Nursestories

Posted on July 13 , 2010

Being Assertive rss

Recently a patient of mine died while going for a test. Although I had warned the doctor that the patient wasn’t stable enough to leave the emergency’s acute care for an ultrasound, he insisted that the patient would go for her test as soon as possible so we could finally establish a diagnostic. Though he brought a good point, I still wasn’t comfortable letting her go on her own. I new she’d be gone for at least an hour and that was way too long for someone I believed needed constant surveillance. I suggested to accompany the patient, but I was told by my supervisor that we couldn’t afford to lose a nurse on the floor, especially if the Dr didn’t feel it was necessary. So I asked that the patient get her ultrasound in the ED. Again my request was refused because we would wait too much time for a technician to come down instead of just sending her directly to the lab. After insisting a little bit more about having the patient stay on the floor, she was sent anyway to ultrasound with the porter. Over an hour later the patient was brought in the resuscitation room in cardiac arrest. She never made it.

Without putting the blame on anyone’s shoulder, I tried to think on how I could’ve gotten the message of urgency through. I definitely should’ve been more assertive. But in order to do so I had to believe without any doubt that I was right. The fact that the doctor was comfortable with his decision, it made me think that maybe I was over reacting. He even told me: ‘‘It’s not like if she was gonna crash in the next few minutes.’’ I actually hesitated for a few seconds before answering because my gut was telling me the contrary. I also should’ve shared all the reasons that made me hesitate sending that patient away. I had mentioned that she was confused, restless and diaphoretic. But I didn’t mention that it was mostly her venous blood gaz result that made me want to monitor her closely. I had assumed that the doctor was aware about the abnormal result, when in fact he hadn’t noticed it yet. There’s also the level of experience that can affect someone’s assertiveness. Although I’ve been an ER nurse for five years, there are still new situations that I haven’t explored yet. And it is through those experiences that I will be able to know a little bit more about myself, in order to test and develop new abilities so I can be more confident next time a similar situation occurs.

I think it’s hard to know when the moment is right to let our voice be heard. If we complain all the time for insignificant things, eventually people will get fed up and ignore us. But if we speak during crucial times by putting emphasis on the main subject that is causing our concern, then people will open their ears. Convincing them that they should listen and follow our lead, now that’s another battle.  But as long as we have that inner voice that’s telling us to follow our instinct, we must express ourselves and defend our cause, because after all, we the nurses are the patient’s advocate.

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