Need Your Opinion About Medical Emergency

[intellica]

I am a nurse clinician, and have been a nurse for 26 years. I have worked at my current place of employment for over 17 years and currently hold the position of head nurse. It is in a community setting with a pediatric clientele. Recently we had a medical emergency (code blue), the client in question was having a seizure and had turned blue. There was no doctor on site, so it became my job to "run the code". (I.e direct the other nurses how best to help this patient)

Near the end of the code, one of the LPN's (formerly called, nursing assistants, but they are now called licensed practical nurses), starts contradicting one of my directives, and our manager (an occupational therapist), agrees with her and implements her directive.

Let's call the LPN Sandy and the Manager, Eva (not their real names)

The clients seizure had ended, but his oxygen levels were low and his heart rate was fast. I needed to monitor him while we waited for an ambulance. I had asked a bystander to please move out the way, as she was blocking my view of the patients face (the bystander was consoling the client).

Sandy the LPN disagreed with me and stated that the bystander should retake her position, and my manager Eva agreed and told the bystander to resume her position which consequently prevented me from seeing the patients face (an important source of clinical information). In addition, it prevented the patient from entering the "postictal state" which is a kind of a sleeping phase that happens at the end of a seizure (the bystander was stimulating him, singing to him, etc). In addition it added an extra voice to the cacophony of voices that were asking questions, commenting, etc. I am hearing impaired and wear hearing aids, so the more voices there is the more difficult it is to hear.

The ambulance came and took the child to the hospital. Afterwards, I met with the team of LPN's who had intervened with the child, because one of them was shaken and needed reassurance.

After I reassured her, Sandy says (in front of the nursing team) "I really did not like when you asked the bystander to leave"

I responded that this was best practice and also institutional policy. She continued however to argue back and forth with me about my decision (which she ultimately overridden). She then proceeded to tell me she did not like that I was telling people what to do, she began imitating me "get me the stethoscope! get me the defibrillator!" She felt I was too bossy and she did not like my tone of voice.

I was hurt and embarrassed. I  told my manager how I felt. My manager states she did nothing wrong because "everyone is allowed to have an opinion".

[Wuzzie]

There's a difference between asking someone to move to a different position and asking them to leave. Can you clarify what you asked as you've mentioned both. Also, who was the bystander and what role were they playing?

Second point is that during an emergency clear, closed-loop communication is the standard. Nobody should get all butt-hurt over it. 

This sounds like a pre-existing power struggle between the different levels of staff. I am put off by your description of LPNs. Nursing assistants are not nurses and they cannot be called LPNs unless they have, in fact, gone to nursing school. If your colleagues have been to nursing school then they are nurses and your disdain for them is likely to be showing. 

[Nurse Beth, MSN]

As head nurse maybe you can arrange to have some mock codes.

[intellica]

I apologize for the tone with regards to LPN's. This post was originally written for a non medical community and hence the explanation.

The LPN and I had a very good working relationship which was why I was hurt. 

When I asked the bystander  (the child's teacher) to leave. I meant to back away from the child so I could see his face. Not to leave entirely.

Thank you

[Wuzzie]

intellica said:

The LPN and I had a very good working relationship which was why I was hurt. 

Sounds like you may need a cup of coffee and a talk. Emergencies are always stressful and emotions run high. You should be able to smooth this over and prevent it from happening again. 

[JKL33]

Just go ahead and review your own actions privately.

Assuming this doesn't happen very often in your area it's possible that your own sense of urgency affected your communication. It's very, very easy for our vocal tone to become stressed/strained, more blunt than is actually necessary, for lack of better words adrenaline takes over and we can tend to be more brusque than necessary.

If there are areas where you can improve these are things you could concede when you get together to talk with your coworker.

That said, if it was clear that my position obligated me to take charge of a situation and someone countermanded me without good reason I would make no bones, "do not ever do that again."

[neuron]

I would brush it off, because someone has to take charge over the code. If it is a medical emergency, people have to move out of the way, get the equipment without thought to their own feelings. I simply would not care what the LPN said, the child needs immediate attention and that is what is important.  To the non medical personnel (teacher), I would make it a point to say it was not meant to be harmful. Easy to criticize someone when you are not responsible for the code. 

[NutmeggeRN, BSN]

I would do a post review and walk through the issue. Why was the teacher right there, they should have (IMHO) been getting the other kids away to give the child with the seizure privacy?  Unless there was another staff member doing that and if she was part of the response and directly needed.

[beckyboo1, BSN, RN]

Am I the only that wonders why the OP couldn't move her own position to see the child or why wasn't she next to the child herself?  Also, signing or talking will not prevent the post-ictal state after a seizure.  

As far as how the OP referred to LPNs, they were never what was "formerly called, nursing assistants, but they are now called licensed practical nurses" whether you are talking to laypeople or not.   LPNs go through a rigorous year of school and clinicals.  It would almost seem you and the LPN had prior history.  Licensed practical nurses are nurses, just like registered nurses are nurses.  As a previous LPN who now holds a BSN, I'm offended.  And why did laypeople need an explanation anyway?  Have they never heard of LPNs?  Would you be this upset if an RN had said anything? 

I'm sure I've stepped on some toes, but it is my opinion.

[CommunityRNBSN, BSN, RN]

 

Wuzzie said:

This sounds like a pre-existing power struggle between the different levels of staff.

This, 100%, pre-existing power struggle.

It sounds like you're a school nurse, since you were in a setting with a teacher and no doctors around.  I would simply move on from this disagreement.  It was minor, the teacher either moved or didn't move, and the child was treated. Work on repairing your relationship with the staff more broadly-- you do not need to prove to anyone that you are in charge, or that you are the Real Nurse, or that you are the medical expert.  You just need to ensure kids get treated in emergencies. 

You can run some practice codes, but the point of those is NOT to prove that you are supposed to be in charge.  If that is your goal, go meditate on it until you're ready to have a more appropriate goal.  To be absolutely clear-- at no point are you going to passive-aggressively teach something like, "Okay so during a code, it is really important that I be able to see the child's face at all times, so we have to keep teachers away from the patient's side."

[intellica]

1)Nope, I tried, the child was on the floor, the teacher was hovering over his face. I circled the child but still could not see his face.  He was cyanotic when I arrived.

2) Although the postical phase cannot be suppressed (confusion, headache, etc) what ABSOLUTELY can happpen is that sleep associated with it can be suppressed. I have worked with this clientele for 

I originally posted this on reddit, the audience was therefore non medical. LPN's,CNA's, RN, CAS,NP, are some of the many titles nurses may have. I anticipated the different roles being confusing to a non medical audience.  My goal was to highlight the different scopes of practice (I.e law 90). I have written above that it was not my intention to denigrate my colleague. 

*for 17 years

[Nurse Beth, MSN]

intellica said:

 

I originally posted this on reddit, the audience was therefore non medical. LPN's,CNA's, RN, CAS,NP, are some of the many titles nurses may have. I anticipated the different roles being confusing to a non medical audience.  My goal was to highlight the different scopes of practice (I.e law 90). I have written above that it was not my intention to denigrate my colleague. 

*for 17 years

There is so much confusion in the general public around nursing roles and the uses of the word "nurse"

It's important to keep educating the public at every opportunity.