I made mention of the potential liability issues in relation to giving your total trust to a physician or your nursing administrator. As an operating room nurse, I am the “gatekeeper”. For example, a patient can come through the ER, be admitted to the ward, go to pre-op and then get checked for surgery. If the consent isn’t just so, or there is a family heirloom earring that is somehow lost along the way to the operating room… well, it’s the O.R. nurse that takes on the full brunt of the liability. I say, “what about all of those nurses along the way that had some sort of pre-op check list to do, or the ER nurse that had collected and bagged the valuables… doesn’t matter a wit. I’ve been told several times, “but you’re the gatekeeper.” Last week I had two Russian brothers in my pre-op. Brother number one, “Isaac”, spoke no English at all. Brother number two, “Asimov” spoke only broken English. The problem before me was that both brothers smelled of vodka. Both brothers had gotten into a fight earlier that same evening and somehow miraculously made up. However while in the heat of the disagreement, Asimov had pushed Isaac down onto a running table saw and now Isaac is being prepped for surgery. He is sitting up in my bed with no clue as to what’s going on while bloody bubbles come out of his three inch deep chest wound with every breath. I walk up and see the surgical attending and resident using Asimov as the “interpreter” to get informed consent for this procedure. I immediately protested and both surgeons were aghast with disbelief. “You need an official hospital interpreter for this”, I say, “How do we know what this brother is saying? He might still want this poor sap dead, for all we know.”
The attending says, “he’s a nice enough guy… and he speaks Russian… he’s got to go to surgery ASAP, so, what’s the problem? I’m calling the nursing administrator, you’re endangering this patient” he said rather smugly.
I said, “are you and anesthesia team both willing to declare this an official level one emergency case? At least that way we can bypass the whole informed consent thing all together and just rush on back to the trauma room… well?”
They looked at each other a few seconds, “well, no… we can’t say that this is classified as a must go right now emergency…. You can get your interpreter.”
We were not even ten minutes later in getting to the OR. Crisis and liability averted and the patient did just fine. It may not have amounted to much, but you need to really pick your battles in case things go south in a really bad way. Be the best patient advocate because no one else will. Just remember, would you want this to happen to your brother, mother or loved one? If not, then stand and fight the good fight.