I work in a small community hospital and our fetal monitors are dinosaurs with NO central monitor. Well, recently we received the good news that we would be getting new monitors and I immediately ASSumed that we would also be getting a central monitoring system too. Well, I was wrong. Let me explain to you our current system, you may be utterly amazed. It is not at all uncommon for us to have 3-4 laboring moms in "the back" at once, the back is our labor rooms. Now I know this is not a lot for many of you that have 100+ deliveries/month, but remember, we are a very small hospital. So since we have no way of monitoring them on a central monitor, we have to keep their doors propped open so that we can be in earshot of the fetal HR. The majority of the time, if I only have 1 patient, I just remain in the room with the patient the entire time *sigh* so that I can closely monitor, or I stand right outside the doorway if I feel like she is absolutely sick to death of me...I would hate having a nurse at my bedside every second. But when I have 2 patients and have to go between, this becomes a huge problem and I'm not at all comfortable with this practice. Sometimes, if mom in room #2 requires a cervical check, bedpan, etc, this of course entails me closing her door to provide for privacy and I can no longer hear mom in room #1's FHR. Now not that their doors shouldn't be shut anyways, my gosh this is a huge breech of privacy but what else can be done when no one else is around? Occasionally, there is a backup nurse to assist, but many times, she is tied up in the nursery with a baby, or out on the post partum floor and unavailable. And our "backup" nurses are LPN's and they haven't been trained as much in laboring a patient, their biggest role is to catch baby at delivery and care for it pp. So I have complained to the manager to no avail, her hands are really tied because the CFO will not okay the expenditures to update our unit to current standards, what a joke. :angryfire He won't be blamed in a lawsuit if someone's baby dies because of inadequate monitoring. So JCAHO visits a couple of weeks back...prior to them coming I find perfect opportunity to point out to my manager that we are going to get nailed on the privacy issue with the laboring mom's doors being wide open. She says the days JCAHO is there we will be adequately staffed so that each patient has a nurse at the bedside so that the door can be closed. :angryfire Okay, so why can't we be adequately staffed at all times? Does this seem ridiculous to anyone but me? I came from a hospital with central monitoring prior to this job and this just seems like the stone ages to me. Maybe I was just spoiled?? I don't think so. I remember from nursing school over 13 years ago the hospital that I did my L & D clinical rotation had central monitoring, so this is not a new trend...seems like my hospital should have had time to get current. I've only been working in L & D for a year. I feel like I'm performing a juggling act at times, it's not fair to the patient who is getting substandard care, and it's not fair that I have to place my license on the line like this. Is this going on anywhere else? If so, please let me know so that I will know this isn't uncommon. If not, what can I do as a lowly staff nurse to change the current standards? I don't want to go over anyone's head, it seems like there should be something to persuade people into thinking differently. I just feel that if there were more awareness of all that could go wrong and the liability the hospital is facing because of lack of appropriate technology, then perhaps things WOULD be different. Maybe not, I don't know. There is so much emphasis on cutting costs there, you wouldn't believe some of the things we have to do. We actually save our monitor belts from moms that come in with UTI's or pre-term labor...we put them in a plastic bag with their name and hospital number on them and reuse them at a later date. (Same patient of course) :rotfl: I realize that a small community hospital has to be more frugal because of type/lack of payment sources, but to cut costs in such an important area doesn't make sense to me (talking about the monitors here not the belts) Oh and one more thing, I was told when I first became employed there and questioned why there wasn't central monitoring, it was because upper management as well as some of the docs believed that our moms got better care without central monitoring because it forces the nurse to constantly be at the bedside. :uhoh21: Uh, yeah it does that all right but it's not reality to be there every second, and sometimes it's seconds that can make a difference. What do you think? Suggestions are very much welcomed!
I miss central monitoring too but mostly because you can chart in real time and see what is going on while you are in another room and thus, chart that you saw the strip. We did it before central monitoring and now I am at a small town hospital that doesn't use it either. I miss it but can deal with it. Took awhile though. I much prefer it.
Let me explain to you our current system, you may be utterly amazed. It is not at all uncommon for us to have 3-4 laboring moms in "the back" at once, the back is our labor rooms. Now I know this is not a lot for many of you that have 100+ deliveries/month, but remember, we are a very small hospital. So since we have no way of monitoring them on a central monitor, we have to keep their doors propped open so that we can be in earshot of the fetal HR. 
The majority of the time, if I only have 1 patient, I just remain in the room with the patient the entire time *sigh* so that I can closely monitor, or I stand right outside the doorway if I feel like she is absolutely sick to death of me...I would hate having a nurse at my bedside every second. But when I have 2 patients and have to go between, this becomes a huge problem and I'm not at all comfortable with this practice. Sometimes, if mom in room #2 requires a cervical check, bedpan, etc, this of course entails me closing her door to provide for privacy and I can no longer hear mom in room #1's FHR. Now not that their doors shouldn't be shut anyways, my gosh this is a huge breech of privacy but what else can be done when no one else is around? Occasionally, there is a backup nurse to assist, but many times, she is tied up in the nursery with a baby, or out on the post partum floor and unavailable. And our "backup" nurses are LPN's and they haven't been trained as much in laboring a patient, their biggest role is to catch baby at delivery and care for it pp. So I have complained to the manager to no avail, her hands are really tied because the CFO will not okay the expenditures to update our unit to current standards, what a joke. :angryfire He won't be blamed in a lawsuit if someone's baby dies because of inadequate monitoring. So JCAHO visits a couple of weeks back...prior to them coming I find perfect opportunity to point out to my manager that we are going to get nailed on the privacy issue with the laboring mom's doors being wide open. She says the days JCAHO is there we will be adequately staffed so that each patient has a nurse at the bedside so that the door can be closed. :angryfire Okay, so why can't we be adequately staffed at all times? Does this seem ridiculous to anyone but me? I came from a hospital with central monitoring prior to this job and this just seems like the stone ages to me. Maybe I was just spoiled?? I don't think so. I remember from nursing school over 13 years ago the hospital that I did my L & D clinical rotation had central monitoring, so this is not a new trend...seems like my hospital should have had time to get current. I've only been working in L & D for a year. I feel like I'm performing a juggling act at times, it's not fair to the patient who is getting substandard care, and it's not fair that I have to place my license on the line like this. Is this going on anywhere else? If so, please let me know so that I will know this isn't uncommon. If not, what can I do as a lowly staff nurse to change the current standards? I don't want to go over anyone's head, it seems like there should be something to persuade people into thinking differently. I just feel that if there were more awareness of all that could go wrong and the liability the hospital is facing because of lack of appropriate technology, then perhaps things WOULD be different. Maybe not, I don't know. There is so much emphasis on cutting costs there, you wouldn't believe some of the things we have to do. We actually save our monitor belts from moms that come in with UTI's or pre-term labor...we put them in a plastic bag with their name and hospital number on them and reuse them at a later date. (Same patient of course) :rotfl: I realize that a small community hospital has to be more frugal because of type/lack of payment sources, but to cut costs in such an important area doesn't make sense to me (talking about the monitors here not the belts) Oh and one more thing, I was told when I first became employed there and questioned why there wasn't central monitoring, it was because upper management as well as some of the docs believed that our moms got better care without central monitoring because it forces the nurse to constantly be at the bedside. :uhoh21: Uh, yeah it does that all right but it's not reality to be there every second, and sometimes it's seconds that can make a difference. What do you think? Suggestions are very much welcomed!
Mermaid4
281 Posts
I miss central monitoring too but mostly because you can chart in real time and see what is going on while you are in another room and thus, chart that you saw the strip. We did it before central monitoring and now I am at a small town hospital that doesn't use it either. I miss it but can deal with it. Took awhile though. I much prefer it.