Please help/advise on class debate

[jhaines123]

I am doing a class debate on a nurse who failed to advocate for her patient. The nurse told the doctor that she coud not find a pulse in the pts left foot/leg after a motorcycle accident and the physician said that he could although it was difficult and discharged the patient. I won't go into all the facts but this is where I am needing some guidance. I am playing a part in my group where I am the Union Rep and the Nurse (defendant) Attorney. I don't even know where to begin on how to defend the nurse when I know that she failed to advocate for the patient. She should of went to her supervisor. Does anyone know of some good advice on how to represent the "nurse" in this case?

[33762FL]

Think documentation: "if it wasn't documented, it didn't happen." How did the nurse look for the pulse? Manually or with a doppler? How did the MD find the pulse?

[ckh23, BSN, RN]

Was the MD and attending or a resident?

[jhaines123]

Here is the class debate:

The patient was involved in a motorvehicle accident in which his bike fell onto and injured his left leg. When the nurses assessing the patient could not find a pulse in that leg, the physician was notified and chose to dismiss this fact and discharge the patient. The patient would return soon after with worsening symptoms that would require emergency surgery? Should the nurese have initially pressed for further action? treatment?

• In the course of a detailed assessment and evaluation by the Nursing staff, it was noted that the patient had no detectable pulse in the left foot or leg. The patient was also complaining of severe pain and numbness in that leg. Though performed several times in different areas, even with a Doppler, no pulse was detected by the nurses.
  
• 
  
• The nurses appropriately brought this to the attention of the physician who would also examine the patient. In the physician's examiniation, he noted the pain, swelling, and tenderness in the knee also noted by the nurses.
  
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• However, he would document that he did find a pulse in the leg, though with difficulty. When questioned by the Nursing staff on why, even with a Doppler, they were unable to detect a pulse, no explanation was offered by the physician. As far as he was concerned, a pulse was present, the pain was due to a "severe sprain" and the patient could be discharged. His instructions to the patient R.I.C.E (rest, ice, compression, elevation) and follow up with an orthopedic physician in a few days
  
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• It should be noted that the physician also reviewed the x-ray of the knee which showed bone "fragments" in the knee. Despite this finding, the patient was still discharged.
  
• The nursing staff made the patient aware that they had been unable to detect a pulse in the leg and explained that it "possibly" could be due to the swelling. They had instructed the patient to call or return to the ER if the pain got worse or did not begin to subside.
  

The patient ended up in the hospital for 35 days with extensive surgery and sued.

I am the "Nurse Attorney" and the "Union Rep" for the hospital in this pretend case. I have never been involved in a college case debate before and am very confused on even where to start? I am in my first quarter of nursing and oh my goodness what did I get myself into!

How would the "Nurse Attorney" defend the nurses?

What is the role of the Union Rep for this case?

[AnonRNC]

My goodness; that's a big assignment!

Hmmm...

The nurse did good by trying to impress upon the patient the severity of the problem, without undermining the doctor.

On the other hand: the nurse could have contacted her charge nurse, for starters. From there up the chain of command, house supervisor, Manager on Call, etc. If it was a teaching hospital, she could also have gone above the doctor to the Junior or Senior Resident or even - gasp - the attending.

The first thing the hospital (or nurse) attorney is going to do is look at policies & procedures. Does there exist a policy that covers unilateral absence of pedal pulses? If not, what would "the prudent nurse" do?

Good luck! This is a tough one.

[KelRN215, BSN, RN]

I also think it's important to know if the MD was an intern, resident, fellow or attending. If it was a Resident and the nurse was still concerned, she probably should have climbed the chain of command. If it was the attending and she expressed her concerns to him and he (being the person ultimately responsible for the patient) insisted on discharge, then I would say the nurse did her job. Who is the pretend patient suing? The doctor? The hospital? The nurse? All of the above?

[nurseprnRN, BSN, RN]

unfortunately, this nurse is going down. just because a physician says so, s/he is not always right. the nurse ought to have followed her nursing standards of care and taken this right up the chain of command, to her supervisor and the don if necessary, and that person ought to have contacted the physician's superior. if the physician was a resident, then the chief resident, and next to the attending. if the physician was an attending, then to the chief of service and then to the chief of staff.

it is good that they educated the patient about why to return to the er if things did not improve (if he was that bad, he would have anyway, i hope), but it wasn't enough to fully cover their collective behinds.

the nurse cannot say she "did her job," and call it a day. she did not do everything reasonable nurses do to keep their patients safe. we don't follow a physician plan of care if we assess danger in it. we have a duty to our patients imposed by our nurse practice acts, and she failed to fulfill that duty to this patient.

[jhaines123]

Thank you to all who have responded. Yes, it is a big project. Wish me lucK!!!!