My heart goes out to you. I think that eventually most of us will experience a situation where we have to choose between our deeply-trained desire to follow doctor orders, and to put our jobs on the line in order to save our patient and/or our license. This is very empowering-- but extremely stressful and traumatic. Your experience sounds horrible and never should have escalated to that point. I hope the hospital had a debriefing not only to examine what could have been done better to prevent it escalating to that point, but to emotionally support those who were there.
I have been a nurse for 7 years now, and I've had a few times when I had the milestone experience of being the ultimate advocate for my license and patient over doctor orders. Here are some of them:
-- I was given report on a pediatric patient who was currently in ER. I knew this patient well, he was very fragile in the best of times, and per this report he sounded terrible. I decided to go to ER to assess him before taking report and accepting him as my patient on my floor (I was charge that night). Our floor was stepdown ICU at a 3:1 ratio, and I was not sure we could provide the best care for him in his current state. My assessment made me very concerned. It was both my knowledge of this patient, and a gut feeling. I refused to take him. I told them he needed to go to ICU instead. The ICU said they didn't have room for him and I said, well then he will be safe to stay in ED until there is room. I got yelled at by the ICU nurse manager, the ER doc, and again by the ICU doc. I stood my ground. He was taken to ICU an hour later. I went to check up on him a couple hours later and he had been sedated and put on some high-stakes drips. I was told that later after my shift ended he coded. He survived it and went on to live many more years. But I'm so so glad I stood my ground.
-- More recently I was the only nurse of a small hospice unit with two CNA's and 4 patients. Not a bad day, right? But one patient required 3 people to care for, as they were very obese, and required frequent hygiene cares. During those times of changing this patient, we had to listen for call lights of the other patients. It was manageable though, being a small unit. THEN I was sent us this patient who was very combative and disoriented and threatening to bite, hit, smear bodily fluids everywhere, and run out the door. I asked for a sitter for this patient until we got him more sedated and calmed down. I was told there were none available, too bad. THEN I was being sent yet another patient and I said no way, I will not take report or accept another patient until we get a sitter for the disruptive one, or until he calms down and is safe. I was told I was being insubordinate but I stood my ground anyway. Well . . funny thing . . they were able to magically come up with a sitter, after all. And all ended well. When the manager heard about it the next day she said I did good. :-)
-- A patient was looking very bad and I kept calling the MD and was being blown off and even made to feel bothersome for informing him of my concerns. After talking with my charge nurse, who was equally as concerned, we agreed to call for a Staff Assist, which is right below Code Blue-- it gets the ICU docs to come and assess within minutes. They took one look at the patient and he got transferred to ICU.
