute brady and I had an emergency forceps delivery. His Apgars were 6/7, and his cord pH was 7.04, and he was dark purple when he was born so he was crapping out on us. I had a CNM but the attending and chief res. did my delivery. I would've been heading out back if he hadn't come out when he did. Peds was called to my delivery. I feel so fortunate that everybody was there where they needed to be and credit my healthy baby to their fast excellent care.
Oh, kiddo, If M.Murry scared you, then DON'T read national ACOG or AWHON standards! You'll have a small stroke!!!!
you wrote: "We have a room that we put PTL and PIH pt?s on MgSO4 that doesn?t have central monitoring."
*so, standard of care requires an nurse at the bedside continuously!!!
you wrote: "we are expected to manage them and a second pt who may be actively laboring or second stage."
Uh, SOC is 1:1 in second stage!
you wrote: "not been able to go into the room for 1 or more hours to view the strip! "
ouch! I wouldn't want to see THIS situation in a court of law!
I can see the prosecutor, unfolding the EFM strip page by page in front of the jury, showing how long this high risk baby was neglected...ugh!!
I won't go through anymore of your scenerios! too painful!
May I suggest:
1) get and read the national ACOG & AWHON Standards of Care
(well worth the investment)
2) in a private meeting, not regular duty time, ask to share your new knowledge with your Unit Manager, pointing out the actual practice on the unit vs unit policies vs national SOC's.
if she is NOT receptive, make an appointment with HER boss AND the Risk Manager together....bet they will listen when you point out the many situations begging for lawsuits! Maybe talk a representitive from your local or states AWHON with you, since you are a "newbie" to L&D!
Michelle Murray scared the shyte out of me, too. Enough to quit doing L and D where I worked. When things hit the fan with a couple of sentinel events things finally changed. Get out of that setting if things don't change. You do NOT want to be involved in a lawsuit and it sounds like your workplace is an accident waiting to happen.
Oh, kiddo, If M.Murry scared you, then DON'T read national ACOG or AWHON standards! You'll have a small stroke!!!!
May I suggest:
1) get and read the national ACOG & AWHON Standards of Care
(well worth the investment)
Where do I get a copy of the ACOG and AWHON SOC? I have been to the AWHONN website, but I don't know how to find this info. Anyone able to help?
I appreciate all of your responses. Right now I am writing up everything and making my small voice heard. So far some are listening.
Last week I had a doc chew me out because I wouldn't go inside the uterus and manually remove clots. He told me they do it all the time on the day shift. Every nurse I asked basically called him a liar. I wrote him up, and gave him a copy. I can't wait to see him. :)
Let us know what his reaction is. I don't do L&D but it doesn't sound like a safe place to me either. Congrats on making your small voice heard! Keep turning up the volume!!! Keep us updated on how things are going.
Sounds like you are partially on the right tract by recongnizing that there is something wrong at your faciility. Don't let the "bad news" at conferences scare you (the way that women love to tell other women their horror stories of pregnancy). Use the information you recieve at the conference for the betterment of your unit.
As others have suggested - use your ACOG and AWHONN and American Acadamy of Pediatrics guidlines as your guideline. Write down what you do and what the guidlines say. Take this to your charge nurse, and then your manager... always use that chain of command! anddddddddddddd always keep a copy for yourself.
If this gets you nowhere, continue on up that chain - with the proper documentation of course. You can't go wrong if you are following the guidelies that leagally we all try to follow.
As for call the docs and no one comes... I hope you are charting in the chart EACH and EVERY time that you call them. Again - documentation.
Did you know that you can do things like turn OFF the pit if there is a problem. Request that the secretary also is required to take NRP - our techs do. Request that there be two NRP certified personel at each delivery - with at least one of them a RN. You can also do things like when given an assignment that you can not do because of staffing. Write it down, not that you are refusing to care for the patient but that you do not feel that the staffing is adequate. This then goes to the charge nurse and the shift supervisor. Of course it will also be going to the Manager.
And remember we all have times that we work short - I think sometimes those pregnant women call each other up and come in to have a party - but you should not be working short each and every night.
Take it easy, be brave, good luck. Sunny in florida
Don't forget to involve your facility's Risk Manager in this process. Do not leave yourself open to risk. if the place is bad, get out. There are lots of other facilities that would be glad to have you. Stand your ground.
mother/babyRN, RN
3 Articles; 1,587 Posts
So very sorry to have offended anyone by making the very true statement that it sounds like every community hospital that I have worked at.....