They sent us a 1 week postpartum pt...we do openhearts!

[MIRockstarRN]

Sunday night i was the contact nurse - nursing sup. calls with pt assignment of pt coming from ED that's 18yo 1 month postpartum, new onset seizures, HTN. Please keep in mind that I work on a tele surgical stepdown... openhearts, thors, general surgeries, bariatric surgery, and many cardiac gtts. When we got the fax report from ED it said pt was 1 week postpartum. I called nursing supervisor to ask if it was appropriate for pt to be on our floor as it sounded like more of an OB type issue not a tele issue. She called ED and said pt was fine to come to us, as "All seizure pt's are pt on tele". I told her we didn't know anything checking those OB things they check, she said all you have to do is check BP and call code if pt seizes again (pt was seizing and posturing when EMT's arrived at her house). So pt arrives, me and another nurse are looking over the pt's orders to help out our third nurse and see pt is on Mg+ gtt, and apparintly this new pt needs basically a whole assessment every hour according to orders. We called over to OB to ask them to come over and check the gtt as that is NOT something we do. OB doc came over also. When OB doc arrived, I told him that if this pt needed to be assessed hourily then she wasn't appropriate for our floor. OB doc tells me that if pt was on L&D and on MG+ she would have 1:1 nursing care!!!! :confused:I told him that we don't even do q2 hour blood sugars nor do we have staffing so pt needed to go somewhere else or we could get on OB nurse to care for pt and we could watch her tele. He said pt didn't even need to be on tele! OB doc called birthing center to see what could be done, then nursing sup calls and tells me she is working on moving pt. OB doc says pt can't go back to L&D because she had already delivered and was no longer pregnant, so the problem was trying to find an appropriate bed for her. Nursing sup calls with bed on peds with OB nurse to care for her then tells me that I was out of my scope by trying to get pt moved! I told her that all i did was ask a question of the Doc and found out pt was 1:1 care, she knew it wasn't appropriate for us! Needless to say, all admits after the spat with supervisor were CRAP (not the first time we have had issues with her).

My question for you guys is this: where would this type of pt have ended up in your hospital???

[cassioo, RN]

if she is already 1 month PP then there is nothing really "OB" in my opinion that you would need an LDR nurse to do. her fundus would already be contracted down too far to palpate and her vag bleeding would be basically done. now imagine the tables turned and a postpartum/nursery nurse gets a general surg, hem/onc, cardiac service, etc patients from the ER because the rest of the hospital is full! it's outrageous!

It's not so much the fundus check but the Mag infusion which should be ran as a special drip with close monitoring. Our OB's would want them until they are release from OB care. We've had them come back with SOB and the ER puts them in on a general medical floor doing all kinds of work up and it's all the fluid shift from pregnancy (and all we give them in labor)

I work L&D and post partum /gyn surgery (we rotate between the 2) but had somebody come in last week with an illius and had to put a NG down. I don't like that we get dumped on all the time if a woman comes in no matter what the problem if she doesn't have a family practice and tells the ER here doc is GYN (because that's the last one she saw maybe 10 years ago) if they say Abd pain it's GYN so here they come...today one of our gyn's took someone to OR for a lap d/t abd pain she ended up with an appy (same with the one that had the NG post op appy with urinary retention)