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".

[intellica]

To Kohai2, BSN, thank you so much for your guidance and support! We need more nurses on this planet like you!

[subee, MSN, CRNA]

lvntrail said:

 I'm confused as to why it became your role to 'run the code'. If the LPN  ( sounds like there was more than one present?) the OT or even the teacher were already managing their student/ patient did they need you to step in? Does the student's care plan or your facility protocol state the RN will take over care?  The reason school based nurses defer to EMS is not because they are necessarily more capable or ' higher' than us but because they have equipment we do not ( they add value to the care). Were you able to give a level of care the LPN or OT  or even teacher could not? ( In the actual event- not scope) Was there need of you taking over care?  Your team definitely needs a post- event review to clear the air and confirm steps for next time. I agree there is a power struggle and part of the issue is you do not seem to respect other professional staff or the dynamics of a team. You have been publicly disrespectful to fellow nurses and to the teacher. Even in your explanation you list CNA with nurses- perhaps you ment CRNA...If there is any chance staff saw your Reddit you will have a hard time overcoming the nursing assistant comment or having referred to the teacher ( who is likely very invested in the child) as a bystander. The explanation that it was to make it clear for the general public is odd since you used nurse clinician for yourself, a very unclear term. I hope you will go back to Reddit and try to undo some of the damage done the role of LPN by correcting your comment. Since you are a RN and have years of experience at this facility,  you are perhaps the best one on your team to set the example of humility, growth and teamwork moving forward. 

 

 

What?  The highest credentialed person in the room runs the code....period.  This isn't about you.  Non-essential people should be removed from the scene...period.  The RN and you should be with the patient and if you become obstructionist, you should also leave.  This isn't as if someone is throwing up at a dinner dance.  This kid is in crisis.

[Googlenurse, ASN, BSN, RN]

This is my first time hearing that the highest credentialed/licensed nurse runs the code.

If it is, I'm in trouble. I have ACLS certification and am available he only one with it and the only RN, but my facility does not have the medication or equipment for that. We just do basic CPR . No telemetry monitors. 
 

The Lpn's are the supervisors in this facility. I'm wondering how this would work?