Med surg patients on OB floor

[Nik32]

I work on a postpartum/nursery/gyn unit with about 150 births a month. Our staff has been very concerned in last few months because our floor has been forced to accept overflow medical patients. Most of us do not have any prior experience except our speciality. We've taken admissions on diagnosis and surgeries that we have never even heard of before and told to just ask questions if any come up. That to me is not a safe way to practice. We recently took a patient that had a diagnosis of "headache" that ended up having meningitis. We recently have been told that we are now going to be forced to start taking alot of med-surg patients on a daily basis because we have private rooms available that the rest of the hospital doesn't have enough of. They are going to do this so that the surgical docs will send patients to our hospital instead of our another hospital in town that has all private rooms. I'm truely saddened to realize that the hospital I love is not putting patient safety first. I also don't believe a nurse taking care of newborn should be involved in overflow admission patients or med surg patients. A headache patient may seem like a great patient for us to take but the what if's are not worth it. I've researched trying to find standards or recommendations on this subject but unsuccessful. Any input??

[babyktchr, BSN, RN]

Unfortunately this happens. There should be guidelines set up as to what KIND of patient is ok for your unit and when it is appropriate. We had the same thing happen, but then got too busy to accomodate. You should not take any patient with a fever or active infection. PERIOD. If it were me, as a manager, I would've written a safety tracking or incident report about the meningitis patient. This could cause serious reprocussion if it were to spread to newborns on your floor. While "headache" is a broad diagnosis, there should have been indications that she was being worked up for meningitis (umm..say she had a LP). If it was told to me in report that she had a LP, then this patient should have been refused at least until the the LP results came back. I have fought tooth and nail with nursing supervision over what is appropriate and what isn't. Seems our opinions differ. If your OB docs are involved wth the goings on of your unit, get them involved. Our docs went to administration and demanded they stopped this practice for patient safety sake. It worked for the most part.

It is a problem. Hospital administration on see dollar signs sometimes. They want to please the docs. They see a nurse is a nurse and they really do not realize that even med sug nursing has become very specialized. If you don't use it, you lose it. I personally was pulled to a cardiac floor many moons ago and wrote a long note to administration stating that you would not want your loved one taken care of post MI by a nurse who works in labor and delivery .

Good luck in your fight. Stay strong.

[MyUserName,RN]

Wow, that is aweful. Sick patients should not be on the same unit as the mothers and new babies.

[morte, LPN, LVN]

Unfortunately this happens. There should be guidelines set up as to what KIND of patient is ok for your unit and when it is appropriate. We had the same thing happen, but then got too busy to accomodate. You should not take any patient with a fever or active infection. PERIOD. If it were me, as a manager, I would've written a safety tracking or incident report about the meningitis patient. This could cause serious reprocussion if it were to spread to newborns on your floor. While "headache" is a broad diagnosis, there should have been indications that she was being worked up for meningitis (umm..say she had a LP). If it was told to me in report that she had a LP, then this patient should have been refused at least until the the LP results came back. I have fought tooth and nail with nursing supervision over what is appropriate and what isn't. Seems our opinions differ.

If your OB docs are involved wth the goings on of your unit, get them involved

. Our docs went to administration and demanded they stopped this practice for patient safety sake. It worked for the most part.

It is a problem. Hospital administration on see dollar signs sometimes. They want to please the docs. They see a nurse is a nurse and they really do not realize that even med sug nursing has become very specialized. If you don't use it, you lose it. I personally was pulled to a cardiac floor many moons ago and wrote a long note to administration stating that you would not want your loved one taken care of post MI by a nurse who works in labor and delivery .

Good luck in your fight. Stay strong.

I think this may be your only way....of course, if the women birthing got ahold of this info....may they would go to the other hospital, too!

[tablefor9, RN]

I'm the women & children's day shift charge RN. Either the director or I interview and chart review each proposed overflow pt before that pt is assigned a bed on our units. Dementia, psych issues, total cares, febrile illness, infections, wounds, N/V/D, and HX of MRSA, VRE, TB, or CDiff-ever- are automatic disqualifiers. And, you have to be female to ride the ride.

[Spidette]

Sadly our hospital does the same thing and it's unfortunate. We have no disqualifies either

[brillohead, ADN, RN]

When my mother-in-law had "lady surgery" (vault reconstruction), they placed her on a post-partum floor simply because the nurses there were so skilled at dealing with that region of the female anatomy and knew what was what, how to work with stitches, comfort measures, etc. That made complete sense to me -- that's the stuff that those nurses deal with day in and day out.

But to put a potentially infectious person on an L&D or Mother-Baby unit? Or a total-care patient? Or a high-acuity patient? Uh-uh, no way Jose!!!! I would be screaming bloody murder if I were a laboring mom, an OB nurse, or the transferred patient/family. That's just scary...

[PinkNBlue, BSN, RN]

We have c section patients readmitted with wound infections, some with a history of MRSA so they're contact precautions. We also get gyne surgicals and all patients must be female.

[dscrn]

I remember years back, when census was low on postpartum, we would get female "clean" pts. At the time, cardiac caths were kept overnite, NOne of us had a clue what to do for them (this was before the table clamps that are used immed post procedure) we'd just pile on those sandbags and pray a lot..when the docs would show up, they were shocked that the pts were on maternity! We also got post-op eye pts, and "female" surgery pts.at least we were used to caring for c/s...