Lesson Learned: Pick Your Battles


By Debbie Moore-Black, RN

It was a known fact — I was 4′ 11″ but I had a mouth on me to compensate. I was loud and noisy. Fellow nurses called me the “rebel without a cause.”

But I had a cause.

I knew I was David against Goliath. Almost everything became my cause. And I verbally fought my way through this iron-clad management structure.

I had to fight for the betterment of the patients, their survival, and the nurse being bullied.

I had to fight in front of an all management team that failed to uphold a safe 2:1 patient-nurse ratio.

Once, I was invited to a grand sepsis protocol debate.

This big meeting had everyone attending — critical care managers from ICU, neuro-ICU, coronary care unit, and the emergency department, pharmacists, physicians, etc.

And I was invited to this “think tank,” too … a little fish in this big pond.

“Code sepsis.”

And at this round table with all of the health care professionals who were accustomed to pounding their chests on how well they set up their sepsis protocol — I had to debunk it.

Sepsis was the newly named diagnosis, and if not treated rapidly and proficiently, a patient could die.

Our numbers showed that our patients were dying.

Cardiac patients have the golden hour; sepsis patients have the golden hour also.

Sepsis: a raging infection that consumes most organs from bacterial, viral, or parasitic infections.

Symptoms: shortness of breath, dizziness, confusion, rapid heart rate, and low blood pressure.

At our institution, a sepsis patient stayed in the ER for hours. Strategic life-saving protocols were stalled, and when the patient eventually got to the ICU, precious hours had been missed.

We had to intubate these patients. Put in a central stat line and arterial line. Hang vasopressor drips, get stat labs and administer IV antibiotics. Not to mention adding liters of IV normal saline. The entire body had to be resuscitated.

I mentioned in the round table that we were doing it all wrong.

I recommended a “code sepsis” should be announced overhead.

The rapid response team (RRT) should respond to the ER stat.

A central line should be inserted stat and an arterial line. Stat labs. are to include a lactic acid level, ABGs, intubation, electrolyte profile, liver function tests and kidney function tests.

All in all, these procedures had to be performed immediately and simultaneously.

But they weren’t. Sepsis patients came to the ICU after being in the ER for several hours. Precious wasted hours. Precious minutes.

The round table got loud and argumentative.

But we began to settle on the truth: we weren’t being aggressive enough medically. And our patients were dying.

Protocols were rewritten and added too.

We fine-tuned.

As an aftermath of this think tank, “code sepsis” was called out on the overhead. The RRT showed up in the ER, and with a rapid succession of intubation and central line insertion, the patient was rushed to our ICU with the goal of one hour.

Feeling that I productively had added my two cents. I was called to the manager’s office two weeks later.

Our manager told me I was brilliant, and my ideas were also “their ideas.” But — she had to write me up.

Why? Because I spoke out of turn. I intruded amongst these professionals. I was out of place.

In years to come, I realized that they had to be the ones in control at this institution. They had to be the ones with the ideas.

I was just that brick in the wall, and they wanted me to close my mouth.

I carried on relentlessly for the betterment of the patients and fellow nurses — until I could no longer feel any support.

They wanted me to be a yes person — to serve, honor and obey.

Lesson learned: Pick your battles.



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