I have known and respected her professionally for over 5 years and can attest that her level of excellence was innate; you could almost mistakenly take it for granted that she would provide the highest level of care to every patient, every day.
I'm speaking of Erin Mann, RN. This morning, as I ended my night shift on Labor & Delivery and the dayshift lead was creating assignments for the oncoming shift, I heard a nurse decline to care for a patient (because she had recently been emotionally spent caring for another fetal demise) who had just been deemed a 21 week demise due to a short, dilating cervix (full-term gestation is 37-40 weeks, and our minimum gestation for viability is 24 weeks). The patient was reassigned to Erin, who had already received report on a healthy primigravida (first-time mother) in labor, who accepted the challenge, admitting that she had never independently managed an actively demising patient.
Erin received either report or direct orders from the perinatologist to start Pitocin for augmentation of labor, given that the patient had presented to the unit complaining of uterine contractions and, after ultrasound reported that the external os was 0.5cm and the cervix was opening, the laborist's vaginal exam revealed that the cervix was 3cm dilated and 100% effaced, indicating very preterm labor was underway. The ultrasound also confirmed that fetal heart tones were normal for gestational age and that the amniotic membrane appeared to be intact with adequate amounts of amniotic fluid. Erin discussed this plan of care, essentially an abortion to speed the inevitable process of loss since the baby was a few weeks short of viability, with a very distraught patient and her husband, who until this point, had been experiencing a healthy, uneventful pregnancy. Before administering Pitocin, Erin performed her own vaginal exam, which turned out to be a game-changer.
Erin's detailed exam found that the external os was indeed open, but she was only 1cm dilated, which is not uncommon for a mother such as this one, who has previously delivered a child vaginally. Erin slowly advanced to thoroughly evaluate the situation, finding that the cervix was thicker than previously believed, about 60% effaced, but that the cervix was beaking (creating a V shape) and the amniotic sac was creeping into the internal os, which was 3cm dilated. She understood how a hasty exam, in an effort to spare the patient as much discomfort as possible during this traumatic experience, could have missed such details, and given her new findings, she did not initiate the plan of care but instead contacted the perinatologist to establish a new plan.
When she did so, she was told to proceed with the plan, because the loss was inevitable anyway, but, being the strong patient advocate that I have known her to be since the beginning of her nursing career, she refused, and was granted 24 hours to observe the patient before reassessment. Instead of being treated as a fetal demise, the patient was reclassified to antepartum care, and measures were taken to stop the contractions to allow the pregnancy the opportunity to continue in an attempt to reach viability and possibly even term. Fetal heart tones have remained stable through the first half of my nightshift and there is no indication of additional complications such as infection. I don't know what the final outcome of this pregnancy will be, but I can only imagine the emotional roller coaster the patient experienced in the last 12 hours after being told the death of her baby was unavoidable to now having hope that with tocolytic medication and bedrest, she may deliver and raise a second healthy child.
Erin is an exceptional nurse, in part, due to her thorough and complete patient care. Many L&D RNs in her situation would not have performed the game-changing cervical exam because they would have considered it unnecessary. Others would have done as ordered by the doctor when he insisted upon the plan of care a second time after being questioned, ending this pregnancy and the fetus's life. The patient and her husband understand that the future for their baby is uncertain, but are grateful that Erin's efforts have given him/her a chance to live. For the life-changing care she has delivered to this family and countless others, Erin is a true DAISY Nurse.
Update: I followed up on the patient's care and was overjoyed to learn that we successfully stopped her preterm labor and that she was discharged home, still healthily pregnant. I hope she returns at term to deliver this baby and that Erin will be her nurse!