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Finding a job with pending accusation

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Specializes in BSN RN CEN. Has 7 years experience.

Hi guys, I'm looking for words of encouragement or success stories.

I'm an ER nurse with 6 years of experience. The past 3 years I've been having the time of my life doing travel nursing. unfortunately my last contract was cancelled 4 days before my start date because of low census ("we hired too many nurses - sorry"). 2 days after this cancellation I'm notified by the board that I have a accusation against my license.

Early last year (2019) I had a emergency verbal order to restrain a confused patient that came into our department in respiratory distress. The patient was pulling out lines and grabbing at the nursing and RT staff. After the ABG came back the physician ordered BiPAP and the patient was placed on BiPAP while restrained. Long story short the intensivist came down stairs and found this patient restrained while on BiPAP and was not happy.

The ER MD denied any knowledge of the restraints and the intensivist reported me to my agency who then in turn "had to" report me to the board.

Now, a year later, and after 6k in lawyer fees, I'm facing the possibility of probationary measures placed on my license.

As I write this I am unemployed in central California. My agency states they cant work with me until the case is closed. In spite of shining letters of recommendation by every job I've ever worked facilities won't interview me with the pending investigation. My last contract wants to hire me but everything is on a hiring freeze because of CoVID - 19.

Has anyone been through this and can you offer words of encouragement or advice?

I'm stuck here in my lease away from home and ruminating about all the possible negative outcomes. Nights are long and days are slow.

Any advice, please - no negativity.

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

16 minutes ago, aspirationpneumonia said:

I had a emergency verbal order to restrain a confused patient that came into our department in respiratory distress.

The ER MD denied any knowledge of the restraints

This sucks like a Hoover!

I'm just trying to wrap my mind around this situation and anything that I can come up with has probably been gone over with your lawyer and others, aspirationpneumonia.

The basic law in Illinois states that anyone can initiate a restraint, but a Licensed Independent Practitioner needs to sign off on the order after making a face to face assessment to justify the need for a restraint.

As I understand, you received a verbal order, implemented the restraints, but the MD denies giving any such order, so didn't sign off on an order.

Jeez, I feel for you, as the patient obviously need to be restrained in order to receive emergency treatment which may have well saved their life, but the MD is crying ignorance.

The most that I can do is give you empathy, support, and maybe some discussion perspective.

I hope the best for you, aspirationpneimonia.

1 hour ago, aspirationpneumonia said:

[...]

The ER MD denied any knowledge of the restraints and the intensivist reported me to my agency who then in turn "had to" report me to the board.

[...]

Reported you for what, exactly?

I'm trying to see how not having a signed order for restraints warrants a report to, and subsequently t investigation by the BON.

Best wishes.

aspirationpneumonia

Specializes in BSN RN CEN. Has 7 years experience.

The allegation is that I did not have an order for restraints and that I restrained someone on BiPAP.

Numenor, BSN, MSN, NP

Specializes in Internal Medicine. Has 9 years experience.

4 hours ago, chare said:

Reported you for what, exactly?

I'm trying to see how not having a signed order for restraints warrants a report to, and subsequently t investigation by the BON.

Best wishes.

BIPAP and restraints are no bueno. that's why.

DextersDisciple, BSN, RN

Has 8 years experience.

3 hours ago, Numenor said:

BIPAP and restraints are no bueno. that's why.

Since when? I was thinking the opposite. In my experience BiPap pts we’re constantly ripping off their masks so restraints are absolutely necessary. Sounds like they could go downhill pretty fast if they weren’t compliant with the BiPap.

Emergent, RN

Specializes in ER. Has 28 years experience.

8 hours ago, Numenor said:

BIPAP and restraints are no bueno. that's why.

I hadn't heard that. Rationale?

Emergent, RN

Specializes in ER. Has 28 years experience.

I'm sorry this happened to you. You were obviously thrown under the bus. You might want to settle in one place and get a regular hospital job. I've heard that travel agencies don't work with people on this sort of stuff.

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

9 hours ago, Numenor said:

BIPAP and restraints are no bueno. that's why.

There are two categories of restraints: Behavioral and medical.

Behavioral restraints are generally applied to a patient in order to keep them from harming themselves or others. Behavioral restraints can also be used in order to administer emergency forced medication. Medical restraints are often applied in order to administered ordered medications and treatments. Medical restraints can be applied for IVs and RT txs.

If the Intensivist observed a a calm and/or sleeping patient receiving BIPAP, they might appropriately question the rationale for the restraints. Then, if the ERP proclaimed ignorance, the feces might hit the fan, as in this case.

24 minutes ago, Davey Do said:

[...]

If the Intensivist observed a a calm and/or sleeping patient receiving BIPAP, they might appropriately question the rationale for the restraints. Then, if the ERP proclaimed ignorance, the feces might hit the fan, as in this case.

Question it? Yes, of course. However, he or she needs to remember that they weren't there to see what precipitated application of restraints. If he or she felt the restraints had been applied inappropriately, or should have been removed based upon the patients current behavior, this should have been treated as a teachable moment.

Unless there is more to this than we are being told, reporting the OP to her or his agency, and the subsequent report to the BON seems rather extreme.

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

12 minutes ago, chare said:

he or she needs to remember that they weren't there to see what precipitated application of restraints.

There's often video monitoring in ERs which can support or negate a claim.

Wrongway Regional's ER recently had a big todo over the improper application of restraints which was caught on video.

12 minutes ago, chare said:

there is more to this than we are being told

Quite possibly.

Numenor, BSN, MSN, NP

Specializes in Internal Medicine. Has 9 years experience.

3 hours ago, Davey Do said:

There are two categories of restraints: Behavioral and medical.

Behavioral restraints are generally applied to a patient in order to keep them from harming themselves or others. Behavioral restraints can also be used in order to administer emergency forced medication. Medical restraints are often applied in order to administered ordered medications and treatments. Medical restraints can be applied for IVs and RT txs.

If the Intensivist observed a a calm and/or sleeping patient receiving BIPAP, they might appropriately question the rationale for the restraints. Then, if the ERP proclaimed ignorance, the feces might hit the fan, as in this case.

I am referring to the fact that restraints and bipap are a nono unless there is a 1:1 sitter.

3 hours ago, Emergent said:

I hadn't heard that. Rationale?

Aspiration. Unless you have a 1:1 sitter.

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

1 hour ago, Numenor said:

I am referring to the fact that restraints and bipap are a nono unless there is a 1:1 sitter.

Absolutely! A patient in restraints needs to be under direct observation.

Thanks for clarifying that point, as it was not made clear if the patient even had a sitter.

Numenor, BSN, MSN, NP

Specializes in Internal Medicine. Has 9 years experience.

3 hours ago, Davey Do said:

Absolutely! A patient in restraints needs to be under direct observation.

Thanks for clarifying that point, as it was not made clear if the patient even had a sitter.

That's what kind of tipped me to thinking that. I cant think why an attending would be mad otherwise.

It seems you were given a restraint order before bipap was placed.

You absolutely cannot have a patient who is on bipap in restraints. The reason being if they vomit, they cannot take the mask off resulting in that vomit being pushed into the lungs thus aiding aspiration, and possible death.

To anyone questioning this, please do not ever put your patient on bipap in restraints. It’s very dangerous. The restraints should have been removed as soon as the patient was put on bipap.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

I get that it’s an aspiration risk, but reporting to the BON seems excessive. How about “this is a safety concern; what other options do we have?” (eg nasal-only BiPAP, anxiolysis, 1:1 sitter.....)

I hate that you’re going through this OP.

Uroboros, APRN

Specializes in Advanced Practice Critical Care and Family Nursing. Has 17 years experience.

The darkest hour is just before dawn, and believe it or not you will be thankful for this experience. As nurses we genuinely desire to maximize and teach the intrinsic value of each and every person. Yet while enduring the reactionary consequences of fear from those very people, we ourselves can fall prey to our own nihilism. Abandonment, blame, feeling victimized, are all very human emotions and rather foolish to ignore. However, no one can endure that dark place for long. Nurses are often dubbed "heros" for various reasons, and rightly so. Heros rise to the top of every situation, they run to the dark cave everyone is running out of, they slay the dragon everyone is running from. Heros climb the tower to save the princess, and tolerate the flames of burning homes to save strangers.

So you're in this dark cave, the scared ER doctor threw you to the flames when his colleague legitimately questioned the restraints. Now the BON, who is the dragon, wants to eat you like a tender morsel, as they do every nurse in their gaze. Best thing you did was get an attorney, let them do the priceless dirty work you're paying them for. Hopefully the patient was not harmed, and if that's the case you'll be fine. Learn everything you can from this, because if I've witnessed and experienced anything in my long career it's the nativity of nurses. Be the hero, not the victim. Slay the dragon.

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

On 4/30/2020 at 4:10 PM, LovingLife123 said:

You absolutely cannot have a patient who is on bipap in restraints. The reason being if they vomit, they cannot take the mask off resulting in that vomit being pushed into the lungs thus aiding aspiration, and possible death.

You make a very good point, LovingLife.

However, if a patient is in restraints, they are considered to be a 1:1 and the sitter, who ranges from being a Tech or CNA to an RN, is required to be within an arm's length.

I have no experience with a patient in restraints being on BIPAP, so all I can offer is conjecture.