Patient Advocacy- what?

  1. I'd like the opinions of other neuro nurses on this.

    A little background- my floor is neurology and neurosurgery. It seems that lately, our neurosurgery team is of the mind-set that no one needs a shunt and that all patients are candidates for endoscopic third ventriculostomies (ETV). I do believe that they have only the best intentions when they attempt this procedure, trying to keep the patients shunt-free. I'm sure it won't surprise many of you that these procedures frequently fail, especially in patients who have been shunt-dependent for their entire lives and who do not have obstructive hydrocephalus.

    Our latest patient on whom they attempted this procedure had been shunt-dependent for many years (almost his entire life) and had presented with an acute malfunction/infection so ended up externalized. This seems to be how it happens VERY often... a patient comes in infected and then the team sells the family on an ETV and how great it would be for the child to be shunt free, no hardware, no shunt infections. Who wouldn't want to try? I do not think the parents always fully understand that if the ETV fails, their child will be as sick as they are with a shunt malfunction and that they will end up emergently back in the OR within a matter of hours. This child had several emergent procedures and transfers to the ICU during this admission (which has been almost 2 months at this point).

    Anyway, my issue now is that our manager told us the other day that we (the nurses on the floor) are being "too negative" when discussing these patients and that we "don't understand the science behind ETVs" and basically that we need to keep our opinions to ourselves. Um, WHAT? Sorry, but if my patient is s/p ETV with an EVD level at 30 and still draining a ton and who's failed several clamp trials with ICPs skyrocketing, then I am not going to apologize for speaking up. Too many times I've seen an EVD pulled and then a child acutely decompensate. I'm very frustrated that she basically insulted our intelligence in this meeting ("you don't understand the science behind an ETV"... A. yes I do and B. when the child has an encysted 4th ventricle, what on earth is widening the opening between the 3rd and 4th ventricle going to do? If the 4th ventricle's output is blocked, it doesn't matter how well CSF flows between the 3rd and 4th, it's still going to back up.) and that we can't advocate for our patients because "the surgeons are the experts". I do not doubt that the surgeons are experts but we're the ones at the bedside 24/7 and we're the ones who have to rush patient after patient to the OR (or assist with them drilling the patient on the floor) when they acutely decompensate because of worsening hydrocephalus. Not to mention, the residents don't always share the whole story with the attending. "Stable overnight" could really mean that the patient had ICPs and HRs in the 40s.

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