Donell Porter, RN
Donell Porter, RN, felt concerned about a patient whose mental status and level of ability had declined dramatically within 24 hours. Donell, who works on the surgical intermediate care unit at McKay-Dee Hospital, noticed the patient had become sleepier and more disoriented. The patient also had subtle symptoms that could be indicative of a stroke.
“On my previous shift this patient was doing well, able to walk to the bathroom and answer questions,” says Donell. “When I came back in the morning, she wasn’t able to communicate or walk.”
Donell worked with another caregiver to help get the patient out of bed, but the patient was unable to stand, which was very concerning.
“I stood there for a moment, thinking perhaps the reason was because we’d just woken her up,” says Donell. “But her condition and deterioration from the day before really bothered me. It caught me completely off guard.”
Using the error prevention technique ARCC, Donell asked a question about the patient’s condition to the charge nurse, Annie Scott, and shared her worries. She also requested a change that the patient should be seen by a doctor, and Annie helped encourage Donell to call neurosurgeon Blake Welling, MD.
After talking to Dr. Welling and voicing her concerns, a CT scan was ordered. From there Donell kept him updated frequently. While Donell didn’t have to use the chain of command to advocate for the patient, she did call back Dr. Welling multiple times throughout the day.
“The second time I called him with the CT results, I had to leave a message with the nurse,” says Donell. “Afterward, I felt uneasy, because I didn’t have a way of knowing if he’d gotten my message. I talked to Annie and we decided I should call him again and read off the CT results, and I left him a voicemail.”
A few minutes later Dr. Welling called back and connected with Donell, but he was busy in surgery and couldn’t come in for a few hours. “He told me to call back if I was concerned again,” says Donell.
In the meantime, Dr. Welling sent his partner in to assess the patient, and physical therapy came over to try and get the patient moving. However, the patient kept falling asleep and PT didn’t feel comfortable getting her up, says Donell.
“At that point I sat with the patient and asked her to squeeze my fingers and move her arms, but she still couldn’t talk or stay awake,” she says. “I was paying a lot of attention to grip strength and testing her for stroke signs. One of her grips was getting weaker, which could indicate a stroke. I talked to Annie again and we decided we needed to either call a rapid response or get a hold of the doctor again.”
Donell called Dr. Welling again, and this time when he answered she remembered something she’d learned during her nurse residency. She says, “I recalled being taught to be direct when communicating and using the phrase, ‘I’m very worried about this patient,’ to help the doctor understand my level of concern and to feel it too.”
Donell shared her worries and soon after the call, she noticed the patient was scheduled for the OR.
When Dr. Welling arrived to assess the patient, Donell says he told her the patient looked a lot worse than he was expecting. “That’s when I apologized to him for calling so often,” she says. “He looked at me and said, ‘Never apologize for calling a doctor. If I’m ever in the hospital, I want you to be my nurse.’”
Ashely Favero, RN, from the surgical intermediate care unit, says, “That’s the ultimate compliment from a doctor to a nurse. It’s also reassuring to a nurse and builds their confidence to advocate for patients by knowing they can call the doctor when there’s concerns. Donell did a great job!”
Ashley Hasler, patient safety consultant, says, “Thank you to this physician for giving a positive and psychologically safe response. It’s important to have good communication with positive reinforcement to build a strong safety culture.”
Annie adds, “Donell did a wonderful job taking care of the patient, and she handled the stressful situation so well. We’re lucky to have her as part of our team.”
After the patient’s surgery, Donell says she was later sent to inpatient rehab. “I saw her walking in the hallway before she was transferred,” says Donell. “She was doing really well.”