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gonzo1 19,628 Views

Joined Jun 8, '05. Posts: 1,727 (46% Liked) Likes: 2,466

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  • Aug 16

    no you are wrong. the hospital can still turn your license in to the BON and you can still be prosecuted. don't ever feel safe no matter who you work for. a patient or family can turn your license in. you are very foolish to think you are safe. get malpractice insurance and chart carefully. your company will not stand be home you if you are let go by the hospital through your company. I know I have been there as the supervisor at the facility wrote me up 3 times without my knowledge and I was let go. I said when was I written up and what was the reason? the company did not know but I was unable to use them for a job. I had to go to a different company. Think again, Nurse, you are not safe.

  • Aug 16

    Come out to the floor and take care of just one patient all day and you will understand

  • Aug 16

    Been there, done that, got the claw marks on my back to prove it. People can forgive anything but a manager who's risen through the ranks. It's the most thankless job there is, and I feel your pain, OP. ((((HUGS))))

  • Aug 16

    Welcome to AN.com I.Am.A.Nurse!

    I appreciate your straight shooting way, telling it like it is, ranting a bit, and then asking for advice. I sense no hidden agendas here.

    I can also appreciate your position as a manager, working long hours, spinning your wheels in superfluous meetings, and lacking support. These are some of the reasons I got out of the management area of nursing and am a floor nurse doing grunt work. I do my job and leave the work when I leave the hospital.

    No matter how hard you try to prove the opposite to those you supervise, you're still one of "them".

    The very best you, I.Am.A.Nurse in your endeavor work in a fulfilling position.

    BTW: If the Mods don't move your thread, check out this forum:
    http://allnurses.com/nurse-management/

    leonard-jpg

  • Aug 14

    The error should be easy to avoid: The little vial (1:1000) that you have to break to get into and extract with a syringe is designed for IM. The big one (1:10,000) which is pre-diluted and comes with a lure lock attachment is designed for IV administration.

    Interesting and helpful discussion for me anyway -- even though we strayed from the medication error part of the story. Thank you to MunoRN and JKL33 for adding the links. So, summarizing some key points from the links, when using epi to treat anaphylaxis:

    1. IM is preferred to SQ.

    2. The right thigh site provides a faster increase in blood levels than the upper arm.

    3. The turning point for using IV epi is "cardiovascular collapse," or a rapid progression in that direction, due to the potential for adverse effects from the IV route if it is not clinically indicated.

    From my experience, IM epi works in minutes. Any IV push can be over one, two or several minutes; it doesn't have to be jammed in over a few seconds -- unless the patient is in cardiovascular collapse or rapidly headed that way. Young healthy hearts can tolerate epi better than old diseased hearts. Evaluate and treat the patient as needed while mitigating risk. Most allergic reactions, even those with mild to moderate angioedema, can be treated with IV benadryl, solumedrol and pepcid. But these patients can decompensate really fast, and they deserve our constant attention until the threat is neutralized.

  • Aug 14

    Quote from JKL33
    It was given for "allergic reaction" as above. I've never given epi IV for that indication; it is given IM regardless of IV access or no IV access. I have seen adverse cardiac effects from the error described in the OP.
    The OP's example was regarding SQ injection, which is not the preferred recommended route for anaphylaxis, IM is considered an appropriate alternative for IV particularly when given by someone not experienced with epinephrine or the ability to closely monitor the patient (or when there is no IV access). When given at the appropriate rate and with the appropriate monitoring, IV is more predictable and better facilitates avoiding giving an excessive dose.

    Appropriate route of administration of epinephrine

  • Jul 8

    Okay that is actually a pretty terrible policy. The hospital I worked for was a small one so everyone got low censused every once in a while. We were called 2hrs prior to start of shift if we were low census. If we didnt go in at all, we got 4 hours of our normal pay automatically. If we got called in, we got however many hours we worked instead of the 4 hours. Most od us live within an hour away but the policy was flexible for those who lived outside of that. Since it was such a small hospital we csn usually tell if our census would increase enough to need to call in our LC nurse. We would end up sending a "be ready" text. That gave them time to get stuff ready of needed. Most of us keep an extra set of scrubs in the car for emergencies anyway.

    I got called into work when I had my kids for an emergency delivery. I wasn't on that day but had the most experience. I had no one to watch my children so my boss told me to bring them with me. She watched them and I went into the OR for the emergency section. I stayed, recovered mom and baby, charted, and left both patients with the on duty nurse and the one who was originally called in but was stuck in traffic and wouldn't get there in time. Ended up being there for about 4 hours. Small town hospital, but a lot of support. It's hard to find that nowadays

  • Jun 15

    PS I love this man with all my heart! He may be "cantankerous and ornery" with me, lowly Dogan that I am, all he wants, but he loves his grandboys! And that is all I care about! I thank the small gods every day that he survived to teach them all he knows about hunting, fishing and snaffling coo beasties!

  • Jun 15

    Quote from Wuzzie
    I went back in about 30-45 minutes later to start morgue care and noticed the tips of his ears were pink and getting pinker. Next thing I know he took a breath. Not an agonal breath but a real honest to goodness breath. I threw the curtain open and yelled "Dr. N he's aliiiiiiiiiive.
    OMG, I might have peed my scrubs! lol. That is pretty amazing.

    Ours was a young patient who apparently experienced sudden cardiac death, found by roommates down in the bathroom after they heard a thud. We worked this patient FOREVER, and achieved ROSC when we thought it was way past time to call it (but our doc just refused to call it, to his credit — spider sense?). That young patient walked in with their parents some months later to thank us, and everyone got choked up. It was amazing. Very few deficits for such a long downtime, just some minor memory issues (I guess we perfused the heck out of that brain with our CPR). I will never forget the patient's mom hugging our crusty ol' doc and thanking him for saving her child. My eyes well up even now!

  • Jun 15

    I know what you mean, but the one time you have someone you thought was futile walk back into your department under his/her own power to thank the physician and staff, it changes you forever.

  • May 21

    Quote from poopylala
    I ... Where have all the older nurses gone?
    Gone? Early to bed mostly as we need more sleep

  • May 21

    Quote from SoundofMusic
    Oh gosh ... a travel nurse ought to have a triple policy.... so much risk, especially also not knowing your staff all that well. I have to wonder about the lawyers, too. Mine never asked if I had insurance -- but I wish I had.
    The facility will throw the travel nurse under the bus any chance they get!

  • May 21

    Hello:

    Wanted to post this, as a way to share my story, and help another practitioner avoid what I've gone through over the past few months. Many of you out there are probably too smart to land where I did, but then again, many out there who are new or who are cruising along just not thinking about it may benefit from my advice.

    Earlier this year I was involved in a patient dispute, was terminated from my position, and the company reported me to the Board of Nursing.

    There was no harm done to the patient -- more of a charting/billing issue in which I made an incredibly dumb mistake while working in a very pressured position in a retail setting and had zero administrative support to fall back on.

    Anyway, a few lessons here I'd like to share:

    1. FIRST AND FOREMOST -- get a malpractice policy and keep it current at all times, every minute while you are working. The malpractice policy will come in handy when you have to hire a lawyer to represent you in any dealings with the BON, even if you are innocent. Remember, ANYONE can report you to the BON -- a co-worker, a patient, a "friend," a doctor ....anyone.

    2. Don't panic, and get a lawyer. There are lawyers out there who do this for a living and will counsel and advise you on how to present yourself in the best light to the investigators and/or board. Be prepared to fork out at least $2500 to start to retain them. It will go up from there if there are additional needs.

    3. If you're in a bad job where you are not supported, or perhaps not really getting along with people you work with, or are unsure of their support, LEAVE as soon as possible and find a better job. Even if you are being paid well with outstanding benefits, etc. There is sometimes so much risk in what we do -- and patients are unpredictable and have the entitlement mentality going in many cases. Don't do patients any favors ...follow the policies of your employer at all times. Do not stay in a job where you feel you are being asked to do more than you can handle -- eventually something can and will happen. Call for help when you need it.

    4. If you make an error, do NOT expect the company to come to your aid. They will throw you "under the bus" so to speak very quickly. And rightly so -- they have a company to uphold, and you are just not the priority to them. Thus, the malpractice policy, again -- very important.

    5. Take care of yourself -- get counseling, get therapy -- whatever it takes. It's an intensely rough situation to go through -- you may be dealing with the loss of your income, the loss of your colleague support, the loss of your identity -- extremely rough thing. Was for me -- it just about killed me, literally. Luckily I had a wonderful medical provider (an NP who is fantastic) who recommended various steps for me to talk to get my equilibrium back, both mentally and professionally. Luckily I also have a wonderful spouse, family and friends who were there to support me. Luckily, my husband provides an income that we can get by on without my income. If this is not the case for you, you REALLY need to hear this.

    6. Be truthful, and tell the story. Tell every detail, and don't try to cover up anything that you did. Yes, it will difficult and mortifying at times to admit what you did ...but this is what I did -- and in the end, the new doctor I will be working with knows the entire details of my story, and has been completely understanding. I had to go on many many interviews after being fired, however, and some of them were not pretty because I was just not ready to present myself properly. I also had to explain to the malpractice company what had happened to be cleared by them. I may receive a "reprimand" to my license soon, and it will follow me forever, unless I get it expunged from my record.

    7. Know that you are in an extremely demanding profession and that you are held to an a very high standard -- higher than an RN. Go on the BON site and do a little CME for yourself -- look at the discipline process - look at the various types of discipline that can result from your errors. (for example, Getting a DUI is an instant LOSS of your license, etc.) Know that once you receive a public discipline, it will not only be reported to the state you worked in, but any other state in which you have a license. It will be public, and it will also be sent to a national data bank where anyone will be able to see it as long as you have it. It may make getting certain jobs very difficult.

    8. While you may love and admire your colleagues, they are not your friends. They are sort of like that company you work for ....they'll help you to a degree, but when push comes to shove, everyone will have their own best interests in mind. You WILL stand alone to defend yourself. Be good, be friendly, but always keep that professional boundary with them.

    9. Do the best job you can and do try to make a few contacts at your job who you may need to use later as references. I am thankful that I had a very good relationship with some of my colleagues and that they were absolutely there to support me through this ordeal. But that's because I always helped them when I could, and I tried to be a decent person at work.

    Now that I have somewhat survived this ordeal and looking back, I'm not sure I'd change a thing -- I learned so much -- learned about the reality of the profession, learned about myself and who I am. Got knocked down from my very high horse (and I was on a high one -- I was a top clinician and producer for my organization and thought I could do no wrong). Learned how to handle a tough situation, learned the law, and learned that there are better jobs out there. Most of all, I learned that TRUTH is key ....be truthful in everything you do, even if it means letting a patient yell or get a little mad. Your license and your livelihood is at risk -- and really nothing is worth that, ever.

    And lastly, do not affix your identity to this job. For me, I had to re-learn that my worth as a person is not defined by what I do, or how much money I make, etc. This is probably one of the hardest things I had to re-learn and face. Love your job, but love your God, your spouse, your family, your life that make life worth living ... these are the things that will ultimately sustain you in the end.

  • May 21
  • May 21

    I got a hearty pat on the back. Of course the hand had a knife in it.


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