[Ahn]

I am concerned that my fellow nurses have become careless in their nursing practice. I can't tell you how many times I have questioned why a patient who is obviously in pain, and hasn't recieved prescribed narcotics for their pain because the nurses on shift before me didn't want to be the first or only one giving a narcotic. I have seen geriatric second day post-op ORIF hips/TKR on Q 4 hour APAP! Is this a trend? Are we too busy? Or is it that we just don't care.

[Erbn Girl]

This is also something I have noticed alot where I work. I notice that there is morphine, ativan and other narcotics and anti-anxiety agents and they never use them! When I ask the patient if they would like something for their pain or discomfort, they say that they were never offered any and/or didn't realize they could have any. Some patients are also afraid and/or misinformed about pain medication feeling that they may get addicted. Patient teaching goes a LONG way!
I also wonder how the particular nurse(s) view pain themselves, looking from a cultural and personal aspect. I personally DO NOT like to be in pain and I frequently ask my patients if there is something I can get for them for pain, restlessness or just to sleep
because I know I would like someone to ask me if I needed some medication. Most patients that I have talked to don't even know they have anything prescribed because no one told them! We can never ASSUME that the patient knows what is available to them!
Patient advocacy...possibly this is a topic for continuing education in your hospital. Speak with your unit manager or educational department about ideas that you may have for future offerings. They want to offer what the nurses need most and the administration is always looking to keep the patients happy, right? If we keep our patients comfortable along with the best service offered, chances are if they must return to a healthcare facility, they will choose yours because of the good service and concern for their comfort and well-being.

[noseyrosey]

I have several friends who worked in a nursing home where a patient died as a result of serious problems that were compounded by improper and inappropriate charting. The administration and owner immediately began to
cover up. Several of these nurses were so very newly licensed that they were easily intimidated by supervisors to "alter and falsify" charts. Because this facility is owned by prominent and powerful people, these same nurses were so haunted by guilt that I assumed that they would tell the truth. But
as it turned out they were made to feel they would be blackballed if they told the truth. So sad. This kind of situation allows substandard care in LT facilities to contiue unchallenged.

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Linda R

[Joe,RN]

There are state and federal agencies run and staffed with nurses that inspect LTC facilities. These nurses will investigate any reports they receive and you can remain anonymous. There is no reason to let these conditions go unreported. Where are your ethics? Are we not supposed to be patient advocates?

[noseyrosey]

Sorry, Joe, guess I didn't clarify something. DHH was notified, and facility was required to "prepare a plan of correction" concerning the death, and the Atty Gen. office investigatigated. They have issued a report to both, RN and LPN boards. Now the boards are investigating ALL involved. The point of my post was that the owners are "connected politically", thus explaining the insignificant reprimand in the face of damning evidence, and because of this, I am assuming that these nurses thought that the powers that bosses were more powerful than official agencies. Sad that they didn't see more clearly.

[Ahn]

To: Joe RN; I did JUST THAT and was terminated. I said nothing about it to my peers before or after the inspection by the DHS and by the regional ombudsman. Somehow they figured out that I was the only concerned party - at least the only party concerned about doing something. Anything that will bring down the "rath of JCAHO," is a Court Marshal offense. The punishment for healthcare treason is public execution by being left out in the elements to whither and die by lack of a professional reference.

[Joe,RN]

Hey Rosey,
I work for the federal gov't and I am well aware of the politics involved in todays health care. I agree, it is sad that the nurses you spoke of did not see things more clearly. It seems there are too many healthcare professionals looking the other way out of self-preservation. I think we all have been there, maybe not to the degree of which you speak, but in some way! I also realize that in small towns with limited facilities, it can be even harder. You would hope that the owner's clout would not affect an investigation by the Attorney General's office. I guess that might be a little naive though!

[Joe,RN]

Hey Ahn,
It sounds like you really got a raw deal. I have a good friend that works on a team inspecting nursing homes for the state of Georgia. She investigates incident reports and makes recommendations to the board. If you want I will speak to her and see what course of action you should take. It is a shame there is no solidarity among nurses. On a more positive note. I once worked for a company as the D.O.N. and went up against the owners regarding an ethical dilemma in our practice. I was given a choice to either let it drop or resign. I resigned and the staff nurses walked out too. Three days later the office staff resigned. Sadly, it did not put them out of business, they just hired all new personel, but it was a good feeling to know we had all stuck together.

I think many nurses hesitate to give narcs because of suspicion of management that the nurse herself is taking them because no one else has given them. I have seen the false accusations but it never stops me from giving a patient pain medication or an ativan because I say GIVE ME A BLOOD TEST IF YOU THINK I'M TAKING THEM.!!! Too many nurses take abuse from management and don't stick together, but instead backstab each other. Why is this?

------------------
jen622

[ecb]

Ahn, Joe, and Rosey
I worked in a facility that was comming out of a "wrongful/neglectful death" investigation by the state. This facility was owned by a big local buisness owner (owned a lot of property in the sorrounding towns) and i was recruted because they needed hard working honest yadda yadda yadda and the DON knew me from before.
When our final inspection was due we had been run through the wrinner a few times, we had tightenend up the place a lot (but not enough IMO). I was on speaking terms with my X and told hoim how nervous I was about all this, that there were still compliance issues, still lazy nursing that all the writting up in the world would not fix (not there anyway) he came to me the week before the inspection was done and told me he had gotten assurances from an AA buddy that the state would go in, find 2 inconsiquential deficiancies that would be forgiven and the reinstatment would be done.

Guess what??
2 infractions (linen on the shower floor, and a CNA not wearing gloves) and reinstated.
I quit after that. They did not need me, just a warm body to push pills and document right.
am I resentful, am I bitter, am I insulted, YES. I expressed my concerns to one of the administrators before I left, she was offered retirement 2 weeks after I left.

I hate this buisness sometimes

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