Code Gone Wrong

[h20rn]

First Time Traveler....half Way Through My Contract And Have Witnessed Multiple Patient Safety Issues And Two Sentinal Events. I Have Voiced My Concerns To The Dirrector Of The Icu And He Said, "i Wish People Would Just Show Up And Do Their Jobs And Not Worry About A Bunch Of Other Stuff". This Morning A 27 Y/o Female Was Intubated In The Right Mainstem And Despite All Of The Obvious Signs Pointing To Anoxia, The Md Refused To Reintubate Until He Got The X-ray Back...basically 45 Min Into The Code. X-ray Showed What All The Signs Were Pointing To And Pt Now Has Anoxic Brain Injury. Also Md Refused To Put In A Line, Order Gtts Or...ok You Get The Point. I Cant Stand By And Be A Part Of This Anymore So I Called My Agency And Asked To Break My Contract....they Will Charge Me 2500.00. Anyone Have Anything Similar Happen? Do I Really Have To Pay Due To A Grossly Negligent Hospital? Am I Over Reacting? Please Advise.

[donsterRN, ASN, BSN]

On the topic of capitalized first letters of each word... this also happens when some posters submit their posts at work. Some corporate computer systems convert the text to what you see here. It is hardly ever the fault of the poster. Wouldn't capitalizing the first letter of each word be very time consuming? I cannot imagine someone doing it deliberately.

Carry on!

[sjt9721, BSN, RN]

Carry on!

...and now back to your regularly scheduled message thread...

:monkeydance:

[NurseCard, ADN]

I have to mostly second what everyone else has said. Do whatever you can to intervene to help your patients when there is an emergency, **DOCUMENT** everything!!! If you do all of this, I don't see why you have much to worry about, as far as worrying about your license. I know it is scary to work in an environment like this, but if you do everything that you can, and document everything, then you have every leg to stand on in court.

I agree with the person who said, when you are a traveler you have to be a "go with the flow" kind of person. That's kind of how I am, and I'd probably make a good traveler; in fact I'll probably try traveling when my kids get much older. I'm not much interested in changing the whole environment of where I work; I'm mostly interested in doing what I can to help my patients, and then going home. I enjoy what I do quite a bit, but I can't change everything that goes on.

[sharona97, BSN, RN]

Forgive me if I sound judgemental, but I keep reading here about travelers who get stuck in contracts and complain about how the hospitals they get assigned to are inadequate and how they need to break their contracts because they just can't compromise their personal standards.

I kind of think that people who travel should realize ahead of time that they don't get to pick and choose the hospitals and if they have really high standards they should not be a traveler but instead carefully select a hospital they want to work for and become a regular employee.

Sorry to be the bad guy, but IMO personal standards are so different inbetween individuals than the correct standard of care. I have to go with the OP on this one. A good insightful nurse, whether travelling or not,has no clue as to how "others" at the facility will or would respond, or how the doctor can be approached or unapproached, all they know is that their nursing standard of care is right up on top and they stick to their guns to protect their license and the patient.

We tell nurses on this bb everyday, walk away. It's not the OP's fault he /she chose traveling rather than outpatient surgery at the same department for 45 years.

It ultimately is the nursing standard of care that all nurses should be following regardless of what or who the patient is.

OKk I'm done now.

[suanna]

You are a traveler- in my experience any hospital that uses traveling nurse contracts has enough problems with staffing and standards of care that they can't recruit and retain a stable nursing staff. As a traveler you are a stop gap to solution to deal with a staffing crisis. By the very nature of traveling nurse you will not be very effective to helping to solve long term problems in a providers care delivery- that requires a long term commitment. That is a generalization I know, but the I can only base it on my experience.

As to the specific instance you described- a RMS intubation is better than none and with adequate bagging and O2 you can mantain an acceptable PaO2 until ETT placement can be corrected. I suspect the encephalopathy could be from inadequate perfusion when the patient coded or hypoxia before intubation. I wasn't there, and even if I was there is no way to say for sure.

KUDOS for you standards but if you want to be part of the long term solution, quit traveling and join the team.

[Ruby Vee, BSN]

sorry to be the bad guy, but imo personal standards are so different inbetween individuals than the correct standard of care. i have to go with the op on this one. a good insightful nurse, whether travelling or not,has no clue as to how "others" at the facility will or would respond, or how the doctor can be approached or unapproached, all they know is that their nursing standard of care is right up on top and they stick to their guns to protect their license and the patient.

we tell nurses on this bb everyday, walk away. it's not the op's fault he /she chose traveling rather than outpatient surgery at the same department for 45 years.

it ultimately is the nursing standard of care that all nurses should be following regardless of what or who the patient is.

okk i'm done now.

actually, it was the original poster's choice to choose traveling rather than outpatient surgery at the same department for 45 years. that said, traveling has it's own particular set of problems, and walking into an unsafe unit with unsafe practices and unapproachable physicians is one of them. if you find that you absolutely cannot tolerate the situation, for whatever reason, then you are well within your rights as a human being to try to get out of that situation. if, however, you signed a contract you may have to choose to stay the course or put up the money you agreed to pay if you break the contract.

i think the experience of traveling has a lot to do with your recruiter and how much they support/protect you. dh and i had a lousy recruiter -- traveling was a miserable experience for us. nevertheless, we're going to try it again when the child is through school!

[sharona97, BSN, RN]

Your right Ruby it is a choice OF A NURSE to either travel or stay put. Doesn't excuse the cost of possibly losing your license. If the contract is tight and they won't budge, I'd be documenting a book, going up the ladder, anything to CYA.

I realize there are some crummy recruiters out there, but that doesn't make it right when someone errors on duty that could possibly take your license. Period.

I'd do the same thing as I just mentioned even if I was an employee in a facility and was involved in something as serious as this appears to be. Just my opinion.

If it was a crummy place to work in the first place without my knowledge, does that mean it's ok to let the nursing standards diminish? No. When you are an active "regular" employee does that mean you should let nursing standards diminish or accept that they have or are? No. My license is just that, my license and I carry great pride in being a damn good nurse and expect others to do their job correctly and within their scope.

For whatever reasons travelers are black-marked by some is a judgement call. The bottom line is that you have privelege and duty to uphold nursing standards and do the right thing if someones life is altered just because.

[sharona97, BSN, RN]

Forgive me if I sound judgemental, but I keep reading here about travelers who get stuck in contracts and complain about how the hospitals they get assigned to are inadequate and how they need to break their contracts because they just can't compromise their personal standards.

I kind of think that people who travel should realize ahead of time that they don't get to pick and choose the hospitals and if they have really high standards they should not be a traveler but instead carefully select a hospital they want to work for and become a regular employee.

There is a difference between personal standards and the oath of the nursing standards we agreed to follow as nurses.

I hear the op expressing the injustice done to a patient that maybe could have had a better turnout. He acknowledges his contract, does the contract acknowledge the OP's licensure? Would any of us want this to happen on our shift?

I don't hear him complaining that he didn't go with the flow, his manager sure complained about that, but what if it was the manager's mother, would the same thing be said?

[sharona97, BSN, RN]

I wouldn't consider avoiding anoxic brain injury in a patient a "really high standard".

I'm sorry this is happening to you, I hope it works out in the end.

WOW. Knock, Knock

[Nurseboy1]

The OP does say that already in this assignment he has witnessed 2 sentinal events already as well as this apparent disaster of a code. What has been described to me seems pure mismanagement, he also described a director that seemed more concerned with warm bodies on the unit rather than the actual standard of care provided.

My 0.02 would be to get out of dodge as fast as possible.

BTW regardless of whether or not the nurse is a traveler, this sounds like a completely dysfunctional unit. If I was hired as a staff nurse I would still get out as fast as possible.

[h20rn]

it wasnt really my choice to travel....family emergency, but all the same I am not complaining about it being such a bad assignment as much as I feel as if I witnessed an actual train wreck happen to this poor little girl who already had enough problems. They wouldnt even order D50 to tx her bs of 40 for God sakes! I just felt like they were killing her rather than helping her

[sharona97, BSN, RN]

You did the best you could with what you had control over to work with.