Tuesday, March 26, 2013

Standing Up For What Is Right

By Chiqui Raveloski



“It is the Divine Order....Being fake is dead and truth is in bloom". Those were the words of a very good friend of mine said when we were having a discussion about being true to yourself and what you believe in. The world is full of uncertainties, and sometimes, you, as a nurse, find yourself lost in the sea of emotions and chaos.  And the only thing you can depend on is yourself to anchor you back to what is important.


Then I started thinking. What is the divine order? Growing up in a Catholic country of the Philippines, God is the answer to everything. And I began to search  for a meaning. And the divine order was summarized as 
" trusting God to give you discernment, to lead, guide, direct, protect, and give you wisdom". It is so much like the "Bahala Na" concept, an attitude / value, embedded in our culture .

With all this talk about the divine order and Bahala Na, I cannot help but think about the moments in my nursing career where I stood up and advocated for patients the best and honest way I can. Against what bureaucracy dictated me to do, there were situations where I had to look deeper within myself and focus on what is important - my personal and professional values as a nurse, for the sake of patients' care and safety.

Like the time, as an ER case manager, I advocated for a patient to be re-admitted back into the hospital 24 hours after discharge.. The patient was discharged with a $900 dollar prescription for blood thinner to treat PE's.The patient showed up back to the ER because the patient cannot afford the medication. Now, the discharging physician wanted the patient to get the AM dose of the medication in the ER and have me set up indigent prescription - Tricky.

 I spoke with the discharging physician and lead case manager and told them that this patient was unsafely discharged. What should have happened was for the patient to stay in the hospital, get the INR to a therapeutic level, then transition to a more affordable medication before discharge.

As an Emergency Room Case Manager, my main job is to screen admitted patients for medical necessity and appropriateness. It is more of the business and financial part of nursing where revenue is looked upon under a microscope. Sometimes, I am in the middle of the ER physicians and Hospitalists, in making the decision whether to admit patients or not. And in the present culture of patient safety, I always stand by the very same concept to achieve the outcome most desirable for my patients, and the values I swear to keep.

After much discussion, the patient was re-admitted back to the hospital. I was thankful for this outcome because my conscience will not let me rest if it went the other way around. 

In the physician's defense, the patient was discharged with the knowledge that the patient was to follow up with the hematologist to transition to a much affordable medication. Yet, I explained that the patient is self-pay and setting up indigent prescription in an ER setting is almost impossible. It was a weekend and the patient needs the medication right away and on a continuous basis. 

So, I guess, my friend is right. Let the divine order lead you, guide you, and protect you. It is a matter of staying true to yourself, against all odds. Standing up for what is right truly reveals pure honesty which in turn. shines truth to everything around you. 

As nurses, we are always torn in between management's demands, budget cuts. and patients' needs. Stand up for what you believe in. It can get tricky at times. But, " Malinis ang konsiyensiya mo"" . "knowing that your conscience is clear" and your heart in the right place, is letting your inner strength guide, direct, and protect you for the sake of humanity.







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