Are you as the RN and the Nurse in Charge that evening legally okay to use an ultrasound to reassure a patient that her baby's heart beat is no longer present? My Patient was not shown her demise at all on ultrasound and the doctor would not come in from home. The ultrasound tech at the hospital did not show her a picture of her baby either. They were still wanting me to give her the cytotec to induce labor; however the pt did not believe that her baby had passed without visual confirmation. No one would come a show her, therefor she thought htat she was terminating a wanted pregnancy. I put the ulrasound on her belly of 15 weeks and confirmed to her that her baby had passed. All the pt wanted was visual confirmation. I as a pt advocate did what I thought was correct and moral. The hospital suspeneded me for a week. Who is right ...the hospital or me for giving the patient and her family peace of mind and visual confirmation of no heartbeat? :confused:
As a patient advocate, I would have supported her decision NOT to accept cytotec unless and until she had received the confirmation she desired that her baby's heartbeat had stopped.
I would have called the physician and reported that the patient would not consent to treatment until she had seen ultrasound results.
But unless you are specifically trained to perform an U/S and permitted to do so by your job description, I would not have done that.
My best to you, as I know that you intended nothing other than reasure a patient experiencing a terrible loss.
I am 100% in agreement with you! And I had to do something similar once for a term demise. It was a horrible situation all around.
Of course no one was physically hurt... It was an ultrasound. The only one hurting in this situation was the patient. April, I think you were acting as a wonderful nurse. I couldn't imagine the emotional pain that patient was feeling, and you were trying to help her. I am a beginning ADN student, and I know I don't know much yet. I do know that there are things nurses "can do" and "cannot do." I am sorry that you were punished, but like everyone else said nurses aren't ultrasound techs or radiologists. "Scope of Practice"
While I do believe what you did was right ethically, it was out of your scope of practice, which is why you were suspended. I understand you want to do the right thing, but if you keep going that route you will likely lose your license.
I'm not a nurse (only a student) but I was in school for Diagnostic Medical Sonography. There are ultrasound techs (people trained to use the US machine) and then there are ultrasound techs that diagnose (they are registered with their own board-ARDMS). You have to have a degree and pass the test to be put on the registry to become a DMS.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
In my L&D unit many nurses were trained in the use of ultrasound for a variety of reasons, none of them medically diagnostic. Demonstration of fetal demise would not be an indication for that procedure.
However, the overriding issue here is that the physicians were unwilling to provide this woman with the medical care she required...you may have stepped over boundaries in your nursing area, but your nursing management should be addressing the unacceptable medical management of this case in addition to addressing your mis-judgment.
In the future...because you DO have a future in nursing...you will know that you simply inform the MD of the patient's request for further info and refuse to move forward with the MEDICAL procedure until the patient has her questions answered satisfactorily.
Cytotec should not have been ordered without a physician discussing with the pt. the presence of a fetal demise. It is not the nurse's job to inform a pt. of this status. The physician must do so. I will say, unless you have a certification for use of ultrasound, it is outside a nurse's scope of practice to interpret ultrasound data. The entire situation could have been handled better. I do understand being a patient advocate, but there are more appropriate ways to accomplish this.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Where I work, this would be out of my scope and I would NOT do this. I understand the reason/intention,but the legal issues are too deep for me to tread. I would have the physician come in and talk to the patient in person, and then let him/her do the job of reassuring the patient and obtaining truly INFORMED consent to proceed. I would not proceed in a case like this until the physician talked to the patient, if there is this much doubt or lack of truly informed consent.
I don't know the legalities, but in my opinion the doctor who refused to come in should have his license taken away. He obviously lacks all compassion.
I find it absolutely unacceptable that a physician refused to come in and attend to a patient in this circumstance. This is an abomination. While I have to agree that the US was out of scope of practice (unless you are certified to do so), what you did was what was best for the patient....however there were other ways to go about it. Refusing treatment would've been the way to go for the patient, and going up the chain of command to get someone to come in and explain what is going on to the patient.
I am curious what happened to the physician who refused to take good care of his patient. I get your patient would be mad as hell to know that you have been suspended for doing her justice. I hope you wrote some sort of safety tracking or incident report about this. This should not go un-noticed.
Specializes in Nurse Leader specializing in Labor & Delivery.
I had a situation similar to that of the OPs. In this case, it was a very young pregnant pt who was going into premature labor secondary to an untreated UTI. Delivery of this baby was inevitable, and she was only 22 weeks pregnant. The family was outraged and could not understand why we weren't trying to stop labor or transport her to a higher acuity facility. The doctor refused to come in to talk to the patient/family, in spite of repeated phone calls from me, telling her that the family requests she come in to talk to them. Eventually the ethics department, risk management and the head of OB got involved. The OB tried to have MY head, saying this was all my fault because I was an inept nurse who needed remedial training in communication. She wrote a letter to our unit manager, saying that she refused to allow me to take care of any more of her patients until I underwent remedial training. Eventually it was resolved when we had a sit-down meeting with me, my unit manager, head of risk management and the OB in question (the meeting was MY request). Everything was resolved (and after the meeting, the risk management person and my manager both gave me hugs and said that I was totally in the right and they had my back and were impressed with how much more professionally I handled the whole thing, compared to the OB).
Anyway, it was a huge learning experience, one that I will NEVER forget for the rest of my career, and after that, I don't back down when I think an OB needs to come in and see a patient in person.
No way would I have done that. I would have instead let the MD know that she would not consent to the cytotec without visual confirmation that her baby was dead, and I would have supported her in that decision. I,as an RN, am not trained to interpret an US, and I'm not going to put myself in that position.
By the way, many years ago, one of our MD's diagnosed a demise in the office, chastized the young girl for not telling anyone that her membranes had ruptured days ago (her mom didn't even know she was pregnant), and told her she killed her baby. The girl came to the hospital, the demise was not reconfirmed, and a few hours later she delivered a LIVING, crying full term baby. The MD had been mistaken, probably due to the lack of amniotic fluid making the US hard to read. I would not have wanted to be the one being WRONG on that one.
I would likely have told the doctor I would not give the med until a ultrasound tech or doctor confirmed the demise for the patient. As the patient I would have refused the med until I was given proof of the demise. I am a strong patient advocate and I have lost a 16wk pregnancy. I understand the legalities of the situation but I would gladly accept the suspension for the sake of the patient. But that's just me.
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LDRNMOMMY, BSN, RN
327 Posts
I am 100% in agreement with you! And I had to do something similar once for a term demise. It was a horrible situation all around.