My wife recently posted about the difficulties she has faced in a new ICU job. She is recluctent to leave because it was tough to find the position that she now has. However, just the other day when her preceptor asked her how she thought she was doing and my wife answered "fine" the preceptor basically said "well I've laid some traps for you that you haven't caught." For example (and this was the only specific that she admitted to) the preceptor said that she had disconnected one of client's chest tubes for four hours and that my wife had not caught the error. My response would have been "so you let a patient go without benefit of a chest tube for four hours due to a deliberate act?" . However, my wife simply smiled, said she would try harder, and learned to focus on the "floating ball" that indicates suction. My question is doing stuff like this (introducing errors to test whether the nurse will catch them and then letting those errors be implemented into patient care) ethical and legal?
Well since I wasn't there personally I cannot be absolutely sure it is the WHOLE story. Furthermore, the nurse stated exactly what she did (remove the chest tube to test my wife). In addition, I know my wife and she doesn't lie. She's not perfect, but she is a perfectionist by nature (she got all A+'s this semester despite working 50+ a week, orientating in a job that is virtually driving her to suicide, and taking care of her brother's out of wedlock eight month old child). The nurse in question has 25 years experience, and more importantly the "ear" of the manager. What's more she rarely takes patients since she usually has an orientee and also acts as unit secretary (and she has the orientee's take two patients from almost day one). She indicated to my wife that she had done several things (to see if my wife would pick up on them and that my wife had missed several). However, the only one that she specifically admitted to was the chest tube. Here's reality folks, if my wife makes an issue of this she will probably be "toast" at the hosipal. She might "win" the issue, but my instincts tell me that there would be payback in one manner or another (you don't take a nurse down with 25 years experience and who is friends with the unit manager without repercussions, it just doesn't happen). It's a good unit, considered one of the top in the city if not the region (at least by reputation).
My question was simple is there anything in terms of laws or ethics that would make disconnecting a chest tube to "test" a nurse prima facia "over the line"? I could see how she might make a case for "testing" my wife, but to let the error continue for several hours (even though my wife should have caught the error) seems clearly over the line to the point of being a license issue. She has been "under a mircroscope" for about four weeks now (ironically ever sense she got this latest preceptor her sixth or seventh), but it's one thing to be "under a microscope" and something else entirely to be "set up for failure". She fears (my wife) that they may well place her in a position to not only lose her ICU job, but maybe her entire job with the hospital or even her license. On the flip side she worked very hard to get this opportunity (and has worked very, very, hard to keep it) so I hate to see her have to take a "step back" to Med surg. (which would be likely since she still doesn't have a full year as an RN, and it would probably be hard to get another ICU job having just failed at one). Indeed, a major reason why I withdrew from nursing school was to accomadate their schedule (her ICU's) which was entirely different from what they had promised. I will try to have her follow up this post, but it won't be until Friday since she is working tonight and has to go back in tommorow afternoon.
One thing that she often says to me is that "I like the job, but despise being under the power of those whom I feel have at best indifferent, and at worst malicious intent." She actually told me that she sometimes wishes she would be involved in a car wreck just to spare her the agony of facing "that place" for another shift. I'm partially to blaime, in that I point out that quitting would probably mean "at least" another year before she can become a CRNA, and that probably means at least $50,000 in lost income (which when amortized over a 20 year investment period at an anticipated interest rate of 7% is more like $200,000 in lost income).
We even discussed taking this post along with the one that she posted herself to her next evaluation next week where the nurse in question, and her unit manager will be present (along with all relevent replies). Just to demonstrate fully (to her manager) how frustrated that she was with the situation (and then if things go poorly to make sure the entire managment chain gets the same information). Of course I can't imagine that having a "pretty" outcome either.
Last edit by NRSKarenRN on Dec 15, '05