These 4 areas of nurse knowledge come up in almost every case...and it might not be what you think.

legal risk patient risk Apr 15, 2021

If I could boil down lawsuit-proofing your practice into one concept, it would be that we get our best outcomes when we don’t intervene in normal and when we intervene in a timely manner in abnormal. Which means, nurses mainly just need to be able to tell normal from abnormal in order to work towards our best outcomes.

In the cases I review, there are four main areas where nurses struggle to know the difference between normal and abnormal. Most nurses are worried about knowing these majorly obscure things, but in reality that’s never the case (I mean, if I’m having to google it…). These four areas of nursing knowledge deficits are maternal/fetal physiology, uterine activity and labor progress, oxytocin, and fetal monitoring. Wait, what? But Jen! Those are so basic!! Yes, yes they are. So this month, I wanted to answer why nurses should spend time reviewing and cementing their knowledge of the basics, besides not getting yourself involved in a lawsuit.


It’s the standard of care!

We know the standard of care is what any reasonable and prudent nurses would do in a similar situation, so think of standard of care knowledge as what any reasonable and prudent nurse should know.  Let me put it this way: if I asked a random pregnant person if they thought their labor nurse should know how labor works or how contractions affected the fetus or what the side effects were of the medications we gave to induce labor, I’m pretty sure they would say “YES! OF COURSE!” Often we think of the standard of care as what is common, but I can say from both consulting and reviewing cases, that whole units can be below the standard of care.  They may have normalized some very deviant practices and don’t realize how far from the standard of care they’ve shifted until there is a bad outcome. Then, in deposition, the fall back to not knowing something is that clinicians will claim they don’t need to...they rely on clinical judgement.  The problem is, clinical judgement can only be as good as our foundational knowledge.


You’ll stand tall and confident, and so will your patients.

When we are competent and confident, our patients feel it.  Whatever is inside us will always project.  Research supports that if we’re passionate about our work, patients feel it.  If our unit is overworked and understaffed and we’re tired, they feel it.  So if we are truly experts in our field and have a grasp of our core knowledge, they feel like they are being cared for by experts.  Having that reassurance in ourselves, that we truly know our foundations, will always translate into our patients being able to relax.  Being relaxed into their parasympathetic state is a foundational tenet of birth physiology.  When we know and trust ourselves, not from unchallenged presumption, but from time spent pushing ourselves to master the subject, we model for our patients how to know and trust themselves. 


You’ll no longer have to suffer foolishness (so much foolishness smh)

Both in my work as an expert and just in my day-to-day work as a nurse, I’m asked a lot of really great questions or receive requests for more information or resources. I love it! Sometimes I’m challenged and get to go down a really lovely research rabbit hole. But a little too frequently someone emails me asking for “evidence” or “articles” or “research” so that they can convince a provider to stop doing a practice which is problematic. Some examples are “What research exists that says oxytocin must be turned off before applying oxygen?” or “What research has been done that proves scalp stim shouldn’t happen during a decel?” It’s always okay to reflect on where and how we learned practices and to question what we’re taught.  But, if the reason for the recommendation or the practice is just basic physiology, then no research exists. In our fervor towards evidence based care, its easy to think research is the gold standard for evidence, but forget that it can also be in our foundational physiology.  In healthy work environments, all clinicians are educated in the agreed upon Labor 101.  In toxic work environments, research and evidence is used to gate-keep and maintain power differentials. When we know our core physiology, we no longer have to suffer the foolishness of bad practices.  That means when we are asked the equivalent question of  “Well, why shouldn’t I tickle a person who is holding their breath underwater? I’m going to continue until you prove to me this is a bad idea” we can take a breath, put down our coffee, look over our readers and answer in our calmest voice that basic physiology and reason tell us not to (and because they’ll drown).  We can answer that if they want to continue to use scalp stim as a resuscitative maneuver, then they show you the research that its a good idea (see above on standing tall and confident ;) It truly baffles me that research is used in this manner by so-called professionals.  It reminds me of a Brene Brown quote I saw recently: “Armored leadership is being a knower and being right. Daring leadership is being a learner and getting it right.”


So there you have it, besides keeping you out of lawsuit-land, focusing your learning on knowing the physiology and normal vs abnormal of maternal/fetal physiology, uterine activity and labor progress, oxytocin, and fetal monitoring has so many benefits, It will help you ensure you are meeting the standard of care for nurse knowledge, make you more confident (and in turn, make your patients calmer) and help you be the leader you are meant to be.  If it seems like a daunting list, it’s ok! It’s a lot, but you’ve got this.  If you want to know more about this topic and all the others ways to keep your patients safe and lawsuit-proof your practice, check out my course Reasonable & Prudent. I'm adding new bonuses to it almost every month!


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