"Nurses Caught Between a Rock and aHard PlaceNurses at Memorial Hospital, a 40 bed rural community hospital, are faced with whatseems an impossible dilemma.Their best efforts to advocate for patients are routinely blockedby the hospital’s physicians and senior leadership.Two recent examples: When Mr. Rodriguez,a seasoned surgical nurse, requested time to administer an analgesic before a patient’s painfulwound debridement, he was told by the surgeon that no pain medication was necessary.Thepatient was clearly in distress while the debridement was performed and so was his nurse.WhenMr. Rodriguez reported this experience to the supervisor he was told that the nurse’s job is to dowhat the physician orders. On another occasion, a woman presented to the emergency room with a fractured distalradius.Because a family member with a similar injury had unsatisfactory results (deformity andpain with movement) when treated by the doctor on call that evening, the woman and herhusband requested transport to a larger hospital.The doctor on call insisted that it was importantto set the fracture as soon as possible and convinced the couple that he could competentlyperform the procedure.The nurse had reservations about the doctor’s competence and wanted tocounsel the couple to be persistent in seeking transport to another facility, but knew that her jobwas on the line if she did.When she reports this to her supervisor she is told that her job is not toadvocate for patients but to be a loyal employee.Repeated efforts by nurses to address these sorts of challenges have resulted in thepersistent message that they can accept the status quo or leave.The nursing supervisor is tightlyallied with medical director and Chief of ED (CEP).The problem for the nurses is that it is a 2hour drive over the mountain to the nearest hospital and there are no other employment options. "