I got in the middle of a nasty issue last night at work and am at a loss. I'm sure that this has happened to many out there and would like to know what you have had to do, or would do next time...
I am a psych traveler but this subject is universal- all specialties have these situations I'm sure. I feel like I was more concerned about my fellow nurses reactions as far as job security, but I didn't need to be- they back the travelers up the same as staff.
OK, we had a serious crisis- needed an MD order ASAP and could not really intervene without one. The situation was a psych nurse nightmare. Brief background- I had a patient who I had put on 1:1 about an hour before (he had scratched his arm open with a toothbrush). That part of the unit was saturated with manipulative behavior and I figured that he wanted to let me know that he was there, psychotic, and not to be ignored. He got what he needed/wanted- he wanted and got his 1:1.
I was in the med room when I heard a scuffle, a few shouts, and someone yell to call security. I ran out and found that he'd grabbed the tech's pen from her hand (he was quick!) and had it to his throat, threatening to stab it in and dig around until he hit something and bleed out. About a dozen security showed upand hung back while the staff attempted de escalation. This was not a situation that was getting better if there was just talk. This guy needed some meds in him and it really didn't matter how he got them, although without a struggle was the hope.
His attending MD was actually on the unit at the time, and I interrupted his visit with another pt (something I don't do unless it's really emergent). I knocked, stuck my head in and said "Dr, we have a crisis out here that needs your immediate attention!" I stepped back expecting him to come out or at least respond. He had seen all of the security come onto the unit. I was actually expecting to get yelled at if he was being a real jerk.... but.... nothing. He was talking to the patient as if I hadn't just even been there. The patient was done and came out a second later. I opened the door and said "Dr (name), you're patient (insert name) has a pen to his throuat and is threatening to kill himself. You NEED to come out here!" then, "Are you coming, or should I just get him some meds? IM injection? He has no prns, as we discussed earlier." The patient had nothing in the way of an antipsychotic, and I'd given him the whopping 0.25mg of ativan earlier that was ordered. The doctor was aware but had not addressed it..
So he- get this- picked up the phone and STARTED DICTATING HIS NOTE!!!
I had a patient about to try to kill himself, staff that couldn't move near him unless he made a move to do worse, and desperately needed to get some meds into him. (He had command hallucinations a few years ago- I was assuming he was again). Obviously he could have severely injured himself, the staff, or both and it was getting worse the longer he stood there. He needed meds. The doctor HAD to do his job. There was no way around it. I opened the office door again and stated the same thing again, louder then stood there and kept eye contact. He stared at me and dictated a little faster. The rest of the staff not with the pt stood behind me and glared at him, just so he would know that they were not happy and that I was serious. He dictated. Finally I held up the syringes in my hand (I'd drawn the standard cocktail when I heard the noise from the med room), and shouted "Haldol 10, Ativan 2, Cogentin 2. IM stat! If you have an issue with that it'll still take about 2 minutes from here to the patient's butt!". Then I went and ended up using it as a chemical restraint as the pt refused. The pen was taken the same time and he was released. He was in a room with not much else in it and the staff was not blocking his way out. He was staying in of his own volition and did not need a mechanical restraint. After a while he calmed down and we were able to keep him distracted until he got drowsier and was in bed, with a one to one staff in a stripped room.
Obviously the MD behavior was so far from OK that I'm not able to find the words... I am so upset. Getting yelled at is bad, but the issue is that the patient did not get the treatment that he needed right away. This MD has done thing like this in the past and I found after that one of the new younger nurses had grabbed the phone from his hand and hung it up about 6 months ago. This was his version of "putting the nurse in her place". I didn't know what to do, as I'd never seen this happen before and wasn't sure how to address it. Didn't have time to call the staff ed person at home either.
What happens on your unit when/if this situation comes up? What would you have done?
BTW, I wrote it as a telephone order and he signed it after I left that night- never saw the pt though.