"Inappropriate" assignment

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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

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

Good luck, Gail. You are VERY conscientious and caring. I am glad there are nurses like you out there to watch out for patients. Keep on keeping on. You are in the right as far as I can see!

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you've got to get other people on your bandwagon too. if only you are upset about this, management will make it "your problem" rather than a unit problem. have other people go to management w/ you or write memos. although i've worked med-surg in the distant past, i do not want to work it anymore. that is why i work in ob now. s for the infection control issue, perhaps you could solicit the opinion of a nursery doc or nnp. they may complain that they do not want nurses who care for babies caring for these med-surg pt's and you could gain a valuable ally. good luck to you!

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Specializes in cardiac, diabetes, OB/GYN.

If you ANYWHERE accept the responsibility of an assignment you know you are not prepared for, or accept the responsibility of supervising an LPN or another nurse in a like situation you must, as you did, inform your immediate supervisor. If you take that assignment and something happens to the patient which warrants a lawsuit, you license may be in danger. Lawsuits are decided by non medical people who don't lend credence to either the goodness of your heart or the fact that you felt forced into something. Managers typically resort to intimidation in the face of staffing issues, and more often than not Maternity personell are used and abused. If you refuse to take an assignment but agree to help out in any other way possible ( such as doing vital signs, weights, physical care of patients under supervision of a nurse already assigned to that unit), that is not regarded as patient abandonment. Fill out an unsafe staffing report every single time, and if you have a union, use it..YOU are right. On our unit, we have much the same difficulty, and I have had many the fight over the same issues....If we float, supposedly there is always a liklihood that we will have to come back to delivery. With that in mind, there are policies in place preventing us from going into isolation rooms, and patients with fevers or draining wounds (so called dirty patients) are not supposed to be admitted to our floor. I have noticed management ignoring that time and again, however. Interesting that they so often cite policies when it comes to staff, but ignore their own rules. They will always attempt to break or bend the rules. Many of them are on power trips..That is not your problem. If I were you, I would mention my concerns that my license is at stake and you are merely attempting to avoid any lawsuit against the hospital and yourself in the event of a potential problem...

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I know that most OB RNs (including myself) have NO interest in working med-surg, but med-surg skills do come in handy when you have anyone with health issues come in for OB care. If taking care of med-surg patients on your unit seems more and more common due to your facility's bed situation...Would you consider taking a med-surg skills refresher class, such as those offered to nurses returning to the workplace? It doesn't mean that you will have to float all over the place (don't tell your boss you took it, if you are worried about being floated!), but at least you will feel more confident when you do have to take a med-surg patient (even OB!), and your patients will receive better, safer care. It will also make you more marketable, if you enhance your OB skills with med-surg and even critical care classes/experience. Helpful in the current day of large sign on bonuses and such recruiting methods! :-)

I am often found to be the "odd duck" sitting in on various med-surg and critical care classes. Often, the other nurses will imply that we just hold babies all day...what do we need to know this for? I invite them to come do my job for a day... LOL!

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WOW! I thought I was alone in my experience here! In the late 80's, I was a green L&D nurse just learning OB and the hospital decided to "pull" from L&D to any and all areas, including ICU, CCU, AIDS floors, etc. and if it got busy in L&D, we had to run back to the unit to do a delivery!!! We were all mostly new nurses so we had little backbone but we knew this was not good for the pts or us! Look at cross contamination like mentioned above just for starters and the inexperience we had in other area. We all decided the next time they called to pull whoever was up to go would refuse. We had all the docs backing us so we were confident things would go well. Well, I was up and things went according to plan except I too was told to go or go home, which I did and I was FIRED and my attempts to get another job were tainted by a certain head nurse (who had NO OB experince and was only using her position to furthur her CAREER which it did)! She went up the ladder and even made TIME magazine in another of her positions in our hospital. In the mean time, she gave out very unflattering and downright malicious references to the positions I tried for at other hospitals and then denied it to my face. The other nurses did benefit though as the pulling stopped at that point so I was the sacrificial cow so to speak. It just goes to show ya!! In the long run, we have to protect our pts. We take that pledge you know, and look at all the nosocomial infections we are seeing and hearing about today!! You know it is related to the bottom line being the dollar and not pt care!! God help us all if we need to be hospitalized in todays enviroment! That's why I'm a radical nurse advocate!!!

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Specializes in Vents, Telemetry, Home Care, Home infusion.

You DON'T want me birthin your babies as have really only my own birth experience to go on. Could pinch hit in any other area.

OB clinical experience was 20 years ago and we cared for Mom-Baby couplets. Only attended 4 births between LPN/RN school.

In Philly area, 99% hospitals have converted to LDRP units so no seperate post partum here which I could probably handle.

Only way to CYA is to request orientation on Med-Surg unit if Med Surg overflow concsistently coming to your unit. DO NOT accept assignment otherwise as could lose license as not area expertise if problems develop. Print out FLA regs to keep in locker at work so you can quote chapter and verse if/when needed.

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I agree with all that you've said. As an OB RN I've been floated to every floor but the ER. I always went in the capacity of a tech. When we started to feel like the hospital float pool because we were floating so much we called the Mass. BON. Although the hospital was using us as techs on these floors, knowing many of us had no med/surg experience for a number of years, we were being paid as RN's and were practicing under our RN license. The BON told us that if a patient we were caring for went down the tubes that we would be responsible for that patient as an RN, not a tech. Since many of us felt uncomfortable with detecting subtle changes in these very sick patients (who would have been dead before they reached the hospital in the days of long ago when we had had our last med/surg experience), and felt the RN's who were actually assigned these patients were relying on our notifiying them of of these changes we sent a note to the VP of Nursing stating what BON had told us and our misgivings with what our assignments were, This, plus the Nurse Practice Act stating that the Hospital will be held at fault for inappropriate assignments has them reevaluating their floating position. Time will tell. And yes, one nurse was fired for refusing to float for the third time--it's three strikes and you're out at our hospital.:o

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Originally posted by NRSKarenRN

You DON'T want me birthin your babies as have really only my own birth experience to go on. Could pinch hit in any other area.

OB clinical experience was 20 years ago and we cared for Mom-Baby couplets. Only attended 4 births between LPN/RN school.

In Philly area, 99% hospitals have converted to LDRP units so no seperate post partum here which I could probably handle.

Only way to CYA is to request orientation on Med-Surg unit if Med Surg overflow concsistently coming to your unit. DO NOT accept assignment otherwise as could lose license as not area expertise if problems develop. Print out FLA regs to keep in locker at work so you can quote chapter and verse if/when needed.

This was going to be my suggustion too. REFUSE the current assignment BUT request Med/Surg orientantion in order to refine your Med/Surg skills. This is much more proactive than just refusing to care for Med/Surg patients, such refusal could be used against you in a patient abandoment suit. Perhaps if you show that you are willing to cover Med/Surge with the proper orientation you can set a good precident for your unit. Good Luck.

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