Staff Abuse

Vignette #3 examines staff abuse and physician to staff relationships: Actor: Nurse Scene: The nurse is on the telephone. Nurse: Yes, and could you send over the Amoxicillin for 408. 410’s IV’s were changed to D5 and half normal saline with 30 milliequivalents of potassium chloride. Yeah…same rate. Nurse hangs up. She speaks to herself: Oopsie! The 2 a.m. sugar on 411 wasn’t called to the doc. Let’s see. Who’s her doc. (She consults her notes.) Oh Jeez, not him. Maybe I could call his partner instead. Maybe he won’t come in today until AFTER the shift change, and I can just let this one slide. Maybe the sugar is OK and it won’t matter that it was called two hours late. (She again consults her notes.) That’s not going to fly. The sugar was 63. This is nuts. I’ve got to call him. Nurse dials the phone and pauses as phone rings: Oh, hello, Dr. Whinnery. Sorry to wake you. I meant to call earlier with Mr. McKnight’s 2 a.m. blood sugar, but we've been swamped tonight with several admissions, staffing is low, one nurse went home sick, there were several codes, and one patient went into DT's. Nurse winces and pulls phone suddenly away from her ear then freezes momentarily to mark the end of the vignette. Some questions to stimulate small group discussion for the third vignette are: What’s happening for the nurse? What does she need? What does the physician need? How can they supply each other’s needs? How can a physician determine what the underlying issues are for the nurse? Is the physician responsible to detect those issues? Can you cite a similar situation that was handled well? Some questions for the larger group discussion: On our staff today how do you see physicians serving the needs of nurses and staff? In an ideal medical staff how would physicians serve the support staff? What would it take to reach the ideal?