BedsideEmergencies-ICUFAQs.docVIP

Bedside Emergencies  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