Mahogany

Is your facility accredited? How could you not have a Policy on the drug most commonly used in labor? Not only have you to be concerned about the mom, where is the baby in all this? What other Policies have you not got? Do you document that despite hyperstimulation x 1 hour, Pitocin infusion was increased to 50 mU/min by RN. and Doc.Doe informed? What is the baby doing during hyper stim-hypoxic may be? I really do not think that you appreciate how serious this violation is. Your manager-how knowledgable is he/she? Maybe he/she has nothing to lose. What will he/she do when there are law suits and he/she can no longer keep you all happy? There seems to be the need to review the systems that are in place--Policies, people, etc. and do some major revamping. What does your Mission Statement say? I would not be caught dead working in such a danger zone.

This sounds like a very serious matter. You must have a Policy on Pitocin administration, which should be accessible on your Unit. Standards of Practice should be enough ammunition for you to approach an uneven table. There may be a slight difference in hospital policies. However, fetal well-being, contraction pattern and maternal response must be considered when administering Pitocin. Was it a typo when you mentioned 50-60mU (per min)? As a group, you should approach your manager with your concerns, because in the end, you will be liable for not following policy and the doctor will wiggle his way out. At my institution, the maximum dose is 32mU/min, but I have never seen it higher than 24mU for induction. Where is your manager in this? The doctor needs to review the Policy and you need to leave a paper-trail--that you spoke to the powers that be, and that you made a copy of the Policy available to the doctor. And you better have good documentation as per your Policy. You also need to pay close attention as to the indication for Pitocin-induction or augmentation. We do low-dose pitocin on VBACs but never without an IUPC. Good luck. Mahogany

In some Units, there is "normalization of diviance". Although standards of practice exists, when there is a shortage of "nursing leadership", and the docs. are allowed to create a new "Unit Policy" whenever they feel like, and there is a poor outcome, do not expect my hospital or nursing management to stand by you, the good nurse. I do not know one way or the other, if m/p insurance would be advantageous, but what I do know is that you be legal-minded. You need to document as though an Attorney is always sitting over you. The docs. get to write retrospective notes, nurses don't.

I have been an OB nurse for over 15 years, with no regrets. I completed my basic training then attended midwifery school immediately after. I am an excellent nurse with limited med-surg experience. If this area is where your passion lies, go for it. My advice to you, though, is carefully choose a mentor.