#1 Nursing Resource: 806,000 unique visitors per month

Suggest you download some spyware cleaner for your computer adware is good as is spybot

Thank you for following up by responding to my question as I often feel like one lonely voice in the wilderness. I believe when, if, and how often medical staff require relief should be predicated by the need to ensure that everyone involved in patient care is physically in a fit condition to focus their attention fully on the needs of their patients. Due to their training Nurses are exceptionally well attuned to judging their own fitness capabilities and should not be forced to deny the obvious: fatigue and inadequate sustenance foster conditions where serious mistakes can harm patients.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
My initial medical background placed a strong emphasis on core elements of survival and the importance of teamwork. My first Medical training was self taught as a necessity of being adequately prepared for my job at sea: I used to deliver sailing yachts on lengthy ocean passages like trans-Atlantic crossings between the <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /><st1:country-region w:st="on">Americas</st1:country-region>, Europe and <st1:place w:st="on">Africa</st1:place>. I soon found my limited medical knowledge was barely adequate considering the length and remoteness of some of my voyages. The New Zealand Navy generously allowed me to train for a few weeks with their Cadet Medics during a brief stop over after functioning as the Medic aboard a racing boat on a Southern Ocean leg, Uruguay to Australia, of the Whitbread Round the World Race. I was given my first experience in the OR and from then on I was hooked on increasing my medical knowledge. After returning to the <st1:country-region w:st="on">US</st1:country-region> I took Wilderness EMT training at the SOLO <st1:PlaceType w:st="on">school</st1:PlaceType> of <st1:PlaceName w:st="on">Wilderness</st1:PlaceName> and Emergency Medicine in <st1:State w:st="on"><st1:place w:st="on">New Hampshire</st1:place></st1:State>. This training was heavily focused on survival and the need to pay strict attention to the basics of staying fit and alert in order to be well prepared to treat others. This small school in NH provides practical hands on training for some of the finest rescue teams in the country.<o:p></o:p>
After this wilderness training and obtaining National Registry EMT my first real medical assignment was as a volunteer after Hurricane Andrew where I teamed up with the Medics of the 82<SUP>nd</SUP> Airborne and remained camped out on site for six weeks. The <st1:country-region w:st="on"><st1:place w:st="on">US</st1:place></st1:country-region> armed services, indeed military personnel in general, place a much stronger value on teamwork and keeping members of the team healthy too; a lesson that Hospitals should take to heart. This volunteer experience also changed my life as I was now totally dedicated to becoming an overseas medical volunteer; all of my training since has worked towards this one main goal. I spent the next 3years working in the 2<SUP>nd</SUP> busiest ER in the country at Jackson Memorial in Miami Dade; I also helped man <st1:City w:st="on"><st1:place w:st="on">Jackson</st1:place></st1:City>’s stand alone trauma center: Ryder Trauma. I was one of the founding members of the South Florida DMAT Team. Once again during our training exercises I couldn’t help but notice the powerful emphasis placed on teamwork and supporting one another to remain at peak preparedness to face disaster casualty needs. I have just returned from six months as a Medical Volunteer out in <st1:place w:st="on"><st1:City w:st="on">Aceh Province</st1:City>, <st1:country-region w:st="on">Indonesia</st1:country-region></st1:place> following the tsunami. I was pleased and reassured to find that NGO personnel stationed in disaster zones are also encouraged to share this valuable, team safety is patient safety, priority in carrying out their responsibilities. This vital component is absent or ignored in staff scheduling and medical training for US Hospitals. <o:p></o:p>
Before entering conventional medical institutions I was especially well attuned and sensitivity to the problems of fatigue; I was at sea for over twenty years delivering yachts offshore. As a US Coast Guard licensed Captain I was responsible for the welfare of my crew while at sea; ensuring that they did not become sick, exhausted and fatigued was a top priority. As a Captain it is necessary to watch your crew like a hawk to spot tell tale signs of any potential medical situation long before they come to you for assistance. Mid-ocean evacuation by helicopter is expensive, dangerous and sometimes impossible; it was my job to make sure those on board stayed fit. A Captain can choose who is qualified to sail with them, who is fit and rested enough to stand a night watch and how many people it takes to man the vessel. In the majority of cases this level of control is denied to Nurses even when they are assigned as the Charge Nurse. We trust Nurses to recognize critical trends in their patients, but we deny their instincts with regard to their own basic needs and fitness for duty. This is disrespectful and, all too frequently, downright dangerous; Nurses know when the need to, eat, drink and rest. However, if a mistake is caused by under staffing, untrained assistive personnel or fatigue, will the Hospital Managers who created this appalling situation be held accountable? I doubt it. <o:p></o:p>
<o:p> </o:p>
RNs are saddled with the full accountability associated with working under their license, but without sufficient authority to insure that the patient environment is genuinely safe. Responsibility without appropriate control is the real downfall of the Nursing profession today; as a yacht Captain offshore it was my license, my responsibility, but under my command. For this reason I have never elected to become a Nurse, but believe me it's no disrespect to this noble profession, far from it. I also believe that <st1:country-region w:st="on"><st1:place w:st="on">US</st1:place></st1:country-region> Nurses are greatly undervalued and appallingly misused; their talents are frequently squandered and they are forced to tolerate serious disrespect on a daily basis. Assistive personnel should have taken over some of the more mundane routine tasks, thus freeing up experienced Nurses to concentrate on more important patient care issues. Instead they are assigned another mindless drudgery task, filling out excessive paperwork! EMTs and Paramedics have reduced paperwork with well designed forms. Hospitals should be revamping their Nursing forms and placing more emphasis on computerized data entry. We did this out of necessity at Ryder Trauma because we just could not afford to tie up valued Nurses during life and death emergencies.<o:p></o:p>
The false "Nursing shortage" crisis situation is being repeated all over the <st1:country-region w:st="on"><st1:place w:st="on">US</st1:place></st1:country-region> and elsewhere. One good look at the actual number of RN licenses being issued right now reveals the real picture: Nurses ready to work, but not ready to compromise patient care by working unsafe hours with too many patients and too few staff. Nurses are leaving our Hospitals in droves and the <st1:country-region w:st="on"><st1:place w:st="on">US</st1:place></st1:country-region> is scavenging Nurses from overseas who will be more compliant with the abusive demands of for profit Hospitals. This not only harms the foreign countries who are now being deprived of Medical staff that they desperately need; it helps support the continuation of dangerous practices and negligent understaffing. We are driving away not only potential new Nursing recruits who are dissuaded by the pitfalls of responsibility without control, we are also loosing tenure Nurses as they simply burn out. We need to rethink our strategies, to encourage experienced Nurses to stay working in our Hospitals, by creating a less toxic, more respectful working environment where they feel valued, appreciated and are capable of making decisions important to the care of their patients. <o:p></o:p>
In over 150,000 miles of ocean sailing I did numerous lengthy ocean passages crossing the North and <st1:place w:st="on">South Atlantic</st1:place> 13 times under sail. Towards the end of my career at sea I did many of my delivery passages sailing double handed. Learning to pace myself to stay alert was critical when sailing with only one other person aboard the boat. I have never needed an alarm clock or a wake up call to rouse me and I believe this is an important indicator of getting enough rest. Looking out for each other is even more critical in a team of two than it was in a crew of fourteen on the Whitbread. This goes for Hospital staff too. That small skeleton crew covering Saturday night must be proactive in supporting one another in the best interests of being well prepared to face the stresses of a full-blown emergency situation. After directing my career focus towards the OR I believed I would see a stronger commitment to team work in a Surgical setting; however OR staff are being neglected and abandoned by recent trends in staff reductions. <o:p></o:p>
In one article I was directed to entitled: “An exhausted workforce increases the risk of errors” some very important points were made and I would highly recommend reading this piece. I was glad to see an endorsement of “power napping” and the suggestion about creating a quiet space for staff to rest while on duty. Unfortunately, in reality this will take a complete reversal of conventional Hospital thinking, since currently employees are often penalized for taking a brief nap even during their break period! Instead a charge Nurse should be empowered to order staff to take a nap if the need is perceived. While this is tolerated better among busy Interns on duty for hours at a time, there is very little emphasis on ensuring that there is a quiet place for them to snooze undisturbed. In addition, while it is assumed that they will rest at some point during a 30hour stint, the practicality of this is becoming more complex. For one thing patients who remain in Hospital are sicker now. With serious cut backs in Nursing and supportive staff our Interns are often left to transport patients and do numerous other tasks that do not require their medical skills: this is yet another dangerous consequence of understaffing. All of this is so counter productive, exhausting and frustrating, not to mention promoting unsafe levels of fatigue that cause medical errors. The single most important need is for all of the medical team to cooperate and give their total focus to the patients needs when called upon to do so. <o:p></o:p>
At sea we consider rest while off watch an obligation that must be taken very seriously by all crew members with everyone cognizant of their duty to maintain the safe operation of the vessel by watching out for the wellbeing of one another. In reality the very hardest thing to do in a dire emergency at sea is go below and rest, but that is your solemn duty to your fellow crew, your most important responsibility so that you do not let them down by being unprepared to stand your watch. Try sleeping after your forty foot yacht has just sustained serious damage following a full capsize hundreds of miles offshore, but sleep you must. When I faced this crisis I had sustained a head injury in the rollover, but that first night was long and terrifying for everyone on board. With the engine thrown from its mounts and useless to us, gapping cracks in the deck and a frigid north Atlantic gale blowing, it took the three of us another four grueling days to bring Pearson 424, “Red Barron,” safely into Bermuda under sail. Despite injury, discomfort and paralyzing fear we all had a duty to ourselves and to one another to try to sleep and stay fit enough to function as a unified crew. <o:p></o:p>
<o:p> </o:p>
There is a good reason why on the airlines you are instructed to don your our own oxygen mask first before attending to the needs of someone else. However, in our Hospitals we are taught that the obligation to our patient must preempt even the most basic self preservation necessities. We are encouraged to feel guilty about abandoning the patient to take a rest break or get something to eat, when instead we should be more concerned that in neglecting ourselves, we will seriously compromise the care of others. The zero redundancy of medical personnel, therefore no one to cover breaks, therefore just go without, situation is happening in all areas of numerous for profit Hospitals throughout the United States. It is all about the money, as our conscience is being unfairly manipulated to enable big corporations to bleed healthcare dry. In contrast the commitment to be concerned about those we work alongside is very strong at sea as mistakes can have tragic consequences for those who quickly become close friends. I watched my best friend on the Whitbread race tossed overboard into the freezing Southern ocean at 50degrees south. While many of us shared feelings of guilt over not watching out for him by insuring that his harness was clipped on, it was teamwork that got him back onboard the boat alive. The crew members on board a yacht live in extremely close quarters, but there is much to be learned from the bonding of teamwork that dictates our cooperation while out at sea. <o:p></o:p>
After a humiliating experience of being screamed at during surgery, I tried explaining to my Surgeons that when at sea; “I tried to avoid alienating those with whom I might be forced to share a life raft!” The critical point being that cooperation, trust, and respect for others is the best preparation for facing an emergency in order to function swiftly and effectively together as a team for the best patient outcome. I wrote about this in a letter that went from me as a rookie OR Tech to the Dean of my former Hospital. He took it seriously and I was impressed by the positive outcome as we organized six multidisciplinary committees to address problems and frustrations with a view to creating a “Perfect day in the OR.” Between us we produced a one inch thick book of positive suggestions. This ambitious initiative culminated with an OR retreat at the <st1:place w:st="on"><st1:PlaceName w:st="on">Inner</st1:PlaceName> <st1:PlaceType w:st="on">Harbor</st1:PlaceType></st1:place> with well over a hundred employees from all levels of OR service in attendance. Then the Director of Surgical Nursing left our Hospital. When she was replaced the situation deteriorated rapidly; we didn’t even see her replacement in the OR once in the first 8months after she was hired! All of our hard work was ignored as the priorities changed to support more “downsizing” for profit. The problems that had been raised were all swept under the rug leaving staff feeling used, cynical and jaded. The “Perfect day in the OR” became an elaborate wall exhibit in deceiving JCAHO during one of their perfectly choreographed scheduled visits. <o:p></o:p>
I tried to submit a follow up to my initially successful effort by proposing a computerized format for employee input with reward incentives and multidisciplinary “think tanks” rather than standard committees. It would have required real decision making power. I called the proposal the “Kaleidoscope of Innovative Momentum,” but it was never even considered; once the OR climate changed all discussion was futile. The Dean who once placed a glowing letter of commendation in my file began ignoring the disquieting realities that might negatively impact patient care. I was now perceived as a threat to the new Management and a potential troublemaker. If I acted as a patient advocate by alerting Management to a problem in a written memo I got a terse reply falsely accusing me of causing a scene in the patient care area. Lulled into a false sense of security by my early success I was too naïve to recognize the dangers of being so outspoken; they were steadily building a case against me with slanderous false statements. I was asked to revamp the General Surgery instrument trays, but after months of work during my personal time this too was shelved. <o:p></o:p>
Although I was not myself a Nurse I was alarmed by the near exodus of experienced OR Nurses as the work environment became more toxic. I tried making suggestions for Nurse retention, but was told “this just happens ever once in a while.” This was just happening all over the <st1:country-region w:st="on"><st1:place w:st="on">US</st1:place></st1:country-region> as the for profit Hospitals promoted cutting benefits and making the Nurses job less and less desirable. As Nurses left the burdens of forced overtime and excessive call commitments made those left behind want to leave too and the situation spiraled out of control. Obviously this had happened before, culling of tenure Nurses was a well proven strategy for boosting profits. Hospitals created this so called “Nursing Crisis” using manipulation and greed. The concept of staff input, teamwork and genuine patient safety is being seriously eroded in US Hospitals as regular Nursing staff are cut to a bare minimum, few long-term dedicated staff are left behind and many of those on duty are providing temporary agency coverage. Under these dangerous circumstances fewer staff are genuinely invested in their job and no one is really knowledgeable about their place of work, the location of critical items of equipment or the reliability and experience of their coworkers. <o:p></o:p>
Add to this toxic mix the stressful job these severely overworked, overstretched colleagues endure and the hostility of those who feel used, abused and manipulated by their Hospital purely to maximize financial gain. This badly balanced “pack of cards” will collapse on occasion, but it is only the unnecessary harm of a “sentinel event” that has any hope of forcing a Hospital to make changes. Even when a perfectly preventable tragedy occurs the Hospital will target Nurses as their scapegoat sighting their incompetence when the real culprit is fatigue, too many really sick patients and too few qualified staff. Even as these incidents are on the rise due to bad Hospital policies they hope to minimize the financial damage with Tort Reform. Tort reform will just help to make unconscionable profit driven dangerous understaffing more financially feasible and more patient will be seriously harmed. <o:p></o:p>
<o:p> </o:p>
I used to give lectures on maritime safety issues and I was in the habit of warning my audience that almost all of the mishaps that occur at sea came down to one of three causes: panic, fatigue or complacency Panic was usually the result of insufficient training and inadequate preparation. This has now started to become a bigger factor in US Hospitals with the deliberate shift from tenure Nurses to cheaper less experienced Nurse grads and assistive staff. These personnel in training should have been introduced to spread the workload for better coverage and create entry level roles in a fulfilling career progression. Instead minimally trained workers are outright replacing the experienced Nursing staff to cut cost regardless of the risk to patients. Complacency is generally demonstrated when shortcuts are made by people who’s greater experience has lead them to become lackadaisical about important details. While this is less obvious in Hospitals; when it does occur it’s generally less likely to be motivated by plain arrogance, but is most often the result of unreasonable time constraints on chronically overstretched staff. Fatigue is far worse in the medical profession as it is not taken seriously at all and it is having appalling consequences in terms of medical errors. <o:p></o:p>
Not only is rest considered a luxury and a privilege, food is trivialized as an inconvenience. The ability to eat a decent meal at regular intervals is entirely discounted by Hospital scheduling policies, especially during the off-shifts and at night. In some Hospitals there is no cafeteria service at night and few food outlets exist in the almost deserted, dangerous downtown areas where these facilities are located. When medical personnel experience a particularly stressful emergency their blood sugar is likely to drop even more quickly in response to the challenge. There may be no inclination to eat, “I can’t think about food at a time like this,” but sustenance is doubly important at such times. We must look out for one another to insure that all of our coworkers remain focused and at their best. In the wilderness and in disaster areas we consciously remind one another to get rest, food and drink plenty of water. We are taught to notice tell tale signs of environmental stress, exhaustion and deprivation in fellow rescuers as well as those being rescued. In a Hospital supervisors question your ability to withstand deprivation as if it was a tangible health defect. When I complained that I had become sick, dizzy and faint after 12hours continuously stranded at the sterile field during a lengthy transplant case my Manager suggested that I should be “evaluated for a sugar problem.” <o:p></o:p>
One landmark court case, Echazabal v. Chevron, 336 F.3d 1023 (9<SUP>th</SUP> Cir. 2003), has altered the situation for the worse, although to date, only a handful of lower courts have applied Echazabal. Advocates, however, fear that the decision will be used in the lower courts as a justification for paternalistic and discriminatory employment decisions. This fear has been realized in at least one recent case: In Orr v. Wal-Mart Stores, 297 F.3d 720(8<SUP>th</SUP> Cir. 2002). This now threatens to normalize the deprivation routinely inflicted upon US Medical staff. When “threat to self” was used to deny a Diabetic Pharmacist the right to an uninterrupted lunch break it signaled the way forward for negligent Hospital policies. Wal-Mart has gained the reputation of being one of the most notorious employee abusers in the <st1:country-region w:st="on"><st1:place w:st="on">US</st1:place></st1:country-region> and I don’t doubt that their Pharmacists are frequently expected to go without food altogether. But, do you want them filling out your prescription when their mind is completely blank from dangerously low blood sugar? <o:p></o:p>
While <st1:City w:st="on"><st1:place w:st="on">ADA</st1:place></st1:City> chose to focus on Wal-Mart’s right to sustain their unacceptable work environment as a “normal” job requirement the unhealthy degree of deprivation tolerated by US employers just got much worse. This will set an intolerable precedent that Hospitals will defiantly take advantage of as the conditions being normalized became more toxic and dangerous to the general public. We, the public, should consider the implications of encouraging anyone to become hypoglycemic while their job of work is filling out prescription drug orders, many of them for strong and highly sensitive medications. This man wasn’t making cookies; medication errors can cause serious harm or death! You do not have to be Diabetic to need regular nutrition and perfectly healthy people can suffer from the affects of low blood sugar after a skipped meal. So what happens when a Wal-Mart Pharmacist is rushed off his feet, stressed out, misses lunch and then makes a tragic error with a drug order due to becoming dangerously disoriented by critically low blood sugar? Simple, the Pharmacist will be found negligent and it will probably mark the end of that person’s career not to mention a lifetime of torment over the guilt of having harmed a customer. What would be the consequences for the Wal-Mart store: bad publicity and the lowest compensation payment they can get away with by using their aggressive attack dog Lawyers to trivialize the damage? <o:p></o:p>
<o:p> </o:p>
I learned in my back country training that not feeling hungry or thirsty was not a reliable indicator of the body’s basic needs. In the OR that empty feeling of nausea, the telltale headache, becoming light headed and shaky, diaphoretic under the heat of those stifling OR lights; I knew when my ability to concentrate was flagging. However, I was expected to remain absolutely focused on the case, anticipate the needs of my Surgical team and pass sutures as fine as a human hair. Why are we trusted to make medical decisions about others when we know full well we are unfit to continue functioning? Why do we have to plead and beg to justify the need for even the most minimal rest break, food or water. I should have been relieved and ordered to break scrub; if not for my personal comfort purely for the safety of my patient. How can Managers get away with denying our basic body functions in a way that would be unacceptable in a third would sweetshop? How can US regulatory agencies endorse conditions that do not meet Geneva Convention standards for working prisoners of war? <o:p></o:p>
It is not healthy to wear a tampon for 12hours straight due to the risk of toxic shock! Should that disqualify all scrubbed medical personnel from permission to use tampons or can we reasonably expect to be given permission to break scrub to attend to this need? But, the patient cannot be abandoned, so we are at the mercy of Managers. Does the <st1:City w:st="on"><st1:place w:st="on">ADA</st1:place></st1:City>, EEOC, JCAHO etc expect Hospital staff to wear diapers while at work? Another required read is the book “Void where Prohibited.” On one occasion when I asked for a brief run to the bathroom the Charge Nurse said jokingly that she could insert a “Foley Catheter,” but there was no chance I could break scrub to leave the OR. Although I bled through my underwear that night I didn’t complain as we had 7 ORs running in the middle of the night and I considered it a real emergency. But we are being conned into thinking abuse and cruelty is not only OK in an emergency it is expected of us all the time. In hindsight I latter learned that the Nurse Manager on call had not been called in to help out with staffing the OR that night. <o:p></o:p>
How does any Manager earning call pay to answer the occasional inquiry from dangerously overworked, overstressed staff justify remaining at home while the OR complex copes with 7 Surgical cases, 7 fully engaged Surgical teams, no spare staff, one Charge Nurse and the Hospital was still not on bypass! We didn’t believe in going on bypass, bad for the reputation and avoided at all costs. During the entire time I was at my former Hospital I never heard of a Manager being called in from home. I think they would have sat out a mass casualty without reprimand or a change in policy! Is the priority: safe staffing for appropriate patient care or continuing the guaranteed comfort of Managers who are permitted to ignore an emergency by remaining in the comfort of their home? I only ever complained about being abandoned in Surgery if I was left continuously scrubbed for a time period in excess of 8hours for no legitimate reason. Incidents like this are not a pleasant experience, but we are increasingly forced to tolerate such circumstances. Those engaged in surgery conscientiously remain scrubbed until they are relieved while Hospital Management abuse this dedication to make dangerous staffing cuts that deny breaks. In my case several public agencies that were contacted all wholeheartedly supported this policy without question; it was portrayed as a perfectly acceptable consequence of the “Nursing Shortage.” When these Hospitals are not held responsible for deliberately downsizing the staff, medical errors will be made. <o:p></o:p>
A few of the less conscientious Nurse Managers are of the opinion that no one needs to eat at night which is patently ridiculous. While such Nurse Managers are more inclined to take care of fellow Nurses, in some cases the disrespect shown to Scrub Techs who are not Nurses extends to not bothering to break them out of surgery to go get something to eat or even to use the bathroom. The Hospitals breed this adversarial attitude towards assistive personnel by demonstrating a callous policy of replacing tenure Nurses with cheaper, less experienced staff. Instead of more affordable staff making it possible to provide better coverage as we all work together, this good initiative has been hijacked to skim off bigger profits with fewer experienced staff. It has bred resentment from tenure Nurses who recognize that their careers are being threatened. <o:p></o:p>
<o:p> </o:p>
We cannot do without these Nurses and attempts to decrease their numbers are seriously misplaced. Due to the increasing age of our population and the acuity necessary to remain in a Hospital bed our patients generally need even more vigilant care and monitoring than they did just ten years ago. It is sickening to watch this immoral process of deliberately downsizing the most experienced and better trained staff to save money at the expense of safety. On Nursing Bloggs on the <st1:place w:st="on"><st1:PlaceName w:st="on">Internet</st1:PlaceName> <st1:PlaceType w:st="on">Hospital</st1:PlaceType></st1:place> staff are reporting the issue of being torn between abandoning a patient to get food or even run to the bathroom; rest is out of the question due to the lack of coverage. It is happening in many of the critical care areas of the Hospital and negatively impacting patient care. I used to take cartons of orange juice to work with me for a speedy recovery after periods of being stranded in surgery. I also kept spare underwear at work! <o:p></o:p>
While these measures helped me to cope with a sometimes intolerably abusive situation this was not some third world sweatshop or imprisoned in a sordid foreign jail, why was it considered acceptable at the “<st1:PlaceName w:st="on">Best</st1:PlaceName> <st1:PlaceType w:st="on">Hospital</st1:PlaceType> in <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>!” <o:p></o:p>
This latest aggressive purging of staff that now fails to provide for break coverage, as if rest and food were an unnecessary job perk, is just one more dangerous trend on the road to disaster. Hospital Management must start taking responsibility for the crisis they created in the name of big profits and start putting patients first. The downsizing needs to target top-heavy Management to recover purely superfluous personnel expenses. Safe care is not possible without adequate, sufficiently trained and experienced regular Nursing staff supported by assistive help working under their experienced supervision. This shift in gears will take nation wide legislation as the American for profit Hospitals have proven in the past to be incapable of acting with integrity. The healthcare advocacy groups, the unions and the Nursing Association must push for legislation to close the cost cutting loopholes that have become increasingly abusive to staff while compromising the safety of Hospital care. The real culprits in the criminal abandonment of patients are the Hospital administrators who are striving for greater profits with chronically few well trained staff while unscrupulous Management help to facilitate this process. There are even cash bonus incentives given to help these corrupt Managers overlook any momentary pangs of conscience. <o:p></o:p>
The most experienced Nurses recognize the risks that understaffing is forcing them to take with the care of their patients, but what are their alternatives? Refuse to participate or endorse these dangerous profiteering strategies: leave the Hospital and the staff mix you leave behind is even less equipped to care for patients. This actually benefits the Hospital’s bottom line as the less experienced are lower paid and the staff mix is relying on far fewer and less experienced Nursing personnel all the time. This is at the very core of the “Nursing Exodus;” experienced Nurses who are no longer in Nursing practice because of the dangerous compromises and the toxic work environment. <o:p></o:p>
A conscientious Nurse might try to lodge a formal complaint about the unsafe practices of understaffing, but they commit career suicide in doing so. Not only are they swiftly removed to silence their protests, but the painful, humiliating and damaging firing process is used to destroy their professional credibility as a warning to others who might consider following their brave example. Once fired it is harder for them to report negligence, abuse or even the retaliation used to silence them to outside agencies. They are systematically ignored, ridiculed and persecuted for speaking their mind; they are now portrayed as a “disgruntled former employee with an axe to grind.” The more prestigious the institution, the more futile any attempt to raise public agency concern over the dangerously negligent understaffing policies at a former Hospital and with elimination from the workforce you no longer have any say in their internal affairs. Despite the appalling personal costs this courageous stand will accomplish absolutely nothing as the Hospital will undoubtedly refuse to change policies that maximize their profits and the agencies are condoning this negligence. We need to recognize deliberate understaffing for what it really is: CRIMINAL FRAUD! <o:p></o:p>
I want to get this important message out there loud and clear so that we do not have to realize our mistakes though more harmful errors and loss of life. I had a rather unconventional start to my career after many years at sea, but my time at sea has given me an unusual perspective on the importance of teamwork and working together to stay fit and able to care for patients. I am eager to continue doing the job I love and this has made it extremely important to clear my name and restore my former reputation as a conscientious healthcare worker. The damage to my credibility is still a major obstacle even as I apply for jobs overseas as an unpaid Medical Volunteer. Sorry about the length of this “Soap Box” piece, but the consequences of my own situation has just made me even more determined to reveal the truth. <o:p></o:p>
Tsunami Kim. <o:p></o:p>
<o:p> </o:p>
<o:p> </o:p>
<o:p></o:p>

There are many, many cost related gross understaffing issues going on in our hospitals and this is one of the worst. Could this lack of O.R. staffing during surgery also be causing the high incidence of staph related post-op infections? I think we all know the answer to that. The fact that this person said she is diabetic does not have any bearing on her position. Come on now, if you can't stand for 10 hours because of poor leg circulation or low back pain should you be tossed out of your job? Too bad nurses can't be like the coal miners.

Sorry about the double post I thought I had edited out post #12 as it contained missing chunks of text and didn't make sense in places because of this. Post #13 seems OK. I found a way to take out the junk without loosing text. Thanks for bearing with me,
Tsunami Kim.

ok...steelcityrn..... explain the coal miner thing to me.
I mean....we have a system here that is broken.Fewer legislative nurse friendly statutes are passed each year.Thank God...that now some of the tainted votes by some of these seantors are coming to light.Like how...these legislators are being paid basically for their votes.It is going to take personal examples to change the minds of these legislators....We need people in positions that can help to change this...legislators...nurses...physicians...mothers ...fathers....children...who are willing to publically tell their story of how their life was touched by these issues.
Post op infections.....yeah....ya know that can cost them their life..
Nurses asked to stand in a 5 ft x 4 ft space in the OR and worknonstop for 12 hours with no meal break...no chance to stretch their legs...no bathroom break etc etc etc are being asked to also be perfect and function as a machine and not make any errors ...even though we have no nutrition or hydration and cant even "relieve" ourselves.How realistic is this?

Instead of TsunamiKims manager simply adding another OR tech or circulating or nurse thats duty is to simply round on each OR suite and relieve nurses for breaks and bathroom. 2.5 hours on each case....and that would allow those nurses to have a quick 20 min lunch, go to the br and keep the staff there to assist that surgeon during the procedure.But.....what the problem is ...is that these managers havent cared for "actual" patients in so long...they cant see that this would improve the M/M rates and decrease infections and assist with retention of the nsg staff. These managers are asking us ...to function in an environment that we as humans cant.We ...unfortunately need food, h20 and unfortunately a bathroom break.When you bring these patient safety issues forward.....these managers...cant get ya outta there quick enough.Boom...you are fired. All these patient safety and public protection acts.....are actually meant for these hospitals......but .......you have to be willing to back up your ethically pt safety complaints with the knowledge that the manager may fire you to simply silence you. It will take more huge settlements against these HCF's before they actually stop this pratice. Unfortunately ...for the HCF's the trend is going up and up that judges are siding more with the whistleblowers who risk everything for these patients.They are being slapped with huge fines, large settlements and more and more and more public attention is being drawn to these prestigious hospitals that are now publically noted to have fired nurses who voiced concerns over pt safety issues. People are thinking....wondering....evaluating ....and discussing how safety conscious is the hospital where I am at...where my son is hospitalized at......was my mothers sentinel event due to these issues.etc etc etc.Instead of standing behind and embracing these new safety conscious laws, standing behind theirown policies, and rewarding these nurses ...these managers are just trying to silence the nurses. It will take a stronger risk management office and a compliance officer that is willing to actually go by the laws, and their own policies...and make a statement within their own facilities by firing these "toxic" managers as tsunami kim calls them.

I will again say what I contributed on several other threads. First and foremost, nurses need to unionize!!!! There is little, if any protection for nurses, in this day and age. Second, nurses need to practice defensive employment. If you see unsafe issues, write letters to management, administration, and also Risk Management. KEEP COPIES FOR YOUR SELF!!
Make copies of policies and procedures. Make copies of all internal memos, pertinant comments in the unit communication book. Take notes during the day, or as soon as you get home, while incidents are fresh in your mind.

Write Letters to the Editor. When administration makes unfounded complaints against your nursing care, ask, "can you give me an example of that, and the date that it occurred?" That will put THEM on the defensive.

I would also call an employment attorney (preferably, a nurse attorney- call the State Bar Association), and discuss the issue with him/her. There is usually a free first consult to duscus your case. If there are others on your unit that have been harrassed, get together, and make an appointment with the senior partner of the law firm that defends the hospital. Supply him with the facts of you issues, the hospital policies that have been violated, Nurse Practice Act, the patients that have suffered due to poor care, (I would have the names to supply him with), and the laws that they are breaking- EEOC, State Labor Department. You can find these laws on "FindLaw.com" on the Internet. All state and Federal laws are on the web sites. Be prepared! Information is ammunition! Make it clear that you will go public with this information if the climate doesn't change, and also that you will contact the families of the patients, and offer to testify on their behalf. I would also contact the news media, and see if you can get some press.

It is a large burden to have to go to this extent, to protect your name and license. It would also not be a bad idea to contact the Board of Nursing, and inform them of the issues with your employer. You should get to them before your employer, to tell your side of the story. This will be a less defensive position for you, than if your employer calls the Board in a retaliatory measure by them. I hope that this has helped.

Lindarn, RN, BSN, CCRN
Spokane, Washington

Good thoughts, <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
<o:p></o:p>
Good advice that I too would give to others, but I did most of the above and still it all failed. I started to fight back through my <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /><st1:place w:st="on">Union</st1:place>. It took them 8months to get the Labor Board to force my Hospital to hand over copies of three solicited letters that were used to fire me! I couldn't even get them to read one direct quote. My former Hospital calls that "transparency." This allowed the Hospital Managers to deliberately misinterpret what was written, embellishing and changing the accusations as they went along. The ridiculous false allegations kept changing and because there was nothing specific in writing it was impossible to fight back. When I went into Hearings I was always heavily outnumbered and the whole process was so humiliating. Every time there were new lies and false accusations; I started calling this crap the “accusation de jour!” <o:p></o:p>
All I had were vague one line statements like "disruptive behavior in the OR," no real details, no account of what I said or did that constituted grounds to fire me. My Manager accused me of “verbal abuse” during a phone conversation over my work schedule. This was after being forced to take unpaid leave and I think she had hoped that my anxiety over the loss of pay would prompt me to loose my temper. I told her I thought she was being “unnecessarily inflexible” with my schedule; hell I didn’t know you could get fired for such outrageous blasphemy. It brings a whole new meaning to “freedom of speech.” 15months after I was fired one of the office staff who was conned into writing a letter of complaint was ask about the subjective comment she had tacked on the end. She wrote “I felt threatened,” but when asked why she stated that I had my hands on my hips in an “aggressive posture” and my arms folder in an “aggressive manor.” Great, my entire career scuttled over what was subjectively perceived as “aggressive” posturing. <o:p></o:p>
I gave a detailed written report to the Hospitals internal Compliance Line who then tried to refuse to investigate saying they could not get involved until I had exhausted all other remedies first. They don’t really explain this little quirk on their “We Comply” website and I must say I fail to see how they can pretend that they protect employees from retaliation. Apparently they need to see that the retaliation has succeeded in reaching its final devastating conclusion unimpeded, before they say Ops; sorry we can’t do anything to protect you now as you are no longer an employee! Does that mean that they lied and they never protect employees from retaliation anyway at anytime or for any reason, well YES! That comes under the Hospital’s glowing statements about honesty, integrity and accountability. The most I managed in the way of “Compliance” was to have them conduct a separate, but rather cursory investigate into the negligence issues and admit to me over the phone that there was “some truth to my allegations.” As for the accountability bit they decided to “just keep an eye on things.” <o:p></o:p>
I made sworn statements to the Board of Nursing about the negligent and retaliatory conduct of four OR Managers. I then went to The Maryland Commission on Human Relations, EEOC, JCAHO, the Board of Healthcare Quality and MEIMSS giving each of them sworn statements. I contacted both of my Maryland Senators and my Congressman, submitting a “Citizens Opinion” on “at will firing.” Each time I trusted a public agency to investigate they let me down. When interviewing the witnesses I provided they all appeared to have focused on establishing my lack of credibility first and foremost so that they could protect a famous <st1:place w:st="on"><st1:State w:st="on">Maryland</st1:State></st1:place> icon. On several occasions damaging paperwork, mostly fabricated, was shown to these organizations behind my back: more “transparency!” <o:p></o:p>
At a supposedly unbiased EEOC Mediation they displayed documents to the Mediator in a separate room and again I was denied access, does that sound fair to you? EEOC insist that such deceitful one-sided proceedings are standard for them; I would never have agreed to Mediation if I had known this ahead of time. If an employer has just cause to fire you there is no possible motive to hide evidence of misconduct. The EEOC Mediator was convinced that I had made over 50 harassing phone calls to my Manager that would be grounds to bring criminal charges against me. However they had never contacted Security once and they never demonstrated having taken any steps to put an end to the harassment. When the Hospital’s Director of Surgical Nursing was prepared to lie to deliberately victimize me she must have seemed so credible to them. The top OR Manager even lied under oath at my Arbitration. <o:p></o:p>
I am originally from <st1:country-region w:st="on"><st1:place w:st="on">England</st1:place></st1:country-region> and what my Hospital did to me could not have happened in this country. I have completely lost faith in everything <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region> stands for, freedom of what??? There is no recourse to justice and public agencies do not protect the public. My former Hospital is the largest employer in the state of <st1:State w:st="on">Maryland</st1:State>, the most prestigious medical institution in the country, the “<st1:PlaceName w:st="on">Best</st1:PlaceName> <st1:PlaceType w:st="on">Hospital</st1:PlaceType> in <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>;” they are completely beyond the law. Even the media will not touch them, there is no recourse, but this does help me tp speak out. My last hope is a Petition I will soon post on thePetitionSite.com. It will demand that the Compliance Line finally conduct a long overdue investigation into my case. I hope that the interest generated by that point will force them to grow a conscience and do a proper investigation as they may be under more scrutiny by then. It is one last slim chance at clearing my name. It will be a real resource document when it is finished with links to multiple sites, that is what is taking time. I will let everyone know when it is posted and hope you will lend your support. This is a real David and Goliath story and I will need all the support I can get, thanks for hearing me out, <o:p></o:p>
Tsunami Kim. <o:p></o:p>

Did you have an attorney represented you in this whole mess? If not, why not? Did you know that you can request the phone records from the phone company, and them demand to have them show you the numerous threatening phone call they claim you made. Have they shown you any concrete evidence concerning these allegations? If you had/have an attorney, you need another one. I can't remember if you belonged to a union. I might also, call the State Bar Association in your state, and speak to someone who does Labor and Employment Law. They have a specialty section, at least they do here in Washington. I would explain the entire mess to them. You might be able to get the attention of a prominent employment attorney, who carries alot of weight in the area. Hospitals are afraid of the "big guns" attorneys. I could look here in Washington, because the Washington State Trial Lawyers Association conducts an Employment Law Seminar every year. I belong to the WSTLA, and I could try to find you someone. Even if the attorney is not licensed in your state, he can sue in Federal Court. There is someone in Seattle that I have in mind. I could give you her name. Also, she might know someone on the east coast who can help you.

Give me a couple of days, to get back to you.

Lindarn, RN, BSN, CCRN
Spokane, Washington

Initially I tried to avoid the possibility of legal action and postponed this option as a last resort. This was mostly due to my belief that Hospitals in general are sacrosanct if you wholeheartedly endorse the concept of universal access to healthcare as we do in the <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /><st1:country-region w:st="on"><st1:place w:st="on">UK</st1:place></st1:country-region>. I tried to resolve my case first through the <st1:place w:st="on">Union</st1:place> and HR, then through the Hospital’s Compliance Line, EEOC and the Maryland Commission on Human Relations. While I did have a <st1:place w:st="on">Union</st1:place>, they proved more of an encumbrance than anything else. The Union Lawyer who represented me at Arbitration first misinformed me, then proceeded to sabotage and wreak my case! It is because of this lousy <st1:place w:st="on">Union</st1:place> misinforming me about binding Arbitration that I now have no legal recourse at all. Their Lawyer totally bared me from presenting all the most relevant facts supporting my case and then put my guilt in writing no less than three times in his written summation which he kept from me for over a year until the ruling against me was final.
The really unfair thing is that to gain access to my own short distance phone records they must be subpoenaed for a pending case. Since I wanted this evidence revealed I signed a special waiver to authorize the Maryland Board of Nursing to gain access to my phone records. They have never indicated that they reviewed these records, but I soon realized that any vindicating evidence was very low on their priority list. Once the Hospital portrayed me as a “disgruntled former employee with an axe to grind,” they just looked for evidence to support this claim and exonerate my prestigious former Hospital of all negligence and retaliation charges. It was truly amazing how selective all of the Public Agencies that I contacted were with regard to what they chose to evaluate in the way of evidence. The main priority always remained the same: demonizing me to protect an iconic Maryland Medical institution. The battle to reveal the truth was totally futile. Even after Maryland BON received copies of all my employee files, I was still not allowed to see them. I do not understand how they got away with this deception as it would not be possible in <st1:place w:st="on">Europe</st1:place>. Any employer who has a valid reason to fire one of their employees should be able to clearly demonstrate cause.
So why did my former Hospital need to keep hiding everything from me, the wrongfully accused victim of retaliation for blowing the whistle on negligence? Put a lie in writing and when it is refuted with a documented alibi the false accusation is worse than useless; it becomes a liability proving deliberate deceit. I also discovered that additional paperwork had been inserted into my file after my dismissal without my knowledge, but the details were sketchy as I could never review any of it. Two Minor Rule Violations were added after the fact, but I had no idea they even existed until just days before my Arbitration Hearing, a full 15months after I was fired. There was no supporting documentation to describe the events that had supposedly taken place, but the Hospital didn’t have similar paperwork describing the events used to fire me either. According to Management these Minor Rule Violations showed a “pattern of behavior” and demonstrated that disciplinary counseling had occurred, but conveniently they hadn’t required my signature. Nothing in writing gives an employer a distinct advantage as your file becomes a minefield of fictitious charges that others can base their decisions upon, but you are unable to refute as you have no knowledge of their existence! My former Hospital calls this tactic “Transparency” in the <st1:country-region w:st="on"><st1:place w:st="on">UK</st1:place></st1:country-region> we call it fraud and defamation! Two Minor Rule Violations showing a “pattern of behavior” convinced the Maryland Commission on Human Relations and others of my guilt!
I have consistently asked to see any relevant Hospital Security records that would demonstrate that not one contact to Security was ever made; however, this evidence is not incriminating, so it still remains suppressed. If Hospital employees feel threatened or receive harassing phone calls they are supposed to contact the Security Dept. Considering the volume of incidents my Managers claim occurred there should be a file a foot thick on my behavior, but there is nothing, so they try not to mention its conspicuous absence. Neither the Hospital’s internal Compliance Line nor a single one of the Public Agencies who have supposedly “investigated” my case have explained this missing Security file: it doesn’t exist, but they just don’t care. At one point my Manager changed my schedule so radically that I went from working over the weekend, at times when she was not there at all, in an OR suite on the other side of the Hospital, to working days alongside her in her OR complex. She claimed that she felt threatened and harassed by me, but she deliberately chose closer, more frequent contact. It was the equivalent of inviting her stalker to dinner!
However, after the unwanted reassignment I wasn’t provided with a locker, oriented to the new ORs, given a mail slot or a Hill Rom Beeper etc.: I was clearly slated for removal and I knew it. I put all these retaliatory measures in writing to the Manager above my immediate Manager, but it was all completely ignored: OR Management in general wanted me gone and they didn’t care how blatantly corrupt the process of removal had to be. They ignored written appeals, lied and cheated all the way up to the Director of Surgical Nursing who lied under oath at my Arbitration. There is copious evidence to support my allegations of severe retaliation, but no one wants to touch it. If I could get a journalist to investigate that might help, but no one will challenge “<st1:country-region w:st="on">America</st1:country-region>’s <st1:place w:st="on"><st1:PlaceName w:st="on">Best</st1:PlaceName> <st1:PlaceType w:st="on">Hospital</st1:PlaceType></st1:place>. This Hospital considers themselves 100% above the law and that is not healthy, but they always win. I am still fighting them after five years, broke, in debt; after being forced to abandon my <st1:City w:st="on">Baltimore</st1:City> home I have left the country where I resided for over twenty years and returned to the <st1:country-region w:st="on"><st1:place w:st="on">UK</st1:place></st1:country-region> in disgust. I am thoroughly convinced that there is no justice system in <st1:place w:st="on"><st1:country-region w:st="on">America</st1:country-region></st1:place>. The following post was placed by me on another thread regarding “Retaliation for voicing concerns over patient safety.” There is a lot of useful information on dealing with retaliation under this other thread that is well worth reading. This piece was written in response to taping calls:
<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
Good advice: you are right about informing the person you intend to tape; that is the law in <st1:place w:st="on"><st1:State w:st="on">Maryland</st1:State></st1:place>. You are able to tape if you inform the person you intend to tape. However, this really puts them on guard, because Management rely on he said/she said where they will always claim more credibility than you. If you don’t tape your next hearing you must at least bring witnesses, preferably one that will transcribe what is said would be very useful. I kept asking at my hearings why they had never informed me that calls between myself and my Manager would need to be taped; this would have been a legitimate and logical course of action, if indeed I had been making dozens of threatening phone calls. <o:p></o:p>
That was one of the major inconsistencies in their lies. Who in their right mind would put up with dozens of harassing phone calls and take no action to stop the practice? At one point my Manager blurted out that my calls tied up her phone for up to five hours a day! But no one thought that such a ridiculous claim was bogus or questioned her total inaction as suspect, after all they had to be in the right. An OR Nurse Manager, who failed to document anything at the time, did not send written warning that the behavior must stop and who never bother consulting with the Security Department. But Management at the most iconic institution in <st1:place w:st="on"><st1:State w:st="on">Maryland</st1:State></st1:place> couldn’t possibly be suspected of lying under oath! That place was way beyond "Goliath." I call this unjust phenomenon "Iconic Immunity" as it is a privilege that I am sure is shared by other iconic facilities. <o:p></o:p>
The inconsistencies in my case were massive, but totally ignored. I will never have my day in court as I was cheated out of that when the <st1:place w:st="on">Union</st1:place> misinformed me regarding the Arbitration being binding. I only found out much later when I tried to hire a Lawyer. If there was any way I could testify under oath in a Government hearing or to a US Grand Jury, on the need for Whistleblower protections for healthcare workers, I would gladly return to the <st1:place w:st="on"><st1:country-region w:st="on">US</st1:country-region></st1:place> in a heartbeat. <o:p></o:p>
More than anything else I want to know that my sacrifices were worth it: that the necessary changes will be made and protections put in place. Of course I would also like vindictive Managers held accountable for wreaking my life. Personal vindication and taking back my self respect are the biggest Christmas Presents I could receive right now. No one should have to face a life-sentence of shame for daring to speak out to protect patients from harm. Getting my house back and paying off the debts I incurred trying to hang onto my home are beyond any hope of possibility, so I try not to even think about that dream anymore as it is unrealistic. This is the worst time of year for me as it is now the fifth anniversary of the day I was marched out of the OR surrounded by security guards as a warning to my coworkers of the perils of rocking the boat. It is also the second anniversary of being forced to abandon my <st1:City w:st="on">Baltimore</st1:City> home and leave the <st1:country-region w:st="on"><st1:place w:st="on">US</st1:place></st1:country-region> as a virtual refugee. <o:p></o:p>
I did not even have the resources to file for bankruptcy before I left so the bad debts still hang round my neck like the proverbial albatross. I contacted all the companies and told them I had been cheated out of any possibility of compensation and there was nothing I could do. I have mail forwarded here and at least one has decided to sue me. I will certainly never have a home of my own again. <o:p></o:p>
I will also have to forgo the security of a credit card just in case I need to fly myself back to the <st1:place w:st="on"><st1:country-region w:st="on">UK</st1:country-region></st1:place> in an emergency from some volunteer assignment overseas. That is still my one greatest ambition, to continue the NGO Medical Volunteer work I began after the Asian tsunami. This is my driving force in maintaining a strong sense of purpose it really gives me hope. I wish that all of you many disillusioned, well meaning, overworked Nurses could find the special peace and sanctuary that I discovered living rough in my hammock/tent and working at Meulaboh's only remaining very badly supplied Hospital, Cut Nyak Dhien. <o:p></o:p>
Perhaps in dealing honestly with the injustice that clouds my past I can regain the credibility I so desperately need, to obtain support for my ambitious program in Aceh. If only I had the backing of my former prestigious Hospital instead I must continue to battle their lies. They should be deeply ashamed of their actions, but I doubt they will ever face the truth let alone apologize. Anyone who decides to blow the whistle on negligence and patient safety concerns needs to understand that the road ahead of them is a very tough challenge. We care so we take on the toughest of challenges, do not give up, <o:p></o:p>
<st1:place w:st="on"><st1:PlaceName w:st="on">Fair</st1:PlaceName> <st1:PlaceName w:st="on">Winds & Following</st1:PlaceName> <st1:PlaceType w:st="on">Seas</st1:PlaceType></st1:place>, Kim. <o:p></o:p>

Tsunami kim.....also these "audiotape" issues really vary from state to state.In my state as long as 1 of the 2 parties knows that a conversation is being recorded then it is ok.....I...was one of the two parties.So taping was legal and completly admissable in court...id it comes to that.
The sad sad reality is.....that unless I had audiotaped that NM ...it would have been her word against mine. Now.....that HCF has to be willing to defend the NM who is on tape stating concrete lie after concrete lie.I mean the lady was so untruthful ....that she couldnt even "get her story straight" on what day an "alledged" event took place on.She is just ....aliar. But....do you think I would have been taken even remotely...the least bit seriously by anyone unless I had recorded that meeting? No....even with my perfect work hx at this HCF...and recent promotion......I would NOT NOT NOT have been believed.Is that wrong? yes....yes it is.But thank god I did record it...and now...that HCF.....has to either stand behind their policies(pt safety policy, code of conduct policy, ethics policy, antiretaliation policy etc etc etc)...and do the correct ethical and "LEGAL " thing...or be willing to stand up in court and say "Well ...you see when this NM stated this "alledgedly"occurred on a friday she was lying then....but...judge please believe her now,.. bc she is actually now alledging this happened on a wednesday ...so ya really need to believe what she is saying "right now"....and lets "just not talk about" what day she said this "alledgedly" occurred on on that audiotape. I audiotaped it....and she is now caught in the tangled web of those lies. But......what if I hadnt recorded it? That NM could have said anything in the world she wanted and I would have been defenseless against it.Is that scary?
I too advise everyone...audiotape, document times dates etc etc., look at all the events leading up to and after the event. Make copies of your long distance phone records.Utilize an atty.....and even though your trust has been damaged by that HCF.......GIVE THEM A CHANCE....as hard as it may be.GIVE that HCF a chance to do the correct thing.In large hospitals...sometimes.....these unethical NM's are not uncovered for years.If that Risk management dept and compliance office...and their legal team doesnt "know" about the problems then you cant expect them to correct it by removing them.They are kinda like a "big machine".....and sometimes they dont realize they have a small malfunctioning "part-NM" until we point it out.As hard as it is...when your trust has been violated...you have to give them the chance to correct it.I...am struggling with that...bc....it seems like all I get are more broken promises.I...loved my job....loved my coworkers...and put alot of myself into it. I lost my job....bc....I saw and reported that NM's best friend working ...praticing unsafely .Does that scare you?well...it should.It should scare the H*** out of you.If they can take a highly skilled CCRN with a long hx at that HCF...with no write ups....in all the years I worked there....and terminate me for voicing my concerns over patient safety issues...then it can happen to you....your coworker.It should scare you so much...and wake you up enough to pay those monthly dues to your state nsg association....and make you get active in their legislative efforts. These laws like the Patient safety act that President Bush enacted a few months ago are begining to be expanded in all the states.Stories are making it out to the public and more legal protection is being offered to the nurses like Barry Adams who have a strong ethical core to their pratice.

Tsunamikim....have you thought about a different avenue?Maybe since ...this is a "broken part-this NM"....maybe ...maybe there is someone at that HCF "the big machine"that is influential enough to actually listen to your concerns.It doesnt have to be in the com