Yikes, L&D Manager Fired...

[chiandre]

This is so infuriating and perplexing!

In an executive meeting, a Nurse Manager defended one of his staff members.

The Obstetrics MD accused the Labor and Delivery Nurse of insubordination and risking patient's safety. Why? The Labor and Delivery Nurse refused to allow 3 medical students to perform lady partsl exam on a patient (in succession)!!! The MD insisted that the nurse should be disciplined.

The Nurse Manager refused and defended the nurse as advocating for the patient. The CNO and the Labor and Delivery Director agreed with the MD that the nurse should be suspended without pay for a week. The Manager got upset and accused the CNO of not defending the nurses. The Manager challenged the executive team to "walk-in-the shoes-of -a-staff nurse."

The only problem was that the Manager made this accusation in front of all the executive team. Also, he used unprofessional and inappropriate accusatory words. The Manager was escorted out of the meeting and the institution by the hospital security.

The final conclusion is that the Nurse will not be disciplined, but re-educated.

WHAT?!!

I agree with the Manager that the nurse should not be disciplined. However, I completely disagree with the way the Manager accused the CNO. As professionals, we should be in control of our emotions and behaviors.

I am elated that nursing leaders are beginning to remember what it means to be a staff nurse, and are taking measures to support the struggles and plight of staff nurses.

What do you think?

Disclaimer: I did not witness this incident. I do not work in the institution in which this incident occurred. An executive in the room related this story to me.

[Pangea Reunited, ASN, RN]

I see no mention here of the patient's wishes/concerns/instructions/consents, so I'm not sure...

[dudette10, MSN, RN]

I am elated that nursing leaders are beginning to remember what means to be a staff nurse, and are taking measures to support the struggles and plight of staff nurses.

No, not really, because the one that did support the nurses just got fired, and it sends a message to the others. Your facility's nursing culture is now in worse shape than before.

Unprofessional behavior is insisting that three med students in rapid succession should do a lady partsl exam on a laboring patient. But, then again, in all the hulabaloo, the patient got lost.

If the executive team decided that the nurse should be "re-educated," what education, pray tell, should she get? That the medical students' needs outweigh the discomfort and possibility of infection in the patient?

[roser13, ASN, RN]

"I am elated that nursing leaders are beginning to remember what it means to be a staff nurse, and are taking measures to support the struggles and plight of staff nurses."

Whaaaaa?? How is anyone supporting the struggles of the staff nurses? Other than the NM, that is, whose actions you condemn. The CNO et al were only doing what they had to do in the end to avoid losing both the NM and a staff nurse. After all, they were all initially willing to throw the staff nurse under the bus. I find your perspective on this to be very strange.

Plus, I really can't even believe that 1) the initial MD demanded that the patient be violated in that manner, and 2) that it's the nurse who advocated for the patient rather than the MD who is brought up on charges. This sounds like something that could have happened 50 years ago, certainly not today. In my hospital, that MD would have been disciplined in a heartbeat.

Just curious, OP: do you live in a small/large town? Small/large hospital?

[richardgecko]

Sad but a reality. I remember when I had my son I was referred out to a teaching facility for prenatal care. This facility was the only facility capable of taking on someone as high risk as myself. Over.the last 8 weeks of my care I saw 8 different residents. Thats 16 hands in my lady parts. When I began active labor, 10 students rushed in to watch without my consent. It was so crowded that my husband almost pushed someone over to cut the cord.

[Nonyvole, BSN, RN]

Wow. Just...wow. What happened to asking the patient?

I'm so glad that the nurse and the nurse manager advocated for the patient. However, the NM really should have remembered the politics of healthcare - and the simple fact that you call out your bosses in the manner which is sounds like he did, you're going to suffer the repercussions.

I'd also love to know how not having three extra sets of hands up there is detrimental to patient safety.

[DoGoodThenGo]

Wow. Just...wow. What happened to asking the patient?

I'm so glad that the nurse and the nurse manager advocated for the patient. However, the NM really should have remembered the politics of healthcare - and the simple fact that you call out your bosses in the manner which is sounds like he did, you're going to suffer the repercussions.

I'd also love to know how not having three extra sets of hands up there is detrimental to patient safety.

At least in this instance attending felt his patient had something those students should "experience" and he was at least comfortable with any possible risks if any. That in theory (in the attending's mind anyway) seems to should have been end of discussion. That a nurse and her direct supervisor thought differently obviously in some way challenged the authority of the attending (in his mind at least) and worse showed him up in front of students. That is something which was not going to go unchallenged it seems.

All this is yet another variation of an oft told story; make an example of a nurse (or two) so the rest won't get any ideas in future.

Being as all this may teaching hospitals do exist for a reason. If enough patients opt out of being part of the post graduate experience (either directly and or via their nurse's intervention) what is the point.

[suanna]

Thus why I've never considered going into management. When faced with stupidity and unfair persecution of a certain level, I too have been known to use "...unprofessional and inappropriate..." language. I can't seem to help myself when I get infuriated, my limbic system rather than my cerebral cortex seems to take control of my mouth. Although I'm thankful the nurse got backing from the unit management, the larger problem is that a physician seems to think he is in charge of the nursing department. The term "insubordination" indicates the nursing department is subordinate to any physician. After almost 30 years in nursing, in my experience, this just keeps getting worse. I can't wait to get out.

[Here.I.Stand, BSN, RN]

Was it brought up that nurses are not on the same hierarchy as physicians? Yes we execute medical orders along with our independent nursing orders, but as our hierarchies are different we cannot be guilty of "insubordination." We could be guilty of insubordination with regard to our NM etc...although doing the right thing for the pt SHOULD trump any thought of insubordination.

I can't think of any instance--teaching hospital or no--where it is appropriate to successively stick four hands in a woman's cervix. That would not be happening to MY cervix if it meant I had to kick med students in the face to get them away from me ('course then I might get a behavioral response "code" called on me, but most of our L&D nurses are good pt advocates and they're the ones who call the "code," so I'd take my chances.) Maybe in a good mood I might allow one to do a check, another when a repeat assessment is deemed appropriate. One assessment ten seconds after another is not clinically appropriate. It's painful and it can introduce bacteria into my sterile uterus and sterile infant.

Rant over. Regarding the NM, no I don't think firing is warranted. It's a tense situation, things can be said that later we might cringe at. A verbal reprimand should suffice.

[jadelpn, LPN, EMT-B]

Doing any of this "checking" without the patient's infomred consent is battery. And if I am "he-he-hoooo"-ing and otherwise attempting to breath my way through labor, Uhm, Noooooo you may not stick your hand (and your hand, and your hand) into my lady parts, thank you. At that point, it is exit only.

It is an unreasonable request with a patient under duress. And time in labor and delivery has noted that there's many patients who don't want to be checked by anyone, at all, pretty much ever. Equally as many who are just this close to losing it if their partners look at them the wrong way, never mind a few residents....

Isn't there a SIM for this? As a primary nurse I would be shocked to hear a doctor suggest this. It is a highly personal time, even if one is fully epiduraled.

Eh, this will all come to a head when the survey comes back......But too bad someone needed to lose their job over it.