Question

Sue Brown, RN, critical care staff nurse with 4 years of experience, just had a problem with one of the new resident physicians. The resident was inserting a pulmonary catheter and Sue notified him that the patient was in ventricular fibrillation. Sue also told him the hemodynamic waveform showed that the catheter had cleared the right ventricle and was now in the pulmonary artery. The physician retorted to Sue, “Don’t worry about a little ventricular fibrillation … it’s expected after right ventricular irritation. You know you should know this. Haven’t you ever assisted anyone with a pulmonary catheter insertion?” Sue repeated herself about the patient being in ventricular fibrillation and the physician laughed and said, “Don’t you think you are getting carried away?” Sue repeated herself again and defibrillated the patient, who responded. The physician said nothing, cleared the bed after two commands, and then just walked away. The patient was stable. Sue notified the patient’s attending physician, the medical director of the intensive care unit and her nurse manager. Identify the leadership issues, analyze the situation, and provide a solution

Answer 1

In a healthcare setting, the leadership is directed usually from top to bottom. But this has been proved to be less effective. The leadership should be decentralized. Decision making is one of the important task of a leader in health team. These decision may be regarding patients treatment, outcomes and futher improvements. The leader should be tactful in analyzing the situation so that correct decision should be made in correct time. The leader should also respect the ideas and statement of their subordinates.

In hospital usually the physician is considered to be the head of the healthcare team who is accompanied by nurses and other care providers. In the above scenario, the physician is found to be over ruling the staff. He is over confident about his decision and is negligent towards patient's outcome. The physician consider himself to be the unique person to decide about the patient treatment, so refuse to pay attention to the nurse's recommendations. He thinks himself to be knowledgeable enough about the condition and look down on the experience of the nurse who has been working since 4 years in the unit. His attitude shows negligence towards patient's condition and being proud to be a doctor. He thinks the nurse do not have enough knowledge about the patient's condition and considers her not responsible to make decision for patient's health.

Although when is physician was present, it was the responsibilty of the doctor to defibrillate the patient. The quick action of the nurse shows her concern towards patient's care, who considers herself to be responsible for patient's outcome. She was intelligent in identifying the patient's detoriating situation of ventricular defibrillation and acted promptly to utilize the defibrillator which is the expected evidenced based practice in that condition. Even though she disobeyed the commands of the physican but the cause and the outcome of her action justifies her.

In the above situation, the physician should be warned by the Medical director of the intensive care unit for his act of negligence. The physician needs to be given extra training and education regarding treating patients. He should also be explained that the role of a leader involves accepting the recommendations of a sub ordinate staffs especially a nurse. He should be made aware that nurses are equally responsible for patient outcome and have the right to make necessary patient related decisions in emergency situation.Its the teamwork that result in a positive patient outcome and improved quality care.The nurse manager should appreciate her staff about the responsible action of the nurse in the above condition and should help her and other staffs to learn how to deal the situation which involves such issues with the team leaders.