Reference no: EM133849869

Question

Did the patient suffer harm?

Marie an RN, a physician; her charge nurse and the nursing supervisor have been named in a malpractice lawsuit. The events pertaining to the action are as follows.

Marie was to administer digoxin to her patient. Per hospital protocol, Marie took the patient's apical pulse for 1 minute before administering the medication. The patient's pulse was 130 and irregular. Protocol also dictates that if there are unusual changes in the rate or rhythm of the patient's pulse, the medication should be held and the physician contacted. The patient denied any chest pain but said she felt 'funny" as though "my heart is jumping in my chest." In the four days that Marie has provided nursing care to the patient, her pulse had never been above 100, nor was it irregular.

Marie held the mediation and telephoned the physician who became quite irate. "She's getting digoxin because of her heart problems! Don't you know anything?" Marie explained that the elevated pulse rate was unusual, but before she could tell him about the irregular rhythm and the patient's statements, the physician hung up. Marie immediately called him back, but the physician's answering service answered and informed her that the physician was now on rounds at another hospital and would not be available for several hours.

Marie returned to the patient who now complained of feeling dizzy. Marie consulted her charge nurse who told her to go ahead and give the medication. Still unsure about administering the medication, Marie consulted the nursing supervisor who, in turn, consulted with the charge nurse. The charge nurse became quite angry and told Marie that she was behaving in an insubordinate manner and that a written disciplinary letter would be placed in her file. The supervisor agreed with the charge nurse. The charge nurse then administered the digoxin.

Marie documented all of her findings, including her conversations with the physician, charge nurse, and nursing supervisor. Within an hour, the patient became quite anxious and complained, "It feels as if my heart is stopping!" The rapid response team was called and the patient was rushed to the cardiac care unit where she spent several days after receiving a pacemaker because of a heart block.

The physician was overheard to say to the charge nurse and nursing supervisor, "I guess you shouldn't have given the digoxin, but don't say anything. The patient will be OK, and there's no need for her to think we did anything wrong." The patient later filed a malpractice suit for pain and suffering. Marie filed a grievance regarding the disciplinary letter in her file.