Somebody asked me the other day why we were expected to take ACLS to work staff in the unit. She meant: we nurses weren’t going to be intubating anybody anytime soon, or putting in central lines, or running codes, or anything like that. I could see her point, I guess.
But I think her point is missing something. Last time around for my continuing ed I did a course on "nursing and the law", which I thought might not be very interesting. Wrong. It turns out that when you look at the legal definitions of what it is that nurses are supposed to do in the course of their nursely duties, they vary. The duties. Nurses do all sorts of things, depending on where they are, what their supervision is, etc. And are held responsible. In other words, the judge may say to me one day:
"Nurse Markie – you’ve been an ICU since the last Ice Age, isn’t that right?"
"Uh, yes ma’am, your honor. Sir."
"And so didn’t you know that you’re not supposed to shock asystole (even though they always do it on TV), or give epinephrine in the tube feeds, as has been verified by the expert witnesses during this proceeding? Aren’t those pieces of nursely ICU knowledge that you are held responsible for knowing when you are a staff nurse in the ICU?"
"Uh, yes sir, I did know those things, and it is my responsiblility to know them. Ma’am. I am supposed to know the procedures for defibrillation, and for giving meds."
"So then why did you allow those things to happen, nurse Markie, in the light of your knowledge and experience?"
"Uh… because the doctors were running the code?"
"You mean those same doctors who, over three years of residency, spend a total of three months in the MICU environment? Compared to your years of experience, spent working in the ICU since the time of the Crusades? You allowed them to tell you what to do, even though your experience told you that it might be wrong?"
Not that you should refuse orders … but are you responsible for knowing better if you’re told by a doctor to do the wrong thing? Legally responsible? Especially if you have a lot of relevant experience?
The apparent answer is yes, documented over and over again by legal case after case. You are responsible. And especially since, in the course of one year, you collect roughly four times the ICU experience that a doc does in her entire residency. So you’d better know your stuff. But play closely with the team, and get orders written!
Disclaimer:
That said, the usual disclaimer applies to this article: the opinions and experiences described here are in no way to be taken as "official" – they are meant to represent the kind of information that a preceptor might pass along to a new ICU nurse, and are not particularly objective, although they do represent a lot of experience (about 45 years!) between the author and Mrs. Author. Please let us know when you find errors (and you will), and we’ll fix them right away. Thanks.
yakubu H.yakubu
