Did I overreact or underreact?

[eden]

I had a patient who SROM'd but not contracting so it was decided to induce her. IV was started and we had just started the pit( I mean seriously like one minute before) when on the monitor popped up a FHR of 60. I thought I must have been oicking up mom so I had her go side to side to try and pick up baby, no difference so I fiddled for another 30 sec, still the same. I took mom's pulse and it was 90's. At that point I inceased the iv stopped the pit, added some O2 and hit the emergency bell to get some help. Sill not recovering sufficently after contiuing to switch positions, ob staff was in at this point. It took 10 minutes for FHR to recover and the decsion was made to transfer her to high risk for closer monitoring.

Then a few days later I was brought in for an evaluation at work and I was told that I was a very capable nurse but that I did not know how quite to act in an emergency. I'm starting to doubt whether this is the place for me.

In the above situation did I react too slowly or would this have been percieved as panicking?? I mean when I knew it was baby my heart was racing but at the time I thought I reacted appropriatly. Then I got called in. Isn't the point of an emergency call bell too get help fast. I thought this would have qualified as emergent. Advice would be greatly appeciated.

[Mulan]

Is that all that was said? No clarification as to what she meant by that or what you should have done instead? I know it's hard to think of what to say at the time but if she didn't elaborate maybe you should ask for further clarification as to what you should have done.

[eden]

No, no clarification was given. It was my fist job evaluation since starting. I suppose tonight I will read the emergency procedure manual if I have a quiet moment.

[Selke]

Something doesn't smell right here. Was the pt contracting when the decel occurred? If so, what was the relation of the decel to the UC? What did the tracing look like prior to this? Was an AFI done? You didn't give a lot of information.

From what little information you gave it sounds like the cord might have been compressed, like the baby rolled onto the cord or squeezed it, and because the amniotic fluid was low, there was a decel in response to the compression, which recovered after the compression was removed. It seems like you responded appropriately if this is the case; you didn't "do anything" to cause this decel and pit wasn't responsible either. I also think it's appropriate to use the emergency call light especially if there is no central monitoring and no other way to alert others there may be an emergency in the works. A FHR in the 60's is not to be second guessed and it is appropriate and within your scope of practice to call for help, alert the provider, and do the interventions you did.

Are you new at OB? If they think you don't know how to react in an "emergency" then challenge them to tell you what you did incorrectly and to teach you the "right" way. It's their job.

[eden]

I've been in ob for 1 1/2 years. Mom was having irregular contractions at the time. Efm had been implemented 20 or so minutes and the tracing looked ok. There was good variablility , no accels but no late decels. A scalp clip was put on. I did find out she ended up a crash section several hours later, it was a tight nuchal cord X3. I was sure the pit was not the problem since it would not even have had time to reach her.

[Selke]

I've been in ob for 1 1/2 years. Mom was having irregular contractions at the time. Efm had been implemented 20 or so minutes and the tracing looked ok. There was good variablility , no accels but no late decels. A scalp clip was put on. I did find out she ended up a crash section several hours later, it was a tight nuchal cord X3. I was sure the pit was not the problem since it would not even have had time to reach her.

Doesn't sound like you did anything wrong. That kid would have kept decelling with a triple nuchal cord .... Do you have a union at your hospital? I hope so -- you need a rep. If not, is there anyone else who can be your advocate to go into this meeting with you? Seems like either incompetent management, or someone wants you out of the unit, or something. Stand your ground and tell them you want to know their reasons for stating you gave inadequate care and what do they think you should have done instead. Look up AWHONN and other standards of care (my books are packed away at the moment but this was covered in my EFM certification exam). Michelle Murray's book I think discussed appropriate action with bad strips. So do the strong perifax modules.

Good luck and keep us updated.

[rpbear]

It sounds like you did the right thing. The only difference that I see at our facility is that you need a reactive strip before starting pit. But if the MD is aware of the strip he/she can order to start pitocin anyway. You did exactly what I would have done. You need some clarification like others have said, if they don't think that you responded appropriately then they need to tell you what you should have done differently.

[NurseNora, BSN, RN]

Are you sure this is the emergency situation your manager was referring to? You did all the right stuff. I might have stopped the pit and increased the IV as I was starting to change her position rather than waiting to see if the position change helped, but your responses were all correct and timely. You do need to discuss the evaluation further. In what way does she want you to improve your responses to emergencies? You can't learn and improve your practice with vague generalizations like that

[LilPeanut, MSN, RN, NP]

The only thing I can think of is maybe they wanted you to hit the regular call, not the emergency?

In some of the hospitals, hitting the emergency call can essentially trigger a code blue.

You definitely need to ask for specifics.