[TsunamiKim]

Hi TNNURSE,

Arden2 has perhaps alerted you to a potential pitfall. At your Hearing, bearing in mind that we should be highly suspicious of such a “Hearing,” the way I see it is that your intent is not as critical as your perceived intent. More to the point it is may not be permitted as much relevance as the way in which Management will almost certainly manipulate your perceived intent to their own advantage. They will try hard to demonstrate that your intent is purely a personal issue, a grudge against the incompetent Nurse and your NM, they will try and isolate you from all of your peers. It is too late and totally ineffective to get defensive when inevitably Management accuses you of trying to launch a personal vendetta against the incompetent Nurse and the Manager at your Hearing. It is almost 100% guaranteed they will take this position, so guard against such manipulations of the truth ahead of time by being well prepared.
Bear in mind your peers have now seen the ramifications of making a complaint known to Management: you get fired. If each of them has been approached individually by Management in a “divide and conquer fashion” you will be astounded how quickly amnesia has set in. They will undoubtedly feel threatened, their jobs are seriously threatened; they have seen the consequences of telling the truth. That is why in my OR, were two male employees had had a knock-down, drag-out, fight without calling Security, Management had me escorted out by two Guards. This is generally done to humiliate the exiting employee while intimidating and scaring the hell out of other workers. It bullies them into compliant silence and believe me it is remarkably effective. As an outspoken English person I was shocked at the speed with which most of my coworkers went to the dark side; my friends vanished and I was quickly ostracized. My whole persona was reinvented by Management and intimidated employee colluded in the cover up, defamed me and dutifully complied with the Hospitals wishes. While your exit might not have been so dramatic or publicly humiliating, the threat of job loss is very real and you are now the example of Management’s abuse of power.
Here is what you might consider doing to combat this. Write a very carefully worded Petition that expresses your joint concerns regarding the incompetence of the Nurse and setting out realistic goals for correcting this problem that are your expectations of the Hospital Management. It should state your collective concerns for the safety of patients in this incompetent Nurse’s care as the number one issue. It should state your concerns for the Nurse herself by highlighting her not having the proper orientation or support to adequately take on a very intense job assignment. Last but not least it should contain an honorable “excuse” for your Nurse Manager, do not discount the need for this last point. Elaborate on the pressures that might have clouded her judgment; her absorption in other important duties with less opportunity to directly observe this Nurse where the failings would have been more apparent to her. Be very, very diplomatic as this is your best chance for success. The expected outcome or request of your Petition should certainly include the missed orientation under the supervision of the most experienced person to tackle the task which might well be you. It might also suggest this Nurse’s reassignment to a less critical area where her skills were a better match for the needs of the Hospital.
Now try and get as many of the Nurses who spoke to you about their concerns of incompetence to sign this Petition; enlist the support of Doctors too if possible. You might remind them all that the Hospital and their Risk Management dept will have to take this on board and they are obligated to keep it on file. This will protect all of you from “divide and conquer” retaliation. Persuade your former coworker that it is very important for you all to speak with one voice and in that way they cannot be individually targeted just as you were. Remind them that while they are still working alongside an incompetent Nurse there might be a serious medical error causing harm to a patient at any time and it will not reflect well on them or their licenses if they knew the danger and did nothing to prevent it. When faced with overwhelming evidence it will be extremely hard for Management to justify ignoring this request for a rational solution to a legitimate concern. Risk Management will also have to weigh the possibility that if this Nurse does cause harm in the future, there is documentation that they were warned by a consensus of the Nurses and they ignored that warning. Make copies of the signed Petition before handing anything in.
It is always important to separate your initial concern goal and good intentions, doing something about an incompetent Nurse, from your most immediate personal needs, your dismissal. The Management operates under the assumption that once fired, the distress caused will send you into self preservation mode and the patient safety issue you raised will be forgotten. This is a common tactic and a very successful one in most instances. Do not let this happen. Circulate the Petition quietly and obtain as many signatures as possibly before your Hearing. Try to keep a lid on knowledge about the Petition so that Management does not sabotage your plans. The Petition will become part of that essential paper trail that may not work at your Hearing, but will be established for future reference. Sometimes in these patient safety issues the most you can do is establish the paper trail and hope that action is taken before a patient is harmed. In the worst possible cases it is a medical error that brings your concern to light sometimes many years later. However, this usually happens when the trauma of personal sacrifice succeeds in silencing the witness.
At your Hearing resist the temptation to deal with your own situation first, they are expecting you to do this and if you fall into this trap the Hearing will be done and dusted before the patient safety issue is ever raised. Hand them the Petition and state how concerned all of the Nurses who signed this Petition are about this issue. They will try to personalize the complaint, you against the NM and this incompetent Nurse; you must be well prepared to vigorously defend your intentions. Reiterate how no matter how experienced you are as a Nurse you and your colleagues would never expect to be reassigned to a completely new practice area without the benefit of a period of orientation. State that doing this places unnecessary stresses and expectations on someone entering a new job and sets them up for failure especially in critical clinical areas like the one in which you work. Now you have provided a reasonable explanation for the incompetent Nurse’s failings and it should be viewed as a genuinely compassionate consideration for her needs too. If done right they will be unable to accuse you of being vindictive or bearing a personal grudge.
Then describe how the meeting you wanted to schedule to discuss these serious collective concerns, being bought to you by your colleagues, with your NM was railroaded to fire you for some minor and totally inconsequential technicality. Present yourself as the elected spokesperson of this much larger group of concerned Nurses. I only hope the Management haven’t already been busy working on whittling away at that supportive group of likeminded Nurses to dissuade them from signing your Petition in the first place. While you were shocked and deeply troubled by such an inappropriate and incomprehensible response “we” (the “Royal we” as we say in the UK, as it includes the Queen) cannot be sidetracked from addressing the real danger to patients in you clinical area. If they try to shuffle the Petition sideways then tell them you will have your Lawyer send Risk Management a copy by certified mail!
Tell them that all of the Nurses represented on the Petition will be expecting to see a written response from Risk Management and a plan for appropriate action to be taken. Then move on to your own defense against being unfairly removed for a technicality. Question the timing of your being fired and why your NM thought it was necessary to focus on such a triviality when you were coming forward to expose significant genuine danger to patients. Show the inconsistencies in discipline and again question why your unit bought a new Nurse onboard without orientation and how this is a deviation from policy besides letting both her and her patients down by putting them at risk.
Do not expect a rational response as it is most unlikely, but I think this might provide your best chance. I was fired for calling my Nurse Manager “unnecessarily inflexible” in a phone conversation about my schedule and the subjective feelings of office staff seeing me with my hands on my hips and my arms folded! At the same time it was OK to leave me in Surgery until I was almost comatose and consistently violate the Maryland Level One Trauma Center COMAR requirements for OR coverage. Not rational? Go figure! Our only possibility for protecting patients is to start the paper trail and then keep it up no matter what.
If your Hospital is equally irrational you have at least given them the possibility to take care of this issue internally first. You can tell them that due to the seriousness of this patient safety issue if you do not receive an appropriate response in a timely manor you will be forced to seek further action by notifying outside agencies. The documented presentation of a Petition calling for action signed by so many other Nurses at the time of your Hearing will help to give credibility to your external complaints. Management often does a preemptive strike at the first sign of potential trouble, firing you before the meeting with your Manager to discuss a patient safety concern, so that they can then discredit you latter. They count on being able to contend that your allegations are unfounded because you are just a “disgruntled former employee trying to cause trouble for the Hospital.” A Petition with plenty of signatures, get Doctors to sign it too if at all possible, would severely compromise this tactic. Hope this suggestion is helpful and don't give up,

Fair Winds & Following Seas, Kim.

[TNNURSE]

Arden2..I appreciate your insight.To clarify things .....numerous nurses on my unit had previously gone to this nurse manager c/o this nurses"performance issues and lack of knowledge".Not one thing was done.This nurse did not "feel she needed to be subjected to orientation"...and the manager agreed and wouldnt listen when good, experienced nurses c/o problems with this nurses performance. I dont think they could say I had any bad feelings towards this nurse....bc I didnt. I was actually the one who told some of the staff to "give her a chance".Before this....when she was in an administrative position I honestly liked her.She functioned well in an administrative role.However,...when she "stepped down" to a ICU staff nurse position she refused any orientation even though it had been "quite a looonnnnggg while since she had actually taken care of a patient...must less a critical patient".We had a good rapport established....but when problems arose...she wouldnt listen to me or the others.The NM wouldnt listen to the experienced nurses whom she interacted with...and she wasnt going to listen to me. She basically was giving the staff lipservice. My ultimate responsibility is to my patient....and myself.I did try to schedule a time to come in and discuss the problems with this NM....and I was met with a time to come in for my termination interview."poof"...I was gone.
On the unit I worked.....I was very much known for my experience, fairness,knowledge,support to my coworkers and my patient safety advocacy. When....even I....was saying there was a problem with this nurses performance.....then everyone knew there was a MAJOR PROBLEM.
In regards to the Resolution meeting....I am just going to tell them what happened.Thats all I can do.After that...the ball is in their court.I am not worried about it. They will do what they will do. Their decisions will be the ones they have to deal with ethically, morally and legally.I have enough concrete proof to prove retaliatory discharge "IF"...if I am forced into that position.I followed their policies, their bylaws etc etc...and look what it got me.
In regards to that nurses performane....like I said....eventually she will have or has gained competency by being allowed to " gain that competency thru trial and error" on her own.It doesnt make it right. The hospital was made aware of my and the other nurses concerns....and they are the ones left to cover her and this NM for the liablity of their actions/inactions.It doesnt make it ethically, morally or legally right to allow a nurse to gain competency thru trial and error.It is a violation of everyone's trust......the other nsg staff...the patient...the patient's family....the physicians.But if a major hospital is willing to condone their actions and inactions and finicially cover them liability wise...then what can we as nurses do?What "law" is out there that will truly penalize them?
You are right...alot of the "teeth" has been taken out of the ANA.I recently heard that what we now know as "physicians orders"...are soon going to be called "physicians requests"...so that if an order results in a sentinel event then the liability issue will return to the nurses...sine it will soon be just a request.I heard this at the orientation of my new job...and was shocked.

[Town & Country]

I voiced my concerns over some incompetency acts performed by a coworker-nurse. These were acts that were not merely mistakes...they were acts that could have resulted in patient death. I tried to set a meeting with my nurse manager to discuss this nurses incompetent level of function...and I was met with a date to come in for a termination meeting...mine!

It sounds like you basically told the NM (in so many words) "it's either her or me."
Maybe in your opinion, this nurse was incompetent.
The NM apparently didn't think so.
Not to mention, most of the time we are only liable for what DID happen as opposed to "what could have happened" (thank goodness!!!)

It doesnt make it ethically, morally or legally right to allow a nurse to gain competency thru trial and error.It is a violation of everyone's trust......the other nsg staff...the patient...the patient's family....

Putting a new on the floor without enough orientation happens ALL THE TIME.
I got one day of orientation at the job I am doing.
It's not right but it happens everywhere all the time.

IMO you should move on with your life...

[TsunamiKim]

We are governed by our consciences. Our level of concern or alarm is typically generated by knowledge and experience as this is the most reliable indicator of the potential for significant harm. When that little voice is telling you: “this could be a problem, someone could get hurt here” LISTEN! On one frigid Christmas night aboard a 42’ sailing boat several hundred miles north of Bermuda we were lying beam on to dangerous seas with the wheel tied. My little voice said: “we could get rolled over in this,” but as the least experienced of three crew members on board I ignored that dire warning and said nothing. Less than an hour latter, following a violent capsize, I was standing knee deep in icy water, a freezing north Atlantic gale blowing through the gapping cracks in the deck, bailing for my life in a bucket chain with blood streaming down my face! I learned to listen to my little voice and therefore I am alive after sailing over 150,000 miles aboard yachts on offshore passages.
Not Nursing you may say, but the lesson is the same: ignore warnings at your peril. I bought the caution and attention to safety of over twenty years at sea, the responsibility that came with a USCG license, to the Hospital setting where it has served me well. Those who foolishly believe that nothing will ever happen to them or to their patient under dangerously negligent circumstances are risking patient’s lives not to mention their licenses. Instances where another Nurse’s inappropriate practice caring for their patients remind us that we must look out for one another too, by being supportive of that person who obviously needs more training to function safely. They say “Ignorance is Bliss.” Inexperienced staff take unacceptable risks because they don’t identify the potential for harm; that is the very hallmark of their inexperience. It is the duty of experienced tenure Nurses to recognize the deficiency and correct it by teaching them safe practices. They aren’t my patients, I provide safer care, but another Nurse’s incompetence is not my business, shows a reckless disregard for human life and the core principals of Medical practice.
Those who, in good conscience, recognize that a situation exists where there is a significant potential for harm are duty bound to speak up. In TNNURS’s case many of the ICU Nurses have recognized how the incompetence of this one Nurse has created a potential for harm. Obviously the potential for harm does exist or they would not all feel this way. This being the case, it would be neglectful to simply ignore it and just hope for the best; however it is vital that you all speak with one voice. I still believe that under the circumstances you are wisest to do this by getting a Petition together that reflects this strong consensus of opinion. This will become a legally valid documentation of facts that will be very hard for the Hospital to ignore. If you do not do this you will be extremely vulnerable to their fictitious accusations of vindictive intent. They will try to make this situation not just you against one incompetent Nurse and your Nurse Manager; they will try to stack the odds until it looks like your word against the remaining ICU staff and the Hospital.
To best accomplish your goals of creating a safer environment where patients are no longer at risk, you must guard against their attempts to isolate you as the only Nurse who is of this opinion because they will definitely do it to you. This is standard Managerial defensive practice; to not recognize or prepare for it, is to walk blindly into a trap. I agree that you must take a stand; otherwise walking away from negligent practice will be on your conscience. If we always blithely waited for serious incidents to cause actual physical harm to a patient we would have a very reckless system. That would be playing Russian Roulette with our patients lives, “hey, there is only one bullet in the chamber,” is no way to practice medicine!
There are numerous dangers accumulating at this time due to the deliberate agenda of understaffing to maximize Hospital profits. Profit driven toxic Managerial policies are instituting multiple minor compromises under the guise of the “Nursing Shortage” which the Management themselves created in unreasonable, unsafe staff cut backs. The dangerous compromises being forced upon Nurses are insidiously trying to creep into the routine of what is we all consider “normal” and therefore perfectly acceptable practice. When this is justified, not by genuinely unavoidable circumstances, but by the relentless drive to cut experienced staff to the bone enabling major healthcare corporations to skim obscene profits, we must vigorously resist these dangerous changes. The most vigilant patient advocates among us recognize these subtle and sometimes not so subtle changes. It is our duty to our patients to remain vocal in our protests by taking responsibility and blowing the whistle on blatant negligence.
Unacceptable practices include: minimizing orientation in a new clinical area, with that orientation led by new Nurse Grads who have barely even completed the inadequate orientation themselves. Floating Nurses to completely unfamiliar areas of the Hospital and filling in all the gaps in coverage with agency Nurses, some of whom are completely unfamiliar with the facility. Forcing Nurses to handle too many patients with too few experienced staff and no supportive help, thus making them feel the guilt of abandoning their patients when there is no one to cover for breaks. Leaving Nurses and Techs scrubbed into Surgery for 8, 10 and 12 hours continuously as there is often no one to break them out, as happened to me. Mandated overtime and double shifts forcing Nurses to continue working when they are dangerously fatigued. “Occurrence policies” that compel staff to come to work caring for very seriously sick patients while they are themselves sick. Excessive call commitments that disrupt family life and leave Nurses overworked and overstressed. The drastically shrinking vacation time that there is never enough staff coverage to accommodate or that has to be taken at the convenience of the Hospital as a brief get away.
By using toxic Managerial policies like the ones listed above it’s possible that some of the most conscientious and experienced tenure Nurses will leave the Hospital, but many are leaving Nursing altogether. However, this is highly desirable for the profit driven Hospital seeking more affordable staff. This clears the way for new Nurse Grads or cheaper assistive help who, in their naivety, are far more accepting of the dangerous understaffing compromises while earning a lot less money. These people should be filling out the ranks to provide better, safer coverage with a healthy mix of trainees and more experienced personnel. Their positions should be part of a steady progression from entry level to higher grades of training through job commitment and length of service. Instead trainees are outright replacing experienced Nurses as if knowledge and experience were unnecessary. The trend now is to make Nurses interchangeable with the minimally trained help thereby creating a generic pool of indistinguishable patient care staff.
Discouraging assistive help and Technicians from becoming better trained is another profit driven dangerous trend. At my former Hospital, “the Best in America,” none of the OR Techs were required to maintain basic CPR skills. Despite being expected to cover Trauma cases as a Level One Trauma Center CPR was either on your own time, at your own expense or if you felt like it and the OR could accommodate being one Tech down on your shift. I questioned whether this fulfilled the facility’s basic training requirements under COMAR, but MIEMSS thought it too unimportant to investigate. There was no real incentive for the Techs to become certified either, as this lack of certification helped Management to keep employees vulnerable to job loss and thereby more compliant. The widely accepted title of Surgical Technologist was disallowed in all official documents as the Hospital felt that it gave the kind of undesirable impression of professionalism that they sought to discourage. While this appalling emphasis on dumbing down the job may now have changed I sincerely doubt it; this from a Hospital winning accolades for excellence in patient safety!
Those in assistive entry level roles should take every opportunity to gain as much experience and training as possible to be well prepared for an emergency, however they are not Nurse replacements. Nurses need to realize that their job is not the simple care giver role it once was. Typically Technicians have chosen a more practical role focused on only one specific area of practice. While Nursing training provides a more generalized approach with a much wider field of basic training, their job is now far more complex, requiring a greater scope of experience. But it is unrealistic for them to be expected to excel in all of the areas they were originally trained in without refreshing their skills on entering a different practice area. It is ludicrous to buy into the hype that any Nurse can be fudged into a demanding critical care role in an intensive clinical area without even a minimum of specialized orientation. Management uses the perpetual short staffing guilt trip to induce arrogant overconfidence that can endanger patients. Nurses: you are highly skilled specialists not interchangeable warm bodies, don’t let Management treat you as such! Standard orientation, like continuing education, is in compliance with cautiously maintaining safe standards of practice: it should not be abandoned.
In an emergency we may be called upon to function above and beyond our standard duty assignment and this is acceptable. When this “crisis” situation is deliberately exploited as a consequence of unsafe staffing coverage to increase profits, there is no slack to deal with a genuine emergency and this is very dangerous. Nurses have to stand up for what is right, so do not capitulate,

Fair Winds & Following Seas, Kim.

PS: I have started a new thread and I hope you will review what I have written and comment on this other post.
RE: BLOWING THE WHISTLE ON DELIBERATE UNDERSTAFFING & TOXIC MANAGERIAL PRACTICES
It asks among other things: How Long is Too Long for a Member of the Sterile Team to Remain Continuously Scrubbed into Surgery?

[imenid37]

I am praying you get justice. You know you're right. So how would this look to the public in this age of the "patient safety act"? Looks like your former employer is in a darker age. I wish you all of the best.

[TNNURSE]

Sunstreak...I have already "moved on with my life".....but...let me put it to you like this.
1.If you were walking down the street and got mugged, your money stolen, beaten up...and then you could prove who it was that actually mugged you.Would you "just let it go".I bet not.So...even though...I already have another great job...it doesnt change the fact that I was still "mugged".And as far as what the nurse manager thinks or doesnt think........its kinda like this. She ...is ....a....fabricator..a liar.She has left that hospital ina tight legal position....bc.....I audiotaped. So...that hospitals atty....is going to have to explain to the judge/jury ......"well....yes....she was lying when she said that...but now she is telling the truth.......yeah...we know she lied about what day this alledgedly occurred on.....but please believe me now....shes telling the truth". Sunstreak....my family and I lost my retirement, benefits etc...all bc......I was "mugged"....so...even though I have "moved on"...people and facilities have to learn for every action there is a reaction...and we all must answer for our actions.While some hc facilities may have made nurses go straight to work without orientation..it is not safe.Only "questionable" nurses would be willing to accept a position with no orientation...thats kinda like playing russian roulette with your nsg liscence....and if you accept a position with no orientation....then my friend... in the game of management "tag" you will always be "it"...you will be their scapegoat.And...in regards to endangering patients in a icu ....there is no excuse for it.I hope you have taken additional malpratice insurance out....bc...unless you are "just talking" ( said jokingly ) you will eventually need it( said seriously).We all have to answer for our inactions and actions.Nsg isnt a job...like fast food.....you deal with sick people....and if you dont have a strong ethical and moral "core"...then you dont belong in a ICU.BC..if ya want a job....where you are not "accountable"...go to work at mcdonalds. Nurses can now be charged criminally for their inactions and actions....manslaughter....negligent homicide. Dont let someone force ya into a job with no orientation. It doesnt make you "superman" bc you can function one day without a sentinel event in a job with no orientation...it just makes you reckless with your liscence and a liability issue....you worked too hard 4 that!

[iowanurse199]

Originally Posted by panhandler

OMG OMG OMG

Who's got the cujones to take on this outrageous problem?

Panhandler... we nurses have to take it upon ourselves to create change. Too many of us are not as outspoken as TNNURSE. Having a union at her hospital would have provided her with a process to fight her termination. If we wait for others to fix our problems...we won't have any nurses to take care of us when we get old and sick!

[AngelGirl]

My heart goes out to you in this situation. I am facing a difficult situation, myself. Anyone with advice, please SPEAK UP!
I work 12 hour shifts in ER, where the pace is fast. our state requires that nurses be given a break after 4 hours. We are allowed one break per day. This means that any way you divide up the hours, a nurse will be working greater 4 hours without a break.
I find that I become mentally fatigued after about 5 straight hours of running. No allowances are made for breaks. I've spoken up LOUDLY, and, in response, have been told that I will need to transfer out of the dept, due to my "frustration."
Any words of wisdom?
Thanks, AngelGirl

[CrunchRN]

Once again the problem is a lack of unity. If the nurses you both worked with would stand by your sides then mamagement would have to do the right thing. I really, really respect both of you for speaking up and I am very sorry about the lack of support from your co-workers. Best of luck to both of you.

[panhandler]

I work 12 hour shifts in ER, where the pace is fast. our state requires that nurses be given a break after 4 hours. We are allowed one break per day. This means that any way you divide up the hours, a nurse will be working greater 4 hours without a break.

Report the situation in writing to your HR department. Ask for immunity from retaliation, and ask for annonymity. Ask that a copy of your report be put in your personnel record. Any nursing supervisor knows that you must be given the opportunity to take a break, or paid overtime if you willingly do not take it.

You are being screwed from 10 paces with no kissy-kissy.

FRONT DOOR:
If there is any retaliation, report the situation to your local newspaper, and report your institution to the state. Labor laws are in place because in the past, employers have screwed over the health and well-being of their employees ... again, it is ALWAYS ONLY and ALL about the money... you will get fired, but hey, that's better than not getting a chance to empty your holding tanks every four hours.

BACK DOOR:
A minimum of three nurses, with each other for witnesses, goes to the full-time charge person and voices a verbal, friendly complaint.

Repeat as necessary.

Reminder, don't act alone. YOu will be fired.