er vs. ob the battle goes on sort of

[imenid37]

i truly don't know how to make this short, but i'll try.

i work in ob in a small community hospital. we are a level one facility w/ no ob dr. in house after hours. if we need the dr we call him or her at night and they come in. if it's a big problem, they are almost always very good about coming in.

we triage or should i say we did for things like r/o labour, ptl ,uti's, etc. for awhile, we like most other similar units were getting pt's from the er w/things like "i have bronchitis, but i am six months pregnant." so up to ob they go. we even got a spanish speaker who was thought to be pregnant (because she had a round belly) and looked to be in pain. turned out she was 10 weeks w/ constipation. this went on for years as it does in many hospitals and yes it was irritating.

Now our er triages pregnant pt's unless they are at term and appear to be in labour. this is very troubling to me. no, i don't want to see your broken arm if you are six months pregnant and otherwise o.k., but this weekend was a real eye-opener to me. they had not let our staff in on the policy change yet, but the er knew about it.

i get a call from the er about a lady 25 weeks w/ cramping and bleeding. they are asking if the ob dr. happens to be in the house. no he is not. o.k. we'll see her and then maybe we'll send her up to you. her ob physician comes to our hospital,btw. huh? to me she needs efm and a ve. maybe she's in ptl. hard to evaluate w/o monitoring and ve unles dr. (hahaha) or er nurse (she's got all the time in the world right?) is gonna stand there and palpate uc's. i thought this was totally bizarre that they were keeping this pt., but i offerrred to send down the prenatals, but they didn't think they needed them. (in mean time i called ob dr. on call who informs me this is the NEW policy, but he is not as angry w/ me as he could've been considering i woke him up at 00:30)so they keep her for about 30-45 min. and send her to be monitored. bleeding is very miniscule and occurred a few days ago and has mostly resolved. they did spec exam and cervix was closed. she c/o cramping, but i don't see and can't palpate uc's. i po hydrate her. they get better, but she still feels a little lower abd. crampiness. so i call er and ask to send clean caught uac on the off chance she has a uti. well why? i was just told to monitor her. that's all. why do i think i have to do anything else for her. (not that the er dr. interprets the strip. ob dr looks at it the next a.m.) then i go through the whole explanation of how and why a uti could cause these sx's. why is er dr. tx'ing pt. if he doesn't know uti could cause this? scary to me.

next pt. is a very young young girl in the early third trimester w/bleeding and cramping after intercourse. they triage her too. she is losing her baby. spec. exam shows bulging membranes. we get her. she delivers for ob dr. ob dr. was called by er (nice for us) and arrives just after we get pt.

is anyone else doing this now too? am i way off to think if they have a pregnancy problem we should be seeing them. this is what we do after all. this is our area of expertise. management says it has to do w/ new emtala rules. please share your thoughts...

[mark_LD_RN]

Originally posted by luv l&d

Over 20 weeks they come to us. Even had on at 30 wks with acute MI come to us. Sent her right to tele. They had a fit, but the supervisor agreed with me. Honest to Pete, what do they think we are???

same way here! supposedly anything over 20 wks comes right to us if cleared by us they go to er. usually er just keeps sending them back like its the plaque or something

[mark_LD_RN]

Originally posted by bagladyrn

deespoohbear - regarding the term stillborn delivery - it's not unusual for mothers who have lost a child to be moved off OB, especially if they express that preference. Sometimes being within hearing range of mothers and babies is just too much for them. However, I think your OB staff should have come over for fundal checks, etc. to help out.

that how its been done at all the hospitals i have been at. If i send a pt to medical like that i make sure i show the nurse how to check the fundus and what to look for.also let them know they can call me for help anytime. i also go check on them occasionally myself

[deespoohbear]

Originally posted by bagladyrn

deespoohbear - regarding the term stillborn delivery - it's not unusual for mothers who have lost a child to be moved off OB, especially if they express that preference. Sometimes being within hearing range of mothers and babies is just too much for them. However, I think your OB staff should have come over for fundal checks, etc. to help out.

That's the problem though. The OB staff does NOT come and check them. The only time I did OB was during my clinical time during college which is close to 10 years ago. I agree that any woman who has lost a baby should not be put on an OB floor with crying babies but she needs to be somewhere in the facility where the nurses caring for her know what they are doing!! Our administration still has the mentality that a nurse is a nurse is a nurse....

[SmilingBluEyes]

Originally posted by deespoohbear

That's the problem though. The OB staff does NOT come and check them. The only time I did OB was during my clinical time during college which is close to 10 years ago. I agree that any woman who has lost a baby should not be put on an OB floor with crying babies but she needs to be somewhere in the facility where the nurses caring for her know what they are doing!! Our administration still has the mentality that a nurse is a nurse is a nurse....

Frustrating huh? I hear you, I do. See, when we (OB) are slow, we are being expected to take increasingly complex med/surg patients. The one we had yesterday had tubes all over. It frustrates us on our end when we are so out of practice and sync with such care. We are getting GI surgicals, (some of which get complicated, like the bowel herniation we had who was with us 10 days). It becomes particulary bad when we DO get labor patients and have to constantly shift nurses and priorities to meet all these demands. Mixing newborns/moms and med/surg patients on one floor can be a nightmare, I tell you. But the mentality is the same ... a nurse is a nurse is a nurse and a bed is a bed, just get one, any one, if she is female. I am certainly having to brush up on some long-forgotten med/surg cares and meds. Yep, frustrating.

[deespoohbear]

Gee, our OB department wouldn't even consider taking a med-surg patient....unless it is one of their own who is having a hysterctomy or some other female surgery....once they took the son of one their nurses when he had his tonsils out...I don't think they should be able to pick and choose who they get as patients and especially if it is non-OB....this has been a sore spot between our dept and OB as long as I have been at this hospital....

[nursenoelle]

Our policy (supposedly) is that we only get them if they are > 20 weeks with pg related sx. That is usually not the case I get called down alot to ER for triage and to check FHT's. We started triaging down there d/t the fact that they would send us every little thing.

Regarding the med/surg issue the battle is between us and admin. We want the preggers with med surge related probs at least in PP so that they can be monitored properly. We are also a closed unit,not floating out due to potetial of cross- contamination of VRE,MRSA, etc. We go through that fight war about q 2 wks. There are solutions, we come to them , but never adhere to them.

[AlaskaKat]

I also work in a small community hospital OB department. We see almost all prego pts over 16 weeks. If they are there for something unrelated to pregnancy, we will sometimes go to the ER to "clear her OBwise", or sometimes she will come here first to get evaluated and then sent to the ER for treatment. But, they never sit in the ER if they have any pregnancy related symptoms. The ER nurses wouldn't have it and neither would we! It is crazy to have ER nurses triaging OB patients for ptl and such unless they also have OB training!

[cindyln]

Originally posted by deespoohbear

I also work in a small hospital, except I work med/surg, not OB. Over the weekend we had a situation where a mother delivered a full term stillborn infant at home but the placenta never delivered. She was brought to the hospital and into surgery for removal of the placenta. By the time surgery is over, she is about 6 hours post-partum. Guess what floor got her? Med/surg. Not OB. Why? I have no freakin' idea but I wouldn't know where the fundus was suppose to be if it came up and slapped me. Our facility is just the opposite. Unless the patient is full term and ready to go, OB doesn't want them. (they will take pre-term labors). Otherwise our floor gets them. One time we had a woman who was pregnant with twins 34 weeks along. She was having abd pain but the pain wasn't contractions. We begged the doctor to put her in OB for EFM monitoring. His reply was, her problem isn't OB related. Maybe not, but sure as hell could be real quick. Ended up having the woman transfered to a facility with a NICU-the woman had an acute appendicitis.....go figure. And another time we had a lady who delivered at home and ruptured her uterus during delivery. Guess what department got her? Med/Surg.

My theory is if the woman is far enough along that the baby is viable and she is not contagious she should go to OB (unless it is something critical such as the MI mentioned in a previous post). Just as an OB nurse doesn't know what to do with an MI patient, I sure don't know diddly about OB....just my .02 worth....

That patient would have been admitted to our Med/Surg floor also. The last place a woman who has just delivered a stillborn wants to be is on a floor where she will be hearing new healthy babies crying and seeing happy new families.We admit all miscarriages and stillbirths women to med/surg floor.

[mother/babyRN, RN]

Guess it happens everywhere...

[ShandyLynnRN, BSN, RN]

We don't put our IUFD's on a different floor. We try to move them as far away from the postpartum occupied rooms as possible, but our docs want them on our unit, where we know how to care for them. Also, in a way it is nice for them to be cared for by staff that has dealt with IUFD's instead of on a busy med/surg floor where they probably can't get as much one on one with the nurses just because of staffing issues.

I'm sure if they would want to be moved off the OB unit, the docs wouldn't have a prob with it, but I do agree that the nurses on the med/surg floors are not comfortable dealing with OB patients. Just as I am not comfortable when I get floated to ICU or ER.

[winewinn]

From another standpoint, since the woman just delivered a stillborn infant, it could have been easier on her emotionally at the time to not be around other women with newborns or near the nursery...

I also work in a small hospital, except I work med/surg, not OB. Over the weekend we had a situation where a mother delivered a full term stillborn infant at home but the placenta never delivered. She was brought to the hospital and into surgery for removal of the placenta. By the time surgery is over, she is about 6 hours post-partum. Guess what floor got her? Med/surg. Not OB. Why? I have no freakin' idea but I wouldn't know where the fundus was suppose to be if it came up and slapped me. Our facility is just the opposite. Unless the patient is full term and ready to go, OB doesn't want them. (they will take pre-term labors). Otherwise our floor gets them. One time we had a woman who was pregnant with twins 34 weeks along. She was having abd pain but the pain wasn't contractions. We begged the doctor to put her in OB for EFM monitoring. His reply was, her problem isn't OB related. Maybe not, but sure as hell could be real quick. Ended up having the woman transfered to a facility with a NICU-the woman had an acute appendicitis.....go figure. And another time we had a lady who delivered at home and ruptured her uterus during delivery. Guess what department got her? Med/Surg.

My theory is if the woman is far enough along that the baby is viable and she is not contagious she should go to OB (unless it is something critical such as the MI mentioned in a previous post). Just as an OB nurse doesn't know what to do with an MI patient, I sure don't know diddly about OB....just my .02 worth....

[SmilingBluEyes]

From another standpoint, since the woman just delivered a stillborn infant, it could have been easier on her emotionally at the time to not be around other women with newborns or near the nursery...

that would depend on the individual. We care for woman who have lost pregnancies often. Often Mother/baby nurses do this cause it's one of the things we are best trained to do, and in a more conducive environment, than, say, ED. We are trained in helping with the grieving process unique to parents losing their unborn babies or newborns. It's what we do.

But if a person absolutely refuses to go to OB, it's understood and respected. It seems many choose to come to our unit, anyhow.