Another OB Problem

mother/babyRN, RN · Nov 15, 2002

I think it can be like this in any facility. It takes a strong person and advocate to keep "bugging" people. I might have told the CNM that I was uncomfortable with her choice of sending the pt home, given the circumstances, and then asked if she had signed a VBAC consent form. If,after saying that to her, she continued to elect to send the pt home, I would have mentioned that I needed to contact the OB for my own peace of mind. And, I would have typed (via computer) or written (via hollister), the exact gist of the conversation prefacing the missive with, "So and so given report and made aware of xyz factors, inclusive of..." You are also liable in a court of law if something inappropriate is done against the standards of accepted care, and believe me, having been in the position of having to go over someones head ( in this case, another MD), it IS nerve wracking, but nothing matches the satisfaction of knowing that you did your absolute best to advocate for the woman , her baby, and ultimately, the entire family..You are an asset to your facility, and eventually you will garnish respect by doing what you feel is just for the pt. It sometimes takes a while, and there is wisdom in time spent refining your approach to people with varied personalities and confidence. Take care...Keep up the good work...

SCB · Nov 15, 2002

The CNM and the charge nurse both knew of my intentions to show the strip to the OB. I told them.

SCB

SCB · Nov 15, 2002

Another CNM nightmare. Yesterday I was helping a CNM in a delivery. The baby had a thight cord around its neck and delivered before the cord could be reduced or cut. The baby was placed on the mothers abdomen, blue and floppy. The infant did not respond to stimulation. I told the CNM to cut the cord three times. This CNM had to take the time to get the cord in a position to place the plastic clamp, then a hemostat, then cut the cord. I have to give PPV for 45 seconds before the baby started up on its own. What a fricken nightmare. I could have slapped this CNM. So I took time to cool off while providing care to the family.

I had a monster of a headache.

The family was Mexican farm workers. This is the population the CNM's serve. I went to CNM to discuss the delivery. I told her that some day, something bad was going to happen and it's going to wind up in court. She said to me "these people are so illiterate they would not how to sue". I walked away.

My conculsion: It's o.k. to provide poor care to poor, uneducated people. It's assumed they are to stupid to sue.

Also as being lower on the food chain as an RN in a CNM world I stand a great chance of being dumped on in a court of law, while they try to save themselves.

This makes me sick, and is far off from my values, morals, and standards of care.

SCB

bagladyrn, RN · Nov 15, 2002

The "Our population doesn't sue" sets my teeth on edge!! When I have a doc or CNM doing crap like this, I chart, sometimes repeatedly, "J.Doe CNM informed of (list all pertinent data in detail). No new orders received. Or discharge order received. This way there can be no later question that I told the provider everything they needed concerning this pt., because you're right, it does roll downhill! And I'm not the least hesitant to call up the chain of command - as I told one CRNA - that's part of my job as pt. advocate - get over it!

anitame · Nov 15, 2002

Wow susan, that's incredible. I'm SOOO surprised to hear all the negative CNM stories. I have only worked with three CNMs but they are ALL highly respected and treat nurses and patients with respect.

SCB · Nov 15, 2002

I need to hear some positive things about CNM's. Right now my view of them is not nice. The other nurses rationalize things, or believe that good charting is the way to go. I disagree. While good charting (may) save your backside, you still are involved in a situation that did not have to happen.

This is not easy for me. I work with nurses who are problems, and CNM's who are problems as well. I'm in the wrong place, and don't fit in. My patients keep me going, and beliving in myself. I get many thank you's, and have even received cards and flowers a few times. These patients have no idea how much it means to me. I can't wait to get another job. I'll miss some of the other nurses as we have become friends over the 9 months I worked there. I hope they move on as well.

I can see things happening once in a while that are questionable, we are human and mistakes are unavoidable. But, everyday, every time I work. Thats a bit much. I only work 9 days a month.

SmilingBluEyes · Nov 15, 2002

Susan where the HECK is your manager in all this? The house supervisor? This is disgraceful and turns my stomach. I would document, document, document. I am so sorry for the very UNenviable position you find yourself in. These CNM's need to be slapped. And I daresay, they must be an exception to the rule...all the CNMs I have worked with would never EVER behave in this manner, let alone verbalized the outright disdain for a populace yours did. REPORT THIS!

SCB · Nov 18, 2002

It has become obvious to me that the RN is powerless in this work situation. I refuse to join the others in keeping my mouth shut. The manager is disconected and powerless. The other day we had an OB doctor section a woman who's amnio result showed questionable fetal lung maturity. This woman was 100% healthy in her pregnancy, she was just tired of being pregnant. No one told this woman of her test results. The infant is in the NICU some 20 miles away. I'm so glad my name is not on that chart. If I had been her nurse I would have told her what her test results showed, what they mean to her and her baby, and I would have documented it. Her nurse knew all of this and said nothing. Her nurse only served as the hand maid in the section.

moz · Nov 18, 2002

You SO did the right thing! I would look for a job elsewhere, I know crap happens everywhere, but it won't get better without a nurse manager to back you, to be your advocate.

NurseDennie, BSN, RN · Nov 18, 2002

Originally posted by SCB
She said to me "these people are so illiterate they would not how to sue". I walked away.
SCB

I'm so impressed with your restraint. I'd want to slap her face.

What an ig-no-raym-uss

Love

Dennie

moz · Nov 18, 2002

Originally posted by SCB
The family was Mexican farm workers. This is the population the CNM's serve. I went to CNM to discuss the delivery. I told her that some day, something bad was going to happen and it's going to wind up in court. She said to me "these people are so illiterate they would not how to sue". I walked away.
My conculsion: It's o.k. to provide poor care to poor, uneducated people. It's assumed they are to stupid to sue.
Also as being lower on the food chain as an RN in a CNM world I stand a great chance of being dumped on in a court of law, while they try to save themselves.
This makes me sick, and is far off from my values, morals, and standards of care.
SCB [/b]

I can't believe someone would actually SAY that...its one thing to think it...

Recently we had a 19yr old, G1, no English, no pnc, just moved here from Guatemala. Very quiet, poor eye contact, day nurses labored her and suspected abuse. The on call doc wouldn't order any abts to tx unknown gbs status; and would not order ANY pain med in labor because "we don't know her history". I brought up the suspected abuse and he stated "all the women down there are treated that way, their husbands can sleep with twelve yr old girls if they wanted to and nothing would be said about it.":( In other words, lets punish her for having no pnc and being hispanic.

SCB · Nov 18, 2002

I have a loss of respect for the people who think this way. How would they like to be in another country, receiving medical care, but no one cares.