What happens when nurses won't speak up and advocate for patients?

I recently read a physician tweet about how when a nurse expresses a concern, physicians should get up and start walking to see the patient.

To me, this shows a doctor who respects the role of nurses. I’m a big fan of professional nursing and my favorite part of their day-to-day job is the role of advocacy.

Texas Board of Nursing Rule 217.19(5) describes advocacy as a duty to a patient, specifically that, “A nurse’s duty is to always advocate for patient safety, including any nursing actions necessary to comply with the standards of nursing practice . . . and to avoid engaging in any unprofessional conduct.”

These days, healthcare professionals are stretched thin. Regardless of that, though, nursing advocacy continues to be a uty that nurses owe to their patients. Perhaps it could be better stated that nursing advocacy is more important than ever when healthcare professionals are stretched thin. That’s because nursing advocacy helps prevent patient needs from falling through the cracks.

In his book “Blink”, Malcolm Gladwell described the cognitive basis for gut feelings, and how they are often right. Sometimes nurses advocate for patients based on a gut feeling that the patient’s clinical condition is trending in the wrong direction.

Other times, though, nursing advocacy involves questioning or pushing back against an order that might not be appropriate for a patient. For example, Texas Board of Nursing Rule 217.11(1)(C) requires all nurses to know the rationale for and the effects of medications and to correctly administer them. Adding to that, Rule 217.11(1)(N) requires nurses to clarify with the prescriber any order that a nurse reasonably feels is inaccurate, non-efficacious or contraindicated.

This brings to mind something that happened to a client of ours. Let’s call him Joe.

Joe went to a Texas hospital because of fluid buildup around his lungs. This is a condition called pleural effusion. Joe had experienced this condition before and on those occasions a doctor relieved the pressure with needle decompression.

This time, though, Joe was kept in the emergency department at the hospital. The nursing staff duly documented vital signs reflecting that Joe was in respiratory distress. The emergency department order set for patients who are feeling anxious, like Joe was, includes an order for Ativan (Lorazepam), which is a sedative.

There’s no doubt that Joe was getting anxious because he was having trouble breathing. Given his clinical situation, though, Ativan was an inappropriate medication order. It doesn’t make sense to sedate a patient who’s already having trouble breathing.

When Joe’s bedside nurse went to administer Ativan, the hospital’s electronic medical record system issued a medication warning. The warning went to the nurse, emergency room physician, and even a nurse practitioner in the intensive care unit (ICU).

To dispense the medication, the nurse had to do a cabinet override. The nurse administered Ativan to Joe without questioning the order, using critical thinking to take heed of the automatic warning, or speaking with the prescribing physician. Within two minutes of receiving Ativan, Joe’s oxygen saturations plummeted. Within a half an hour, he went into respiratory and cardiac distress.

This registered nurse really dropped the ball. Perhaps she was busy and stretched thin, but she let the patient down by forgetting her duty to be an advocate for the patient and his safety.

If you’ve been seriously injured because of poor hospital, medical or nursing care in Texas, then contact a top-rated, experienced Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.