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5 more days until Kentucky

Posted Nov 26 2008 10:26am
Last evening was a bit of a wacky shift. I started out with a young multip being induced for medical reasons - actually, several maternal medical reasons, including active cancer. Such a sad situation with her, but she was so upbeat and ALIVE! Her cancer was in an advanced stage, and her prognosis was poor, but she was actually living her life, and not giving in to the bleakness of her medical situation. I find that absolutely amazing. Unfortunately, she didn't give birth on my shift, however, she had an awesome nurse for her delivery after I left.

I picked up a second laboring woman, just "covering" for another nurse who had to circulate for a c-section. Well, the c-section turned into a much more intricate surgery due to some complications that happened, and a general surgeon was called in to assist. What should have been a 30 minute surgery, turned into a 3 hour major operation. She almost lost her uterus, and did lose part of her bowel, from what I heard.

Anyhow, I kept her laboring woman, who was comfortable with an epidural, for those several hours, until her nurse was able to come back to the floor and take over her care again. This laboring woman, more like a girl, was sweet as can be, albeit very nervous about labor and birth. I spent a lot of time with her, educating her, and trying to put her mind at ease about what her body was going through.

Later on in the shift, things finally did start to slow down a bit, and I was able to catch up on my unit email. I found out that our OB tech are no longer able to unhook patients from the fetal monitor to get up and go to the bathroom. It's all about liability folks! I heard through the grapevine that something happened recently where an OB tech unhooked the patient from the monitor, but the baby needed to stay on continuously, and something bad happened as the outcome. I don't know the details, but it was enough to cause the management to come up with an official statement about OB techs and fetal monitoring. The key thing about the liability is that the nurse is the licensed, trained person responsible for both the mom and baby. The OB tech is working under the RN. If anything happens, it's on the RN for liability. They're trying to eliminate the liability for the OB tech, since she/he is not a licensed person, nor is able to read a fetal monitor strip and know if it's ok for the woman to get up to the bathroom or not.

Years ago, our OB techs used to apply the fetal monitor, but that was taken away from them - liability once again. They are also not allowed to readjust the monitor parts - yep, liability. Basically, they cannot have anything to do with the fetal monitor or it's parts.

I have questions about when we (the RN) teach the patient on how to unhook herself from the monitor to go the bathroom? Is the liability all on the RN? Or does the patient take some responsibility? I believe that ultimately, it is the RN who is liable, since she is the one who is continuously reviewing the EFM monitor strip for decels or non-reassuring fetal status. If the patient should not be getting up to go to the bathroom due to compromising fetal status, chances are very good that the RN is already in the room as it is, doing intrauterine fetal resuscitation maneuvers! (Position changes, oxygen application, IV fluid boluses, etc).

Back to work tonight again. Have a great Turkey Day tomorrow everyone!

5 more days until I leave for Frontier Bound!
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