What is a Nurse? Part II



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 Let's continue our discussion of what a nurse's role really is and how you can use this to increase conflict in your manuscript. Last post we looked at the nurse as patient advocate. This post, we'll look at the nurse as the patient's safety net. Which dog would you rather have defending your house? The cute, furry puppy? Or the grown dog with the watchful eye. A strong nurse is the patient's watchdog. I look out for my patient's interests when they may not be able to do so.



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 I am often the last line of defense between everything and the patient. Let's delve into the medication arena. The nurse gives the patient's medications. It's my job to ensure that what the physician orders is the correct medication for the illness, for the right patient at the right dose given the right route (by mouth, intravenously, etc...). One of the challenges in pediatrics is there is no standard dose. Every drug dose is based on the patient's weight. I'm not going to give the same amount of morphine to a 5kg infant vs. an 80kg teen. If the patient is not weighed or their weight is entered incorrectly, this can have disastrous effects when medications are given.

Medication errors do happen. I want to reassure you that there are a lot of safeguards in place to prevent such occurrences. Most departments are going to computer based medication ordering. This is beneficial in many ways. One, the order is typed and therefore easily read eliminating mistakes in reading handwriting. Second, most medication based ordering systems have built in safeguards that will check the prescribed dose against the patient's weight to make sure the dose is not too high. In pediatrics specifically, all high risk medications are double checked by another nurse and co-signed on the chart. But as a good nurse functions as a safety net, so should the parent question what is being given to their child and why.

Let's take a real life example. During my years in the pediatric ICU, I worked at a teaching hospital. At this particular institution, residents could rotate through the unit their second year. I had a second year resident order potassium, which is a potent electrolyte, at four times the recommended dose. Now, if too much potassium is given, it will cause the heart to stop beating. That's how big this error could have been.

I approached the resident and questioned the order. He stated, "But the drug book says to give 4meq/kg/day."  I explained that the "per/day" was the key term. That the drug should be divided into four doses given every six hours, no more than 1meq/kg at one time. I told him he could order it that way, but the pharmacy wouldn't fill it and I certainly wouldn't give it.

Needless to say he changed the order and the drug was given correctly.

If the nurse serves as a poor safety net, how can this increase conflict in your manuscript?