From the Guidelines
The correct answer is b. Authority gradient, as it refers to the power imbalance between healthcare team members that prevents effective communication, and in this scenario, the nurse should escalate the concern through proper channels if the doctor ignores the initial warning, prioritizing patient safety over hierarchical considerations. This situation is dangerous because it can lead to medical errors and patient harm, as seen in studies such as 1, which highlights the importance of medication safety in the operating room. The authority gradient is a significant barrier to patient safety, and all team members should feel empowered to speak up about safety concerns regardless of their position, as emphasized in 1.
When the doctor ignored the nurse's warning about the wrong medication, this demonstrated a steep authority gradient where the hierarchical difference impeded crucial patient safety communication. The appropriate action would be for the nurse to:
- Speak up clearly and assertively about the safety concern
- Escalate the concern through proper channels if the doctor ignores the initial warning
- Prioritize patient safety over hierarchical considerations, as patient safety is the top priority in healthcare settings
- Document the incident and report it to the relevant authorities, as seen in studies such as 1, which emphasizes the importance of reporting medication errors.
In healthcare settings, effective communication and teamwork are crucial to preventing medical errors and ensuring patient safety, and the authority gradient should not be allowed to compromise this, as highlighted in 1.
From the Research
Situation Awareness and Medication Administration
- The nurse's action in informing the doctor about the wrong medication during CPR demonstrates situation awareness, a critical component of effective deteriorating patient response systems 2.
- Situation awareness is essential for nursing practice, particularly in dynamic task environments like CPR, where accurate assessment and decision-making are crucial.
Authority Gradient and Communication
- The doctor's decision to ignore the nurse's warning about the wrong medication may be related to authority gradient, where communication is hindered by hierarchical relationships or power dynamics.
- However, there is no direct evidence in the provided studies to support this claim, as the studies focus on situation awareness, medication adherence, and opioid use disorder rather than authority gradient or communication in healthcare settings.
Incident Reporting and Management
- If the nurse's warning was ignored, and the wrong medication was administered, resulting in an adverse event, an incident report would be an appropriate action to document the incident and facilitate investigation and improvement 3.
- Incident reporting is essential for identifying and addressing system errors, near misses, or adverse events, which can inform quality improvement initiatives and enhance patient safety.
Available Options
- Among the provided options, "Incident report" (c) seems the most appropriate action in response to the doctor ignoring the nurse's warning about the wrong medication.
- The other options, "Negligence" (a), "Authority gradient" (b), and "Call the manager" (d), may be relevant in certain contexts, but they do not directly address the immediate need to document and investigate the incident.