My poor co-worker!

[tryingtomakeit]

I really guess I would just like to hear some opinions about something that happened to one of my fellow nurses. I'll try to make it short.

One of the 7a - 7P L&D nurses came onto her shift to be floated to med-surg. Bear in mind that this young lady has never worked med-surg a day in her life.

We have been told recently that if we are floated, we may be asked to take a couple of low accuity patients so that if we are needed in our own area we can quickly hand then off to another nurse. None of us has had any orientation to med-surg, other than to occasionally help out as a "runner", and our L&D is staffed with a MAXIMUM of two nurses per shift. Only if there is a second nurse are we expected to take patients.

Back to my co-worker ... She came in at 7a and was to be floated. She was already upset that she would have to take patients because she had very rarely been over there to work at all, but she held her head up and went anyway. When she got there, she started taking report. After two patients, the offgoing nurse continued. The L&D nurse stated that she was only supposed to have two patients. The offgoing supervisor told her that she was going to take a full load - that the med-surg manager had approved it through the CNO.

My co-worker became upset and told the nurse supervisor that she had to go to the restroom (she didn't want anyone to see her crying). After coming out of the restroom, she told the supervisor that she would be right back, that she really needed to speak to the L&D nurse manager, who's office is just down the hall from med-surg.

When she got there, the NM wasn't in yet, and she ran into the CNO, who told her that she needed to wait for the L&D NM to get there so they could talk about the situation. The nurse was still visibly upset, so she thought they were just going to maybe work out a compromise of some sort.

When the L&D NM got there, she was taken into the CNO's office, told that she had abandoned her patients, and escorted off the property by security with the NM telling her that she was going to report her to the BON.

The other nurses were still taking report and hadn't even been on the floor to see their pt's yet, and she had told the supervisor that she would be right back, which she had every intention of doing.

That night, another L&D nurse was pulled and was given a full load also - without any form of orientation. I guess I'm just wondering if I have lost perspective of the whole incident and was wondering how you guys feel about it.

Thanks so much!

[Annointed_RNStudent]

I am a new Grad May 07 and I am going to L&D. When I interviewed for my jobs and the ones that I choose to accept , I made sure they were all closed units and couldn't float anywhere else in the hospital. I am doing a specialized internship now, before I graduate in a community hospital setting, where they cannot float, and the supervisor has made hint that they are Lazy and could be going to help on other floors, they haven't budget yet, as no one would ever come and help with Labor patients.~

[pagandeva2000, LPN]

What concerns me is that they told her that they may contact her BON. If that is what happened, then, she most certainly needs to contact not only the union, but, I think if she has malpractice insurance, she may consider reaching out to them as well.

[magz53]

Check with your State Board of Nursing. New York's came out with a position statement on abandonment and sent it to every license holder some time ago as they had so many problems with just this type of thing. I would say if she hadn't accepted the patient load that there was no abandonment. I would find a good nurse-attorney........there are plenty of them. No small wonder why.

[DEB52]

After many trials and nurses quitting , our OB department decided on a simple pulling plan. L&D and High Risk pregnancy would cover each other and NBICU and MBU(postpartum) would do the same. This is a simple pull plan for us because we have seen alot of different ways. Our hospital merged with two other hospitals. When this happen, we were getting pulled to the other hospitals without any orientation to equipment layout of the unit ,ect. They said that the paper work and policies were the same. This stopped after many nurses quit at all three hospitals. We are much happier with this way. I am happy to say that we don't get pulled off the OB unit.

[crissrn27, RN]

We too do the "call-offs" for low census in the nursery and PP. In L and D all 5 of the RNs come in regardless of patient load. Last night we had no one all shift in L and D with 5 RNs back there doing nothing. That would drive me crazy. None of our nurses have to be pulled anywhere if they don't want to. As for this situation, I agree, tell your friend to get a good att. and sue their pants off....for loss of wages, etc. I know there has to be something she could do. I don't think the BON would actually do anything to her after they new the real story, but she better see whats to be done to protect herself from this also, just in case.

[Minou]

Unbelievable !. I work in a small Birthing Center that is actually in a separate building from the main hospital ( soon to be changed ). We are a closed unit so do not float ( that is nice !!!! ) The price of that is we take mandatory call twice a month for FT and once a month for PT.

Personally I think floating should be illegal ...it is dangerous. Someone mentionned a rn is a rn is a rn.....that is the mentality indeed.....However, would anybody ever think of having heart surgery done by an orthopedic surgeon ? Every hospital unit has become so specialized with highly skilled RN's ( the professionals that we are ) that I dont understand how they can just throw a rn into a different environment and expect her/him to function normally. I'm glad I don't float but if I had to, I would expect to help out but not take a full load.

This should never happen to anyone !

Minou:

[oneillk1]

I'd be hitting the want ads. If you are expected to take a full med-surg load, then orientation is in order.

Exactly, the same thing happens where I work, (I am in ICU and have never worked in my hospital before this, my only ward experience was as a new grad for three months in an elective orthopaedic ward, and for the last 3 years worked in OR!!). Fortunately I have not been sent yet but if I am sent and am put into a situation where I feel unsafe, I will be telling everyone about it then and there because at the end of the day I am not prepared to risk my registration because the hospital has staffing issues. I have never been oriented to any of the wards. If worst comes to the worst, I would go off sick. I know that sounds like a terrible attitude but at the end of the day you have to put yourself first because noone else will!

[janetrnc]

In our facility every nurse knows she might get floated but each department has a list of what their nurses are allowed to do when floating. L/D nurses don't take assignments or give meds. Saying they could give meds after looking them up is unreasonable, how many times do med/surg patients have pages and pages of medications? If that is true by the same token then why couldn't a med-surg nurse be expected to float to l/d and take a Mag patient? They can look that up in a drug book! It's all about patient safety. If you are put in that situation you need to say out loud to whomever is in charge "I do not feel safe working here and taking a full load of patients".

[caroladybelle, BSN, RN]

Originally Posted by Bridget O'Malley

Why these nurses can't...take care of an infected foot of a diabetic (as though everyone who delivers a baby and her multitude of visitors is 100% healthy);...is beyond me.

If a nurse cares for patients with active infections, he/she must scrub, shower, and change clothes before returning to OB. This is not feasible, given that an emergency on OB would require the nurse's immediate return.

First, I believe L&D should not be floated to MS without previous orientation. That is just inappropriate.

Second, how come on most MS units, nurses must take care of BOTH infected and immunosuppressed patients in the same assignment?

I recently spent 10 monthes on a hemo malignancies unit in a facility considered one of THE BENCHMARKS of care. These patients are among the severely immunocompromised patients you will see. Some will have ANCs of less than 50 for over 60 days after chemo. Yet on the same unit, and in the SAME assignment, a nurse may/will care for another patient with VRE/MRSA/C-Diff. That is why you adhere strictly to contact precautions, handwashing and universal precautions. Nobody obviously has us shower between patients.

Interestingly, this unit screens all patients for Cdiff/MRSA/VRE. The rates of infection, even in those that come in healthy (new dx) and without histories of chronic disease, are incredibly high. There are a lot of people carrying this illnesses without symptoms.

Yes, it would be nice and optimal to have a nurse only care for clean patients and another have the infected ones. But given the number of "hidden" infections out there, it is not going to happen.

[caroladybelle, BSN, RN]

In our facility every nurse knows she might get floated but each department has a list of what their nurses are allowed to do when floating. L/D nurses don't take assignments or give meds. Saying they could give meds after looking them up is unreasonable, how many times do med/surg patients have pages and pages of medications? If that is true by the same token then why couldn't a med-surg nurse be expected to float to l/d and take a Mag patient? They can look that up in a drug book! It's all about patient safety. If you are put in that situation you need to say out loud to whomever is in charge "I do not feel safe working here and taking a full load of patients".

As an MS nurse, I have been floated to Postpartum and had to take a mag patients.

But my favorite is the fact that many family care units will not take patients that clearly would be better cared for on their unit yet have a MS problem, that they will not care for.

For example, patient that is 8 monthes pregnant gets into an auto accident. She is admitted to ......ortho w/premature labor and a fractured ankle. Why? The family care unit, several blocks down, does not know how to care for a fractured ankle. Patient is on antilabor meds and requires fetal heart tones to be assessed every two hours. MS section DOESN'T EVEN HAVE something to assess fetal heart tones with, much less anyone that could do so. We have to get family care nurse to come down every two hours to assess. But will they accept the patient? No, because of the fractured ankle.

Which is of more ultimate concern to the patient's health? The baby. You can repair the problems w/ a mismanaged ankle much easier than a mismanaged birth.

And, yes, the MS nurses had to look up and give alot drugs that we had no experience with.

As an Onco nurse, there are lots of meds I give that are new to me, that I have to look up. Somehow, we are expected to just deal.

[General E. Speaking, RN, RN]

First, I believe L&D should not be floated to MS without previous orientation. That is just inappropriate.

Second, how come on most MS units, nurses must take care of BOTH infected and immunosuppressed patients in the same assignment?

I recently spent 10 monthes on a hemo malignancies unit in a facility considered one of THE BENCHMARKS of care. These patients are among the severely immunocompromised patients you will see. Some will have ANCs of less than 50 for over 60 days after chemo. Yet on the same unit, and in the SAME assignment, a nurse may/will care for another patient with VRE/MRSA/C-Diff. That is why you adhere strictly to contact precautions, handwashing and universal precautions. Nobody obviously has us shower between patients.

Interestingly, this unit screens all patients for Cdiff/MRSA/VRE. The rates of infection, even in those that come in healthy (new dx) and without histories of chronic disease, are incredibly high. There are a lot of people carrying this illnesses without symptoms.

Yes, it would be nice and optimal to have a nurse only care for clean patients and another have the infected ones. But given the number of "hidden" infections out there, it is not going to happen.

interesting point- so true!

[withasmilelpn]

My guess is that there is a bigger liability issue involved in L&D. Probably we shouldn't be taking care of mixed patient populations (known ones at any rate). Cost is probaly the deciding factor, not good care.