As most of you already know, Obstetrics is one of the most litigious areas for both medicine and nursing. When a pregnancy or delivery goes wrong, and the perfect ending is not realized, questions surface and fingers begin to point. Navigating a “Bad Baby” case can be both arduous and technically challenging.
Unlike other specialties, obstetrics is an area that crosses over into multiple specialties and disciplines. These include AWHONN, ACOG, AAP, SOCG, ANA, AORN, ASPAN, ASA, and AACN, all of which are either obstetrical or cross over into obstetrics at some level. The challenge arises because due to the involvement of the many different specialties and disciplines, many different applicable Standards and Guidelines apply which can become vast and overwhelming. The OB LNC working with you on your case needs to have a strong foundation, working knowledge and familiarity with all disciplines, organizations, standards, guidelines, protocols and policies, in addition to regulatory requirements governing this large specialty area.
To detail this multidisciplinary specialty, labor and delivery on any given day can be an emergency room, an intensive care unit, an operating room, recovery room, a triage, an outpatient testing unit, in addition to a place where without complications, a woman comes to deliver her baby. This delivery may take place in a Level I, II, III or level IV hospital, all which vary in their capabilities, availability of services and resources, all of which can essentially effect and impact care delivery.
The OB LNC needs to demonstrate a vast and in-depth knowledge of fetal heart monitoring. A strong working knowledge of fetal heart monitoring and associated physiology is without a doubt critical when analyzing a case of this nature. An administrative background can also add an additional benefit. This knowledge enables the LNC to speak confidently to staffing issues and organizational issues which can frequently be encountered in these type cases. An OB LNC with an advanced degree can also be an asset. A Masters degree in Nursing, which can have varying focuses, a Clinical Nurse Specialist, or even a Nurse Midwife, all can add unequivocal strength and knowledge when navigating these cases. Another aspect to consider when retaining an LNC is, “Does she teach?” An LNC who actively lectures on OB-related issues will have an easier time engaging and educating the jury, as well as attorneys, and is more apt to provide well articulated and easily understandable responses to the medical jargon so often spoken and so often misunderstood. A consultant involved in lecturing will also more likely be current on OB related care, treatment and diagnoses.
The smallest and most critical of details can and will be discovered by the knowledgeable OB LNC. Attention to detail, knowing what “should have occurred” in a given situation, and expanded experience with various types of medical records are crucial. When searching for an OB LNC credibility is paramount. This specialized body of knowledge branches into multiple areas which therefore requires that an OB LNC posses both broad and specialized experience. An OB LNC can simplify, uncover, and explain what can appear to be a tremendously complex case if she has the right background and experience. Do not sell yourself short in your next OB case…know the right questions to ask, and examine the LNC’s background and credentials with a scrutinizing eye. You will be glad you did!
Karen M. Harmon, RNC, MSN, CNS
Legal Nurse Consultant