Nurse X confronts a cutting-edge technique

Nurse X confronts a cutting-edge technique

December 14, 2013 -- Today the Irish Examiner ran a report by Kevin Keane that featured a remarkable piece of patient advocacy by an unnamed nurse:  snatching a scalpel from a physician's hand as he was about to "cut into an elderly patient's vein in order to take a blood sample." The piece describes evidence presented at a recent "medical council inquiry" into allegedly poor care by the physician in 2009 at Midland Regional Hospital, Portlaoise. The nurse, identified only as Nurse X, had apparently asked the physician to insert and draw the blood from a tube. After she took the scalpel away, he reportedly "mumbled something under his breath and had a blank look on his face." Although it may not have taken a lot of health care knowledge to see that this method of drawing blood was a danger to the patient, it did take courage to take a scalpel away from him, particularly in a setting in which nurses apparently are not permitted to draw their own blood samples. The report includes some additional comments from Nurse X to the effect that the physician "just hadn't a clue how to treat a patient," as well as information from a senior physician along the same lines. The scalpel anecdote is brief, but it's a great illustration of the role that direct care nurses can and should play in protecting patients from any threat. We thank Mr. Keane and the Irish Examiner.

The article, "Nurse snatched scalpel off doctor about to cut vein," explains that physician Vincent Osunkwo faces multiple allegations of "poor professional performance and professional misconduct" arising from his work at the hospital in March and April 2009. The piece reports that Osunkwo got the position of "senior house officer" at the hospital after a posting in which he was the only applicant. The piece quotes Peter Naughton, then a consultant surgeon at Portlaoise (below), who said (apparently at the inquiry) that "he would never have been happy to give Dr Osunkwo any clinical responsibility." Presumably Naughton is also the "senior consultant" the piece quotes as saying Osunkwo did not have "basic knowledge that could be expected of any medical student." Osunkwo allegedly "attempted to read an X-ray upside down" and "told a consultant a scan performed on a patient's kidney was 'fine' when it in fact showed multiple abnormal masses." The piece notes that "Dr Osunkwo has returned to his native Nigeria and did not turn up for the inquiry," and that his request for an Irish visa earlier in 2013 was denied.

But the most striking parts of the piece are from Nurse X, whose name was withheld "at the direction of the fitness to practise committee." At the inquiry, the nurse explained that in March 2009, "a frail, elderly patient was admitted to A&E from a nursing home." Because the patient "needed to have her blood type checked in case she required a transfusion," the nurse "asked Dr Osunkwo if he would 'canulate,' or, insert a tube, into the patient." The nurse continued:

Dr Osunkwo had a scalpel in his hand. She (the patient) was crying he was about to cut into a vein, I said, 'Jesus what are you doing? He was holding her hand quite tightly and she was saying, 'no it's sore.' I pulled it out of his hand and I said why? He mumbled something under his breath and had a blank look on his face. I didn't honestly believe that that was a real doctor that night. He just hadn't a clue how to treat a patient.

No doubt readers will be struck by the gap between the apparent knowledge of this physician and what one might hope for in the hospital. But it's also a powerful example of patient advocacy, a great illustration of the protective role direct care nurses have and why they must have the power to stop threats to their patients, regardless of the source. (See our nursing autonomy poster you can print and hang in your workplace.) No doubt it did not require a great deal of health care expertise to see that this was a harmful and incorrect approach to the task at hand. But it took courage for the nurse to remove the scalpel from the physician's hand. And that is especially true for nurses who practice in settings in which they may be underpowered and physicians as a class may enjoy excessive deference. It is unclear to us why it would be necessary for a physician to take this blood sample in the first place. In fact, it would appear that nurses, who typically have much greater experience with needles and IVs, would be far better choices to take blood samples from frail, elderly patients.

In any case, we thank Mr. Keane and the Irish Examiner for this helpful story.