Describe a recent issue you had with a doctor or co-worker's decision. How did you handle it?

"During my time working at a skilled nursing facility, we were short staffed one evening during medication passing. Our standard operating procedure was to pass medications to patients in teams of two to ensure that proper medications were being given to each resident. My co-worker told me to do two of the wings alone to save time and I immediately told her that I was uncomfortable going against policy for the safety of the patients. Another co-worker and I teamed up to complete the pass in the entire facility in a timely fashion with no incidents."

"During my clinical rotations, I was training in a PACU and there was a particular patient that I noticed wasn't coming out of anesthesia very well. After the standard waiting time for their surgery, the patient was still very drowsy and incoherent but the operating physician gave them the clearance to be released to their family members and leave the hospital. I was against the decision, as the patient still couldn't walk very well or talk very well but I wasn't in a position to question the physician's decision. The unit was busy that day and in stressing my concern with my preceptor, she followed up with me weeks later when she had seen the patient was in great shape to come in for a follow-up procedure."

"In my current position working on an OB unit, a young, single mother came into our unit in full blown labor. She came alone and in talking to her, I learned she didn't have any family or friends near to be with her in time for her first child's birth. As the labor progressed, the physician was noting obvious signs of stress in the baby but was still holding off on performing a c-section. At this point, I began to think that the patient should be put into surgery to get the baby out before any complications. But, the physician's experience held true a while later when a healthy, happy daughter was born to the first time mother. While I didn't agree with the decision to hold off on c-section at the time, trusting the physician's judgment was the best thing that I did and seeing the gratification on the mother was well worth it."

"I actually recently dealt with this type of situation during one of my clinical shifts in the emergency department. We had a patient who presented with extreme muscle spasms and joint pain. The patient's joint pain was so bad that she could not move her joints, particularly her jaw. After the physician I was working with examined her, she diagnosed her with pain from an arthritis flare; however, I did not agree with the diagnosis because of the patient's symptoms. Using a professional approach, I urged the doctor to do exploratory testing, giving her clinical rationale of what I thought was wrong with the patient, and once we received the test results back we learned that the patient had a life-threatening infection that needed immediate medical attention."

"I recently had a patient who had a PICC line placed at the beginning of my shift. Later in the day, I began noticing that the patient seemed more lethargic but still arousable. I notified the physician and was told this was only due to the pain medications the patient was receiving and that I shouldn't worry about it. As time passed, I did not feel this was the reason. However, the physician declined coming to reassess the patient when I paged. I discussed with my charge nurse and decided the safest thing for the patient was to call a rapid response. Ultimately, the patient was found to be septic, and immediate intervention was required. Thankfully, we were able to get the patient the treatment he needed right away and prevented it from becoming any worse. After this, the physician came to me and apologized for not taking my pages as seriously as he should have and thanked me for my commitment to my patients."

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