Medical patients on post-partum floor?

webbiedebbie · Mar 2, 2004

I work PP and we usually have GYN post ops which I don't mind. However, when we get 70 year old females with lots of medications and need lots of lift help, this puts us in a bind. We on PP are the overflow for the hospital. I came in to work a shift one night and one patient was getting blood and a male patient was getting platelets, and I was the only nurse on PP with 5 other patients!

nekhismom · Mar 3, 2004

debbie,

how very scary!!!

Darchild77 · Mar 3, 2004

Our L+D floor also is a pediatric unit. We take everything on our floor. We always get overflow from med-surg. One nurse up here got a patient with a dvt in his arm the size of a grapefruit, bp started bottoming out and she was told to watch and see:angryfire . OUr unit is L+D, pp, nursery, primary recoveries, female surgicals, and 80 yo respite patients that are drooling at our nursing desk all day. I happen to believe that if I'm taking care of kids with RSV, I shouldn't be taking care of newborns the next day. I feel quite strongly on this issue!!!:angryfire

TeenyBabyRN · Mar 3, 2004

OK, the RN credential may cover us to take care of all patients, but could the same not be said for the MD? Last time I checked, docs did not specialize until their residency, which begins a year AFTER they finish med school and plop that MD behind their names.

I can see it now:

Yes, Dr. Y, we realize that you are a dermatologist, but Dr. Z is tied up performing his scheduled cases, so we need you to zip down to the OR and perform an emergency open heart on this patient that is crashing in the cath lab. We seem to be seeing a bit more of that since we started having podiatrists perform PTCA's, but I digress. You are an MD, you can handle it! Oh and by the way, we didn't have an OR team available, so we pulled some nurses down from the med/surg floors -- they can scrub in and assist, after all, they are RN's.

:uhoh3: :uhoh3: :uhoh3:

sbic56, BSN, RN · Mar 3, 2004

If census is low on the Birthing Center, we take clean med/surg patients. No MRSA, no weeping wounds, no respiratory infections. When the med/surg unit is full and we have extra beds, I don't see how the hospital could do it any other way. It is a business, after all. We already care for all gyn patients, so perhaps we are a bit more open to it than those units who are strictly mother /baby. If we are full with L&D patients, med/surg will take our gyn patients, if their census is low. All makes good sense.

kyti · Mar 3, 2004

Our PP unit takes all of our post-op gyn cases. The GYN/OB docs like to have all of their pt on the same unit with the nurses they know and trust.

Quicksilver · Mar 3, 2004

I have a question, are there any other hospitals that are sending medical patients up to post partum? We have brand new baby's down the same hall as an MRSA pt and we've had cocaine addicted pt's high on crack at the time down our peds hall. My nurse manager has told us that this is the way of the future, there aren't going to be specialized areas any more, if we have room, we're going to get whatever they send us. One of the newer nurses to the floor asked the NM if she could have a little more extensive orientation if she was to get med/surg pts and the NM told her that her RN degree covers all areas of nursing:angryfire so she should be able to handle ALL areas of nursing. YOU KNOW, JUST LIKE THE MD'S DON'T SPECIALIZE..........

I used to work on a unit that was a combination postpartum/GYN and med surg unit. The standing rule was "nothing draining or infectious" and usually the same nurse didn't take care of postpartum moms and med surg patients. As for a nurse taking the medical patients, we all did it on a regular basis so we were comfortable with it. But I know some places have just postpartum units that don't regularily take medical patients. I say if the nurse is not comfortable taking a certain type of patient, they shouldn't. But thats the ideal, not the real world. I think it comes to standing up and not doing something potentially unsafe. After all, if you take the assignment and something happens, it's your fanny in the wringer, not your manager! It's bull that nurses should be able to handle ALL areas of nursing. Things are too specialized, maybe way back when it was true, but not now. I wouldn't dare take care of a ICU patient or ask a ICU nurse to take care of my postpartum mom and baby!! I agree that's why theres a shortage, people are getting tired of the crap they get from management. Good luck

MandyInMS · Mar 4, 2004

This is why we have a nursing shortage - because of the attitude that you must adapt to whatever is thrown at you or get out! Unfortunately, many took that advice and did leave.

ditto that

purplemania, BSN, RN · Mar 4, 2004

If caregivers practice universal and contact precautions it should not matter that the MRSA patient is down the hall. Heck, all kinds of visitors and family can traipse in! I do agree that you need orientation to kinds of nursing for which you have not been practicing. A skills lab would help, and a competency list to check off on things you have never done, or not done since whenever. We put only women on PP but some are med-surg. No hi temps or known MRSA, VRE, C.Diff. However, sometimes you just don't know. And sometimes the new moms are infected. It is not easy to weed out who can stay or go.

mtnmom · Mar 4, 2004

Oh my gosh. Just a few hours ago I was caring for a 25-week pregnant HIV+ MRSA + on my postpartum/antepartum floor.

The HIV was not such a huge worry to me...very careful standard precautions - I have never been intimidated by caring for HIV+ pts.in any setting.

But the MRSA? Different story. Infection control apparently told the nurse on the shift prev to mine that no Contact Isolation needed, only Standard precautions. And here we were with neonates and fresh sections down the hall! From my Med/surg experience I remember MRSA being a huge deal...big red sign on the door, gown, glove, dedicated equipment, etc. My charge nurse and the OB doc on call shared my concern so we dedicated equipment and gowned/gloved

The really pitiful aspect to this story is that the OB manager herself lobbied to have this pt admitted to us yesterday instead of to a medical floor....and did not advocate contact isolation because her MRSA was not "active"...well, who's to know? A pt probably in the midst of seroconversion, Oral candiasis (sp?) raging, the pt. spotting blood (not from the lady parts), no swab or culture done yesterday and we can just assume that she is not active anywhere?

I am really upset about this situation. I enjoy caring for complex antepartum pts, but not when it puts the rest of the floor at risk! Thankfully my assignment was arranged so I only had antepartums and no couplets. Am I right to be so upset about this? and where should I go from here if I am?

(even looked up the CDC guidelines - no, they haven't changed)

tiliimnrn · Mar 9, 2004

Today we had a staff meeting, I brought up the fact that for one thing we don't have the equipment, medications, or knowledge as far as some of the staff goes to deal with all of these medical patients. Some of the nurses have worked on Post-partum for 30 years or so, and yet others are new nurses just starting on our floor and all they know are PP and gyn surgeries. The Nurse Manager basically said....from now on we are going to be getting whatever walks in the door if other floors are full......whatever walks in the door....that's kind of scarey:uhoh3: because I don't believe ETOHers should be on a PP floor, or dripping wounds,

MRSA,VRE, and others too numerous to mention. But, they say just wash your hands and deal with it!!!! I'll deal with em all right. Seriously people, what can we do...as nurses to better our profession? I want some advice here, cuz I love nursing, I just hate the job.....I'm sick of paperwork up the :imbar I'm tired of not being able to talk to my patients due to lack of time. HELP PLEASE!!

fergus51 · Mar 9, 2004

What the hell does "active" have to do with it? Once a person is colonized they can spread it to the compromised patients on the floor (read: BABIES) through the nurses. I do believe an ante-partum patient with MRSA or VRE should be on an ante-partum floor, but infection control measures do need to be followed and the equipment needs to be there. A med-surg floor is not the place for an ante-partum patient.

And I see no reason to put a patient with any contagious disease on pp if they are not pregnant like in tiliimrn's case