Published Nov 13, 2004
You are reading page 4 of RN Functions
EricTAMUCC-BSN, BSN, RN
I agree alanpe, The political machine is slow and lags behind a dynamic healthcare system. It is frustrating to operate under politicians and leaders who do not understand current trends and technologies or have little experience with the industry.
Loose his job and RN licensce? I'd sue the hospital for wrongful termination. I would have already called a lawyer and started researching past employment suits and med-mal cases.
A)What were the child's damages from receiving that neb? Are they permanent and directly related to that neb?
B)As an RN, are you asked to make clinical assessments?
C) As an RN, are you asked to start nebs and are you competent at it? How many nebs have you started in your career?
D) What might the consequences have been had he not started that neb?
E) A non-medical person at home has the ability to assess then start such a treatment (mom and dad) but not a trained RN?
YOU THINK HE SHOULD LOSE HIS JOB??
YOU HAVE GOT TO BE KIDDING!!
With increased autonomy comes increased responsibility. Protocols are inherently inflexible, and require someone on the other end to make judgments about when to apply them. Those who undertake that responsibility need to be prepared for when someone comes to them and says "justify yourself". As for giving a nebulizer without an order, I have questions about your situation. If the child had been there for two hours, was the situation really that urgent? In the end it doesn't matter. Your duty ended when you performed your assessment and consulted the physician about the urgent need to see this patient. If a nebulizer treatment was not included in your standing orders, you absolutely deserve to lose your job and your license. If you don't have the credentials, you are just freelancing. It is illegal, no matter how dire you think the situation is.
As for giving a nebulizer without an order, I have questions about your situation. If the child had been there for two hours, was the situation really that urgent? In the end it doesn't matter. Your duty ended when you performed your assessment and consulted the physician about the urgent need to see this patient. If a nebulizer treatment was not included in your standing orders, you absolutely deserve to lose your job and your license. If you don't have the credentials, you are just freelancing. It is illegal, no matter how dire you think the situation is.
Heck Big02 - if you are lookin for work there is plenty of ED work in Australia as well. While I haven't spent a lot of time in ED I do know that everywhere a nurse works there are times that the ability to accurately assess a patient is potentially a lifethreating process. Working nights means that often the medical cover is short or inexperienced or worse - both. Many times Interns would be covering an acute medical ward and review a patient in obvious resp. distress with acute renal failure - with the response of well what do you want me to do. I am fortunate that in the hospital where I work there are MET teasm (Medical Emergency Team) made up of a doctor, critical care specialty, senior nurses from ICU and ED. Often the nurses are the first on the scene in a MET call and they definately start the treatment prior to the Doc arriving - that is because there are protocols and standing orders. Should something go wrong - provided that protocols have been followed then everyone is covered.
(ie if a ED nurse administers a asthma med to a baby prior to a pead rvw - watch the RN's liscence get torn up (only if things go south though) - Protocol says all peads get reviewed - such is the potential viarability in dealing with the young child)
At times we are caught between a rock and a hard place - but remember it it is critical a yelled order across a busy room is a valid order..... a stressed nurse demanding that a doc review a pead would have to be a 1st priority in any triage area (unless you have 12 of them at once that is).
tridil2000, MSN, RN
lose her/his job?
i wish more nurses had a pair of balls this big to do the right thing for the patient!
as far as the nurse from spain and consent, the patient does sign consent for treatment after they sign in. plus, by coming to the hospital, or calling 911, implies consent, and that they are expecting YOU to help them.
after 18 years if i don't start a line on a pt that obviously needed one, i think i'd be in a lot more trouble legally than if i held off.
it comes down to would any prudent nurse, with the same level of expertise, training and knowledge do the same thing?????
that's what will hold up in court.
in general, people trust nurses more than almost any other professional. respect that trust and do the right thing by them!
PA-C You make an excellent point. You could have asked a doctor for a verbal order, that woldn't have taken more than 10 seconds and since the child had been there for about two hours another minute or two wouldn't have mattered. Why didn't you let your charge nurse know?
the treatment was initiated 10 min after we found a strecher in a 15 bed er with 60 in the waiting room.........i took care of the patient as i saw fit in the manner that i was trained,it was prudent for me to do what i did, and as a nurse i feel good, as a professional i feel sad that this the result...........
Yah.... what Dixie said.... We do have more autonomy, it has to work that way. In fact, our ED is even building bigger and better protocols to allow the RN's to work more independantly from the docs.
I AGREE, BUT IT IS NOT ALWAYS A BUNCH OF ACCOLADES. IT OFTEN IS NOT ONE PATIENT BUT MAYBE 6-7 CHARTS UNDERMY ARMS. MOST OF US HAVE SPENT MORE TIME WITH OUR ER DOCS THAN OUR OWN FAMILIES. I SWEAR HALF THE TIME ON A BUSY NIGHT NONE OF US EVER FINISHES A SENTANCE, BUT WE ALL HAVE A GENERAL AIR OF WHAT IS GOING ON AND JUST HOW FAR TO GO. REALLY I WANTED TO AND STILL DO WANT TO BE A NURSE NOT A DOC IT CAN BE LONELY UP THERE.
I KNOW THIS SOUNDS CORNY BUT I EVEN FOUND ONE OF THOSE CARDS FROM 1ST GRADE ON WHAT DO YOU WANT TO BE - SURE ENOUGH NURSE. I'M PROBABLY A LITTLE OLDER THAN MOST OF YOIU STARTED IN SURGRY AS A VOLUNTEER PARAMEDICqUIT FIRFIGHTING WHEN I HAD TO GO UP THOSE LADDERS SO I SAID I'LL JUST BECOME A FULL TIME TRAUMA NURSE. FIRST FOR EVERYBODY AND THEN EVENTUALLY BAD, BAD NEIGHBORHOOD ON 16 HOUR WEEEKENDS TO RAISE MY KIDS. AN THEN HELICOPTERS, I CAN STILL REMEMBER THE EXACT FEELING. WELL BACK EAST THE YOU WANTED TO WORK TRAUMA, YOU GO RIGHT AHEAD BECAUSE AFTER A COUPLE A YEARS THE BURNHOUT WOULD STARTAND BELIEVE ME YOU HAD TO BE TOUGH THAT WAS LEARNING BY FIRE. NOT THAT WE DIDN'T CARE SOMEHOW IT JUST SEEMED TO BECOME THAT WAY. THEN YOU RODE IN THE SMALL COPTERS OFTEN GETTING 2 PTS. IN WITH YOU AND A PARAMEDIC. AND THE PILOT.IT WAS EXCITING AND WE WORKED HARD AND TENACIOUSLYAND WE LOVED IT, UNTIL. WHO ARE YOU GOING TO TALK TO YOU'VE SPENT THE LAST SIXTEEN WITH YOUR PARTNER. SOMETIMES WE WOULD BE 40 MINUTES OUT IN A BAD STORM. I NEVER KNEW FOR A LONG TIME WHAT A TOLL IT TOOK, CERTAIN FACES WILL NEVER ERASE. WHO YOU GOING TO TALK TO KNOW STILL WOULDN'T BE TOUGH ENOUGH FOR AN ER RN. CRY, WHEN AND IF YOU HAD TIME YOU JUST WOULDN'T. BUT SOMETIMES I STILL JUMP WHEN I HEAR THE HOMES ON TV. TO THEM THOSE GUNS DON'T REALLY KILL YET. THE GIRLS ARE AL PORTRAYED AS SO TOUGH BUT THEY HAVEN'T GONE OUT WITH THAT CUTE BLONDE GUY YET.THEY HAVEN'T LOOKED DOWN INTO THAT BEAUTIFUL MADONNA FACE OF THE 14 YEAR OLD HISPANIC GIRL'S FACE. MOST OF THESE WERE LONG AGO AND WHEN I ASKED WHY -I GOT ONE SHRUG 1-WHY NOT 1-WITH THAT SMALL LAUGH THAT SAID YOU''LL NEVER WIN I REMEMBERTHESE AND OTHERS AT DIFFERNT TIMES BECAUSE YOU MIGHT BE FLYING ON YOUR ADDRENLINE GIVING YOURSELF (WHICH WE DO DESERVE) WHEN YOUR MODONNA FACE COME IN. AND YOUE 40 MIN. OUT IN BAD WEATHER
My Case Was A Little Different I Was The Only MICN We Only Ran With A Paramedic In Those Days. And Quite Some Time Later I Got Permission From Those Kid's Experiences To Use When We Would Go To The High School To Teach. Sorry To Bring Things Down But My Friend I Went To Nursing School With Was Murdered Yesterday On The Way To Work. She Always Said She Would Stay And She Did Probably Knew 5-6 Generation Of Some Families. I Really Kind Of Meant When I SAID IT GETS SO EXCITING And Our Adrenline Is Popping SO We Forget. What DO They Calll Him "gumby" Well In Real Life Mostly He Stays Down.
Well, it is time to decide how can we help Bio2; all nurses think his action was correct and ethic, this is what mater now.
Wich Hospital and What managers run against him?, we can talk with them and try to solve the proiblem like authentic health profesionals, we can post mails and letters; I do not think it will be necessesary to demand the hospital, talk and discussion is what we need.
Bio2 must be follow in the hospital, he must not change his job, this is the people that change the job.
The other thing, to avoid this will happen more times, we need to start a campaign to defend us against this kind of terrorism, always with the respect of different points of views. Any ideas?
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