When Teri Dreher, RN, CCRN, iRNPA, owner of NShore Patient Advocates, LLC in Chicago, Illinois, was still working as a nurse, she remembers when a patient kept having massive hemorrhagic episodes after a routine surgery. Despite this, the doctor wasn’t running tests to determine what was happening. When she questioned him, he yelled at her, became defensive, and threatened her. But that wasn’t the end of it.
“The next day, he transferred the patient out of ICU. She went into shock, and the family begged me to intercede. I told the daughter what I would do if it was my family member: insist she be transferred back to ICU and get a CT scan for an interventional study to find the cause of the bleeding,” recalls Dreher. Turns out that the patient had a bleeding splenic artery aneurysm that could not be accessed by the interventional radiologist to stop the bleeding.
“When the patient came back to ICU, she immediately started bleeding again, and we coded her for four hours, transfusing more than 30 units of blood. During the CODE, I had missed scanning out a narcotic, and 10 days later was charged with being a drug-abusing nurse,” says Dreher. Although her urine test was clean, she was put on 10-day suspension. This convinced her that she would never be happy again working as a bedside nurse. Her nurse manager had warned her not to tell the family member what to do to force the issue.
“I took a course in patient advocacy and started my own business. I vowed that no one would ever tell me not to advocate for a patient again,” says Dreher.
“Nurses today are taught to question, speak up, and challenge when they feel something is not right,” says Dreher. “Decades ago, the system was much more patriarchal, and nurses were frowned upon when questioning doctors. Doctors are human and make mistakes. Nurses spend more time with patients—we are the doctors’ eyes and ears.”
She says that good doctors generally listen to nurses, and nurses are free to speak with physicians as well as mid-level practitioners. If you don’t get a response from the doctor, she suggests speaking with the nurse manager, supervisor, and even the risk management department.
Dreher admits, though, that nurses who are “whistle blowers” can be at risk even with the nursing “bill of rights.” “Everything in hospitals is focused on data, stats, and money. If a nurse goes up against a physician, just do the math regarding who is more valuable to that hospital: a nurse who makes 80K annually or a doctor who makes millions per year for the hospital,” says Dreher. “I almost got fired for strongly advocating for a patient. Even though I was right, I was almost fired by a hospital that I had served well and faithfully for over 23 years.”
As a result, Dreher suggests that nurses still speak up, but tread carefully while doing so. “I think it is important to be humble and go up the chain of command carefully. Doctors have more training than nurses, and sometimes there are things we do not know,” she explains. “Communication is key—as well as respect. None of us knows everything, but if we have the courage to confront and work together collaboratively, everyone wins—especially the patient!”