Emergency outside of work

Published

Hi all,

I had a situation today. I was out with my husband with some friends. A motorcycle lost control pulling off the parking lot and the rider went down hitting his head and knocking him unconscious. I'm a new RN of 2 weeks on the job and an Lpn of many years. I responded along with others but I was the only nurse along with a " medic". I monitored pulse and respirations while someone else held his head stable. I was also concerned if the neck strap to his helmet may be a little tight and affect his breathing so I went to feel for tightness and the medic told me not to. I also was concerned for vomiting and possibility of seizures. I wanted to check his pupils too but the medic again told me no. The patient regained consciousness and went in the ambulance when they arrived. I didn't speak to actually say what my intentions were and I feel I may have been timid and should have took more control or spoken up more. The patient was taken care of and that's most important. I find in other situations other people tend to take over and I feel incompetent because I don't feel I took enough of a role. I don't really know how to react . I feel like I did the right thing but I'm not really the type that jumps up and yells "I'm a nurse!!" Because I'm not that confident yet.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Hi all,

I had a situation today. I was out with my husband with some friends. A motorcycle lost control pulling off the parking lot and the rider went down hitting his head and knocking him unconscious. I'm a new RN of 2 weeks on the job and an Lpn of many years. I responded along with others but I was the only nurse along with a " medic". I monitored pulse and respirations while someone else held his head stable. I was also concerned if the neck strap to his helmet may be a little tight and affect his breathing so I went to feel for tightness and the medic told me not to. I also was concerned for vomiting and possibility of seizures. I wanted to check his pupils too but the medic again told me no. The patient regained consciousness and went in the ambulance when they arrived. I didn't speak to actually say what my intentions were and I feel I may have been timid and should have took more control or spoken up more. The patient was taken care of and that's most important. I find in other situations other people tend to take over and I feel incompetent because I don't feel I took enough of a role. I don't really know how to react . I feel like I did the right thing but I'm not really the type that jumps up and yells "I'm a nurse!!" Because I'm not that confident yet.

If there's a medic there, I'd defer to them. I have zero experience as a first responder, and that's the medic's area of expertise.

Up Vote Up Vote ×
Specializes in Flight, ER, Transport, ICU/Critical Care.

You were willing to get involved. That matters.

I think you did fine & the situation worked out. That matters.

:angel:

This is not criticism, just a question or three.

• What was making you think you should have taken more control in this situation? Have you been led to believe that any RN has certain responsibilities?

• What would that have looked like and what could you have done differently to establish control?

• What if the medic had not been there - what would you have done for this patient? Would you have taken off the helmet?

Now, it's might be hard to answer the last of these (as hindsight never gets it wrong).

As part of a larger issue, I get the idea you are feeling that you are not communicating as effectively as you would like within the healthcare team. It can be difficult at times. Some of that may be communication style vs. seriously just being a brand new RN (seriously, it's okay to be unsure of some things – the ink on your license hasn't dried yet).

As for learning to speak clearly and communicate effectively in high stakes situations, I recommend two books to most everyone - Crucial Conversations & Crucial Confrontations. Both are awesome and have been around for over a decade and used within AACN.

Experience comes with time. Not all experience is created equal though. It's just not. Not better or worse, just different.

Not every person that works in any role in any healthcare job has a complete body of healthcare knowledge. It would be great if every nurse just instinctively knew all the things they needed to know about everything they ever encountered anywhere, but it doesn't work that way.

Some shared skills and shared knowledge sets among providers and specialities do not equal shared clinical practice & competence.

In other words, you don't know what you don't know, till you know it. Deep.

You will gain experience. Be able to speak with more authority in time (even if the answer is, I don't know) I'm not sure what area you are working, but being an RN (of any experience) does not give you magic powers.

Example: I had a neighbor that fired 2 home health companies/multiple nurses over the perceived maltreatment of non-healing venous stasis ulcers on her legs. She would then call me to come change the dressings and ask me to try to fix them. Not happening. I'd have to explain that I'm sorry, I really wouldn't be much help with that and might make it worse. I don't know enough about chronic wound care to be able to meaningfully help. It's beyond what I'm comfortable with.

Now, while some of you may think I'm a awful person, but when signs point to badness – that's my sign to stop. BON's take licenses for complaints over practice issues like this (and I could envision things going sideways). And as a bonus said neighbor liked to sue and had mentioned suing her current and prior nurses (for no reason IMO) in front of me! I felt bad about the episode for about 2 seconds, then I called the home health and had non-HIPAA fueled discussion and she was referred to another agency to help her. Now, had she fell in the yard - I'd been to her in a heartbeat. Chestpain, I'm calling 911 and on my way over. Acute illness and need to go to ER - I can help. Chronic complex wound care - complicated by patient non-compliance - yeah, out of my wheelhouse.

Often, the first person that nurses must save first in any situation is themselves. Repeat that. Even in an emergency - unless, you are the public service responder - remember my amazing NURSE peeps - please do not run headlong into badness and danger. I mean this. There is no law anywhere that requires or demands anyone (NURSE - off duty folks generally - anyone) respond to anything outside of work - if ANYONE tells you otherwise, they are INCORRECT. And within any job, there is a framework to guide your response.

I encourage everyone to think carefully before getting themselves into situations where you are lacking duty or authority to act. And to act without training, experience and/or equipment/support in uncontrolled high risk circumstances is a serious decision and can have real consequences.

Good Samaritan laws are not what I'm talking about here. They can sometimes protect you from monetaryjudgment in certain circumstances of liability, they have no force field and have limitations.

Practice SAFE!

:angel:

Up Vote Up Vote ×

I agree and thank you so much!

Up Vote Up Vote ×

I appreciate this! And I agree!

Up Vote Up Vote ×

I meant by take control, in that I should have been more vocal and worked with the medic. I didn't work with him as a team, I became timid because of my inexperience and now I know next time to handle it differently. I am now realizing even though it was an emergent situation, stay in my scope of practice and don't feel like I need to be supernurse.I just kept thinking I should do more, in reality everything was being done that could be.í ½í¸Š

Up Vote Up Vote ×

Thank you so much for that!

Up Vote Up Vote ×

I really appreciate your comment!

Up Vote Up Vote ×
Specializes in PACU, ED.

I have stopped and aided at several MVAs, especially when I'm there before Police/Fire/EMS. I work in critical care and maintain certification in TNCC as well as other certifications. However, without a bag of supplies I can really just help stabilize C-spine, support airway, apply direct pressure, etc. Every little bit helps though even if it is just keeping a dazed person from wandering into traffic as I did one time.

However, I'm happy when EMS arrives so I can give report and leave them with someone who has the equipment to intervene.

Also, I don't stop every time. Sometimes I do a 50 foot assessment and can see someone is not in acute distress and should be fine standing with a small crowd milling around talking on their phones.

Up Vote Up Vote ×

I agree with everything previous posters have said about stabilizing only and deferring to a medic or anyone with prehospital experience. I have no nursing experience with trauma or prehospital care (was a ocean lifeguard for a few years in college), and the way I think for myself providing prehospital care is to prevent further injury, call 911, and the only actions of care that I would provide are rescue breathing/chest compressions as necessary. Otherwise, I'm minimizing actions, deferring to anyone with prehospital experience, and waiting for EMS.

It always amuses me on plane when someone has an issue and they ask for a nurse or a doctor. I work someplace where I can have a patient in CT in fewer than 5 minutes if I need to, and no prehospital experience--what the eff am I going to do on a plane? Any EMT, paramedic, military medic, or even ski patrol would probably be a better choice.

Up Vote Up Vote ×
+ Join the Discussion