Nurse manager says you can't refuse iv

[paintedbison]

This is at a hospital a friend of mine works at. She said the nurse manager in L&D says you can't refuse an iv access in labor. She said you can refuse the fluids, but not the iv access. Is their any truth to this whatsoever? I don't see how this can possibly be legally correct...

[Batman24]

I am an IV nurse. When a patient who is mentally competant refuses an IV, I definitely do not put one in. I could get charged with battery.

Good advice. I wouldn't put one in either. I'm not risking my license nor am I going to put myself into a position where I could be charged. They have the right to refuse.

[Blee O'Myacin, BSN, RN]

I think that in an L&D situation, I'd call the patient's doc if she was refusing an IV. No IV means no epidural...etc. As long as the doc goes along and is informed, then I see no reason to push the issue this way there's no confusion when the doc comes in, the patient is ready to push and there is no IV.

If your NM wants to make a policy where no one can refuse IVs, then perhaps she needs to talk to each patient refusing them and put them in herself. Refusal by an A&O patient means that I keep my hands and needles to myself!

Blee

[HappyNurse2005, RN]

OB is different than any other part of the hospital as far as refusing IV's. In most other parts of the hospital, the patient is actually sick and needs meds/fluids/etc. In OB, most women aren't sick and don't NEED meds or fluids.

THey can refuse anything anything they darn well want to and we can' do anything about it. I can tell them why we usually do IV's, offer just a heplock, but if they refuse it all, then thats okay. ONly the rare few have refused every needle. Many refuse IV fluids.

Honestly, most women who have babies are relatively young (40 or under) and could have an IV popped in quickly in an emergency, should the need arise.

[shortstuff31117]

Of course someone can refuse any procedure. I remind my pts. of this when I take over their care. This is all about educating people.

Besides, are you going to hold someone down and jam an IV into their arm?

[MIcrunchyRN]

ROFL your nurse manager is in for one hell of a lawsuit if patients are told they HAVE to have one even if they refuse. I wouldn't touch that with a ten foot pole....

Haha that's like saying when you go to the grocery store you HAVE to buy a pop and candy bar each visit. (not the best analogy I know).

Oh boy what hospital is this so I can remember to stay far away if I ever have another baby

[zyna15]

Where I work we never put IVs upon admission, unless the pt is GBS+ and needs antibiotics, or it's a VBAC. I put hep lock to pt who say they will want an epidural, and none to the others. Whenever they ask for it (the epidural), then I put the IV on.. Those 5 minutes are usually not that much of a deal for my pts, and the pain of labor drives them away from the «pain» of catheter insertion...

[SmilingBluEyes]

Any competent person can refuse any procedure. Your manager has no leg to stand on and may really get in trouble for this. I want to know; what do your midwives/MDs have to say?

[Satori77, ADN]

When I was in labor with my daughter, I was GBS+ and needed abs. With my son, I just got a heplock, I didn't feel fluids were necessary (but I understood why access was important). As far as the consent form, next to where I signed my name, I wrote out that I had to expressly give permission on EVERY procedure beforehand, and if I was unable, then my husband had to. The nurses were not happy about this at the first birth (teaching hospital, but with my son at a different hospital, they didn't even bat an eye). Oh, and I did this at the insistance of my mom, who is a nurse.

[eden]

They certainly have the right to refuse IV access. Now in the US I know many say that it is a liability to not have one but in canada where I work we have many a person without IV access and we have never had a problem getting access when needed.

We do have criteria for those who must have IV access but it is certainly not mandatory.

[ruralnurs]

In my small facility it is definitely an option not mandated. I teach the CB classes and even with moms that come in that did not come to my class I give them my speech:

You do not have to have an IV, if you want pain meds, you have to have an IV, if you want an epidural you have to have an IV, if somethings goes bad and we need to save you or your baby, you have to have an IV, so ask yourself....Would it be easier for you sit still for an IV insertion when you are scared or in pain and when things are rockin' and rolin', or now when things are a bit more quiet?

I remind them that no one will put anything into the IV without their permission. Usually they want the lock.

I agree that an IV can usually be popped in pretty quickly but I have had some women that are very fluffy or with edema or a bit of a drama queen that I would not relish the idea of trying to put one in when she is in pain or things are circling the drain.

[MomX2andNurse]

If you do ANYTHING to a pt they dont want, they can get you for assault.

[SmilingBluEyes]

Our docs want everyone saline-locked upon admission. I teach in the childbirth classes this is their preference and if they have other plans or wishes, they should discuss these with their care providers long before they come in labor. We have had those that refuse and as said before me, that is not only their right, but you have to respect it. You CAN have them sign AMA paperwork, upon refusal of procedures required by policy. That really is about all you CAN do. That manager surely knows this.