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Presented to the workshop for nursing leaders in the National Institute of Neurology by Prof Omar Hasan Kasule Sr

CASE #1: The Director of the ICU was very angry because he was embarrassed by the absence of the head nurse of the pulmonary and critical care unit to explain the working of the unit to the visiting Minister of Health.The junior nurses on duty could not respond properly to the Minister’s questions. The Director was told that the head nurse was on leave which mad him even angrier he questioned why a senior person like her could go on leave without his knowledge. On return to his office he called the Director of Nursing and told her that from then onwards all leave by nurses had to be cleared by the departmental secretary. The DON protested strongly saying that nurses reported to the nursing division that approved their leave and the director could not interfere in this. They then calmed down and discussed the matter.

CASE #2: The Head of the Pulmonary Medicine and Critical Care (PMCC) ordered a respiratory therapy technician who had finished working on an assigned patient to suction an unassigned patient who had a DNR order. The technician refused to obey until she received further orders from her boss the head of the respiratory therapy department (RTD). When contacted by phone, the head of respiratory therapy confirmed that according to standard operating procedures, respiratory technicians could not offer services to patients with DNR orders. When told of the refusal the head of PMCC was angry and walked briskly to the RTF where an angry exchange ensued with the head of RTD. They later calmed down and talked about their conflict.

CASE #3:An accident victim was admitted and was stabilized in the emergency room (ER). He was then taken to the operating theater (OT) for a minor procedure. The OT nurses called the ER nurses to take away the patient. The ER nurses refused saying the patient has to be taken over by either the ICU nurses or the surgical ward nurses. The OT Head nurse called all involved to the OT to discuss and sort out the matter.

CASE #4: The primary physician signed a DNR / AND order for his patient with terminal cancer, deep coma, and multi-organ failure. He went on a long leave to his home country and the doctor on duty who did not believe in DNR. When the patient collapsed the doctor ordered the nurses to initiate resuscitation measures. The nurses disobeyed but fortunately the patient recovered spontaneously. The doctor accused the nurses of disobedience that caused a fatality. The nurses said they were following orders. There was an angry exchange between them heard by the director of the hospital. He called them in and told them to sit down and solve their differences and make sure that such a conflict never recurs.

CASE #5: An exhausted emergency nurse who had worked two shifts because her colleague did not report for work was handing over a patient to the ICU team at 2.00pm. The ICU nurse, who is from a different part of the world, asked her whether she had given the 2.00 pm medication. Her affirmative response was not heard because of her soft voice from the exhaustion but she moved her head up and down which in her culture was body language for ‘no’. The receiving nurse prepared to give the injection but the emergency nurse pushed her aside and she fell down. A noisy quarrel ensued between them. The Director of Nursing who happened to pass by told them to sit down and solve their differences and do so quickly because the patient needed urgent attention.

CASE #6: The Assistant Consultant on duty at the ICU prescribed morphine for severe pain in a 95-year old patient with severe terminal cancer pain. The nurse refused to give the injection and told the doctor that the dose was too high for the patient who had chronic renal failure. The doctor was angry at the nurses’ disobedience and asked another nurse to bring him the morphine so that he can give it himself. There was a 3-way noisy argument among the doctor and the nurses. The consultant appeared and asked them to calm down and talk about their differences.

CASE #7: The head of the neurology department had a research grant from KACST. He reached agreement with one of the nurses in the department to be his research assistant. She was trained and started working on data abstraction and data entry outside her official working hours, on weekends, and when she was off. Later she started doing some research during her official working hours when she had nothing to do. The head nurse noticed her and was angry for her doing research work during official working time. She was also upset because the nurse accepted working on research without permission from the nursing division. The head of neurology was very upset when he learned of the head nurse’s unnecessary interference in his research.


Writings of Professor Omar Hasan Kasule, Sr

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