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A Nurse's Responsibility
Posted by at 6/9/2008 5:10:48 PM
I watched this scenario unfold in the ICU last week. What would you do?
Nancy is caring for a patient who has been in the ICU for a number of weeks with respiratory failure. The physician is adamant that this patient be weaned from the ventilator today. He writes an order to place the patient on CPAP (a setting on the ventilator that allows the patient to receive oxygen with a little pressure support but he breaths on his own). Nancy knows this will be difficult. She has been caring for this patient for several days, and for the past three days he has failed weaning trials. The patient becomes very hypoxic; his respiratory rate increases into the 40’s, his SpO2 decreases into the low 80’s his heart monitor shows an increase in PVC’s, as he thrashes in the bed. Nancy approached the physician about his order telling him of her concerns. The physician tells her, “I don’t care-leave him on CPAP. This man can breathe, and he needs to come off the ventilator today. I do not want ABG’s and ignore what you see on the monitor. If you won’t follow my orders, then I want another nurse in here. I can’t work with you.” At this point the patient care supervisor stepped in to mediate the argument.
What should you do if you receive an inappropriate order? Question the physician in a non-threatening manner as it could be a simple mistake or misunderstanding. If it is not a simple error, and resolution cannot be achieved, the nurse must take necessary and appropriate clinical actions to provide safe and prudent care to the patient, and then ask the charge nurse or nurse manager to intervene. The issue may need to be addressed through the medical staff director, quality assurance or ethics committee. Your nurse manager should help with this.
What happened with Nancy and the rude doctor? The patient care supervisor had a long talk with the physician in a private area. Later that day, Nancy and the physician were able to meet in a calm manner, and reach an understanding. What happened with the patient? A good ICU nurse knows of what she speaks! After two hours on CPAP the patient tired, and began showing signs of distress as suspected. He was placed back on rate on the ventilator after a set of ABG’s revealed extreme respiratory acidosis without compensation!
Comments
Do you really think that questioning a doctor's order is that easy? However, if the patient died, the nurse would have probably been held responsible. The only thing that the doctor would have to say is, "I didn't give that order!" How could the nurse defend herself?
Posted by:
Barbara
at
6/11/2008 4:03:19 PM
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Comments:
1
Categories:
Patient Care
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