Newborn Resuscitation in the absence of a Peds Provider

[USNRN309]

I am an RN in a Level II Nursery. Occasionally, our peds provider does not stay in house while on call. The labor deck we request a nursery nurse to be in attendance for deliveries the suspect will require resuscitation (such a mec staining). While they usually have paged the doctor to come in, one of us from the nursery usually ends up attending because the doctor has not arrived in time. All L&D and nursery staff have completed the NRP certifications, but how much of a risk are we taking with our license, since we have no doctor in house? And, since the L&D nurses have as much resuscitation certification, would it be unreasonable for them to simply use their additional staff (they frequently have twice as much staff as we do in the nursery)? I have also been told that until a pediatrician arrives to care for the infant, the baby remains under the legal care of the midwife or OB delivering.

It all seems like a giant lawsuit waiting to happen. I've discussed my concerns more than once with my chain of command, but so far, no changes in getting our doctors to stay in the hospital when they have the pager. Any advice?

[Mimi2RN, ASN, RN]

Until we had inhouse pediatric hospitalists, we attended all mec deliveries, with an RT. The labor nurses can do NALS, but have their hands full with the delivery, and the baby benefits from the care of level II nurses.

Sometimes the OB would try to visualize below the cords, but not many of them would try.

We brought more babies back to the nursery for observation than we do now, but most of the mec babies did fine, with or without a ped in attendence. Most of the private practice peds had little practice with intubation, and were very happy when we got the hospitalists.