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. What is the issue here? Provide examples of Assertive, Passive Aggressive, and Aggressive approaches to dealing with the physician behavior. What is the best approach? What is your plan to resolving this situation and preventing future recurrences?

Answer 1

The issue that happened here is very clear that the new resident physician was unaware of the process that pulmonary catheter is not required to the patient and he doesnt have much experience as he's a fresher.Even sue kept on telling him about the ventricular defibrillation which still made him to go for his ego but finally left the place.This kind of inappropriate behavior causes aggressive disruption and will be more threatening to patient safety and and staff morale.Assertive behavior explains a person whoc cares about others and speaks to the point like the nurse in this situation.Passive aggressive is clearly the new resident who is not listening to the nurse and causing more threat to the patient.In this kind of behavior who disregards safety protocols and opts his ego is not at all safe for the patients and also the staff.Many passive aggressive people are reacting to perceived and sometimes very real disempowerment in the work environment.Such situations can be resolved by addressing the issues as early as possible like the nurse did by notifying the situation to the medical director and nurse manager.The future recurrences can be prevented by posying a proper resident physicians and creating a plan and policy that such kind of behaviors will not be tolerated and strict action to be taken against them.