Student one

I had a disagreement with a superior, an administrator who was over the jail division. In our medical department when an Inmate/patient has to be sent to the hospital he is transported via ambulance and two armed officers must accompany him. For jail administration this creates a problem for staffing of the jail and patrols.

We had an inmate/patient with a seizure condition and heart problems made worse by abuse of methamphetamines and not taking his seizure medication or heart medications in over 2 years. The conflict arose when the administrator told his officers they would have to get permission from administration to send an inmate to the hospital. The first time I was informed of this change was during a cardiac arrest. I will admit I was really short and to the point but as I explained later “It was an emergency”. The patient was in full blown arrest with me doing chest compressions and being informed I would have to call for permission to send the inmate/patient to the hospital. I was asked to come in and speak with administration and at that time the agreement was made that medical should never have to ask administration for permission to send an inmate/patient to the hospital. The entire incident was a miscommunication between administration and one of the senior dispatchers who made a decision without consulting with others. We have clear policy in place, and jail standards to be followed but when 1 person unilaterally makes a dissension about an area he is not trained in, this can be a dangerous thing if left unchecked.

It required communication and for that officer re-training on jail standards and the chain of command. I would consider this a win/win as this officer has a greater understanding of our actions in the medical department during emergencies. What we do can mean the difference between life and death. That officer is now very much aware of the struggles we go through as a department and he no longer makes remarks like “They just send them to the hospital for anything” “they need to go sit with the patient”. He was very focused on a small portion of the picture and forgot our purpose, which is to protect and serve.

We now work much better with that officer and he is much more considerate now as a superior he has been forced to look at our department as part of his team.

Student two

There was a conflict between myself as a charge nurse and a provider. There was a scheduled cesarean section at 0730, and at 0600 a patient came into our OB triage

area bleeding; her condition required immediate cesarean section. As the charge nurse, I asked the secretary to call the patient scheduled for a cesarean at 0730 and let

her know she could come one hour later to avoid waiting at the hospital, because there was going to be a delay. I then went to the OR to assist with the cesarean. When

I came out of the OR the provider of the scheduled cesarean was upset that I had told the other patient to come an hour late. He stated that he had people in his office

waiting. I attempted to explain my rationale, and let him know that the woman had waited the hour while we were in the OR at home, and actually had just arrived,

and was being admitted as we speak. He knew the OR has to be cleaned prior to starting another procedure, and there was plenty of time to get his patient ready by the

time the OR was clear to proceed. The director of our unti was walking through, and I saw him pull her into the hallway. I followed them. He was speaking about the

fact that I had delayed his case without asking him. He said that nurses shouldn’t make whimsical decisions. I spoke up and stated that I needed to ensure the safety of

the patients that were there before bringing a scheduled procedure in. I stated that I believed that the patient would be more comfortable waiting at home for an hour

than waiting in her room. My director did not say anything to back me up. I waited, I looked to her, and she just stood there. So I backed down and told him that in

the future I would surely let him know the situation so that he could decide whether the paitient should be called to come at a different time or not. My director never

brought it up to me.

The director’s role is to maintain the service of women’s health services. She believed that in order to do this well, she needed to have a trusting relationship with

providers. This particular provider has been known to make threats to the director to bring his practice elsewhere if he doesn’t get his way. The system is very

patriarchial, I was fairly new at this hospital. I did not feel comfortable at the time having a discussion about any of this with my director on a voluntary basis.

I still would describe this as a win – win situation because in the end we did all grow and learn from the event. That provider never has crossed me, or treated me

that way again, the director has since realized that patient safety is more important than anything, and that the provider’s threats didn’t hold water because no other

place was going to allow that behavior either. At the time things could have been handled differently. The director could have backed me up and diffused the situation.

Perhaps the win win would have looked differntly then. Now that I am the manager, when there is conflict. I listen to all sides, I back up my nurses and take the heat

from the providers for them if the providers are upset. The providers know that I support a culture of mutual respect, and they are still working this out, howeve, the

nursing staff, are very good about telling them to go and talk to me if they are upset, because they trust that I am fair. This is how the service line is built. Through

mutual respect and caring for our patients.

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