In working with a client recently, a hospital nurse relayed a situation to illustrate some of the conflicts that can arise between staff. The loose details are as follows: a patient is recovering in hospital and begins to feel nauseous in the middle of the night. The nurse records a prescription for Gravol on the chart. The following dialogue ensues during the doctors rounds:
Doctor: Who prescribed Gravol for this patient?
Nurse: I did; he was nauseous.
Doctor: Listen, I prescribe meds for patients, OK?
Nurse: (either out loud or internally) It’s Gravol! The patient was nauseous, and you weren’t around. Would you rather I let the patient vomit on themselves while I wait for you to come around and prescribe Gravol?
Behind this conflict, there may be several issues (interpersonal history, sleep deprivation, emotional strain of the job, frustration at poor handwriting, etc.). One of the issues may well be that this particular doctor does not respect the nurses full ability to provide insightful medical care. If the nurse suspects or understands this to be the doctor’s orientation, he/she has two options:
- Change the doctor’s orientation toward him/herself and toward nurses in general;
- Work around the orientation to get the right treatment for the patient.
The nurse pursuing Option 1 may face this interaction:
Doctor: Who prescribed Gravol for this patient?
Nurse: I did; he was nauseous.
Doctor: Listen, I prescribe meds for patients, OK?
Nurse: Gravol does not need a prescription. Since the patient is not allergic to Gravol, it was the best and safest answer. I am in a position to make that call.
Doctor: No you are not. Doctors make decisions.
Nurse: With all due respect, my training gives me the expertise to make this decision. This can allow you to focus on more serious issues. You would be my first contact if I had any uncertainties. With this patient, I believe this was the right approach.
Doctor: Doctors make decisions.
Nurse: …
The nurse pursuing Option 2 may find this:
Doctor: Who prescribed Gravol for this patient?
Nurse: The patient was nauseous; I suppose I should have written “nausea” on the chart instead of “Gravol,” but because the patient has had Gravol before, I didn’t see a problem.
Doctor: Just give me the information; I will make the decision, OK?
Nurse: Sure.
From the outside, it is objectively wrong and a misallocation of resources for nurses (or any other participant in a system) to not be allowed to make full use of their training and expertise. Although in selecting Option 2, you are enabling that misallocation, you are saving your time and energy with a work around solution. It is a trade off.
In a very real sense, objectivity allows you to pick your battles. You have the option, in some cases, of steering away from the “let me change your mind” conversation and still get the “right” outcome. It is a tough turn to take, but often an easier and faster resolution.
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