Posted by Lieutenant Junior Grade Leah Hart (Nurse Practitioner/Counseling) in The Arrival of Leah Hart

Posted by Lieutenant Kreed (Chief Medical Officer) in The Arrival of Leah Hart

Posted by Lieutenant Junior Grade Leah Hart (Nurse Practitioner/Counseling) in The Arrival of Leah Hart
Posted by… suppressed (7) by the Post Ghost! 👻

(snip)

Kreed looked at her and said “I have no idea. That is your purview.” He took a breath and then said “I believe that one of us should be on duty at all times… or at least on call… but I would like to see some overlap in our daily routine so that we have a chance to confer or for any issues that may arise. I, of course, have the utmost confidence in your abilities as a nurse and a medical professional. The same cannot be said of the computer or of Star Fleet Medical. There will be some things that you will simply not be allowed to do by regulations. I will have to either approve or do the action myself. I do not want you to ever believe that is my doing. I would have no compunction to you treating me for any physical malady… and we know that you have the psychological side of health and wellness as your domain. I will strive to give you complete autonomy with regards to that; although I do want to be informed of the need for any kind of medications outside the normal anxiety, depression, et cetera. Just so I can be aware of where the crew is at. Is that reasonable?”

Kreed, CMO

“Absolutely,” Leah said with a firm nod. “I understand that there are limitations and I’ve never sought to go beyond those. Now, I might argue for a course of action I believe someone should take who has the authorization to do so, but at the end of the day, you have the medical degree. I appreciate that you want us to be partners here though. It makes my job easier, not just because we’re not automatically at odds, but because our works needs to dovetail neatly together in order to be effective. I like to talk things out with someone when I’m trying to make a diagnosis, and I have no issues going to you with medication requests above what you’ve outlined.”

“Can you tell me more about the organization of the department in a practical sense? I’m coming form a hospital background, so I know there will be a slight adjustment.”

~Leah Hart, NP

Kreed said “We are currently staffed with three Doctors, one Nurse Practitioner- yourself, of course-, seven nurses and four medics. I have assigned dedicated staff to each of three shifts, with an hour of overlap between shifts to allow for hand-downs of information. Sickbay is open at all times, and in the case of an alert all Medical staff report here for assignments. Most ships allow the highest ranking officer to be in charge if the CMO is out. I do not do that. When I am not here, it will be a doctor in charge. If there is no doctor, it is you. Regardless of that hierarchy, you as the Nurse Practitioner are in charge of the nursing staff. This has northing to do with doctors being superior to nurses; it has to do with the jobs being markedly different to those of us who do medicine. I would not know how to be a nurse. A nurse would not know how to be a doctor. What we do is complimentary, of course… but it is different. As such, a Nurse should be in charge of the Nurses. Is that reasonable to you as well?”

Kreed, CMO

“That’s fair,” Hart said before she brought her hand to her chin and tapped it with her index finger. “What is your stance on disagreements between nurses and physician? I will add the caveat that the issues isn’t one where someone is overstepping their bounds.”

~Leah Hart, NP

Kreed was silent a moment, thinking. “Disagreements between nurses, you. Doctors, me. Doctor and nurse? Both of us. But we do not take sides based on title. We do what is right for the patient, first and always. A nurse will get in more trouble with me for not doing something they know needs to be done and they know how to do because they were waiting for a doctor to sign a form. But that doesn’t mean they are free to make decisions outside of their medical purview. If they are not qualified, don’t do it. If it’s a matter of regulation or protocol getting in the way of proper patient care… that is an entirely different matter.”

Kane, CMO

“Good,” she said simply. “And my being around helps with that because I can authorize the basic things. I just wanted to be sure because I’ve dealt with more than my share of doctors who forget that nurses tend to spend a great deal more time with individual patients and might have information that doctor does not, or a better idea of what the patient needs holistically. I know you, but I don’t know the other doctors, so I just want everything to be clear up front.” He knew all to well that Leah wasn’t afraid to fight for a patient, even at the risk of conflict with those that thought they knew better. But that had been a different scenario altogether.

~Leah Hart, NP

“I have had no reservations with any of the staff thus far. But we haven’t really had much time for interpersonal interactions, either.” Kreed said. “Any other questions or concerns before address the other matter?”

Kreed

Leah shook her head and then sighed as she tipped her head towards the ceiling. Surely, that said a great deal to him?

“The other matter being our first officer,” she said, lowering her head to meet Kreed’s gaze. “As you know I allowed him to remain on duty while I was in transit with specific criteria he has to follow or that approval will be rescinded. There is some leeway, but very little and he knows that I won’t tolerate being lied to in order to get that leeway. Simply put, I needed more time with him in order to flesh out my report. I have a preliminary report that explicitly says that a follow up appointment is necessary in order to complete it, but at that time I would then have enough to come up with a treatment plan that can be discussed with his other care providers,” she said, gesturing to Kreed. “I almost didn’t clear him for duty though.”

~Leah Hart, NP

“Same.” Kreed said flatly. “I am still wondering about that decision, but I am glad you did the same. If both of us felt it was appropriate, then it assuages some of the conflict I felt in it.” He looked at her intently for a moment and then said “I would like an agreement from you about him. And I ask it because I feel giving him any wiggle room will be used to take advantage. I want to note his record as a ‘Mandatory Compliance’ patient. Meaning… if he fails to do any of what is told to him as part of his treatment plan, he is immediately placed on Medical Hold and removed from duty. If he was ‘just’ and Engineer. Or ‘just’ a Scientist, then this would not be an issue. But as the First Officer and Chief Science Officer, he has access to systems and records that are highly sensitive and mission critical. We cannot risk him being a petulant child and doing something as a reaction to his trauma. And I do not want to do this behind his back. I believe he should know exactly where he stand with this department at all times.”

Kreed, CMO

“No, I agree. He’s shown no sign of being a willing patient and if I want him to treat with with respect, I want to do the same and treat him as the capable adult he is.”

Leah pressed her hands together before her as she considered how to best explain the rest. “In terms of my initial assessment, it doesn’t surprise me that you have to order him to have the eval done. In fact, he waited so long to pick one of the times I gave him that he couldn’t have simply not met the 48-hour condition you stipulated by default. And all that because the denial he is in about his issues runs so deep that his mind has created a wall around it all and he can’t see any of it. He can acknowledge the symptoms of an anxiety attack when they occur, but he can’t connect them to anything. I can extrapolate a lot from his records, but it does me no good to know all that myself. He has to accept for himself that those are the things he is dealing with. Until he can actually acknowledge them aloud, we’ll get no where.”

“Agreed. Hence my insistence on bringing you on board. I do not have the training to deal with psychological issues of that magnitude.” Kreed said

“I’m curious what was the deciding factor for you? What made you let him stay on duty, even with the condition?”

~Leah Hart, NP

“This crew has seen a great deal of turmoil and instability.” Kreed said almost immediately. “I weighed the potential negative impacts the Commander’s attitude, demeanor, and capabilities have now versus the impact yet another new officer in a position of leadership would have. It was very close. But I think, for now, that having the stability in the role outweighs the impact a new XO would have. But it is such a small difference to me that if he does not do every single thing he is directed to, I have no compunction of removing him and dealing with the impact of the change.”

Kreed, CMO