Ethical ???

caliotter3 · Mar 13, 2007

If you are concerned that the doctor did not make a correct decision, then bring the matter to the attention of your nurse manager and/or the supervisor of the doctor. Make certain you do this in writing in case there is a problem in the future, and your involvement is called into question.

subee, MSN, CRNA · Mar 16, 2007

Okay I am a new grad on a Neuro ICU unit. I am not sure if I have endangered my liscense by taking this job.
Yesterday I had a patient who was TBI and his ICPs( >60) were out of control. The family wanted everything done for the patient and the doctor disagreed and told the family he would no longer treat the ICPs. So he wrote for us to d/c the drugs that were treating the ICPs and also told me not to treat the pt. BP which was 220/120. Now I am still on training but I asked my nurse at what point in time is this a ethic board issue and she didn't seem to have a problem with it. I understand the doctors point not wanting to treat the kid any longer but at what point and time is my license endangered. And the family really did want everything done.

Dang! This is meant as no insult to you but why, why, why is a new grad in a neuro ICU? These problems are too difficult even for experienced staff to navigate and you're put right in the hot seat (neuro ICU).

RoxanRN · Mar 18, 2007

Dang! This is meant as no insult to you but why, why, why is a new grad in a neuro ICU? These problems are too difficult even for experienced staff to navigate and you're put right in the hot seat (neuro ICU).

So how is an experienced staff person supposed to handle something? You make it sounds as though no one can handle an ethical dilema. Personally, I would have been on the phone to the house sup to find out what needed to be done to protect my a$$ (ie. potential legal ramifications, etc). And yes, that is a very hot seat.

Oh, BTW, as a new grad, I went to the Neuro ICU and have since (even during orientation/training) handled many difficult situations. The only way to learn is to do.

Now back to our regularly scheduled vent session....................

nurseguinness · Mar 18, 2007

Thank you! I think as a new grad I picked a challenging unit but it is the only way to learn. I did talk to my manager and many of the other nurses on the unit. They explained to me the doctor does have the right but to still question it. Anyways thanks for the help.

gasmaster · Apr 11, 2007

As a long timer (and I mean L-O-N-G timer) in the neuro ICU, I also am a professional witness and case reviewer. First of all, ICP's in the 60's with treatment? This kid is going down. No matter what....however, did anyone sit down with the family & say to them, "he's going to die, no way we can cure him, this is it"? Sometimes docs aren't really good about that. Second, is there an ethics committee in your facility? Next time call them. They must be involved. Legally, the family can continue treatment until the patient is declared brain dead. Were they aware that the doc dc'd everything? They could sue if it was done without their consent. Now, was this kid alive or brain dead? If brain dead they can't sue because the time of legal death is the time declared brain dead. No matter what they say the vent goes off (unless you are harvesting) and the kids body goes bye-bye. I assume he was still (barely) alive. Always call ethics in these cases. CYA.

By the way wiht an ICP in the 60's what the heck was this kids CPP running?

jill48, ASN, RN · Apr 11, 2007

Dang! This is meant as no insult to you but why, why, why is a new grad in a neuro ICU? These problems are too difficult even for experienced staff to navigate and you're put right in the hot seat (neuro ICU).

Where do you think new grads should be?

gasmaster · Apr 11, 2007

If there is critical care internship in your neuro ICU then by all means go for it. If you're not fortunate to have an internship at your hospital then ICU is still ok as long as you have an extensive preceptorship. For a new grad with no internship this type of patient might be too challenging for the first few months. Again, it's all dependent on the training. I don't support that old theory that a nurse should work med-surg or tele for a year or so before transferring to ICU. See, those dept's are great but won't teach you a thing about being a critical care nurse. I've heard people argue about how it will teach you assessment skills, etc. Floor nurses don't assess pt's the same way ICU nurses do. I can take a green nurse to the bedside and teach her all the skills she could learn on med-surg in a couple of weeks (IV's, foleys, assessment, etc). It's the other stuff....the gut instinct, the critical thinking skills, that take time. And all the time in the world spent on tele or med-surg isn't going to grow that in a nurse. However, if there is no training program and not a good preceptorship (just the old sink-or-swim method) then I wouldn't consider it as a new grad.

jill48, ASN, RN · Apr 11, 2007

If there is critical care internship in your neuro ICU then by all means go for it. If you're not fortunate to have an internship at your hospital then ICU is still ok as long as you have an extensive preceptorship. For a new grad with no internship this type of patient might be too challenging for the first few months. Again, it's all dependent on the training. I don't support that old theory that a nurse should work med-surg or tele for a year or so before transferring to ICU. See, those dept's are great but won't teach you a thing about being a critical care nurse. I've heard people argue about how it will teach you assessment skills, etc. Floor nurses don't assess pt's the same way ICU nurses do. I can take a green nurse to the bedside and teach her all the skills she could learn on med-surg in a couple of weeks (IV's, foleys, assessment, etc). It's the other stuff....the gut instinct, the critical thinking skills, that take time. And all the time in the world spent on tele or med-surg isn't going to grow that in a nurse. However, if there is no training program and not a good preceptorship (just the old sink-or-swim method) then I wouldn't consider it as a new grad.

Now I see what you are saying. And I agree. After 11 years in med/surg and geriatrics, I can honestly say that there is nothing there that would ever prepare me for such a specialty. I admire a new nurse that can just dive into a specialty like neuro; I don't know if I could do it. But on the other hand, I hear all the time how new nurses want to get into OB and they are told they have to wait for one of the OB nurses to "die or retire". I don't agree with that.

gasmaster · Apr 11, 2007

OB? Gads, why would there be a fight to do that? I guess it's a relatively nice environment, not the dog-eat-dog world we live in....:smiley_ab :smiley_ab

jill48, ASN, RN · Apr 11, 2007

OB? Gads, why would there be a fight to do that? I guess it's a relatively nice environment, not the dog-eat-dog world we live in....:smiley_ab :smiley_ab

They say the OB nurses tend to stay at the same job longer. I don't know if that is true.

gasmaster · Apr 12, 2007

Probably do stay longer because of the low stress and satisfaction. Most of their patients are happy and so are the families. :idea: Idea: if we went back to the OLD WAY of the patient just takes what we give them & the family has no say all would be well, right? JUST KIDDING!