Being an advocate on behalf of our patients is one of the most rewarding and sometimes challenging roles nurses perform. I recently had an experience where I needed to go out of my comfort zone to advocate and provide a safe environment for my patient. After the shift I wrote about the experience, as this is my new self-styled “therapy”. I have just re-read my account of that evening and I was immediately transported back into the busy bustle of the trauma room that evening. I remember the patient, his cries of pain, his gratitude for the morphine, his concern for his injuries, and all the little details that built my suspicion of further injuries. I cannot put all the details into my blog for professional reasons but keep in mind as you read that it was a highly stressful fast paced situation in which I knew the patients care was going in the wrong direction. And the Doctor wasn’t listening to my concerns. I knew that for the safety of my patient I had to speak up.
The patient had fallen from a motorbike at high-speed. A mechanism which is highly suspicious for sustaining injuries. This patient had walked into the Emergency Department. This is a little unusual but not unheard of. He had an obvious injury which we call a distracting injury. It was a busy night in the trauma/resuscitation area with all our resus rooms full. Trauma patients have multiple staff providing multiple procedures simultaneously, there is actually a process to this type of trauma care but on this occasion I was not happy with this process and I believed some of the routines for this patient had been skipped or rather decisions were being made not to have certain procedures performed. I repeatedly attempted to discuss with the doctor some of the decisions that were being made, however this was to no avail. My level of concern was so high, that I felt it was necessary to take things further and ask the Consultant to review the patient. This step effectively went over the head of the treating doctor in the trauma room. The review by the Consultant took some time because we were very busy that night. In the meantime due to the concerns I had regarding possible spinal injuries, I remained at the head of the patient manually maintaining the alignment of his spine and ensuring he was not moved until the Consultant had addressed my concerns. After his review of the patient, the Consultant agreed with my concerns and ordered the patient to under go the appropriate scans. When I returned for my shift the next day I discovered that this patient had extensive injuries from his accident, including spinal fractures, which had been my main concern.
My recount of this situation has been the short version of the long story and has really just summarised the events of the evening. It was an extremely stressful and upsetting situation, I can only think of two others that rank up with it for me. Unfortunately the doctor involved never spoke to me again, however there are positives which I have taken away from it and valuable personal lessons learnt about assertion, advocacy and backing your judgement.
In every action we undertake and every decision we make, the safety of our patients should be our number one priority. A good question is to ask yourself when advocating on behalf of a patient is, “What treatment would I want to be happening if this were my husband, child or parent”.
Following this incident I had great support from my nursing colleagues and from the medical consultants involved. I work in a department that has a fantastic team culture and a big thanks to you all. In the end, having checks and balances and being able to question and agree or disagree with one another’s decisions provides a place where the patient has the highest level of care resulting in the best outcome possible. I will never forget this experience and will use it to grow and develop my practice and assertion skills, especially when dealing with patient advocacy.
Do you have a story you can share about a time you advocated for a patient? I would love to hear it!
Stay safe, be happy!