PT. advocacy- Was I out of line?

Specialties Ob/Gyn

Published

I really need your help here guys- pt. came in c/o srom. Nitrazine was +, no doubt. Orders to pit her were received, vag cx obtained. At the end of the day the doc on call for the weekend came in, did an ultrasound and vag exam and said pt. was not ruptured. No fern test was done. Pit was cut off, pt watched all night then sent home. The next day (48 hrs after ?srom) pt came bak with c/o leaking fluid, temp of 100.7 night before. Temp now was 97.9, pulse 130's. FHT's 160/170 with decrease variablity but reactive at times. Doc got cbc which show white count had double from 2 days before and was now 27,000. Vag culture for 2 days before was + for group B. She was nitrazined and neg. She is also 41 weeks and 3cm dilated.

Doc on call wrote prescription for antibiotics and gave orders to d/c to home. At my facility 2 Rn's must sign the strip before the pt is d/c'd. This pt belong to my charge nurse and I would not sign the strip because I did not think she should go home.

The partner of the doc on call was notified of the situation by my charge nurse. He ended up taking over care for this pt. Well the doc on call let me have it. Among all the things he said to me was that I should resign and I did not belong in L&D. You can only imagine all the other things he said to me as he stomped around shouting and pointing his finger.

Anyways- The pt was induced and followed by the on call doc's partner. Was I out of line? I felt like I was being an advocate for the pt and her baby. I just could not live with myself if she had gone home and came back with a dead baby. Please give me your opinions. Thanks, LDRN

Specializes in cardiac, diabetes, OB/GYN.

One of the most difficult things I have ever had to do as a nurse ( and it has, unfortunatly, occurred several times), is put my job on the line, go in to a room, close the door and outright beg a patient and his or her family to demand appropriate treatment or a transfer. It is scary. Your heart rate and stress level increase. Confrontation with people/staff who totally disagree can be terrifying. In the end, if I had the life of a patient on one hand, and my job and some unpleasant backlash from superiors on the other, I know I could go home to my family and sleep well knowing I did all I could coupling my education with life skills and those feelings which come with experience, to save them, fully prepared to take the heat if I was incorrect. Thats why we are all here isn't it? To care for and advocate for the people we take care of? I ask patients to remember that I (and the docs) work for them....To someone who "doesn't want to bother me", I remind them I am there of my own choosing , and then ask, "You'd do the same for me if you could, wouldn't you?"

It is only human to question yourself, but you will learn to trust your instincts. In doing so, so will the professionals you work with and for. Someone who is as insecure as the resident you describe has issues of their own. I would be proud to work with you....

Strong work, Nurse!!!:D

Was a BPP done, and if so what was the score? Also, I would question why the pt. was sent home on p.o. antibiotics. It is the standard of care to treat GBS with IV Pen-G, Ampicillin or Clindamycin. I think you did the right thing and should be commended by your co-workers as well as the hospital. I'm sure the OB M&M commitee would like to question this so-called physician about his actions.

GOOD JOB!!!

Gosh, did this doc never hear of small leaks, or chorio, or that stupidity will definitely be rewarded by litigation?????

Even the Board of Nurse Examiners tells us that we are obligated to intervene if we know that a treatment regimen is non-efficacious. Sending this patient home would have probably resulted in fetal demise--so remember that when you think back on this or get anxious when you see this physician that it's better than carrying around the image of that mom with a demise.

You were absolutely right and I've got a pretty diverse background. OB is the toughest area I've ever worked, when it comes to physician/nurse collaboration. It's hard to take a stand and be burned at the stake (usually in front of co-workers, patient and visitors). I don't know if it ever gets easier.

Dr. Phelan is a nationally renowned speaker who lectures about forseeability of injury--if the mother/fetus showed signs of foreseeable injury and action is not taken you will be liable. Nurses are just as liable as the physicians if we fail to act as an advocate.

This patient definitely showed signs of forseeable injury--questionable time ROM'd, fever, elevated WBC, fetal tachycardia (we should be just as concerned with tachycardia as fetal bradycardia)--you know what you're talking about. Thank you for taking a stand--that patient will probably never know that a living angel crossed her path and saved her baby's life...........

God bless you. You are a great nurse & a strong patient advocate. You did the right thing. Absolutely. I believe you saved the baby's life. Don't let the doc's hissy fit make you think any different. You are the kind of nurse every patient needs. So proud of you!!!!!

Bravo for standing up and doing your job! We have been intimidated for too long by MDs who are in need of a change in their life and or career! How many times has this happenned and the nurse just went along with the MD? MILLIONS OF TIMES! It is our DUTY to protect the pt. Period.

Specializes in cardiac, diabetes, OB/GYN.

Usually, with doctors like that, it's all about control....In that case, the patients needs become second, unlike first, in your case...You did a great job and I would hope my family and friends would be fortunate enough, given a similar situation, to have a wonderful nurse like you to intervene...You have integrity, smarts, compassion and guts.....Thats why we are nurses, after all, isn't it?

Our policy is to use the ladder of command and notify risk mgmt if you are not happy with the final decisions so you can cover yourself (sad but true). You were appropriate in trying to protect your patient and anyone who belittles you for doing so is a below par person, if not a below par doctor....doctors need to listen to us...we are their eyes and ears. We go to court right there next to them when an outcome turns bad.

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