Who assigns APGARs?

[ruralnurs]

I am in a very small (less than 60 babies per year) facility. Recently was in a c-sec and took the babe and a few minutes later our RT spewed out APGARs and everyone heard what she said. They were not the scores I assessed and not the ones I documented either. Also we have an MD that always has APGARs of 9 and 10. I did a baby with him a month or so ago and it have PPV for 10 minutes, and O2 in the hood for an hour and O2 per NC for 4 hours and he still documented 8 and 9.

So now our medical records dept is noticing that what the doc dictates is not always what the RN documents on nursing forms. I don't want to sign my name to a form that I do not agree with an assessment. And some of these are nursing forms and some are for the MD but they still have us fill out most of the info.

So questions for all of you OB nurses, who does APGARs and can there be different scores?

Thanks!

[PICNICRN, BSN, RN]

APGARS should be assigned by the person who receives the baby. Depending on the size of the hospital, this could be the NEO, NNP, RN from the NICU, well NSY, or sometimes the L&D nurse..... whoever provides the initial care for that infant(not the RT). Never should an OB assign their own apgar score. The OB is at the mother's bedside (usually) and is responsible for the mother.... in my experience.

Where I have worked, the RN(MD, ect) receiving the infant documents APGARS on the delivery summary. On a few rare occasions, an OB would fill out that part of the form- usually, they filled out the APGARS I assigned, a few times they tried to fill in something else. I went right to them and said "Dr. Soandso, I gave that baby a 6-8 (or whatever) did you want to change this?" Only one time did I have an OB argue with me over it and I documented right on the delivery summary "APGARS assigned per DR. Soandso." If she wanted to assign APGARS from the between the mom's leg's, that's on her- not me!

[RNmama05]

It has to be the person who is directly caring for the baby. Apgar scores are *real time* assessments of the status and level of care the baby needs *now*. They really aren't supposed to be assigned retrospectively.

[mom2michael, MSN, RN, NP]

Whoever receives the baby from the delivery assigns our APGAR's. As long as I can justify my APGAR's, I don't much care what the doctors or other RN's say. I work with some RN's that will actually fudge APGAR's because they are scared of our doctors or they'll assign the 1 min APGAR at 3-4 mins (after PPV for 2 mins) so it looks better.

As far as I'm concerned I don't get very excited about the 1 min APGAR and as long as the 5 min. APGAR is better than the 1 min, we are headed in the right track and all is good.

I did have a mom freak on me the other day because her baby had a 3 for the 1 min. She was so upset about that 3 she didn't noticed that the 5 min. one was 8 and the baby was doing great.

And I truly think that doctors think APGAR's directly reflect their ability to care for their mom/baby and effectively and somehow the # deems whether or not the delivery was a success which is totally not the case, obviously.

[Montessori Mommy]

I work per diem at two hospitals. At both, the RN assigns Apagar scores. Even when an RT is called to the delivery, it is the nurse's responsibility to do Apgars. The MDs and midwives always ask me for the Apgars so they can include them in their note.

[Elvish, BSN, DNP, RN, NP]

At our place it's the RN who is actually caring for the baby, regardless of what the doc or anyone else thinks.

[iteachob, MSN, RN]

At the hospital we use for our clinical rotations, it is the person (usually an L&D nurse, but sometimes NICU or Newborn nurse) who the baby is handed off to........

[NurseNora, BSN, RN]

As everyone else said, it is the person with the baby at one and five minutes who gives the Apgar. If it's a doc who holds the baby until the cord stops pulsating, then clamps it and hands it off, I'll ask him/her. Otherwise, if the babe is in my hands, I give it.

RTs go to sections in my hospital, but I don't think I've ever had one to assign the Apgar. I may on occasion consult with the RT, but it's always been my final say. You might want to check what your hospital's official policy is on that.

If the doctor disagrees with my score, I'll write both of them with who assigned which one. It's only happened infrequently, but sometimes the doc won't back down. I won't either unless I'm convinced I'm wrong, so I'll document both. But mine is the official one. The MD does often view the Apgar as a grade on their delivery skill and cannot be as objective as the nurse.

[crysobrn]

The nurses assign apgars where I work. We rarely have RT at deliveries and if we do they never assign apgars. If we do a c/s then there is generally a pediatrician present and for the most part they assign... but honestly they often ask the nurses what they were.

We have one OB that on occasion will stretch the truth and give 9/10 to a baby that wasn't doing quite that well.

I think that they do case reviews in our dept for every apgar less than or equal to 6 so generally the docs get a little testy if they get one like that.

[Spidey's mom, ADN, BSN, RN]

At our place it's the RN who is actually caring for the baby, regardless of what the doc or anyone else thinks.

The nurse cares for the baby where I work - the nurse assigns APGAR scores. And we don't have respiratory . . .the nurses are respiratory.

steph

[feminist-mama]

RNs do APGARs at my hospital- unless the ped is there. Even then, they ask the nurses...