What would you have done in my situatio

[ldcmw1]

I worked a 12 hour shift yesterday and did c/s's until 3 pm when I picked up a patient from another nurse I was upset after getting report. The patient was a frequent flyer. 26 yrs old g5 p4 at 35 6/7 weeks admitted many times for low back pain and pre-term ctxs. Received betamethasone 3 weeks previously. Her chief complaint when arriving on the unit at around 5 am was contractions. She was so uncomfortable the nurse checked her right away and charted she was 2/70/-2. Called the MD and he told her to treat her for a UTI and to start ampicillin 2 grams. He didn't ask for a UA to be sent even after the nurse requested it. She started the IV gave ampicillin and handed her off to the day shift nurse. MD saw pt around 8 am and checked her cervical exam 2/70/-2. Patient was contracting upon admission and was still contracting when MD saw her but no cervical change. He ordered Nubain 10 iv and 10 im. Patient was ok for about an hour but then was uncomfortable again and MD told nurse to give pt an epidural she was in labor. Patient got an epidural and was nice and comfortable she was still contracting every 3-5 minutes when nurse checked the patient around noon. Patients cervix hadn't changed. MD ordered pitocin to be started. The nurse caring for the patient questioned it but the MD was adamant. When I received the patient at 3 pm she was on 22 mu of pitocin. The patient had just been checked at 2:45 pm by the MD and she was 2/70/-1. The patient had made no cervical change for 10 hours clearly she wasn't in labor and we are essentially inducing someone who is not even 36 weeks. I explained to my charge nurse I was going up the chain of command. I spoke to my assistant manager and manager and explained the case to them. I didn't feel supported by them and they told me to speak to the physician and ask him for the rationale of why he was doing this. I called the physician and he explained that the patient was in labor. I stated that from all the information I gathered the patient hadn't changed her cervix for 10 hours. That isn't labor even if you are contracting! He told me the patient had made cervical change and I asked him when? He said her last exam I just didn't make a note of it when I checked her. I stated it was charted by the nurse and the only thing that had changed in 10 hours is that the head went from -2 to -1 (very subjective). He then stated he didn't have to explain to me why this patient was on pitocin and being admitted for labor and hung up on me. He then called the charge nurse and told her he didn't want me taking care of the patient! I then went in and spoke to both my manager and assistant manager and told them what transpired. They told me they would support me if I called the chief OB and I was happy with that but felt like he wouldn't support my decision and would say "What do you want me to do?" The chief OB still does fundal pressure on his patients when he does deliveries so how do you think I'm gonna get anywhere with him! I handed the patient off to another nurse and finished my shift. I didn't feel right taking care of her knowing what was being done to her was wrong! The sad part is that she wanted to deliver her baby. She was sick of being pregnant!!! I'm just so over this mentality!!! I was only trying to do the right thing and protect this innocent unborn child!!! I feel like being a patient advocate gets me nowhere except being a difficult nurse to work with!!! I'm just so sick of it!! I'm frustrated and want to quit!!!!:angryfire

[netglow, ASN, RN]

OP, Hugs to you for insisting on being the "sane" one. Hopefully things end up OK for the mom and little one. After all it's simple, isn't this :bby: the goal? Sometimes it seems that everybody has forgotten.

[jo'ee]

I would want you fighting for me and my unborn baby even if I didn't understand the ramifications of delivering too soon and was "tired" of being pregnant. Keep up the good work....that is what a good nurse is....fighting for the patients and a safe outcome even when it is not the popular thing to do.

[moonblossom]

Don't give up! Mamas and babies need more people like you advocating for them! It enrages me too. My background is in Peds but my goal is to become a CNM. I just finally landed an L&D job. I knew going in that there would be frustrating moments and that I would see lots of things that are not right and are not based in evidence. BUT I am hoping that I can maintain my sanity and continue to make a difference for those who I can. Every little bit helps! If you leave, that is one less person who will stand up for what is right. You did nothing wrong. It sounds like that OB just doesn't really give a toot. That is so sad:( Don't let it get to you, though! You stood up for your patient and for what is right and for what you believe! Educating our patients is key, too. When women think they want to be done with pregnancy "due to discomfort" - we need to educate them about all the risks of laboring before the body is ready and all the risks and illnesses associated with prematurity.

I hope you are feeling better. Be sure to take care of yourself and don't give up!

[ldcmw1]

Thanks guys for all the positive feedback!!! I'm just so frustrated!

[DeeAngel]

Paragraphs please, it will make many more people read your post. I'm going to pass on reading it in the form it's in.

[sethmctenn]

You are so needed exactly where you are!

[CEG]

You were totally right. Is there an automated system to report risks or near misses? At my location you can use a computer system to report advers events anonymously.

[jemeko]

:yeah::loveya::loveya::loveya: I applaud you!! they need more nurses like you! but what i would do is to report this in risk management (anonymously) as a near miss and write this scenario down somewhere just in case it resurfaces.

[Black Jade, BSN, RN]

You are being an advocate for the patient and for the unborn child; you are doing everything right. The sad part for me (besides not getting the support that you need) is that the patient is 26 y/o and already had 5 pregnancies complaning of "sick of being pregnant". I hope she gets her tubes tied after this pregnancy...

[klone, MSN, RN]

Ugh, I feel for you. Where I work it's a bit different, as we're a Level 1 and it's hospital policy that we do not deliver any moms earlier than 36 weeks, except in cases of emergency. We would not induce ANY woman prior to 37 weeks unless there's a compelling medical reason (like PIH). My manager would totally back me up if I refused to induce that patient. You absolutely did the right thing.

I would probably write up an incident report to QI.

[babyktchr, BSN, RN]

as a nurse manager, I would have a safety tracking tool or incident report done so it could be forwarded to a peer review. This most definitely needs to be talked about. The patient was NOT in labor and inducing her was so not indicated. I am with you , sister, and I would've been right there with you. Kudos to you for not backing down. Unfortunately this is only going to be one of many frustrations you will meet in the wonderful world of OB. Find peace in the fact that you did the RIGHT THING.