Reamed for ordering an ethics consult - Page 4

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  1. Feb 2, '09 by
    Contagion,

    You sound like a great nurse.

    I think the phrase "no good deed goes unpunished" should be printed across the top of our nursing licenses.

    ##$%^&^ that resident.
    Jarnaes and WalkieTalkie like this.
  2. Feb 6, '09 by
    I just wanted to let everyone know what happened with this situation. Monday morning, the ethics committee did meet with the family and the docs. The docs managed to talk the family out of making the patient a DNI, but she is now a DNR.

    But get this... the reason they talked the family out of DNI status was because "the patient has pneumonia" and "we think if we have to reintubate her, we could get her off the vent." Well okay, but I discovered a major med error regarding the patient's antibiotics on Monday night.

    As it turns out the patient was being double covered for pseudomonas pneumonia with Zosyn and cefepime. One doc wrote to stop the Zosyn and then the next day, the PA wrote to stop cefepime. I thought it was strange that I didn't have to give her any antibiotics, so I went looking, and realized that she hadn't gotten any antibiotics for over 48 hours! The patient had been febrile with confirmed pneumonia on CXR!

    I called pharmacy and she then called the surgery team and got new antibiotics ordered. I gave her a dose of cefepime about 30 minutes after the error had been discovered. I had to fill out an incident report on this. Talk about poor management in general! :lol_hitti

    Sorry, just had to vent!
    Last edit by WalkieTalkie on Feb 6, '09
    lpnflorida, suzy253, RN1982, and 3 others like this.
  3. Feb 6, '09 by
    What an awesome nurse you are!
    WalkieTalkie and Jarnaes like this.
  4. Feb 6, '09 by
    It's really too bad our so called nursing leadership doesn't show this kind of nursing backbone.
    Maybe then we could stand up to these systemic situations, including staffing, that both devalue and disempower nursing.
    Our administrative "leaders" are for the most part paid stooges, unable to realy exert any serious control over vital issues to the bedside nurse.
    Our educational leaders have yet to present a coherent nursing vision for how the nation's healthcare system should be resructured, preferring to merely accept conditions on the ground with their collective heads deeply buried.
    We preach evidence based practice to bedside nurses, and completely ignore it when it comes to evidence based administrative decisions.
    Where is the critical self reflection that marks a true profession?
    Where are the nursing leaders?
    This problem is not isolated just here in the U.S. either.
    What's happened to the nursing visions of Lavenia Dock and Lillian Wald?
    How do we get this back?
    WalkieTalkie likes this.
  5. Feb 9, '09 by
    Just another update on this situation...

    Apparently the idiots on the surgery team wrote me up for calling ethics. My manager told me about this but she also told me that I did everything right, it was all documented correctly, and that anyone should have done what I did in that situation. She said it will go higher up and that they will likely get in trouble for it, and that I certainly will not.

    It's nice to be supported by management for once!
    truern, awsmfun, lpnflorida, and 8 others like this.
  6. Feb 11, '09 by
    the chief resident is a prat of the highest order

    1. s/he is NOT the Medical Practitioner in Charge of the patient's case .

    2. s/he obviously doesn't understand DNAR


    however the Nurse

    1. shouldn't have paged the on call team for a DNAR, thisshould have been dealt with by the Medical practitioner in Charge of the patient's care at a sensible time (i.e. office hours the next day)

    in volvgin Erthics dept is a good idea - this patient needs a 'best interests' meetings
    WalkieTalkie likes this.
  7. Feb 11, '09 by
    Quote from ZippyGBR

    however the Nurse

    1. shouldn't have paged the on call team for a DNAR, thisshould have been dealt with by the Medical practitioner in Charge of the patient's care at a sensible time (i.e. office hours the next day)

    in volvgin Erthics dept is a good idea - this patient needs a 'best interests' meetings
    In my opinion, this wasn't something that could wait. The patient was in the ICU for a reason. She was close to being reintubated during my shift. At bare minimum, the chief resident should have come up to speak with the family at this time (both she and the junior resident were in house, and were in house all night long). This initially happened around 2100, so it's not like I had to wake anyone up for it.

    I guess I would have just expected common decency with regards to this woman's family, as it took them a lot of strength to decide that this was what was best for their mother. Had the chief and junior residents come upstairs, chatted with the family, and told me that they would discuss this with the attending, I would have been okay with that. However, they did not, and essentially told the daughter (on the phone) that they would not even consider making her mother a DNR.

    I don't think they understand the difference between a DNR and withdrawing cares.
    Last edit by WalkieTalkie on Feb 11, '09
  8. Guide
    Feb 11, '09 by
    however the Nurse

    1. shouldn't have paged the on call team for a DNAR, thisshould have been dealt with by the Medical practitioner in Charge of the patient's care at a sensible time (i.e. office hours the next day)
    In most places, anyone who is involved with a patient--doc, nurse, family member, even the patient herself (if capable) can initiate an ethics inquiry. And, if, as in this case, time is of the essence, this activation can take place whenever it needs to, not just during business hours.

    If docs are the only ones able to start the ball rolling. what happens when the docs are the problem? In an ideal world, physicians would be able to let go when appropriate, but in the real world, that often goes against their programming. Highly self-aware people recognize their own internal limitations and call on the wisdom of specially trained others to make certain that personal and professional bias aren't getting in the way of ethical considerations. Unfortunately, that self-awareness is not as common as it should be. Then others need to step in and ask for those who are specifically trained to help determine the patient's best interest.

    The second part--waiting for a sensible hour to call--is a nicety that should be observed when possible, but emergencies can't tell time. There have been cases where several members of an ethics committee have met via conference call in the middle of the night, made a decision, and contacted the hospital attorney to call a district attorney to ask for a warrant on behalf of a patient whose situation couldn't wait until office hours for a decision.

    Each of these aspects of ethics committee initiation need to be just as they are.
    truern, RN1982, Elvish, and 1 other like this.
  9. Feb 11, '09 by
    You did the right thing, ethically, legally and morally. The surgeons and the hospital don't want her to die because it affects their statistics for mortality rate.

    Interestingly, a friend had a similar situation in a SICU, it is the accepted practice at this facility NOT to make any of the open hearts DNR until 30 days after the surgery. They actually tell the nursing staff this. It makes me sick......
    WalkieTalkie and RN1982 like this.
  10. Feb 11, '09 by
    I am so proud of you, as everyone appears to be who has read your post.

    I am especially proud of the fact that though you feared possible repercussions you have continued to work with this same patient. Others might have gone under the radar by requesting to have a different patient. Not you, you not only advocated for her before you are being proactive by continuing to advocate for the best for her as evidenced by your finding no antibiotics ordered. Again someone else might have shrugged their shoulders and believe the discontinuation of all antibiotics was as it should be. Not you ,you recognized this had to be a mistake.You again did what needed to be done for your patient.

    You are now my ideal of what it means to be a nurse.
    rn/writer, RN1982, and WalkieTalkie like this.