It's not the ED nurse's role to report patients
It's not the ED nurse's role to report patients
By Timothy Bray, RN, BSN, CEN
Emergency nurse
New London General Hospital
New London, NH
Recently, an incident occurred in our community hospital's ED, which presented an ethical challenge for nurses. A state police officer accompanied the driver involved in a car crash via ambulance to the ED, and ordered the nursing staff to draw a blood alcohol level on the patient. The patient, who was in full c-spine precautions, adamantly refused to have his blood alcohol drawn, stating it was a violation of his rights, and that he would physically resist any efforts to draw his blood. The law enforcement officer, acting under her training and interpretation of the law, threatened to arrest the ED nurse if she did not draw the blood alcohol while the patient was restrained.
This is not an indictment of the police officer or any actions or decisions that were made that night, but it illustrates the need to evaluate the impact of this law on the nursing and medical professionals. As ED nurses, we are closely involved in the implementation of blood alcohol reporting laws. For the first time in our profession, we are no longer the patient's advocate. We were not acting to protect the health and well being of this patient as an individual. Rather, it seemed that in this case we were part of a team, adversarial to the patient, to protect the safety of society.
As a result of the incident, the county attorney was kind enough to come to our hospital and explain his interpretation of the law (which states that law enforcement can request that emergency personnel draw a patient's blood in case of motor vehicle accidents causing "serious bodily harm."). It was made very clear to the nursing and medical staff who attended this meeting that "serious bodily harm" was basically any injury (a broken finger was used as a specific example), and that law enforcement may order a blood alcohol under physical restraint of any patient who was the driver in a vehicle accident, providing the officer has probable cause that the driver was operating under the influence of alcohol or a controlled drug.
As ED staff, we have always enjoyed a close, amicable, and mutually beneficial working relationship with both local and state police. This was the first time that a conflict of this depth was experienced between these two groups of public servants. The law brought to light the conflict between the obligation of the police department to protect society from the dangerous actions of the individual vs. the nursing profession's obligation to always remain the patient's advocate and protect the health and safety of the individual.
In these times, when law enforcement, medical staff, and nurses are all working diligently, both individually and through our professional organizations, to remove drunk drivers from our streets, we are faced with ethical dilemmas on how to accomplish this while still maintaining the civil liberties of each citizen/patient. Police officers and ED nurses are all too familiar with the needless tragedy drunk driving exacts on our community. Yet, how far are we as ED nurses willing to move from our role as patient advocate in order to protect the safety of our highways?
It could be argued that the nurse is protecting the patient from harm to himself by alcohol abuse and/or the dangers of driving while impaired, but what about the individual who is not guilty of either? We as ED nurses must be vigilant to the rights of a patient in the hospital environment. Blood alcohol reporting laws shake the very foundation of our role as patient advocates. As health care professionals, we need to review and reflect upon these laws and ask what is lost and what is gained for both our patients and ourselves.
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