The Nurse as Advocate
Concerning your fourth interview question, the primary function of every nurse is to be the patient's advocate. Thus the issue as to what the nurse would do if one of the doctors or practitioners wrote a harmful order determines whether you can count on the nurse to be an effective promoter of your health. Repeatedly I review cases in which nurses did nothing when a patient needed medical attention and was not getting it or stood by while an intern or a medical student pushed the wrong medication. If I have to sleep in a hospital bed, I want a nurse who will guard me from some educated arrogant fool who is resolute to trying a bizarre medical experiment.
For a case in point, back in 1986, while working the night shift as a nurse in the intensive care unit at a community hospital in the Bronx, I was caring for a female in her mid-fifties who was receiving abdominal dialysis for kidney failure. In addition, she had liver cirrhosis with ascites (fluid collection in the abdominal cavity). An intern was on duty with me.
At 3 A.M. he wrote out several lines on an order sheet and handed it to me saying, "I expect you to carry out these instructions as soon as possible."
I looked at the paper in disbelief. The intern had written, "After the dialysate solution drains from the patient's abdomen, hang the drainage bag from the IV pole and administer solution to the patient intravenously at one hundred ccs per hour." I looked at the doctor and asked:
"Is this a joke?
- No, I'm serious.
- Why would you write such a bizarre order?
- The patient is low on protein and I want her to receive her own protein."
I reminded him that the solution in which the protein was floating is lethal when administered intravenously. He told me to stand aside so he could do it himself. I couldn't believe it and told the doctor that I simply could not let him do that and barred his way. He just turned and left the unit in a huff. I immediately notified every person in the hospital hierarchy. I assume that the chief of medicine promptly removed that doctor because I never saw him again.