Something has to give here....us or them?

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    I am posting this subject in response to minurse and her topic of the nurse who got fired for making a mistake. I am wondering what other nurses think about the issue of nurses who continue to work in these unsafe conditions (we all have), and what happens or potentially could happen on our most busy and stressed out of days (frightening). What steps have we as nurses personally taken in this situation, and what were the consequences or outcomes?
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    Hi goldilocksrn. On the incident that minurse brought to our attention, I don't feel we know all the relevant facts. 1. What type of med errors did he/she make before? 2. Had this nurse been counseled or warned with pass med errors? 3. Had this nurse been on probation before with med errors? There are other questions. It may go back to this particular nurses schooling. Did the nursing instructors do their job?
    With regards to your question, what will happen is that the health care industry will eventually collapse taking the U.S. and possibly the global economy with it. I don't think that you can continue to put the "devil in the details" and expect a so-called win-win outcome.
    Health care at the outset was never intended to be an exploitative venture. It was intended to be profitable, however. There was to be profit for all the receivers of health care as well as the administrators of health care. As I see it, the only ones who are profitting in this "industry" are CEOs with prohibitive contracts, specialty physicians and practitioners who put the "advance" in advanced technology, pharmaceuticals who make RJ Reynolds appear to descend from heaven, consulting firms, land developers, politicians, and lawyers. Nursing and most allied health practitioners, and especially patients and their families serve as the pivotal foundation and the backdrop for which the groups listed above are able to profit. Internally, nurses must find common ground for wide scale unity if we are to soften the blows to ourselves and our patients.
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    About 3 years ago as I started to feel the effects of cost cutting and profit taking it occured to me that these measures would eventually bring the whole health care system crashing down on our heads. The goal seemed to be to increase profits over the next two to four years. There was no long term plan what so even. I just hope the people at the top who are responsible for what is going on are called to task for their actions. I fear they wiil take the money they skimmed off the top(legally but not ethically) and sit in their mansions and drink expensive wine and go to the few "for the rich only" health care providers that remain while the rest of us suffer.
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    thanks goldilockrn for keeping the focus. I can tell you that one previous med error had to do with the fact that a dose of the same med charted as "given" for the same patient was found by the next shift, and that even though my FORMER coworker had charted the med., she was still accused of not giving it. GOD forbid the pharmacy may have sent two doses on mistake!!?!???! This last error had to do with hanging the wrong concentration of heparin for a gtt. She was hurried and grabbed the concentration used to keep an art line open not for a therapuetic gtt. She should have been offered education according to policy but was not. In addition---the night shift never even noticed the error. It was found the next day shift. Basically, it all boils down to what we will allow ourselves to put up with. I have since downloaded that assignment with objection form and intend to use it. I also met with the rest of the staff and nursing leadership and reminded them of 1. the hospital mission statement, 2. the policy on staffing the units, and 3. the corporate compliance program. I don't know what got their attention but we have had a great deal of supplemental, agency staffing since that meeting.I intend to keep up this fight until we care provide the level of care we claim.
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    Minurse, I really like the fact that you used the hospitals' own mission statement and staffing policies and corporate compliance program. There is a great mind at work-- spoon feed them their own words! I wonder if that would work for others; I suppose it would if the language isn't too convoluted. I really feel bad for your former co-worker; is there any way she can petition the firing; or is she glad to be out of there? The firing may make it harder for her to get another job.

    [This message has been edited by Jenny P (edited November 15, 2000).]
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    Jenny, my coworker could grieve, but feels too humilitated. How could you want to work for someone that won't support you? I had a similar experience 8 years ago, I won't let her down. I am supporting her career search efforts and am going to introduce her to this website tomorrow. I am also a former manager in an out-of-hospital job and knew just how to get administrations' attention. My coworkers are quite proud of me, and I must say, so am I.
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    Too often I have seen the true patient advocate punished for the same thing that would be ignored in a less outspoken nurse. Sometimes the nurse is the last in a chain of errors starting with poor handwriting, through complicated systems, ending with an error. This nurse becomes a scapegoat.
    Once an LVN on a telemetry unit was terminated when the patient removed the leads, coded, and was revived with brain damage. She went into the room when she heard the tech say, "Mr. so & so is off the monitor." She started CPR and called the team. Why was she fired?
    Probably to have something to tell the family.
    The JCAHO has a policy on Sentinel Events that a "Root Cause Analysis" be done focusing on the system, not the individual.
    Management needs to learn this!
    Only the abusive, unsafe, or incompetent should be fired (and lose their license).
    One mistake by a competent caring nurse should be documented and that's all because the nurse is more disturbed than anyone else.
    Punishment serves no purpose.
    If the problem is lack of training about a type of medication or treatment the education should be provided.
    PS the www.florenceproject.org
    Assignment despite objection form is good. I suggest filling one out any time unsafe staffing or floating make mistakes likely.

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    [This message has been edited by spacenurse (edited November 15, 2000).]
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    Minurse:
    I am proud of you too!
    My belief is that nursing is going to greatly improve the delivery of care through such actions as yours.

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  11. 0
    Originally posted by minurse:
    thanks goldilockrn for keeping the focus. I can tell you that one previous med error had to do with the fact that a dose of the same med charted as "given" for the same patient was found by the next shift, and that even though my FORMER coworker had charted the med., she was still accused of not giving it. GOD forbid the pharmacy may have sent two doses on mistake!!?!???! This last error had to do with hanging the wrong concentration of heparin for a gtt. She was hurried and grabbed the concentration used to keep an art line open not for a therapuetic gtt. She should have been offered education according to policy but was not. In addition---the night shift never even noticed the error. It was found the next day shift. Basically, it all boils down to what we will allow ourselves to put up with. I have since downloaded that assignment with objection form and intend to use it. I also met with the rest of the staff and nursing leadership and reminded them of 1. the hospital mission statement, 2. the policy on staffing the units, and 3. the corporate compliance program. I don't know what got their attention but we have had a great deal of supplemental, agency staffing since that meeting.I intend to keep up this fight until we care provide the level of care we claim.
    Great work minurse! That's being proactive in the mist of battle. Every hard-working nurse should apply facility policy, procedure, mission, values, and goals to their work. It definitely holds the facility responsible and accountable. I realized that I responded to goldilocksrn from a different angle.


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