Honesty Goes a Long Way
I just wanted to share a pretty significant story with y’all, one about one of my favorite nurses. This story makes me really proud to have been a part of this Emergency Department.
It was a very busy day. I got to the ER around 10am, and already we were using all of our hallway beds. There wasn’t a huge amount of critical patients, but it seemed almost everyone needed a workup, and almost everyone was requiring a hospital admission.
On this particularly busy day, one of my favorite nurses was working. She is older, and after a very successful career overseas, she decided to become a nurse, literally so she could do something meaningful with her free time. She’s amazing. Literally the example of warm, compassionate, and a fierce patient advocate. On this day she was taking care of a young girl who fell of the monkey bars. This young girl had a pretty bad elbow dislocation and needed conscious sedation to reduce.
We set everything up, got respiratory therapy in the room, and got the medicine (Ketamine) ready to go. The dose for Ketamine in kids is 1mg/kg, but to be honest we normally give half that, or at least only give ½ at a time. So the nurse pushes half the dose of Ketamine. We wait a few seconds…nothing happens. We all think this is weird, so we push the second ½ of the dose. Wait a few seconds….nothing happens. We give her a little ativan, still nothing happens. At this point we start theorizing why it isn’t working, and we send the secondary nurse to go get more Ketamine. She comes back, and while scanning the new vial into the EMR, looks down at the old vial of medicine, and gives kind of a startled noise. She shows the doctor, the old vial of medicine, and the doc lets out an audible sigh. We give another “1/2″ dose of Ketamine, this time from the new vial, and it works almost instantly. We reduce the patient’s elbow no problem, and everything seems to be going fine.
We step out of the room, and it’s immediately brought up to all of us by the doctor that the patient was accidentally given Toradol (Ketorolac) by mistake. The primary nurse was besides herself. She had never made a mistake like this she says, and said she was horrified. Someone brings up that maybe we just shouldn’t say anything to the parents or the ER admin, and immediately you can tell that she was not for that.
Immediately, this nurse takes responsibility. The first thing she does is to tell the family. The family came into the room, and she straight up told them that she made a mistake, and that she was extremely sorry. Toradol isn’t always a dangerous medicine, but we avoid giving high doses to kids because it can cause some Kidney issues. So we draw some labs to look at her renal function, give her some IV fluid, and watch her for a while. Everything checks out fine, her labs are fine, and after calling peds we find out that the patient should be fine.
After telling the family, the nurse immediately went and told ER administration. Instead of getting in trouble, instead of getting reprimanded, she was praised. It takes a lot of guts to own up to your mistakes, especially in a culture where nurses and doctors are thought to be beyond human and beyond capable of making mistakes. I’ve seen many people hide their mistakes instead of owning up, precisely because they are afraid of consequences that might be out of proportion.
Despite the possibility that she may be fired, this nurse spoke up. She considered the safety of the patient and honesty to the family more important. And that is what makes me so proud. No one would have necessarily thought she was a bad person if she didn’t tell the family. But that didn’t matter to her. She was honest, and she set an amazing example for the rest of us.
This nurse has remained one of my role models since I’ve met her. She exemplifies everything the profession stands for, and such an example of how we should all remain open with out patients. This incident may have not been a big deal overall, but it was a big deal for me. Now, every time I think of this nurse, I am going to think of the importance of honesty, and just how much of a significance it can have.
Powerful example of integrity and ethical fortitude! Bravo to her!
“One who is faithful in a very little is also faithful in much, and one who is dishonest in a very little is also dishonest in much.” Luke 16:10
