Dec 072012

“I don’t know why they sent her to me?” – L&D triage nurse overheard referring to a mother 28 weeks pregnant who came in with heart palpitations and difficulty breathing.

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 December 7, 2012  L&D Nurse  Add comments

  38 Responses to ““I Don’t Know Why They Sent Her To Me?””

  1. Maybe because they expect you to do your job? Just a thought!

  2. earshot of patients do you complain about treating them.

    • Amen! I totally ripped into a nurse years ago because my grandmother over heard her day to another nurse “these old people are always complaining about something”. My g-ma had just come out of surgery to remove scar tissue from a prior surgery 6 months before to remove art of her colon. Hell yes she was in pain but after hearing that nurse she didn’t say any thing more and just lay there in pain. I saw red. I told her if she could do her damn job, which was to help patients she needed to quit. How ashamed she should be to treat an elderly woman like that. And if she was going to talk shit about her patients to make sure they could t hear here. I then demanded she get a doctor ASAP to give my grandmother something for the pain.

      • GOOD FOR YOU.

        I wish I had had the courage to do that for my boyfriend last year when he was coming out of a brutal sinus surgery with NO pain medication at all. The nurse just told his mother and me that his pain was normal and she couldn’t give him anything else, so he just needed to deal with it. Even though he could barely breathe because of the pain (which you would THINK would be a sign that something MIGHT be wrong…), she kept nagging at him to take deep breaths so his blood oxygen would go up, because he “couldn’t leave until it stayed above 90%”. And then two minutes later she kicked us out – er, DISCHARGED him – despite his levels still being around 85%. I would love to know what changed in those two minutes. I didn’t even KNOW he was unmedicated, I just trusted that the nurse knew what she was doing, and I was too busy trying to keep him calm and breathing to realize that something was wrong.

        I wish his mom, who DID see that something was wrong, would have said something, but the sad truth is that she was only there to swipe the credit card and sign the papers. I always end up taking the “responsible adult/caregiver” role away from her since she would rather use his pain to get sympathy for herself than actually help him out. (Boyfriend has FMS, so unfortunately this kind of thing happens all the time.)

        Phew. Sorry, had to get that out of my system. >_< I am so sorry that that happened to your grandmother, and way to go for standing up for her. I really hope she got her pain meds in the end!

  3. At our hospital, pregnant women who have complaints other than labor issues first get seen in ER to get ruled out and then get sent up to L&D. From this quote (obviously have to wait for the pink) this woman needed to be seen by someone other than a L&D nurse. It’s not the L&D nurses job to rule out asthma attack, PE, anxiety attack, etc.

    • Exactly my thoughts! This should be a Thoughtful Thursday quote, the L&D nurse recognized this was an issue not with the pregnancy but the mother’s health and would be poorly cared for on L&D, better addressed by ED.

    • A lot of hospitals these days have it so 20 weeks on up are labor and delivery, regardless of why they are seen. And regardless of how you view it, I can not swing this in my mind to be thoughtful.

      • In the event that this hospital had a similar policy, it should have been the nurse’s business to know her hospital’s policies and to know how to treat the patients that are sent to her, even if that’s only to page an obstetrician while checking out the baby and getting vital signs.

        • Agreed. I am pretty sure the hospital I was at triaged (sp?) all mothers 20 weeks on up, then transferred accordingly. L&D Triage takes 20 minutes for what would take 7 hours at our ER. We have a very poor ER

      • The hospital I delivered at had a policy that ANY pregnant patient was to bypass the ER and head right to the maternity ward, regardless of how far along they are. However, the maternity ward at that hospital was very high tech and had all the same stuff/equipment that the ER department had, so maybe that is why.

    • Heart palpitations and shortness of breath are possible symptoms of preeclampsia, which is a pregnancy complication. It seems VERY appropriate to me that she’d be seen in L&D to be evaluated for that. Plus they can monitor the baby to make sure whatever is causing the heart/breathing issues isn’t compromising blood flow to and through the placenta.

      • Perhaps she should be seen for suspected pre-e, but I’m not sure an L&D nurse is the person for it. By the quote, I am sure THis nurse wasn’t up to the job.

      • The ER would have been able to do a urine test to check for proteins and get the mom’s blood pressure, though, so it seems they could have ruled it out.

        I agree about checking the baby, but it would seem the first priority should be stabilizing the mother, since the baby’s not going to fare well if the mother crashes because they sent her to L&D to get the baby monitored. ;-)

        • I can’t speak for all doctors or all hospitals, but when I was borderline for preeclampsia my OBs and MFM all said to bypass the ER and go to L&D for any new or worsening symptoms. They’d check me there and then call my OB for further instructions. The couple times I went to ER, they were more of the “treat ‘em and street ‘em” philosophy, and they didn’t even call my doctor to say I was there.

  4. Actually, unless they needed to check on the baby, I’m not sure why heart palpitations and difficulty breathing would get treated in L&D either. I’m not a medical type, so I honestly don’t know. Wouldn’t that be something to assess in the ER on the assumption it was a cardiac problem? You can’t do an echocardiogram in L&D.

    • They’re possible symptoms of preeclampsia.

      • Even if the signs point to pre-eclampsia, it may not have been. It should have been determined in the ER first before sending the patient to LD. They could have easily taken a medical history, and used a fetal monitor down there. At the very list they should have had someone in the ER call the LD floor and tell them they are sending up a pregnant patient for x, y, and z. It seemed the nurse thought the patient should have been seen in ER, or sent to cardio for better diagnosis. However, since I wasn’t there, and havn’t read the pink yet it is hard to be determined.

        • It also could have been SVT, Afib with RVR, any other tachyarrhythmia, asthma, PE or a number of other conditions that require immediate rule out in the ED. Nurse shouldn’t say that to patient, but as an ER nurse who later became an L&D nurse, no, there’s too much going on there that cannot be managed appropriately in L&D to start. Take the few minutes to *at least* get an EKG in ED triage to rule out a fatal arrhythmia before transferring to L&D. And then remind the nurse to handle this situation with more delicacy and respect.

  5. At the hospital where I gave birth to my oldest, if you went to the ER for as little as a hangnail after 30 weeks you automatically got sent to L&D. Anything except contractions/water breaking and you stayed in the ER. Maybe she sees this is cardio and mom doesn’t need to be in L&D? Either way, she’s out of line complaining where it can be heard.

  6. Goldilocks, I just thought you should see everyone defending the CHOICES made at the hospital, calmly discussing all sides of the issue, even if we don’t disagree with the complaining in front of the patient. However, there might not have been an attitude she might have been simply stating, not complaining.

  7. At my hospital, if a pregnant woman checks in to the ER for any reason as soon as the problem is taken care of they insist on making sure the baby is okay.

  8. I know in the military your PCM won’t TOUCH YOU if you’re pregnant. You have to see your OB for everything.

    • This was my experience also. No matter what the complaint was, first you went to L&D, then IF they determined it wasn’t due to contractions/labor/etc. you might be sent to a different department, or the OB on call might still try to treat you. But you had to go there first for them to decide.

    • Same here; even though I was seen at a civilian hospital they wouldn’t cover me if I went to the ER after 20 weeks, I had to go to L&D for EVERYTHING.

  9. Could this have been that nurse’s way of asking for the chart? I could easily see this as a request for information rather than a complaint.

  10. I apologize the OP felt bad about this. But as someone who has ONLY worked L&D I can tell you what was going through this nurses head. “This is most likely NOT pregnancy related and NOT something routinely seen up here and over our heads!! I want someone more experienced in this!”
    It would have been more appropriate and SAFE to have this patient in the ED and call the L&D nurse down. That way the patient has the BEST person to care for her very serious complaints AND the BEST person to evaluate the baby. This would be better care for the patient by using a team approach rather than dumping an inappropriate patient in L&D soley bc she is pregnant, not based on her symptoms.
    Would love to see the pink link to know what happened. Hopefully she received appropriate care and everyone was fine!

    • I have gone down to the ED to monitor a pregnant woman on EFM when she is being treated for non-OB related illness or injuries. It is really not a big deal. But we seem to have a sense of (in most EDs) that if a woman is pregnant (or heck, thinks she’s pregnant), no matter what the complaint – send her to L&D! L&D is for the obstetric complaints — not for: broken legs, heart conditions, dental pain, dog bites, vehicle accidents (still in c-spine precautions). Please, assess and triage the patient appropriately first!

  11. <— This L&D triage nurse would not be able to assess and treat a pregnant woman for a possible cardiac or respiratory problem. L&D is not the place to go for cardiac or respiratory problems. If I had someone present with these complaints, I would: grab a set of vital signs, put on a pulse oximeter, and grab some fetal heart tones. Then I would stat page her OB. If her OB was not in house, and she obviously had some kind of cardiac or respiratory thing going on, I would call the ER and tell them that I am bringing down an XX weeks pregnant woman with palpitations and shortness of breath.

  12. It’s unfortunate that the patient had to overhear it, but the L & D nurse was probably referring to the fact that the patient should have first been evaluated in E.R. Breathing difficulties, cardiac-related complaints and the like have no business being worked up in Labor & Delivery! I’m an L & D nurse, and I love my co-workers, but if I ever code, I hope it’s in E.R., not on my own unit. :)

  13. unless the patient was named she could have been talking about anyone, at any point in her shift.

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