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

[babyktchr, BSN, RN]

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.

??????

[Jolie, BSN]

Was this patient taken up with the Chief of OB, or was the assumption made that s/he wouldn't support your position that induction was inappropriate?

I don't mean to sound over-bearing. I know how difficult it is to be on the "outs" with phyicians, but stopping short of the Chief Medical Officer in a case where the best interests of both mother and baby are being ignored is not good enough.

In my experience, this induction would not have been allowed to proceed.

[zahryia, LPN]

I think it took a lot of courage to do what you did. Kudos to you. Please keep doing what you're doing!! You're a role model for many of us.

[vivacious1healer]

??????

This was an especially long post that was not broken up into paragraphs. It was difficult to read....that is what the critic is trying to convey.

[ldcmw1]

Sorry for no paragraphs! I just kept typing away in frustration! Will do better next time. I will be writing up a QI on this and I will be taking this up with the Chief OB.

Mom delivered about a hour after I went home. Baby went to regular nursery and as far as I know all went well. I'm glad but there is so much information out there on late pre-term infants these days, why would you take the risk of delivering someone early for no good reason.

Thanks for all your support!!!!