Hold Your Horses

“Doctor, the nurse put the needle into my arm and took it out, but did not give me the tetanus toxoid injection. She said get the doctor to write the prescription.” I was in the antenatal clinic, seeing pregnant women, normal and also those with ailments. It is a routine for us to prescribe tetanus toxoid injections and for the nurses to administer the injections. I had not heard of such a thing in the last thirty years. Perhaps the patient was mistaken. Perhaps the nurse had administered the injection, then realized that there was no prescription, and sent the patient to get it prescribed. Post facto prescription is not the right thing to do. But our nurses are good, and the antenatal clinics are quite crowded. Then sometimes they do this to save time. I do not encourage this. But if it happens occasionally, I do not react more than telling the enurse not to do it again. “I will come with you and see what is the problem” said. We went to see the nurse. “Sister, this patient says she has been poked with a needle but not given the injection” I said. “Is that true?” “It is” she said. “Who did it?” I asked. It could not have been her, since she appeared cool. “That student nurse” she pointed with her chin. There was a student nurse from another college posted to work at our hospital because they did not have a hospital of their own and hence no patients to nurse. She was standing outside the injection room, well away from the scene of crime. But at least she had not run away. I called her in side. “Nurse, why did you put an injection needle into this patient but not give her any injection?” I asked. “I put the needle into her arm, when the sister stopped me. She said there was no prescription. So I just took the needle out and sent her to get a prescription written.” “There was no prescription because she did not need an injection” I said. “Do you not check what is prescribed to a patient before giving an injection or medicine?” That concept seemed a little new to her. She kept quiet. Perhaps she was there just to practice giving injections, not the entire nursing process. “Not if the patient goes to court and sues you, then what will you do?” She continued to keep quiet. That concept was also probably a little new to her. I turned to the patient and said “you do not need an injection. No harm has been done. It would not have happened if you had gone away after your check-up instead of standing in a queue meant for injections. No don’t stand in any more queues. Take your medicines and go home.” She went away. I went back to the examination room to see patients. The student nurse followed me after a while and said ”doctor, I am sorry.” “No. Getting an apology from you is not the result I want. If at all, you should have apologized to the patient. I am unlikely to recommend any disciplinary action against you. I would have asked you your name if I had wanted to do so. What I expect from you after whatever happened today is that you will be careful in future and not do such a thing again.” “I won’t do it again” she promised.