I am about to tell you a true story of a crisis that happened in 2011. And I ask you to consider what could have prevented it.
I received (mandatory bedside) report from the night nurse (I’ll call her Rose) that this one patient’s blood pressure had been low all night, she had been difficult to arouse, and her high blood sugar had been treated and not rechecked. The doctor was not notified because it was the hostile house doctor with a very ugly temper.
Rose was seasoned and well-respected, so I was shocked by this report and asked Rose if SHE was OK. I nudged the patient, and asked how she felt, and she complained clearly that she wanted to be left alone. This patient was very obese – in a “Big-Boy bed with an air mattress. She had orders to get her up in chair for each meal.
I told the CNA to please check this lady’s vital signs and blood glucose first and report them to me ASAP – before attempting to get her out of bed. I then I asked Rose to just report on the other patients quickly so I could tend to this one.
While receiving a rushed bedside report on the next two patients, we heard a man’s raised voice and a female voice trying to respond to him. This was obviously disturbing, but the two of us kept pushing on to try to finish report. When we exited the room of the fourth patient, we saw that our nurse manager was trying to get the lethargic patient out of bed with a hoyer lift! And a large angry man was towering over them – yelling complaints!
Come to find out – the man was this patient’s husband, who had arrived shortly after Rose and I left that room, and was bellowing about his wife still being in bed. The nurse manager had no clue of the patient’s level of stability, and she was trying frantically to placate him. She had also gotten her boss to help her since the CNA was busy!
Before I could get to that side of the unit and tell them to stop, they called a code!
Evidently, when they rolled her onto her left side, her heart couldn’t take the pressure. So there we were – air bed in full-inflate status, and us standing on stools doing CPR, and the husband still complaining! Meantime, Rose thrust her worksheet at me to serve as report on the fifth patient so she could go home.
The nurse manager and her boss had a mandate from their superiors to ensure patient and family satisfaction at all costs. So, to keep the peace, they went against their own best judgement.
In addition, all the nurses on the unit were continually kowtowing to pacify aggression in patients and family members. Fear of yelling was the norm – even to the point of a nurse not calling a hostile doctor when she should have.
I have a lot more to say about this. But, for now, I’ll just say – yes, we brought the patient back and sent her to the ICU – and no, the husband never returned to apologize for being an unreasonable bully.
But what attitudes and policies can you think of that could have been put in place to prevent this kind of event? And how hopeful are you about the idea of Zapping Conflict in the Health Care Workplace ? I look forward to hearing your thoughts.