When I think about medication administration, it’s a wonder that we ever get it right. Nurses administer medications that are dangerous, to patients who are unwell, in healthcare settings that are complex, with sometimes limited and unreliable resources. Liken our circumstances to other professionals, let’s say a chef, and there would probably be many more tantrums in the kitchen. We wouldn’t expect a chef to bake a cake without flour, but it is common that we expect to treat disease but must wait for the proper medication to do so AND when we cannot administer the medication on time, then we are criticised for improper practice.
I think about the mountain of literature that condemns nurses for making medication errors, and I cringe about what provokes them. I wish those authors could see what I’ve seen. In my opinion, nurses who administer medications in health care settings are hero’s and should be given a Hi 5 each time they get it right rather than shot down as soon as they get it wrong. For example, I return to my PhD findings where it took one nurse more than two hours and three negotiations with the prescriber to get the documents completed so that a patient could receive their scheduled blood transfusion. The nurse, in this case, prepared the pathology results, arranged the cannulation equipment and prepared the transfusion paperwork. Her first approach to the doctor was brushed aside; the second was ignored and then on the third request for the signature, the prescriber rudely relinquished and signed the order and the procedure commenced immediately. It was unclear to me why the doctor was obstructing, but the nurse stayed calm and used humour to get the patient what he needed.
If you have worked in a hospital, then you may have encountered something similar. Fortunately, the nurse I was observing was a strong patient advocate and a peace-maker. She had known the behaviour of this doctor and had developed strategies to manage it even if it required unnecessary and lengthy manoeuvring. It was apparent in one encounter with the doctor that she was resisting because she had delegated the job of admitting this patient and preparing his prescription to the junior doctor who as you can imagine was time pressured and not available. However, this consultant was not willing to support the junior by finalising the process so that the nurse could get on with the job. I’m making some assumptions about what I thought was happening. However, this consultant, who has the position and authority to provide leadership and learning to others was acting up and to the detriment of patient care. Luckily, the nurse in this circumstance was persistent and persuasive. She was the more exceptional leader in the doctors meeting room that day.
There are no prizes for belligerence in healthcare.
Regards Julie Martyn PhD Senior Lecturer in Nursing Nursing, Midwifery and Paramedicine
Faculty of Science, Health, Education and Engineering USC Fraser Coast
Ph: +61 7 5456 5614