[m4blondi]

I'll be graduating in May and at a recent job interview I was posed this question: "If your supervisor was in a patient's room and made a medical or ethical decision that you didn't agree with, what should you do?"

I felt that my answer wasn't what they were looking for and was wondering how experienced nurses would respond to such a question.

[allthingsbright]

Well, personally I would start with asking them about it--if it endangered the patient, I would go up the chain of command.

[m4blondi]

Thanks for your response. That is pretty much what I said. Oh well, I'm not sure what response they were looking for.

[jill48]

Depends on the situation. If it is something minor, I can ask the manager about it as soon as we leave the room. If it's something BIG, I will step in and take over the situation regardless of who is there.

[Daytonite]

Well, this is a kind of interesting question, especially since I've been a supervisor. My first thought was that I was trying to imagine what kind of decision I would make in a patient's room that would be an ethical one, let alone a medical one. Nurse's can't make medical decisions. So, the question is implying that the supervisor would be doing something to the patient without a doctor's order. So, if I was with a nurse who overstepped her boundary and did something without a medical order, I would speak up immediately and probably say something like, "What are you doing?" or "Stop that now". I'd probably try to physically stop the nurse if what she was doing was life or limb threatening. Then, I'd be out of that room in a flash and on the phone with the attending physician of that patient to let them know what was going on. I think that is probably the answer your instructors were looking for.

Depending on how outrageous the thing this supervisor was doing would depend on whether or not I would need to notify the next supervising nurse up the chain of command. Sometimes the supervisor is the highest nursing personnel in the hospital at that moment of time and the regular nursing staff don't know how to get access to the people who supervise them if it is on the off shifts. If a nursing coordinator or DON was in the house I would call them as soon as the patient had been taken care of and let them know what had happened. If they weren't, I'd tell the doctor when I got in touch with them what was going on and hope that he would get on the phone with the supervisor and intervene. One thing for sure is that after things were squared away with the patient, I'd be documenting some kind of incident report or administrative memo to my unit manager so this incident got attention. Most nurses are aware of incident reports. What most people don't know is that there are also memos that are written on things like this that involve misbehavior of an employee in order to document their actions.

I think that, maybe, what your instructors were looking for was that your answer included making sure that the safety of the patient was attended to first. The disciplining of the supervisor can be handled later. If you absolutely had a nurse who was causing injury to the patient, you just have to assertively undo what she's doing, get other nurses to help you and order her to leave the room. If she won't, call security. Always remember that the patient comes first.

One thing that came to my mind in thinking on this is if a supervisor pulled the plug on a ventilator. Another would be delayed calling of a code blue when a patient stops breathing to assure that they won't be successfully resusitated (these used to be called "slow codes"). Another might be grabbing D50W and proceeding to give it IV without calling for an order for a low blood sugar in a diabetic. When I worked in a nursing home I recall one charge nurse who used to routinely give any patients who she felt were noisy or acting up any old sleeping pill she could find without bothering to get an order. She got away with it for a long time because no one could catch her at it.

[llg]

As others have said, my first priority would be to protect the patient from anything unsafe. However, if at all possible, I would try to do so in a way that preserved the appearance of everything being "OK" in the patient's eyes. For example, instead of screaming out something alarming, I would ask the supervisor to supervisor to step outside the room before discussing it with her. I would try to interrupt her potentially dangerous action, delay it, by asking her to step outside and talk to me -- even if I had to make up an excuse to get her outside. ("Excuse me, Ms. ---, could I speak with you outside for a moment.")

So ... while the patient's safety would be my top priority ... I would also try to preserve the patient's trust in the institution by not alarming the patient ... and I would try to preserve the supervisor's dignity by having the necessary discussion in private ... if at all possible. Let's face it, no one likes to be accused of bad practice in front of the patients and no patient wants to doubt the competence of his care-givers by being subjected to the details of every disagreement. Also, by moving the discussion away from the bedside, I would be protecting myself in the event that I turned out to be wrong.

Making a big "public" fuss at the bedside would be my last choice. I would do it if there were no other choice, but I would be trying my best to avoid that if at possible.

[Daytonite]

llg. . .you're right, of course. In the heat of a situation it's very easy to get emotions and the urgency of the situation confused. Always keep a cool head.

I was just realizing that this thread title was "Job interview question?" I happen to keep a file of job interview questions (although this isn't one of them!) as well as this: a list of the top common characteristics that employers like to see in their professional workers. I've seen a lot of different forms that are sent out over the years requesting a reference on people when they are applying for jobs as well as had to make out a lot of yearly evaluations on staff that I supervised. Many of these are listed on these kinds of forms in one way or another. They are behaviors we should all strive for!

• initiative
• motivation
• positive attitude
• dynamic energy
• responsibility
• ability to give good customer service
• capacity to learn
• productivity
• flexibility
• leadership
• team work
• ability to tolerate pressure
• analytical ability
• desire to develop professionally

I was trying to think under what category this OPs question might fall and I suppose it would be a combination of responsibility, the ability to tolerate pressure, analytical ability and initiative. But, let me assure you, I have never heard of any kind of a question like that being asked in a job interview. My response (remember I was and still am a spoiled brat even at my age) would be "why? have you had problems with some of your supervisors?" because, to me, a question like that would only get asked if the situation had come up before and the way the nursing staff had handled it had not been stellar. I've always been quick in looking for reasons behind why people do or say things, and in my mind a question like this just reeks of a previous incident that occurred.

[llg]

Originally Posted by Daytonite

, to me, a question like that would only get asked if the situation had come up before and the way the nursing staff had handled it had not been stellar. I've always been quick in looking for reasons behind why people do or say things, and in my mind a question like this just reeks of a previous incident that occurred. [/font][/color]

While I would not ask them directly if they had been experiencing problems with their supervisors, I agree that this question probably comes as the result of a previous situation that was not handled well. In fact, perhaps the supervisor had been correct in that situation and someone had made a fuss and caused a problem by the way she handled her doubts about the supervisor's actions.

I think the principles they were looking for as they asked the question were: (1) Protect the patient.
(2) Keep a cool head and protect the positive image of your institution and your colleagues. Preserve the hospital's public image and the dignity of your coworkers (supervisor)
(3) Realize that you may be wrong and investigate/ask for an explanation before assuming you always know best.
(4) Utilize appropriate resources and appropriate reporting mechanisms when there is a potential problem. Don't fly off the handle and assume you have to handle everything yourself.

[m4blondi]

Thank you all for your words of wisdom and experience. I appreciate your input and will incorporate your suggestions and advice as I start my career and on future interviews. Hope you all have a wonderful weekend!

[margaretptz]

I was just realizing that this thread title was "Job interview question?" I happen to keep a file of job interview questions (although this isn't one of them!)

Daytonite, I think we should petition to rename you the student's godsend.
I just finished my first semester of Funds in an ADN program and I am interviewing for some nurse intern type positions next week. I would really appreciate it if you would share some of those questions with us. I have no idea what to expect and what kind of questions I should be asking in return. I'm doing really great in school, but my age is 55 and I am a little concerned that that might be a detrimental factor. I'd appreciate any advise you might have.