Did I participate in an unethical situation?

[defib queen]

I am worried that last week I participated in an unethical event. Here is the situation.

At our facility, we have a, usually yearly, mock disaster. At our facility it is known as a code delta. Usually it is a staged mass casualty situation such as an interstate pile-up or bus wreck. Actual participants from local high schools etc. are the "actors."

Well, last week was that time, but instead of the usual mass casualty type situation, our DES and administration thought they would be "with the current times" and have a smallpox scare, which qualifies, naturally, as a disaster. Here is the problem.

We had kind of been expecting it to go down all day because our supervisor stayed really late and just acted strangely. Our ER was completely full, hallway beds too. A full arrest had just come in, a 55yo breast ca pt, we worked her for 45 minutes to no avail. The family was taking it really hard, especially the daughter. I had been in the resus. room with the family for 30 min. or longer trying to calm her and then stepped out to call organ donor people, which in our state is mandatory on all deaths, and get the death certificate going. The triage nurse had stepped off the unit for a moment when two people came to the triage window with dots painted on their faces and hands. Needless to say, I had the priviledge of triaging them. Our resus. room is also the resp. isolation room in our er. Our supervisor made us clear out a sick person from another room to the hallway, place the body and grieving family into it, and place the two actors in the resus. room. I was so angry about doing that that I had to leave the er and cry for 15 minutes before I could go back and face the family and my co-workers ( who also thought this sucked, however the family did not find out why their mother was moved to a smaller room on the other side of the er). Had this been a real situation or similar need for the room I totally would not have had a problem, as it was, I feel that what we did was cruel to the family and unethical. Am I wrong about this?

[following_faith]

Please note this thread is nearly 4 years old and the OP unlikely to reply.

If the OP is still around, I would love an update, however.

An answer to your question is:

Yes it was unethical.

I hate it when I do this! I see the thread on that opening page and I never think to check dates...darn!

[MMARN, BSN, RN]

Um. Excuse me, but that is THE most untactful (is that a word?) thing to do!!!! Those people were grieving and they had to move so that a DRILL could be ACTED out??!!!:angryfire No drill is more important than a patient and a patient's family who are going through one of the saddest times in their lives! I'm not sure if it was unethical, and I'm glad you were upset and furious, but why couldn't they have waited until it was less busy or just found another place to do the drill in?

I would have risen HELL if my family were treated that way. Management cares a lot about law suits. That is one that's just waiting to happen.

[BamaBound2bRN]

WTF...i would be flaming livid...i mean, obviously, had it been real, there would have been no issue...shove the dead lady and her fam to a closet if need be.( sorry)...but this is pure unadulterated BS...how rude, mean, callous, cruel...(not you...) how inappropriate.....how awful that you had to do this...

How soon Katrina and 911 and the Tsunami fade away. If we as a Nation, World, Profession, etc. do not plan and practice for disasters, then many of the same mistakes made during Katrina will continue to happen. A perfect scenerio would be that we would have a hospital encapsulated in glass in every part of every city, fully staffed, with a sign that says "Break Glass in an Emergency". However, common-sense says that is not possible. So, we have to practice, and that means no warning-as real as possible drills and scenarios. I have read many posts here and elsewhere from practitioners who moan about being short staffed and the stresses of getting that late shift admission while trying to give report and get caught up on paperwork and meds. If you didn't practice during and within the real world, then when the "Big One" hits then 100's or maybe even 1000's could die.

Yes, this case was inconvenient, and unsympathetic, but if the hospital is not properly prepared for a real Major Catastrophy, then how bad do you think the inconvenience and heart aches will be?

Sorry, I didn't check the date either- I wonder how many views have been changed over the last year after seeing the devastation and gross negligence during Katrina, Ivan, the Tsunami, etc.?

[nursecave]

I agree that we must practice for the real thing, but it was inappropriate to move that family. The deceased should have been moved to another room, even if it had been a coat closet, before the family was brought back anyway. With the ER that busy, the room she was in was probably needed for a real patient anyway. I think that sometimes administration gets so caught up in the what ifs that they forget the here and now. yes we need preparation, especially for when disasters like hurricanes or terrorist activity occurs, but please don't compromise my family members care to practice for what may never come.:angryfire

[BamaBound2bRN]

I agree that we must practice for the real thing, but it was inappropriate to move that family. The deceased should have been moved to another room, even if it had been a coat closet, before the family was brought back anyway. With the ER that busy, the room she was in was probably needed for a real patient anyway. I think that sometimes administration gets so caught up in the what ifs that they forget the here and now. yes we need preparation, especially for when disasters like hurricanes or terrorist activity occurs, but please don't compromise my family members care to practice for what may never come.:angryfire

The question is not IF, but WHEN disasters will strike. As those who are currently working in our ER's know, people have come accustomed to demanding that they be seen first and that their runny nose is a crisis that MUST be taken care of immediately. We have become a nation of convenience, where we get incensed at the thought of having our routine disrupted for any reason. As long as Life and Limb are not placed in jeopardy, even the inconvenience of death must be put aside to practice for the inevitable. If their was a plane crash and 150 patients were wheeled into the ER, then guess what- the families of many would be "Rudely Pushed Aside" and that is exactly how we must practice our drills.

[NHNurseMan]

I never thought mock disasters should be a surprize to health care workers. By not allowing them to anticipate their roles, they end up making more mistakes.[/Quote]

Maybe I'm a purist but isn't the whole idea of a "mock" anything to find and address deficiencies?

I think it's better to know what day the drill will occur so nurses can do some mental rehearsal and they can focus on getting things right instead of having so many mistakes to go over in the review.

Again see above, when are we warned of an impending disaster. "This just in there will be a plane crash in (your city here), all emergency personel please prepare yourself for this disaster." That just isn't the way it works. Disasters and emergencies are events that we as emergency personel should always be mentally preparing for.

And, most definitely, a manager who is there after hours is a sure sign that something is up,lol.

That is so very true......:rotfl: :rotfl: :rotfl:

That all being said, though I feel for the family's grief as well as the people already in the ER, IMO this triage situation is something all of us need to take seriously. So many of us and our colleagues take these "mock" situations as a joke and more of a nuisance than anything else. I for one take them as a chance to work on my skills and knowledge. I for one learn from my mistakes (Thankfully as I made plenty of them on my nursing tests....:rotfl: :rotfl: :rotfl: ) and from these mistakes I've learned things I will never forget.

[Redlady]

Drills are a necessary part of life, but they can not and should not trump the real reason for being there - the actual patients. Do we need to be prepared for the unknown? - Yes. But, as in this case, the actual drill was mostly nulified (at least for this nurse) because she was focused on her actual patient and the pain it was causing. The drill did her no good. If I was that dec. patients family, I would be absolutely livid. I would be in front of the ethics board myself, have the responsible management staff stand there in front of me and explain to me why high school kids with painted dots on their faces took precidence over my situation. I would have a lawer there with me - just for tatical scare purposes. Part of medicine (esp. nursing- IMO) is caring for your patients. This expressly violated that oath.On another note - I'm not crystal clear how this drill was done, but isn't there the risk of mass panic if you have a completly full ER and you start toting "smallpox" patients all over the place?

[BamaBound2bRN]

Drills are a necessary part of life, but they can not and should not trump the real reason for being there - the actual patients. Do we need to be prepared for the unknown? - Yes. But, as in this case, the actual drill was mostly nulified (at least for this nurse) because she was focused on her actual patient and the pain it was causing. The drill did her no good. If I was that dec. patients family, I would be absolutely livid. I would be in front of the ethics board myself, have the responsible management staff stand there in front of me and explain to me why high school kids with painted dots on their faces took precidence over my situation. I would have a lawer there with me - just for tatical scare purposes. Part of medicine (esp. nursing- IMO) is caring for your patients. This expressly violated that oath.On another note - I'm not crystal clear how this drill was done, but isn't there the risk of mass panic if you have a completly full ER and you start toting "smallpox" patients all over the place?

If you believe that drills are necessary, then how can or should you drill so to obtain the most benefit for the organization?

[Redlady]

If you believe that drills are necessary, then how can or should you drill so to obtain the most benefit for the organization?

Very good question. Unfortunately, I don't have an optimal solution. Drills can be done in all sorts of ways - during less busy (ha ha) times, in less used areas, on paper (not the most effective), or somewhat low key so that the actual patients are not disrupted.I understand that it is in the benifit of the general patient population as a whole to have a medical staff who has been trained to handle emergency situations, however we need to temper that with the actual goings on at the time. We do need to be prepared, but if we're overlooking the needs of the patients we have right now, we're defeating the purpose anyway.

[BabyRN2Be]

Drills should never supercede the needs of real, live patients or family experiencing an actual problem. Never. This should be written into your policy and procedure for drills.

As others have pointed out, aside from the unnecessary cruelty, that is a lawsuit just waiting to happen.

That was just unneccesarily cruel. Yeah, in real life things happen w/o notice but in this situation, how could this not have waited a day??

I would be livid as well.

[Lorie P.]

how horrible, just the last week right at shift change we had some one come up to our desk and announce we are conducting a fire drill, we all just looked at her and she said did you hear me. charge nurse said yes but we don't have time. this person wanted to know why and also why are about 8 people standing outside this room right next to the nurses staion, we needed to move them. i looked at her dead on and replied "no, they family just got here because their loved one passed away and more family is in the room saying good by".the poor family just looked at this lady like how could you.

the pt had only passed away about 5-10 minutes before the fire drill. this lady replies well this floor will fail, we just shrugged our shoulders and sai whatever.

mine youif this had been a 'real fire' we would have acted differently, but just cause it was a drill at shift change and with a newly demised pt..we went about our regular duties and try to comfort a family when they needed it.

aslo got no flack from house supervisor or our nm caused we failed.

[BamaBound2bRN]

mine youif this had been a 'real fire' we would have acted differently, but just cause it was a drill at shift change and with a newly demised pt..we went about our regular duties and try to comfort a family when they needed it.

aslo got no flack from house supervisor or our nm caused we failed.

thankfully, most people will never experience a "real" fire, disaster, or catastrophe, but no one except god can say who will and who will not be faced with situations like katrina or 9/11/01 or the tsunami, but the attitude that training needs to be scheduled for a "more opportunistic time and place" is the very reason that 36 residents died in a new orleans nursing home, and this very attitude is the same attitude that mike brown formerly of fema had.

this very debate raged in one of my classes this week, and like many of the posters here, i am convinced that america will never really appreciate the need for realistic disaster preparedness.