"Pit to distress..." (Rant)

[camay1221_RN]

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!

[JVanRN]

"Pit to distress?" I'm NICU not L+D...but that doesn't even make sense to me. Last time I knew fetal distress was something you wanted to avoid. What is his logic for that I wonder...Good thing the nurse used her judgement here.

[SmilingBluEyes]

You did WELL, way to go!

[tntrn, ASN, RN]

The terms one of our docs uses (and it's not a teaching hospital, BTW) is "make that baby prove itself." It's basically pit to distress, put in nicer words, but amounts to the same thing. And you still have to document, document, document; toss in the "policies and procedures" phrase a time or two (I asked him if our policy had been rescinded); and keep your cool. You are right; the doctor knows that. Most docs will come to respect you, even if they know they won't get their own way (unless they're right :chuckle ); and you can have a wonderful working relationship with them.

What I find interesting is that, especially in the smaller hospitals, the same docs that expect this kind of care, are the ones who've signed off on the policies.

[BETSRN]

The terms one of our docs uses (and it's not a teaching hospital, BTW) is "make that baby prove itself." It's basically pit to distress, put in nicer words, but amounts to the same thing. And you still have to document, document, document; toss in the "policies and procedures" phrase a time or two (I asked him if our policy had been rescinded); and keep your cool. You are right; the doctor knows that. Most docs will come to respect you, even if they know they won't get their own way (unless they're right :chuckle ); and you can have a wonderful working relationship with them.

What I find interesting is that, especially in the smaller hospitals, the same docs that expect this kind of care, are the ones who've signed off on the policies.

Even in hospitals with good nurse/doc relationships, the docs want you IN BACK OF them until they go to court. Then they want you RIGHT OUT IN FRONT OF THEM. Don's ever assume that they will back you. Even the best of docs Who are easy to work with will screw you to the wall if it means they will look less guilty.

Cover your you-know-what each and every time!

[tntrn, ASN, RN]

Of course you are correct about them backing you until something goes bad. I keep that in the forefront of my mind at all times, and if I make a phone report that includes my concerns about whatever, that goes into my documentation, not just the phrase "phone report to Dr. So and So." You can't be too careful. That being said, you can still have a good working relationship, but I think that includes honesty. If they know you're not going to back down and why, they will not try to run you over as often as they might try with another nurse. Believe me, they do know who the pushovers are!

I called one of my favorite docs in too early for a delivery not too long ago, and he'd had a rotten day from the beginning. Of course, my part of that day didn't begin as early as his did, but along the way he not only got crabby about getting called in too early but also about how the "patient had gotten crummy care all day." I flat out told him I would accept responsibility for the part I had in it, but would not be responsible for anything that happened before I clocked in." I had witnesses to all of this. It was done in a quiet manner, with no raised voices.

The patient HAD NOT had crummy care, BTW. The progression of her labor just didn't quite fit into his plan. She had a good outcome; she had absolute 1 to 1 while I was there because it was a difficult one. He knew that. I knew he knew that. We're fine. But I won't let anyone, even a doc I like and enjoy working with, scold me like that.

[BETSRN]

Of course you are correct about them backing you until something goes bad. I keep that in the forefront of my mind at all times, and if I make a phone report that includes my concerns about whatever, that goes into my documentation, not just the phrase "phone report to Dr. So and So." You can't be too careful. That being said, you can still have a good working relationship, but I think that includes honesty. If they know you're not going to back down and why, they will not try to run you over as often as they might try with another nurse. Believe me, they do know who the pushovers are!

I called one of my favorite docs in too early for a delivery not too long ago, and he'd had a rotten day from the beginning. Of course, my part of that day didn't begin as early as his did, but along the way he not only got crabby about getting called in too early but also about how the "patient had gotten crummy care all day." I flat out told him I would accept responsibility for the part I had in it, but would not be responsible for anything that happened before I clocked in." I had witnesses to all of this. It was done in a quiet manner, with no raised voices.

The patient HAD NOT had crummy care, BTW. The progression of her labor just didn't quite fit into his plan. She had a good outcome; she had absolute 1 to 1 while I was there because it was a difficult one. He knew that. I knew he knew that. We're fine. But I won't let anyone, even a doc I like and enjoy working with, scold me like that.

Our crystal balls are never quite clear enough for these docs, are they?? LOL!

[BETSRN]

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?

Of course he would NOT.......but it is not his wife or his baby.......but it IS his schedule!

[profjanmc]

I TOTALLY agree, we used to have a doc who used high dose pit until the kid proves himself, in other words pit them until they crash....never mind the postpartum hemorrhage that comes with the ton of pit! You did well, you did the right thing for the kid. Kepp your chin up! Jan

[SmilingBluEyes]

Will they be able to "prove" themselves in a court of law?

Sick. Glad I do not work w/physicians like this.

[profjanmc]

Will they be able to "prove" themselves in a court of law?

Sick. Glad I do not work w/physicians like this.

Yep, they left to go to another hospital-we were glad!!!!!

[Mermaid4]

The thing is if they ordered you to do something you KNEW was wrong, it is your duty to do the right thing and you did. If you continued to do so just because he ordered you to and something untoward DID happen, the fact that he had ordered it wouldn't protect you in court or with your conscience. You thought about telling him what you quoted and could take him outside the room and tell him and then continue if he wanted to up the pit with hyperstim, which is clearly contraindicated, you would document same and also that he had been informed why you turned it off, and then let him know if he intended to do so, he would have to do it, and then document same. They do seem to turn around with that...Just keep your voice calm and stick to your guns and document document document....

[Mermaid4]

The thing is if they ordered you to do something you KNEW was wrong, it is your duty to do the right thing and you did. If you continued to do so just because he ordered you to and something untoward DID happen, the fact that he had ordered it wouldn't protect you in court or with your conscience. You thought about telling him what you quoted and could take him outside the room and tell him and then continue if he wanted to up the pit with hyperstim, which is clearly contraindicated, you would document same and also that he had been informed why you turned it off, and then let him know if he intended to do so, he would have to do it, and then document same. They do seem to turn around with that...Just keep your voice calm and stick to your guns and document document document....And ,while it might be best for you if he did all that, the bottom line is the patient and as an advocate you would have to let him know ( and it is your duty to go higher if need be) that you disagree, discuss the policy and your particular part in it if need be....