"Pit to distress..." (Rant)

kmchugh · Mar 1, 2005

You know, I've always found in dealing with hard-headed residents there are two simple solutions. The first? "You do it." i.e. You want to keep upping the pit till there is fetal distress? Fine. You stay here and manage the pit, cause I'm not doing it. After all, she's "your" patient. The second? "Great, let's call your attending, and let him/her know what you want to do, then he/she can help you administer the pit. As an added bonus there will be two of you here when there is uterine rupture."

Kevin McHugh

SmilingBluEyes · Mar 1, 2005

Kev said it. I will NOT ever turn up or leave pit on when it's clear hyperstim or distress are happening. Hyperstim to distress is opening yourself up to a non-defensible and vulnerable position. Not to mention how would you feel if you caused a poor outcome? I could not sleep at night, myself.

SmilingBluEyes · Mar 1, 2005

And another thing: in cases like this, use your chain of command. DOCUMENT DOCUMENT DOCUMENT. it may save a life and your butt one day.

allnurses Guide · Mar 1, 2005

Kevin and Deb have said it all. Just wanted to let you know you did the right thing - we have P&P's that state under what circumstances we as nurses can turn down the pit .. . check your P&P's.

Taking the time to contact the physician before taking action is ridiculous . .. that's why we have protocols.

steph

tntrn, ASN, RN · Mar 1, 2005

I totally agree with the posters. You are being paid to make constant judgments and assessments, and then act accordingly. Evaluate, turn off the pit, re-evaluate the result, then call the physician.

fergus51 · Mar 1, 2005

You did the right thing. Next time be sure to mention the P&P like Steph suggested. Also, using the word "lawsuit" a few times is never a bad idea with residents like that. ("I'm not opening myself up to a lawsuit. If you and YOUR ATTENDING want to be sued, you can sit here and turn up the pit until she ruptures....")

camay1221_RN · Mar 1, 2005

Thanks everyone! I was comfortable with the decision, but mad as blazes with the resident. As a matter of fact, the whole concept of my license being jeopardized irritates me to no end.

Because I am so new, I have a binder with some of the P&P's in it. After posting OP, I pulled out the binder, found the part about the Pit being shut off or decreased per RN judgment and hightlighted it in orange. When the occasion arises in the future, and I'm sure it will, I will pull out the P&P and share it with the MD who questions me. If he/she is still p*ssed, then that's their problem. At least I will sleep at night knowing I made the right call for my pt, not for the MD's convenience.

PinkDiamond6 · Mar 1, 2005

I have to agree with everyone else. Always refer to the policies and procedures in situations like that. Ours says that you increase Pit until the contractions are q 2-3 minutes!

Jolie, BSN · Mar 1, 2005

I agree fully with all the above posters. I would add that should this jerk resident want to up the pit to distress, he can write the order verbatim in the chart, then tend to the patient himself!

JaneyW · Mar 1, 2005

Thanks everyone! I was comfortable with the decision, but mad as blazes with the resident. As a matter of fact, the whole concept of my license being jeopardized irritates me to no end.
Because I am so new, I have a binder with some of the P&P's in it. After posting OP, I pulled out the binder, found the part about the Pit being shut off or decreased per RN judgment and hightlighted it in orange. When the occasion arises in the future, and I'm sure it will, I will pull out the P&P and share it with the MD who questions me. If he/she is still p*ssed, then that's their problem. At least I will sleep at night knowing I made the right call for my pt, not for the MD's convenience.

Another reason I'm kinda glad I don't work at a teaching hospital! You DID THE RIGHT THING! We have specific mention of hyperstim and not having UCs more than 5 in 10 minutes in our P&Ps re pit. Pit to distress?? Does he hear himself? Would he do that to his wife/baby?

BETSRN · Mar 1, 2005

I'm gonna try to make a very long story short...
I had the chief resident today give me an a** chewing because I had turned off the Pitocin of a pt who had persistent episodes of hyperstimulation. I had only turned it down a few minutes before he came in, so I had not informed him of this. He asked why I turned it off, and I showed him on the strip the pts ctx pattern. He looked at it and said, "Well, there's no fetal distress." I told him I understood that, but the pts uterus was not getting any rest between ctx. He then proceeds to tell me, "You need to call me before you do anything like this again, this is my pt." It took everything I had to keep from saying, "No, she isn't your pt, she's our pt, and it is my license on the line should something happen at your wanting to misuse the Pit." I didn't say anything though. So, I restarted the Pit, but only after I saw the pt had resting tone, and I started from the beginning, 2mu/min. She handled that okay, but when I got up to 6mu/min, she started having the ctx one on top of the other again. I pointed this out to the resident and he said, "Keep upping the Pit until there is distress, then you can back down on it." OMG, my tongue was almost bleeding by this time! Well, lucky for me, but not for the RN who followed me, this was right at change of shift, so I'm not the one having to deal with the aftermath. Which hopefully, there won't be one.
You know, I know I am new to this whole L&D experience, but when I have my preceptor and my RN educator agreeing with the actions I took, I can't help but think my actions weren't that far fetched.
I'm sure I left tons out, but I think I covered what I wanted to.
Thanks for letting me rant!

You did what was right. Next time this resident tells you that, please tell him exactly what you said here about your license, etc. You would be held accountable (in a court of law) if you had NOT turned the pit down or off. You should NEVER pit to distress and do not ever allow yourself to be put in this position by any midwife or physician. Also, make sure that you always DOCUMENT if a practitioner ups the pit, refuses you anything, etc. Remember, regardless of what happens, your license is STILL on the line. Saying you were following doctor's orders (when they are dangerous) will NOT stand up in court ever. Don't put up with that stuff from a resident or any attending for that matter. if you ahve a problem, go up the chain of command.