Because while there is overlap between the definition of Good Nurse vs Good Person, nursing has a professional code of conduct. There’s patient autonomy and safety, there’s duty of care, there’s equitable and impartial treatment, etc. So the question is: by the yardstick of our profession is she upholding the standard of care?
(And lemme sneak back here and add this to provide some context for the rest of this post. Marta’s situation is affected by class, money, power, immigration, concern for loved ones, character dynamics, the concerns of the plot, Benoit Blanc’s whole deal—but this post isn’t about any of that. This post is just about the theoretical Best Nursing Action. This post is a case study in your third semester Patient Safety class. This post exists in the same perfect world that NCLEX questions exist in.)
By the professional standards of nursing, when she gives the medication without checking the label, she fails at doing a universal safety check that can have catastrophic consequences. Let’s ignore the fact that the meds were maliciously switched (we’ll get to that, it’s a real fuckin wrench in everything). The fact is that she should have verified that she had the right medication rather than go by routine. Med error is so so easy in part because passing meds can become so routine. Especially in home health. You lose the fear of fucking up, you don’t check something bc you’ve done it a hundred times before, oops something goes wrong.
Additionally, she fails to assess her patient. Harlan is not showing any signs of morphine overdose. (I also want to be clear as I’m saying all this: if I thought I had given someone 100x their morphine dose and then lost the narcan, my asshole would have fallen out so hard you would have heard a clunk when it hit the floor. I like to think I wouldn’t let the dramatic old man rope me into an elaborate coverup, but like. He was very convincing. Anyway—)
Most importantly, she does not admit her error. Every single person in healthcare will make a mistake. If you are lucky, it doesn’t cause any harm. If you aren’t lucky, you think about what you did for the rest of your life. Sometimes you’re lucky and you still think of what you did for the rest of your life. What’s important is not keeping mistakes secret. It doesn’t help the patient harmed by the mistake to pretend there isn’t a problem or that you don’t know what the problem is. And on a larger scale, it doesn’t let the system know what happened, how the mistake happened, and what we can do to stop it. Marta doesn’t tell anyone what happened, largely in part bc Harlan is fucking wild and so hyped to die dramatically, but still for the point of nursing argument: she conceals her mistake.
And that causes about every problem in the film. Because if she’d been like “Harlan, this is insane, I am calling an ambulance” (and to her credit—she did try to call an ambulance. That crazy bitch Harlan ruined that plan) then the med switch up would have been caught because he would have been fine. So much of the situation was out of Marta’s control—literally, malicious interference with the medication and hiding the reversal agent, like what’s she supposed to do about that—but after the error happened, she engaged in a cover up.
And the moment in which Marta is a by the books Good Nurse is when she performs CPR and calls 911 to save someone she believes is blackmailing her and is the only person who knows Harlan’s death is her fault. She is providing care to someone in need regardless of her personal situation. She is owning up to what she did to prevent further harm. In a world in which Harlan was dying from a med error, she provides the family closure regarding his traumatic suicide. Being a Good Nurse means owning up to your mistakes, even if it is too late to save the patient, because we can’t find ways to address problems we don’t know exist.
But like to get back to the murder of it all, her failure to check the medication DID prevent a catastrophic med error. Like yeah she fuckin t gave the right med! She did know it by touch! And on one hand, that’s kinda bullshit, but on the other hand, I know what dilaudid feels like when I draw it up. I know what Ativan looks like in a syringe. And to be clear I would not give anything on a purely vibes based premise, but with experience you do get a nursing sense that’s difficult to articulate. It’s knowing someone has a fever from the doorway of their room, or that someone has a GI bleed from the faint smell of their poop, or that someone is in the early stages of sepsis from a glance at their respirations, or that someone’s getting delirious from just a passing comment they make. Intuition is not a consistent safety system, and also it is an invaluable asset. Sometimes you just know something isn’t right. That cannot be the entire basis of your practice. But it helps!
Marta knew the med was right because she’d drawn it up a hundred times before. That’s horrible safety practices, but also she was right. If she’d done the med check correctly by verifying the label on the vial, then she would have killed Harlan. So in this sense, ignoring protocol and going by pure intuition resulted in the correct decision in the context of unknown but extraordinary circumstances (Chris Evans). So like. Not sure exactly what the takeaway there is. I think mainly just murder is wrong.
And also just generally speaking—stepping back from the murder of it all once again—Harlan clearly liked her. Marta and Harlan had good therapeutic rapport, by which I mean they enjoyed each other’s company which was probably Harlan’s chief need. Like medications, treatments, those are all good, but so is talking to patients like they’re people and making them feel comfortable. I mean, she did that so good she got millions of dollars and a mansion. Girl knocked it out of the park.
So is she a Good Nurse? I’d say overall yeah. While at times throughout the movie, she is more concerned with being a Good Daughter or a Person Who Isn’t In Jail, the overall impression is a compassionate person who is normally competent at her job, tries to save others despite her personal situation, and takes responsibility for her mistakes. I think that’s why she rings true as a character who is a nurse, even if you could quibble with the exact medical details.
But like. To be clear. 1) Holy shit you should read the labels on your drugs. And 2) do not let a man with a knife throne take charge of your emergency response.
amandla
