No central monitor?

Specialties Ob/Gyn

Published

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. :o 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. :uhoh3: 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!

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smaller community hospital here too, 60-80 deliveries/month- we don't have central monitoring either, and I don't feel that our patient care is suffering for lack of it. We feel that if a mom needs to be on continuous monitoring, then she needs 1:1 nursing care.

If baby's looking good and mom is just being continuously monitored for an epidural, sure we'll leave the room so mom can get some rest, we'll just go back and check the strip as often as we feel is necessary, at least q 30 minutes but usually more often.

We're going to computer documentation soon, and the ability to have central monitoring is coming with it. I'm afraid that our patient's quality of care IS going to suffer when that comes with certain nurses, who will take advantage of the ability to spend less time in the room. A nurse who started with us last year, who came from a hospital with central monitoring, brags about how she used to be able to do an entire pit induction from the nurses station!

That is not going to fly in our hospital!

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Are all your laboring women on continuous monitoring? I actually don't mind working without central monitoring in regular L&D units (definitely want it in a truly high risk unit) because those women do get one to one care and I do think it cuts down on nurses congregating at the monitor. Are you all not doing intermittent monitoring on your low risk patients? I don't understand. If they expect you to look after 2 women who need continuous fetal monitoring they do need to reevaluate their approach: either one to one nursing (the ideal imo) or central monitoring.

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We don't have central monitoring and I don't mind it. Most of our patients are not high risk, so there is no need for continuous monitoring anyway.

If for some reason I need to be aware of the FHT at all times, I would stay in the room most of the time.

Do you have a lot of high risk patients that you are needing to be continuously aware of the FHT?

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Are all your laboring women on continuous monitoring? I actually don't mind working without central monitoring in regular L&D units (definitely want it in a truly high risk unit) because those women do get one to one care and I do think it cuts down on nurses congregating at the monitor. Are you all not doing intermittent monitoring on your low risk patients? I don't understand. If they expect you to look after 2 women who need continuous fetal monitoring they do need to reevaluate their approach: either one to one nursing (the ideal imo) or central monitoring.

Small rural hospital here too and no central monitoring. Pit inductions are 1:1 but staffing is tough as there are only 9 of us who are also OB nurses. Our regular job is acute nurse or er/sup nurse. So we don't have nurses soley for OB. On the very rare occasion we have two pit inductions, they go in the same room. And the nurse stays in the room with them.

I can see how central monitoring could be helpful for us . . . but most of our moms don't have continuous monitoring anyway. No IV's.

And yes, we use the same monitor belts on the same patients who come in for NST's . . put them in a plastic bag with their names on them. Just seemed sensible to me.

We only have about 10-15 deliveries a month - sometimes a few more but more often less.

steph

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Sorry, I didn't make myself clear. Yes I'm talking about moms who need continuous fetal monitoring, at least that's what the doctors' orders/hospital policy state. Whenever we have a Pitocin induction or membranes are ruptured, our protocol states continuous EFM. You wouldn't mind stepping out of the room for 30 minutes despite if mom is having lates/minimal variability? I feel like I am neglecting a "possible" accident waiting to happen, plus I know that I will be the one blamed if something goes wrong. But then something could be happening with the next mom so I'm torn.

I'm afraid that our patient's quality of care IS going to suffer when that comes with certain nurses, who will take advantage of the ability to spend less time in the room. A nurse who started with us last year, who came from a hospital with central monitoring, brags about how she used to be able to do an entire pit induction from the nurses station!

We actually have a nurse who does not provide bedside care and just goes into the room every few hours and "catches the chart up". You don't need a central monitor to identify a slacker. When I work behind her, I actually have patients tell me how much they appreciate that I stay with them followed by "that nurse last night never came in my room" :uhoh21: Even if we had a central monitor, I would still stay with the patient much of the time because I'm very one on one, AND tend to err on the side of caution with all of my moms, but I would have the peace of mind knowing someone else is there to view the monitor in case something goes wrong (like when I have to take a pee break)

I have 3 kids, ranging in ages from 10-2 yrs and had central monitoring with all of them at different hospitals. I can honestly say I had a happy medium when it came to nursing care. It was nice to have someone there on occasion, but none of my nurses stayed at my bedside constantly and in hindsight, I'm glad. It was nice to have a little privacy every now and then. Of course if something started going wrong, there were about 4 nurses in my room within seconds. Thanks for the input, it's interesting to see what everyone is doing other places. :)

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If they need continuous monitoring (like pit inductions) and there is no central monitoring then they need 1:1 in my opinion.

You have to meet JHACO requirements all the time, not just when they visit.

You have a right to complain. What is happening at your hospital is dangerous.

steph

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Small community hospital here WITH central monitoring. It's wonderful. Our standard is 1:1 nurse-patient ratio in labor. You might want to try and work on that, especially if you do not have central monitoring. Most of our monitors also have telemetry and that's something else your unit might want to consider when and if there are rennovations done. We do not use belts at all. We use the stockinette that comes in a long roll. All used girdles go right in the laundry (except those that are used in a delivery). Those are cut off and thrown away. We do not monitor continuously either. I remember when we did NOT have central monitoring: we just checked the strip frequently if we were not in the room. I hate always being right at the bedside: the pateint and SO never have any provacy that way. That's my favorite thing about central monitoring.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Just for some information: AWHONN Standard states pitocin inductins can be 2:1 (2 patients, one nurse) so central monitoring IS HANDY in many cases. We are doing pitocin inductions EVERY day. And, Ideal versus REAL staffing is also an issue. And yes, I can see where central monitoring can be a crutch for some. As for me, I do nurse patients, not monitors. I never practice any other way. But some are not as diligent or caring, I know. Like stated above, central monitoring does not make us bad nurses,however.

Also where I work, The vast majority of moms (most who have gone thru childbirth preparation) still choose epidural anesthesia,which also requires constant monitoring). I can see where central monitoring for some of us is critical, esp when you realize standards say you can have 2 labor patients per nurse. I would not be without where I work. We do about 70 deliveries a mo, so not a HUGE hospital either.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

JCAHO does not state pitocin indx must be 1:1 that I know of. WE (as OB nurses) are held to AWHONN standards. Again, IDEAL versus REAL must be considered here in the decision to have, or not to have , central monitoring available is considered. I think in the case where realworld situations can be more dicey, it's not a bad thing to have it, if you are going to use the monitors at all!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I agree w/Bets. Sometimes, central monitoring can be a BOON, esp at night. When patients are wanting to sleep (on epidural anesthesia mostly) . I would prefer NOT to enter the room EVERY 15 MINUTES, disturbing everyone in it, to check the strips. That is a distinct advantage w/central monitoring. Also, if you have mom or baby in trouble, and you are doing some sort of resuscitation (fetal decels come to mind), it is nice to have your coworkers notice and come to the bedside w/o your having to scream for help...I have had a bunch of cases like this, where I could not leave the bedside, due to taking care of patient and have people show up to help, based on what they saw on the monitors outside the room! I found that handy many times.

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Sounds to me like your problem has more to do with inadequate staffing than with the lack of central monitors. I also work in a small hospitals, about 20 births a month and we just got central monitoring about 4 years ago. I do love it and can't really remember how we got by without it, but we did...

BUT, pit inductions without central monitoring should be 1:1. You just have to be able to watch that strip. However, low risk stuff that can be done with intermittent monitoring does not require that. Also, there is no reason that all pts with ruptured membranes need to be monitored contiuously. That's just crazy...

Do I understand you correctly that you don't have another RN there with you when you have somebody in labor? You are staffed with just 1 RN and an LPN for backup? This is the part that worries me most! Even if you had central monitoring, who is going to see the strip and come help??? We staff with just 1 on if there's nobody in labor, say just 1 mom/baby but if there is anything at all going on we always have 2 RNs that can do labor! Sounds like you need to work on your staffing... and that your NM doesn't really get it...

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