"Inappropriate" assignment

[GailWHNP]

I work L&D. I worked as a health department nurse in high-risk obstetrics after graduation then as an Ob-Gyn nurse practitioner. I have *never* worked med-surg or in anything *but* OB.

On my floor, I can "float" to postpartum where we also manage GYN surgical patients. This is still in my area of expertise, and I feel confident delivering quality care to these surgical patients. BUT . . . lately we've been having more and more med-surg patients assigned to our floor due to lack of beds on that floor. Caring for patients with ng tubes, hyperal, central lines, etc is out of my experience. Sure, I learned about all that around 18 years ago in school but have never used it. It would take all night for me just to cipher the all the protocols for some of the patients that appear on our floor.

Fortunately, I have not been assigned one of these patients as I frequently work with another nurse who has med-surg background. I will take all the OB/GYN patients and leave her with that one patient just to avoid the responsibility. I fear the night when I will be assigned such a patient.

Before this happens, please, please . . . what would be an appropriate response to my nurse manager should she assign such a patient to me? I can easily learn the technical stuff but lack the experience in caring for such patients and in recognizing subtle signs that the patient is going down hill. I truly do not feel that it would be in that patient's best interest to have me as their nurse! Now, if she were in labor or with a high-risk pregnancy, I would have no problems caring for her and another patient or two.

Thanks for your responses!

Gail

[renerian, BSN, RN]

Gail here is my story. When I worked at the hospital in the 90s I refused to float to L & D as I had zero, zippo, nada experience in OB. I was written up and suspended even though I had walked down to the department which was super busy and they said I would have a patient load. I felt scared and I had to do what I did. I told my super I would do the same thing again if I had to. She told me she was making an example of me to show staff they need to do what they are told. Believe me I feel for you. You have a tough call................

[renerian, BSN, RN]

I forgot to add to my story, I worked on the bone marrow transplant floor HEHEH nothing to do with L&D.

renerian

[sleepy247]

Funny how L&D nurses can get pulled all over the hospital but no one ever gets to help us when we are going down the tubes! I don't blame you for not wanting to leave your area of comfort. I feel the same way. But recently at our hospital we have had a string of unusually sick antepartum patients. We had everything from pancreatitis (complete w/ central lines and hyperal) to 2 orthopedic patients (one of which got put on a heparin drip). Those old rusty med/surg skills sure came in handy! Most of the time, when L&D nurses get pulled from our unit to another area, they are used more as a tech than as a nurse. Most of still don't feel comfortable w/ that but feel we don't have much of a choice. That doesn't help you much, does it? But remember that as an L&D nurse you have many skills on your side....like being able to react quickly in an emergency....and NOT being afraid to call doctor in the middle of the night...and attention to detail....and assessment skills, the list goes on. Maybe you could request some additional inservices on equipment you aren't comfortable with. Personally, I pray every night that we are busy enough not to get pulled to another area. I feel extremely lucky to be a labor nurse when I come back to my own area!

[GailWHNP]

Thank you both for responding. I looked up the FL nursing practice act last night to see what might cause reprimand. One of the infractions was . . . "delegating or contracting for the performance of professional responsibilities by a person when the licensee delegating or contracting for performance of such responsibilities knows, or has reason to know, such person is not qualified by training, experience, and authorization when required to perform them.

This sounds like to me that if I inform the nursing super, should she assign such a case to me, that I am not trained nor do I have the experience required to care for such a patient, *she* could be in deep do-do if I reported this. I'd feel better if she would sign a paper stating that she is indeed aware that I do not have the med-surg experience required to care for such patients.

The nurses with med-surg experience who have taken care of this woman on our OB unit have stated the lady belonged in PCU. I also have a lot of questions about the wisdom of putting a lady with muscle abcess and septicemnia on a floor with newborns. In clinics where I have worked, pregnant women were well separated from the general population.

Gail

[renerian, BSN, RN]

Wow I don't think I would want that patient near my newborn.....scarey stuff to me....

renerian

[Fgr8Out]

Our Med-Surg Unit was requested to float an MS nurse to Postpartum... I thought to myself, "no big deal." The nurse who was requested to float apparently thought differently and pitched a fit. I could see if she were being asked to work L&D or Newborn Nursery... but, Postpartum????

Anyway...I agree with you, Sleepy, about assessment skills, etc... being a key point. I also agree that no one should be forced into working a department where they feel completely ill prepared to work. But I also think that, with a bit of reorganizing of assignments, such as Gail mentioned (where the MS experienced nurse handles those patients and the OB nurse handles those of her own specialty) that floating need'nt be a traumatizing event. It's certainly not the BEST situation, by far.... (I was going to add a "but"...then decided against it).

The old Nurse to Patient Ratios just don't cut the mustard any longer... the people we care for are more complicated and the demands placed on Nursing to cater to the patient AND family create additional work constraints that require better staffing.... Period.

Good luck to you, Gail....

Peace:)

[indynurse]

What does peds think about having an infectious pt on the same floor as newborns. If everyone is using proper precautions, technically, the only problem would be if it was an airborne infectious agent. Of course, we do not live in a perfect world and Suzy visitor who just contaminated herself by touching Uncle Joe may not be able to resist the urge to reach out and touch a baby she sees a Mom wheeling down the hall.

If your nurse mgr doesn't seem helpful, talk to your risk mgr. It probably won't get you out of taking care of med-surg pts, but he or she may see the need for better education for the nurses without any med-surg experience.

[Brita01]

I have very strong opinions about floating to other units and/or being made to accept patients that is out of the nurse's level of expertise. It should not occur. Period! All administration cares about is that there is a "body" there to take care of the patient, not whether that "body" knows what he or she is doing or not. Nurses should have the right to feel comfortable with where they're working. The job itself is stressful enough without adding to it. I know of no other profession where people are made to work like this. And I get so tired of hearing nurses bash other nurses for refusing to float or complaining about floating. I say bravo to them! Being made to float is one of the many problems with this profession, not to mention a danger to patients. We all need to stand together and try to put a stop to it instead of just accepting it as another thing we have to put up with.

And Gail, you're problem sounds like some weird reverse floating thing that they're trying to start. If these are patients being admitted as med/surg, then med/surg nurses should be taking care of them. The question then is, where will these extra nurses come from? I don't know. And that's really not the nurse's problem is it? But if the hospital is accepting these patients and their money, they should be providing the proper care for them and not just using OB nurses to try and save $$$.

My thing is just this: people should be comfortable at work. Comfortable people are happy people. And happy people stay on the job.

[GailWHNP]

Originally posted by Brita01

And Gail, you're problem sounds like some weird reverse floating thing that they're trying to start. If these are patients being admitted as med/surg, then med/surg nurses should be taking care of them. The question then is, where will these extra nurses come from? I don't know. And that's really not the nurse's problem is it? But if the hospital is accepting these patients and their money, they should be providing the proper care for them and not just using OB nurses to try and save $$$.

My thing is just this: people should be comfortable at work. Comfortable people are happy people. And happy people stay on the job. [/b]

It *is* reverse floating. When the nurse with the med-surg experience stated the woman belonged in PCU and here she is on our OB unit, I wondered what the heck the nsg super was thinking of in allowing the woman on our floor. The two nights I worked postpartum, I took care of all the OB patients and let the other nurse with med-surg experience deal just with that one patient. It took all of her time. She was in the room every hour.

I was hired with the understanding that my main area would be L&D. I would float to post-partum. So far, I've been floated to nursery and GYN. I don't mind that; it's still within my realm of experience. But this? It's starting to be a more common occurrence. If the other nurse had called in sick, I may well have been stuck with this lady. It is most unfair to her.

It seems there is no way out of my accepting her care except to abandon my duties. This is so not right! I am hoping that if I present the statement in the nursing practice act, whoever assigns this pt to me will reconsider. And they talk of nursing shortage. I think I'll go back to being a nurse practitioner . . . at least no one told me I had to take care of anyone but well women!

Thanks, guys.

Gail . . . somewhat new to all this hospital stuff

[SmilingBluEyes]

I would be LIVID if i were the parent of one of the newborns on your floor knowing this septic person was on the OB unit. Ummm totally inappropriate. Not to mention, no one there to care for HER properly since it is NOT your area of expertise. A lawsuit waiting to happen to me. I would raise the flag HIGH, were I you, Gail. Good luck!

[GailWHNP]

Originally posted by SmilingBluEyes

I would be LIVID if i were the parent of one of the newborns on your floor knowing this septic person was on the OB unit. Ummm totally inappropriate. Not to mention, no one there to care for HER properly since it is NOT your area of expertise. A lawsuit waiting to happen to me. I would raise the flag HIGH, were I you, Gail. Good luck!

Yeah, I'm trying to get feedback on how to raise the flag, particularly *before* I have been assigned such a patient and preferably without being fired!

Gail