The OB hospitalist model from a nurse’s perspective

Looking back on her days as an OB nurse, Shari Arner recollects the joys and challenges of her job. She graduated from LPN school in 1973 and became a registered nurse in 1977. Shari’s nursing career took her from Michigan to Arizona and lasted 41 years, most of which she worked in the L&D unit. She received her bachelor’s degree in nursing and spent some time in management as well as taught OB nursing students at the local community college.

Shari worked at a community hospital in Arizona for 21 years before retiring in 2013. Then, the hospital was a level II OB unit with no OB/GYNS in-house. She worked the night shift for her first three years there and it was quite the shock.

“Coming from teaching hospitals, I always had residents as backup, and all of a sudden it was just me and the patients,” said Shari.

Shari came from a setting where residents did most of the exams and said that the biggest difference was not having a physician there for big medical emergencies such as bad heart tones or a prolapsed cord.

“I had delivered babies before when the resident couldn’t make it to the room in time, but it got to the point where it became a fine art of making sure that I got a doctor there,” she said. “I needed to get them there in time for the delivery but not too early, where they would be waiting around for a couple of hours.”

She recalls times when a patient would have bad heart tones and her team would take the mother to the C-section room and get them prepped and draped and just wait for the doctor to come.

“Looking back on it, I think the nurses made a lot of decisions that weren’t really nursing decisions,” said Shari.

She said that they triage unit was very busy and although her team kept in phone contact with the physicians, most patients left without ever seeing a physician.

“This put an added responsibility on nurses,” she said.

Although she never got the opportunity to work with an OB hospitalist program, she thinks it could have many benefits.

“It would have to make patient safety better because there wouldn’t be delays in care,” she said. “When there wasn’t a physician in-house and a patient had bad heart tones, we would just wait for someone to get there. It’s pretty scary for the patient and the nurses.”

Shari also said that having a physician in-house would be beneficial for the interpretation of fetal monitor strips.

“You could show the same strip to multiple people and everyone might see it differently because it’s open to some interpretation.”

Although the benefits to nurses and community OB/GYNs is clear, the public has shown some skepticism.

“I think patients think there is a much more intimate relationship with their OB/GYN than physicians or nurses think there is. This is their job! They don’t sit up at night waiting to hear from you!” said Shari.

Shari also pointed out that due to higher risk potential, emergency rooms don’t want to deliver babies, so there would be an advantage of having a hospitalist there – when the unexpected happens.

During one of her last shifts before she retired, Shari had a patient come in who had intrauterine fetal demise (stillbirth). The ultrasound technician performed an ultrasound, and there was no heartbeat. The patient and her husband were both semi-hysterical. Because the nurses aren’t supposed to deliver this type of news, they had to call a physician and wait for him to arrive to the hospital.

“To me, this is just torturing the patient.” 

An OBHG hospitalist not only provides immediate care for patients in emergent situations, they provide a safety net for community OB/GYNs and nurses. Highly skilled OBHG hospitalists close the gap in time delays and are ready to take action 24/7 so that the responsibility does not fall to the nurses on shift.

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