Nurses entering the nursing profession pledge to do everything in their capacity to ensure that the care they deliver is in the best interest of their patients. However, nurses inevitably encounter many restrictions in striving to meet this pledge. Nurses are therefore constantly wrestling with a major dilemma: should they blindly adhere to the policies of their hospitals, or should they do their utmost for their patients in accordance with their nursing code, even if that might mean disregarding protocol.
In many case, nurses will of course resolve this dilemma and manage to both remain within the boundaries of hospital policies and deliver the best possible care for their patients. However, on occasion, they may find this is impossible and they have no option but to breach the policies and bureaucracy of their employing institution in order to meet their pledge to deliver care in their patient's best interests.
In my years working as a physician in India, I have observed many such events, and I would like to highlight two occasions on which the actions of quick-thinking nurses made me feel proud and fortunate to be working with such caring colleagues.
Nearly 30 years ago, when I was a medical resident, I was working an afternoon shift on a multispecialty medical intensive care unit (ICU). Suddenly, we all heard a loud crash as one of the staff nurses from a neighbouring ward burst into the ICU, propelling a trolley with a patient who had a history of sudden collapse. The nurse had been the sole trained member of staff on the ward next door, and had felt compelled to leave the other patients in the best interests of this man. (The other patients were in a stable condition and there was no immediate risk to their health.)
On examination, the patient was found to be suffering ventricular tachycardia. He promptly underwent cardioversion in the ICU and was resuscitated to full normalcy.
The ICU team thanked the nurse and congratulated her for her quick thinking. But the hospital administrators failed to appreciate her actions, which had saved the patient's life. They wanted to take disciplinary action against the nurse for ignoring procedure and barging into the ICU without informing the doctors and ICU staff first as per protocol. However, good sense prevailed. The hospital director lambasted the administrators for contemplating disciplinary action and the nurse was recognised for her bold and prompt action, which had led to saving one precious human life.
The second incident occurred more recently. In this instance, the nurse was administering medication that I had prescribed to a number of patients who required it for one or two days to manage a short-term condition. I had instructed her to use common packs for these individuals, in order to reduce the costs for the poorer patients by sharing packs, but the nurse had contradicted my instruction.
I was not best pleased by what I thought was her lack of consideration for these patients, and I gave her a piece of my mind. The nurse later came to my office and gave a detailed explanation of why she had acted in this way. The hospital's management had sent out a circular instructing ward nurses to charge patients per unit of this medication, which was an amount that turned out to be three times the actual costs. Buying a new pack was in fact a great deal cheaper for patients than receiving a few units from a common pack. I thanked the nurse for acting in the best interests of the patients and apologised for expressing my anger towards her without asking why she had not followed my guidance.
Every now and then, we encounter unsung heroes such as the two nurses that I have described. These nurses stand by their pledge to do the very best for their patients, even if in some cases this might mean breaching accepted protocol. It is our duty to ensure that they are not victimised when their thinking outside the box results in saving or improving patients' lives, and that they are able to continue pursuing their noble profession. We need to nurture and nourish such dedicated nurses – these are health professionals who are not afraid to put their job at risk in the service of their patients.