Question about a nursing situation in laboring diabetic patient

[Moondance]

The patient I observed today is type 1 diabetic, 37 weeks pregnant, who was being inducted. Her petocin drip, started yesterday evening was at 20 units/hr. and labor was not progressing. When I started my labor/delivery rotation this morning at 0700, the doctor had spoken with the night nurse on the telephone and ordered the petocin to be increased from 20 units up to 30 units. The night nurse relayed this information to the patient, and increased the dosage to 22 units, letting the patient know the petocin would be increased 2 units approximately every 15 minutes.

The day shift nurse was given report and afterwards stated to me that she was not going to increase the petocin that way, saying that it was her license on the line if something happened to the patient and she was not going to rush the labor and not going to risk her license by increasing the dosage as ordered.

When I left at 1300, the patient's petocin drip was still sitting at 22 units. Both the patient and the baby were tolerating the petocin well, her hourly blood glucose levels within normal limits (ex. 100, 96, 94), but still nothing was happening, so I am wondering why the nurse was reluctant to increase the petocin as ordered. The patient and her family was getting frustrated at the nurse for not increasing the dosage, and the nurse was rather defensive towards the patient and her family, not really saying why she refused to increased the dosage other than stating, "I'm not going to rush the labor" and "I'm not going to jeopardize my license by increasing the pet".

I was reflecting on this after I left the hospital, and wondering why would the nurse be so reluctant to increase the dosage as ordered if the patient was not progressing and she and the baby were ok? I wanted to inquire more with the nurse, but she made it plain to everyone as to her reasons (as I stated above) and she was so defensive about it, I was reluctant to ask.

Thanks :redpinkhe

[Daytonite, BSN, RN]

page 959 of 2007 intravenous medications, 23rd edition, by betty l. gahart and adrienne r. nazareno says this about oxytocin with regard to the induction of labor:

"begin with 0.5 to 2mu/min (0.05 to 0.2 ml), increase in increments of 1 to 2 mu/min at 30-60-minute intervals until contractions simulate normal labor. maximum dose rarely exceeds 9 to 10 mu/min at term, average is 2 to 5 mu/min."

http://www.drugs.com/ppa/oxytocin.html - monograph on oxytoxin injection

it may be in the difference between units and milliunits. the drug comes in units, but the dosage infused is stated in terms of milliunits. i wonder why she didn't just call the physician to clarify the order? even when a nurse disagrees with an order and doesn't want to give what the doctor has ordered, we are obligated to inform the physician that the medical plan of care is not being carried out as ordered so the physician can take further steps. so, from that perspective alone, this nurse was wrong, even if she might have had a valid reason for not increasing the oxytocin.

[Moondance]

Thanks Daytonite for the reply and for the information link. :nuke: A good learning experience from that situation. I agree that she should have phoned to the doc if she did not want to administer the med as prescribed.

Thanks again!