Chain of Command

[DEB52]

I was wondering how many nurses are comfortable with using the chain of command. We had a situation over the weekend with a Fetal Heart Tracing and the residents stating that it would be fine. The mother had polyhydraminos and uncontroled diabetes. The residents wanted to get the blood sugars under control. The tracing had no reactivity and was having late decels. The chain of command was not used. I talked with two nurses involved to see what they had to say about what happened. I told them that they could of called a senior resident, the attending on-call, the manager on-call or the night superior.

So how many of you us the the chain of command? Were you comfortable with it? Did you get the support of those that called? How did it turn out?

[cmo421]

Pt's life vs protocol? Always choose the pt. I have used the chain of command many times. I have also gone straight to the top when needed. When it is involving the doc's , I always ask the resident if they would like to talk to their senior about whatever is happening. If they do not,and I feel strongly enough, I make the call. Not once,have I gotton negative feedback for doing so.

[TrudyRN]

Cover thy tush. Period, amen.

[TrudyRN]

Actually, let me elaborate just a bit.

In protecting yourself, you will also be protecting your patient. Residents' feelings be damned. When your license and your livelihoood and your sanity and the well-being of your family are at stake, plus the life and well-being of your patient, the choice is totally simple and clear. I don't care a hoot about the residents' feelings or pride if the choice is them not liking me or them not getting to save face or the pt living to see tomorrow and me getting to keep my job, income, license, etc.

Always call whoever needs calling, be it the next Res up or the Nursing Sup or the Attending or the Chief of Staff, DON, or God Himself. Actually, for me, prayer is the first thing I do - quickly and privately. Then I take the necessary steps to make sure the patient is properly cared for. By His mercy and His love, we've always had happy endings.

I hope this helps you.

[Cardiac-RN]

have had to call the attending on a couple residents. mostly because patient safety is always the top priority, and if there is a serious pt situation that the resident is just not addressing (for a variety of reasons, but mainly b/c they are unsure of how to proceed and do not want to ask their senior for fear of appearing stupid) then i have no choice but to call the attending. the attending is always very professional when this happens, gives appropriate orders, and gets the situation under control.

i have had residents come up and try and give me grief for going over their heads ::rolls eyes::. i just tell them that i do what i have to do to give my patients the safe care they deserve and walk away.

just a note, before i call the attending, i (and other nurses) have generally spoken with the resident numerous times regarding the patient situation and needs- alot of useless banging our heads into the wall.

you can lead a horse to water but u can't make them drink!