confidence and standing your ground

[Rivka P]

I start this post by saying that I acknowledge that I made a mistake and should be more confident and stand my ground next time. Here's the scenario and I want to hear if any of your struggle with this kind of thing, and how you deal with it.

I worked in a camp this summer with a large inclusion and special needs population. We had 2 RNs (including myself) and a med tech on staff in addition to a health room administrator. Yesterday morning, as campers were arriving at camp, we were told by the camp secretary that there's a kid in front having a seizure. The other, more experienced RN was not there. We got the name of the camper. No emergency meds (diastat etc) His health form had no medical issues listed at all. I ran, grabbing some towels from lost and found, to protect his head. I got there and thank G-d, the episode was over, his head was resting on his backpack. The head of inclusion knows the camper, he is one of hers, and kneels down, assists him to walk to the library, a few feet away, to get out of the flow of people arriving at camp. I see that he is A+O, the inclusion head is with him. I run back to the health room to get his chart, so we can call his parents. I relay from info to the med tech. We talk about how we should get vitals, I bring the thermometer, his temp is 98.4. Mom gets onto the cellphone. She is about to teach a yoga class and will call dad. I say, I think she should cancel her yoga class. This is an emergency. I say this to the staff around me, not to the mom. To the inclusion staff and SW in the room, I say, is there a reason we are waiting around? This is a seizure in a child with no history. This needs to be checked out. I am ready to call 911. Is there a reason we are not sending him to the hospital now? Inclusion head says, this child is autistic and anxious. An ambulance will set him off, we don't need that. He is stable for right now, let's wait for the parents. I say, fine. The head nurse gets to camp. I give her the BP cuff and let her handle it. I find out he gets sent to the hospital in an ambulance, with dad following in his own car. Inclusion head rides in ambulance with the camper. I feel vindicated that the head nurse also felt it appropriate that he be monitored and transferred immediately, and called 911. I say to myself, see, I was right.
I meet with the camp director this morning. Why didn't you call 911? Can we count on you to act on your medical knowledge and instinct in the future? I explain to her how the Inclusion Head intimidated me and told me that I shouldn't make the call. Here comes the big deal: Camp director wants me to talk to inclusion head and tell her that in the future, she should be more careful about how she communicates because she is not the medical personnel on staff and the intimidating way she spoke to me made me second guess my medical gut feeling and the camper's care was delayed.
I pushed it off all day and it's the last day of camp. I plan to call her later, as she'll be in her office, she does inclusion all year for the JCC. I couldn't bring myself to confront her.
Confidence and standing your ground can't be learned from a book. Can you all give me some words of encouragement and advice? Thanks! ---Rivka

[achot]

Rivka, we were all in your shoes once, it does get easier but you do have to bite the bullet, prepare in advance what you want to say, and call the person involved into your office or your room or any appropriate private setting. Sometimes I make sure another staff member is there as witness, thats your call and appropriate to the work setting. If the other person is a member of the opposite gender I will definitely bring in another staff member and not close the door but talk quietly.
Start with thanking the person for coming and telling him or her that you have to tell her something that you know they will not like hearing but you need them to listen till the end and then you will respect their response. Stick to the objective points that you want to make and how you would want the scenario to be handled in the future. Dont corner the person, and place blame and guilt etc, just unemotionally explain that which was unacceptable and what standards you expect for the future.
Also please know that not everything is in the medical chart, and parents or patients sometimes lie. So there might have been some things that you didnt know about the child and a seizure is certainly reason for hospital check up. Camp nurses lack all of the equipment and support etc that one finds in a hospital and your job is to triage what you can handle and what you cant.
All the best! Achot

[medic09]

Since no harm came of it, don't agonize over the incident. It was a relatively small learning event for you.

As for gumption: remember always that you are Hashem's shaliah as the patient's advocate. The patient's welfare is your only concern. When someone intimidates or just harasses you - stop and take a deep breath to center yourself. I tell you in all candor that even under fire, that's the thing to do. Don't let them distract you from your task as patient advocate.

As for Ashot's comment that parents sometimes lie by commission or omission - remind to tell you sometime about the late night rescue we did for a teenager hiking with a group at altitude. Seems no one thought it relevant to inform the group leaders that he had a congenital cardiac problem. Well, when it bothered him hiking at nearly 10,000 feet (he lived at sea level) we had to do a full on rescue and evacuation with no idea what was really happening. Always be prepared for surprises. Patient care is an adventure! ;-)