As I sit here typing this out, I am still replaying the events that happened to me last week at work. I knew this day was coming, I was just hoping to find another job first. It was Monday and I saw them pull up. State surveyors. I have been a nurse for over four years and was a CNA for over 11yrs. I have been thru survey before. For the first time, I wasnt nervous. I was scared. I knew this wasnt going to be good. Things have changed at the nursing home since I started working there last November.
My nurse manager had just been promoted from floor nurse to manager right before I started working there.( I thought it was odd an LPN could have a manager position). At first, working for him wasnt that bad. We worked together great. Then sometime in the January, things changed. He changed. He was more demanding and kept asking me do to more. Which at first, I loved the idea of having more responsibility and felt I could handle the challenge. As the nurse manager, he was the wound care nurse and was to do all the wound care. By the end of January, I noticed most of the wound treatments were not getting done and I started to pick up the slack. I also noticed a lot of other things were not getting done. We had a lot of residents who had a peg and were npo...so all meds given via peg.
Well, a lot of meds that were ordered were not crushable...said so right on the card!! So, when the pharmacy rep came, I sat down with her and we got a lot of the meds changed to liquids and/or crushable tabs. Every Thursday, the wound doc came and I rounded with him. At the end of each month, the house MDs came and I also rounded with them. And not only did the pysch doc come every Wed and I rounded with him as well, but I also managed to get most of my residents OFF the antipyschotropic meds (some remained PRN).
Then there was three residents who had pegs but were taking all meds PO, eating a reg diet and gaining wt. So I also had them set up for eval to have the pegs removed. Alot of my DM residents were getting their blood sugars checked QID...and they have been stable!! So I asked the doc to change them Q week and she agreed. I did this for a unit of 30 long term care residents with various degrees of aquity of care required. Some were s/p strokes, some were major TBIs and were young. A lot of end stage HIV/AIDS. A lot of behaviors. No computer charting or mar/tar. All paper. I did it because it was my job. I was overwhelmed. I passed my meds not by the book...but by the letter, with the exception of one rule. The hour before and hour after.
I started my med pass at 730 and was done by 1130 ( AM med pass). I never sat down unless it was to chart. My nurse manager would always come to me and ask me to call this doctor and make this appt or do this paperwork. One day he needed to know which residents were on ABT, the DX, how long they were on it and what labs were done or were going to be done. I said no problem, I will do it after my med pass. He said, "no...now. I need it now." I just looked at him...I have never been spoken to like that...not by a manager at least. I got the report for him and went to give it to him. He snatched it from my hand. I was so mad!! But... I let it go. I needed this job...I am a single mom. So I bit my tongue and kepts on trucking!!! But things continued to get worse.
One morning, I had a resident who is alert but very confused and is normally up, walking around. He is known to be combative at times, but I figured out, if you let him be, he wont bother anyone. Well that morning, he was very tired, sleeping in his w/c. Opens eyes when spoken to but speech was very slurred. Tried to get him in his bed, but he resisted. So I left him in the w/c and took his vitals. BP was high 188/100 HR 110 RR 22 sats 90% and afebrile. Lungs were noted with crackles in lower lobes. Skin dry and mucus membranes also noted to be dry. Now....before I go calling any one, I always double check my vitals...that bp was with my manual cuff..not the house electric cuff.
I was in the process of calling the doc...with my note of vitals and resident's condition when my nurse manager came around the corner. I showed him my notes and he hung the phone! He said, " That is not right..take it again with a manual cuff." I told him that I used a manual cuff and he said, " Then your a ******* idiot, that is not an accurate BP." So I gave him the cuff and said then you do it and he did and he got 200/110. Needless to say, I ended up calling 911 for my resident. Another resident was having s/s of a stroke but he wouldnt let me call the doc bc he felt the patient was stable and was not having a stroke but a seizure. That was on a Friday.I had the weekend off and when I came back to work that Monday, not only was the resident not speaking at this point, she was not able to swallow. So I called 911 and guess what..she was admitted bc she had a stroke. I spoke to my DON and my adminstrator. I was advised to file a complaint. I did.
Then there was the patient that changed every thing. She is young. History of MS. She was on another unit and transfered to my unit. I am still not sure why she was moved. She had been in the facility for years. She was non verbal, npo, and was on a tube feeding 18hrs per day with scheduled flushes. I remember when she was moved over, I had been off that weekend. Mondays is known as lab days and I always check for new labs and that is when I noticed that my new patient did not have any labs ordered. I thought this was odd because she was on Coumadin and I knew she needed a PT/INR. So I go back and look for new orders and check previous labs. This resident had been here over two years and there were NO labs. I checked with lab to see if maybe they have done any and never faxed results. Nothing.
So I updated the doc and new labs were ordered. I also spoke with my nurse manager and asked him why no one ordered labs. I mean how can you give Coumadin with no lab? He told me I needed to focus on my work and not worry about getting other nurses in trouble. *****!?! I bit my tongue and went about my job. I got my lab results and updated the doc. New orders noted and transcribed. The doc d/c the Coumadin. Also alarming was that she was severly dehydrated. The flushes were increased. After another lab a week later came back, the doc wasnt impressed and ordered for IV fluids for 48hrs and labs repeated the next day. The DON was getting upset bc according to the labwork..it looks like she is not getting her flushes. SMH. I made sure I had someone with me when I gave her her flushes.
Then. it happened. State walks in. Not for survey. For a complaint. I thought my nurse manager was going to die. He was running around like he didnt know what to do next. A very nice lady asked me a question, I answered her honestly. It was about a resident that was no longer at our facility. She then asked about who does the wound care and who is in charge of wound treatments. I was about to answer her when my nurse manager jumped in and took over. I laughed because he had no idea when the wound doc made his rounds....and he is the wound care nurse!!!
That wasnt the only time I was able to see my nurse manager freak out...state came a total of 6 times since January!! And not for survey. By mid April, I started looking for another job. There were so many things going wrong...I knew when state came back for survey..we were in big trouble. It was just a matter of time. I stayed as long as I did because I loved loved my residents. They were like my family!! So when state walked in last week, I was scared.
On Monday, they came in and just walked around. They asked questions, I answered. They watched me pass meds. They reviewed charts. On Tuesday, I was again asked if they can follow me and I said yes. I went about my day as if they were not there. I felt I did everything to the the "T". It was about 1pm, when a surveyor was reviewing a chart,and asked me a question. It was my new patient with MS . She wanted to know why no one ordered any lab work prior to last month. I said I wasnt sure, she was a new transfer but I would get my nurse manager to help. After that, she said thanks and she went on down the hall. I sat downt to start charting but then I was paged to the Admin office. I go in and there is my DON, a social worker, and the Admin. My DON tells me to sit down and she starts talking about my med pass and me answering questions to the surveryor. She said that I violated the facilities policy about speaking to a state surveyor. Then she said that during my med pass, the surveyor said that I gave a patient their inhaler and instructed them to take one puff and then to rinse their mouth, then took the inhaler back. She spoke to her nurse consult and it was suggested that I be terminated. I was to immediatly give the report, count and the keys to the nurse manager. I was also instructed to do so without causing a scene. I had 10 mins to leave the premises.
I was shocked, but not because I was fired...the reasons I was fired and the way they treated me. I was followed by the social worker. I was not allowed to speak to anyone. And then I was followed out to my car. Really?!
What hurt me was that I was not given the chance to say good bye to my residents. I became attach to them and I find my self still thinking of them.
I did get a new job on Thursday. I also heard that the nurse manager, two other LPNs, and the DON have also been fired.
The adminstrator called me this morning and wants a statement from me. Its not required and it will not get my job back. But he feels that my termination was premature, if even at all necessary and that other events that could have been prevented it.
I am not sure what happened...and at this point..does it really matter?
