[Corvette Guy]

Originally Posted by NRSKarenRN

May I make a suggestion here? Management folks tend to get very defensive when the work "incompetence" is thrown at them as SUBJECTIVE term. Much better to use phrase "nursing practice issues" as that can be described in concrete objective terms using state board of nursing standards, department policies and procedures, nursing textbooks, ANA Standards of Practice and Code for nurses, specialty organization standards: AACN standards apply here

I'd recommend printing out those emails with glowing praise and having copy of last evaluation. HR required to allow you access to employee files and for employee make any corrections, add explanatory note-since you've left, lawyer might need to help you gain access.

I'd write down time line of all issues you brought to Managers attention, note any documentation supporting your concern, etc and your managers response or lack thereof to each issue.

Each state has its own practice act with interpretations by each state board of nursing(SBON). Link to all SBON here:
http://allnurses.com/nursingboards-a-k.shtml

Google search "Determining competent practice + nursing" came up with these interesting articles



The ANA supports the professional obligations of the nurse to safeguard patients.
It is the nurse's responsibility to:

• Provide competent nursing care to the patient.
• Safeguard patients and avoid actions that place the interests of the patient(s) in jeopardy. The right to refuse an assignment should be narrowly construed and the nurse must balance such a refusal against the obligation to provide for patient safety and to avoid abandonment. A refusal of an assignment may be justified when the risk of harm to the patient(s) is greater by accepting the assignment than by rejecting it.
• Exercise informed judgment and use individual competence and qualifications as criteria in giving, accepting or rejecting an assignment. Nurses are individually accountable for the care of each patient.
• Clarify assignments, assess personal capabilities, jointly identify options for patient care assignments when the nurse does not feel personally competent or adequately prepared to carry out a specific function.
• Determine what will put a patient in immediate, serious danger. The nurse may be held legally responsible for judgments exercised and actions taken in the course of nursing practice. ...

Nurses are accountable for judgments made and actions taken in the course of nursing practice. Neither physicians' orders nor the employing agency's policies relieve the nurse of accountability for actions taken and judgments made.
http://www.nursingworld.org/readroom/position/workplac/wkassign.htm


Nursing Management - Fulltext: Volume 36(5) May 2005 p 14-16 What ...
Nurses have the legal obligation to report conduct that's incompetent, ...
safety are affected by incompetent, unethical, or illegal practice by any person. ...
www.nursingmanagement.com/pt/re/ nursemgmt/fulltext.00006247-200505000-00006.htm


Assuring Competence
A Regulatory Responsibility
Figure 1: Standards for Competence
www.ncsbn.org/resources/complimentary_ncsbn_competence.asp


North Carolina Board of Nursing
Section: § 90-171.37. Revocation, suspension, or denial of licensure.
(5) Is unfit or incompetent to practice nursing by reason of deliberate or negligent acts or omissions regardless of whether actual injury to the patient is established;
www.ncbon.com/NPA.asp


Nursing Practice Act
Administrative Code (Rules)
Learn About North Carolina’s Nurse Practice Act-and Earn CE Credit!

Kansas Nurse: Kansas guidelines for the registered nurse in ...

Connecticut Nursing News: Continuing education: Scope of practice ...



-------------

Depending on facility, review boards may be helpful. Ones I've been involved in as part of Grievance Task Force about 60% sided with management, 40% sided with employee and able to overturn termination decisions. Take a look at your facility's process. Often employee is able to bring colleague to provide support to you along with lawyer. Some allow you to choose members of pannel from those on a list so cross section of departments represented. Look carefully at this option, and don"t choose only those in nursing-- maintenance and radiology staff often look at issue as department outside and are able to look objectively at situation, instead of having "department blinders" on.

Good luck in taking this stand.

Edited for clarity, spelling and links!

That was a 5 star post.

[Corvette Guy]

Originally Posted by NRSKarenRN

May I make a suggestion here? Management folks tend to get very defensive when the work "incompetence" is thrown at them as SUBJECTIVE term. Much better to use phrase "nursing practice issues" as that can be described in concrete objective terms using state board of nursing standards, department policies and procedures, nursing textbooks, ANA Standards of Practice and Code for nurses, specialty organization standards: AACN standards apply here

I'd recommend printing out those emails with glowing praise and having copy of last evaluation. HR required to allow you access to employee files and for employee make any corrections, add explanatory note-since you've left, lawyer might need to help you gain access.

I'd write down time line of all issues you brought to Managers attention, note any documentation supporting your concern, etc and your managers response or lack thereof to each issue.

Each state has its own practice act with interpretations by each state board of nursing(SBON). Link to all SBON here:
http://allnurses.com/nursingboards-a-k.shtml

Google search "Determining competent practice + nursing" came up with these interesting articles



The ANA supports the professional obligations of the nurse to safeguard patients.
It is the nurse's responsibility to:

• Provide competent nursing care to the patient.
• Safeguard patients and avoid actions that place the interests of the patient(s) in jeopardy. The right to refuse an assignment should be narrowly construed and the nurse must balance such a refusal against the obligation to provide for patient safety and to avoid abandonment. A refusal of an assignment may be justified when the risk of harm to the patient(s) is greater by accepting the assignment than by rejecting it.
• Exercise informed judgment and use individual competence and qualifications as criteria in giving, accepting or rejecting an assignment. Nurses are individually accountable for the care of each patient.
• Clarify assignments, assess personal capabilities, jointly identify options for patient care assignments when the nurse does not feel personally competent or adequately prepared to carry out a specific function.
• Determine what will put a patient in immediate, serious danger. The nurse may be held legally responsible for judgments exercised and actions taken in the course of nursing practice. ...

Nurses are accountable for judgments made and actions taken in the course of nursing practice. Neither physicians' orders nor the employing agency's policies relieve the nurse of accountability for actions taken and judgments made.
http://www.nursingworld.org/readroom/position/workplac/wkassign.htm


Nursing Management - Fulltext: Volume 36(5) May 2005 p 14-16 What ...
Nurses have the legal obligation to report conduct that's incompetent, ...
safety are affected by incompetent, unethical, or illegal practice by any person. ...
www.nursingmanagement.com/pt/re/ nursemgmt/fulltext.00006247-200505000-00006.htm


Assuring Competence
A Regulatory Responsibility
Figure 1: Standards for Competence
www.ncsbn.org/resources/complimentary_ncsbn_competence.asp


North Carolina Board of Nursing
Section: § 90-171.37. Revocation, suspension, or denial of licensure.
(5) Is unfit or incompetent to practice nursing by reason of deliberate or negligent acts or omissions regardless of whether actual injury to the patient is established;
www.ncbon.com/NPA.asp


Nursing Practice Act
Administrative Code (Rules)
Learn About North Carolina’s Nurse Practice Act-and Earn CE Credit!

Kansas Nurse: Kansas guidelines for the registered nurse in ...

Connecticut Nursing News: Continuing education: Scope of practice ...



-------------

Depending on facility, review boards may be helpful. Ones I've been involved in as part of Grievance Task Force about 60% sided with management, 40% sided with employee and able to overturn termination decisions. Take a look at your facility's process. Often employee is able to bring colleague to provide support to you along with lawyer. Some allow you to choose members of pannel from those on a list so cross section of departments represented. Look carefully at this option, and don"t choose only those in nursing-- maintenance and radiology staff often look at issue as department outside and are able to look objectively at situation, instead of having "department blinders" on.

Good luck in taking this stand.

Edited for clarity, spelling and links!

That was a 5 star post.

[pickledpepperRN]

YES!
Usually I would post suggestions and thoughts for a situation like this but others have posted better than I could have.

I am so sorry you another nurses are being punnished for doing the right thing.

[mtnmom]

I applaud your decision for taking the high road and being a patient advocate.

I have had a similar instance in the past. Although it did not result in my being fired, the manager made my life miserable including unwarranted discliplinary action! (on a previously flawless record). And in this case my documentation was not tampered with but rather the documentation of the instance in question.

I ended up leaving that facility a few months later and wrote a lengthy letter to chief nursing official detailing that and some other concerns with the unit and the manager. I tried to be as professional as possible.

I will never know whether I had anything to do with it but about 2 months later, the manager in question was fired. it didn't give me back all of what I feel that I lost but I do feel that justice was served by getting rid of a horrible manager.

Perhaps voice all of your concerns in a narrative as I did and send them to the chief nursing officer, VP nursing, etc....copy the BON if you feel you need to.

[TNNURSE]

You know...I can think of 22 instances...but we'll just discuss 3 of them... in which 3 seperate employees failed to document any vitals or ANY type of assessment on a CC patient in the hospitals ICU.Would you like to know what happened to those 3 nurses? One got a transfer request shed asked for..with a good reference....one got Performance Improvement counseling....and the other got no form of reprimand at all. The great " crime" for which I was alledgedly fired for was "documentation of vital signs before the time had occurred".So when searching for a REASON to terminate me.....all they could come up with was something like saying "she charted 8 am vital signs at 7:30 am" or something crazy like that.But...the ones who charted nada /zilch on these critical patients for an entire 12 hour shift received usually no form of reprimand. I have like 23 examples of nurses who did the same "alledged" offense...and basically nothing happened to them.
I have checked and I am actually covered under 4 different laws in TX from retaliation.

[Haunted]

I can top that! I was recently assigned an older man with PNA and broken ribs, on IV ATB and bedrest. MS PRN. I taught him splinting, his 02 sats were 88% so i hooked him up to NC, called attending for some RT, he refused. I documented this in the patients chart, found another Doc on the unit and without going into history of other idiot doc, this guy said, yeah, write him up for RT , whatever you need, I'll sign it.

Guy improved throughout shift, o2 sats went up, he was sitting at bedside chair, ambulatory, able to cough and move secretions, received zero MS on my shift. I also noted that the previous shift indicated his o2 sats were 98% which is a fairy tale, when I took them they were 88, so you do the math.

I completed my shift and called my registry on the way home to DNR myself from this place and then included a 4 page document about this "facility" for my personnel records. Well, I got notified that I am DNR'd by the hospital because I have charting errors (they never provided any orientation, which I also documented and spoke with CN about).

I sent a copy of my 4 page letter to my State Senator, my newspapers, JCAHO and DHS. Now that's a whistleblower.

I feel like a fool and a failure and have to kick myself (volunteers anyone?) to remind myself that I am a patient advocate and DID THE RIGHT THING!!!!

If I never get hired again to work as a bedside nurse because I am "blackballed" then I sure would not want to be a patient at any of those facilities. GO FOR THE THROAT and make it PUBLIC!!!!!

They have to prove YOU wrong. But get a pitbull for an attorney, I have a friend who used to be a nurse and she goes for the nards with crap like this.

GET ANGRY!!! They are wrong for keeping Nurse Wretched there and placing other people in jeopardy. Try and maintain some communication with someone who still works there. If they slander your name or professional reputation that is another hit in the wallet. Have someone contact the HR department and ask for a professional reference, some states will allow this.

Get loud, public and angry. I do it all the time. I am probably one of the most competent nurses on the unit, being registry I set the bar very high, so I do take it personally when I am DNR'd for stupid stuff and they think I will just shut up and move on. I document everything wrong and forward it to the appropriate agency. I am beyond whistle, I am a full blown TUBA blower!!!

GET EM!!!!

[TNNURSE]

You know...you are probably right.I am going to allow them a last chance at my dispute resolution hearing....and if they dont do the right thing then I will do what I have to legally. I am a patient safety advocate. I feel like everyone that is a patient,..esp in a ICU setting is tremendously dependant on receiving quality competent nursing care...and when a facility allows a nurse to "GAIN COMPETENCY" thru TRIAL and ERROR in a ICU when patients potentially loose their lives then I can not in good conscious be quiet.I have a LONG history of being a patient safety advocate at this hospital...so I am going to allow my old facility a last chance. If not,...then according to The Public Protection Act of 1990 and other various statutes I am ethically bound to do the right thing.It is a sad day in healthcare when facilities willallow a incompetent practitioner to gain competency in a ICU setting by trial and error.

[sjrn85]

Originally Posted by hrtprncss

Just adding here...Since you think that they have tampered with your charting...And I assume that it's computerized charting...If it's ''edited'' by either you or someone else, then you should be able to know who edited it. From the IT department. Though I wouldn't mention that over the phone, it's better if you can print out the info right before the grievance process and you're in front of the board, just to avoid additional tampering from their part. I'm glad you want to clear your name, but for me personally I would not return. But your reputation is what you're basically after.

Written charting can also be investigated for tampering. They have ways to compare the age of ink from one word to the next, ways to tell if there was an erasure, etc. (One of the reasons to always note a late entry as a "late entry")

[sjrn85]

Deleted; double post.

[Lisa CCU RN]

Originally Posted by TNNURSE

You know...I can think of 3 instances in which 3 seperate employees failed to document any vitals or ANY type of assessment on a CC patient in the hospitals ICU.Would you like to know what happened to those 3 nurses? One got a transfer request shed asked for..with a good reference....one got Performance Improvement counseling....and the other got no form of reprimand at all. The great " crime" for which I was alledgedly fired for was "documentation of vital signs before the time had occurred".Like documenting 8 am vitals at 7:30 am.The problem is....I was actually doing frequent assessment vitals on a patient every 15 minutes because the patient was rapidly changing. Now...after telling that incompetent nurse that I was going to inform risk mgmt of her unsafe pratices...she ripped my frequent assessment vital sign sheet out of the chart while my head was turned and it is now MIA...conviently.So when searching for a REASON to terminate me.....all they could come up with was saying "she charted 8 am vital signs at 7:30 am".But...the ones who charted nada on these critical patients for an entire 12 hour shift received usually no form of reprimand.
I have checked and I am actually covered under 4 different laws in TN from retaliation.

Why would you tell the nurse you were going to report her? Why not just report her without her knowledge? I'm not a nurse yet, but why can't you chart vitals early?