You don’t ask for help if you don’t need it.

“There is a strong culture in medicine – you don’t ask for help if you don’t need it.”

That is a quote from today that sticks out to me because as a nurse I’ve seen it in action. There was an instance a few years ago when I was the charge nurse on our pediatric floor. It was a weekend morning around 7:30am. Right away at the beginning of the shift one of our newer nurses called me in for a second opinion on an infant who seemed lethargic and whose vitals were off. We called a Rapid Response and had a team respond within a few minutes led by the PICU fellow, which was pretty typical. She clearly saw that things were not right with this baby, and began calling out request for support teams: lab, X-ray, IV team, etc. After trying to get in touch with a few of these services by phone and having encountering barriers, I sidelined with the bedside nurse and the RN responder and we decided we needed a code. In our hospital, when you called a code, you’d get all of those necessary services, and you didn’t need to waste time trying to make the 10 phone calls and pleading with busy people on the other end that, “no, this is really more urgent than what you’re doing.” So I did it – I called the code. Unfortunately the fellow didn’t hear the plan like I thought she did, and she became visible angry with me. “WHY did you do that?!” I explained my rationale and the barriers I was encountering getting the services this baby needed. It didn’t go over great – she clearly was offended, and took it as a judgement of her competency. She worried what the attending would think about it…she obviously didn’t have things under control and that’s why we called a code. That simply wasn’t the case. It was the case that we needed to use the systems and infrastructure in place to get timely interventions to the bedside. The baby ended up transferring to a higher level of care and the Rapid Response team accompanied her there.

We had almost no opportunity to debrief on that experience. I certainly acknowledged my role in not speaking up louder and ensuring everyone understood the plan and rationale. I did share my perspective on the situation with my nurse manager and medical director who were both supportive and helpful. I have thought quite a bit about that experience since then, and it was definitely one that made me wonder – what was going on, that that was the natural reaction to asking for help?

We can’t let that type of culture live on in medicine, in nursing, or in our teams. The culture of a team makes itself very obvious in stressful situations. We have to make sure it is pruned, nurtured, and then protected because culture is a matter of safety. It’s that simple.