Fired nurses in Louisville, Ky

PMHNP10 · Nov 3, 2003

So bottom line...please someone redirect me if I am misunderstanding this: You were all practicing medicine in effect, but so have many many nurses before you and your colleagues in this hospital. So what this boils down to is y'all were sacrificial lambs because of perhaps some extracurricular activities y'all were supposedly participating in--I dare not mention that supposed activity. If I am totally off base, then I am flapping my jaws in the wind so to speak. If I'm not incorrect, then I have to wonder who was the stoolie who left y'all out to dry? I also have to wonder how the day shift nurses handled such situations (pts pulling on tubes).

I guess no matter what, this teaches many people a lesson...1)CYA 2) never assume 3) always get a MD order 4) if you aren't in nursing, don't start now (most unfortunate, but most true as well I fear).

Anywho, I wish y'all luck in getting this situation resolved.

Fgr8Out · Nov 3, 2003

Originally posted by nursek86
Recently I was going through Google about this subject and found your web site. I think it is great. I found the discussion about the fired nurses. Well I am one of those nurses. The practice of giving Diprivan to patients that are on the vent has been one that has gone on for years. The adm have known about this but have given the blind eyes and ears to it. Other nurses that I know in other ICUs stated that the same is true there. Giving Diprivan is not a common or continious proceedure, only when the vented pt is combative or restless and no other sedation will help. It is only the LAST resort. Pt familys have even been grateful that it has helped through the nite. Ironic that all the nurses that it effected were nightshift nurses. I would be thankful to those of you to keep us in your prayers. YES the hospital did this to cover up what is really going on. I will keep you all posted about this. Thanks for letting me tell my side

All of your excuses do not negate the fact that you willfully sedated patients without an order, with medication that was 'left over' from a previous order, in a manner that was not prescribed. If that isn't "harmful" I'm afraid I don't know what is. You and your cohorts are ignoring a cardinal rule in nursing... ACCOUNTABILITY.

You are NOT accountable when you negligently fail to communicate with a physician that a patient requires pharmaceutical intervention because of a reluctance "to wake a doctor up in the middle of the night." You are NOT accountable when you say "everyone was doing it." You are NOT accountable when you attempt to play martyr and foist YOUR lapse in judgment onto others while you KNOWINGLY jeopardized lives that you were responsible for protecting. Regardless of the fact that others in this hospital may have been negligent as well, no one put a gun to your head and forced to you act as you did.

Just so you (and those respondents who appear to SUPPORT this event) don't think I'm without understanding... I can't imagine working under the conditions that you relate and I sympathize with the obvious frustrations that most certainly were felt. To try and practice in a facility where physicians and administration were not accountable would surely elicit fear and insecurity in myself. However, you chose to remain in spite of this knowledge and willingly participated in the malpractice that was supported by this institution. You DID have options, including leaving that particular Unit, notifying the appropriate authorities or even leaving the hospital entirely. Unfortunately, you and your coworkers made the wrong decisions and you are being held accountable for that action. To blame anyone else for your decisions is simply further evidence of your lack of accountability.

Yes, I'm sure you and others will berate me for my comments with such logic as "no one would support our efforts to properly care for our patients and unless we acted as we did their lives would be compromised anyway, so we chose the lesser of two evils." To which I would once again respond, "where is the accountability?" Two AM phone calls to physicians, documentation, changing shifts or units, reporting to your supervisors/managers/administration and even resigning are examples of being accountable... and preferable to the decisions you made. It's certainly fair to say you were in a no win situation.

I offer my prayers to you and hope the administration at your hospital is held accountable for their deplorable lack of action in this case.

mattsmom81 · Nov 3, 2003

Just a tad harsh Figure8out. Kick 'em when they're down, eh?

Nurse 86, I am glad you found us and I am sending out good thoughts to your group and hoping for good outcomes for you all.

As someone who also struggles in an unsupportive critical care environment with coercive 'common practices' that are not always clear in writing, I can empathize.

(((HUGS))) Hope you have a strong support system to help get you through all this. PM anytime if you want to vent. :kiss

sanakruz, ADN · Nov 3, 2003

Fgr8Out of Reno Nevada-

I agree this cant be "justified", but most of us can see the real reason these nurses were fired had little to do with the official reason:eek:

Fgr8Out · Nov 3, 2003

Originally posted by mattsmom81
Just a tad harsh Figure8out. Kick 'em when they're down, eh?

Not at all. I conveyed my concern for the situation and it's a tragedy at best, particularly for staff who felt they had no choice but to violate State Nursing Laws. Having sympathy for another does not have to include agreement with how a situation was handled. But all the hugs and best wishes in the world don't negate the fact that laws were broken. The role of "cheerful martyr" just isn't very appealing and all the boohooing I see on this post further illustrates my belief that accountability is not being stressed in our Profession often enough. Or can we even call ourselves a Profession when we don't even have the ethics to be accountable for our actions, or lack thereof?

I hope the case in Kentucky will put on alert others who are making excuses for (or turning their heads at) inappropriate practices and spur them into making better choices and placing accountability as a priority for everyone.

Fgr8Out · Nov 3, 2003

Originally posted by sanakruz
Fgr8Out of Reno Nevada-
I agree this cant be "justified", but most of us can see the real reason these nurses were fired had little to do with the official reason:eek:

Please elaborate. I'd love to know what "the real reason" has to do with bad Nursing Practice, regardless of extenuating circumstances. If a situation is bad, you get out. Period.

sbic56, BSN, RN · Nov 3, 2003

Fgr8Out

I think what we will discover is that there is much more to this than giving diprivan w/o an order. nursek86 is wisely not giving all the details while the case is pending. Moral of this story is apt to be: no matter how much of a supernurse one tries to be, if the administration is out to get you, you're gone. I choose to see how this plays out before I admonish anyone for anything.

sanakruz, ADN · Nov 4, 2003

Well said, sbic

Fgr8Out · Nov 4, 2003

Originally posted by sbic56
Fgr8Out

I think what we will discover is that there is much more to this than giving diprivan w/o an order. nursek86 is wisely not giving all the details while the case is pending. Moral of this story is apt to be: no matter how much of a supernurse one tries to be, if the administration is out to get you, you're gone. I choose to see how this plays out before I admonish anyone for anything.

No amount of harassment or blinders on the part of administration or whomever justifies practicing medicine without a license. Period. Not only does one put their license in jeopardy, but there is also the risk of criminal charges. I'm certainly not willing to go to jail for my employer. Nothing my employer threatened me with would force me to risk MY livlihood for a business. I truly would seek employment elsewhere, notify the AMA, the press and my Representatives, the Ombudsman and anyone else I could think of, to expose the practices of such an institution. I simply would not allow myself to be victimized and I won't be swayed by any conspiracy theories or anything else to that effect.

Thank you, Sbic56, for your professional response to my comments.

sbic56, BSN, RN · Nov 4, 2003

Originally posted by sanakruz
Well said, sbic

Thanx, sankruz. It will be an education to us all to see how this plays out.

Fgr8Out

I understand the ideals you support; it's just that I don't see the illegal use of diprivan as being the issue here, so the actual allegations are of less importance than the reasoning behind them. If the reasoning were to assure patient safety, that would be a totally different situation, but this is nothing more than bad politics.

grouchy · Nov 4, 2003

Nurse K86,

I was so glad to get a chance to hear your side of the story. However, I would agree with what was previously said about saying little or nothing - even anonymously- while litigation is pending, unless you have your lawyer OK it.

My prayers go out to you and your coworkers.

I have to say my jaw dropped as I read your post. I recently left an ICU. It was my first and only ICU job. It was the practice in my unit to have an order that allowed us to titrate Diprivan and other drips to sedation. This is what I was oriented to do, and it was the standard practice. I literally had no idea that this could be illegal until I read your post! Did I misunderstand you? My interpretation of what you said was that you had an order for the diprivan drip, but did not get orders to bolus or titrate it upwards. However, I may have misunderstood you, as it sounds like you were also using leftover meds.

Maybe you shouldn't even reply to this. But, can anyone else comment on what the legalities and general standards of practice are in this area?

I feel frustrated when I read posts here condemning the fired nurses. I don't think giving meds without an order is OK. But, when I look at the fired nurses, I think "There but for the grace of God go I." I know that I work in an extremely dysfunctional health care system ( And, by that, I mean the health care system in general, and not my employer.). Often, as I return to work after a really scary shift I wonder if the upcoming shift will be the one where I lose my license. No, I don't routinely cut corners, but, yes, I have been in plenty of emergencies and crazy sitautions where corners got cut as I attempted to deal with the most important priorities. When this happens I pray that noone is harmed - including me.

Some people say you had a choice to walk away and go to a better employer. Did you? One thing I immediately thought of as I read the initial news article was that this occurred in a relatively rural state. Maybe there are not alot of other opportunities within a reasonable distance. Personally, I work in an area with many hospitals. I stay at my present employer because, despite the problems I have alluded to, they are considered one of the best in the area by nurses. So, there are alot of jobs but not alot of choices.

Some people here seem to be under the impression that "not bothering the physician" is a simply a matter of the nurse not being assertive. Well, I have seen situations where there are institutional disincentives for calling. For example, I have seen both nursing managers and medical directors chastise nurses for calling doctors "too much". Sometimes, all of the experienced staff have learned to go along with these expectations. If you are new to the profession or the floor, it can be very difficult to buck the system without making yourself a target of dysfunctional, punitive behavior.

Having seen what I have seen, there is no way I can seperate out these illegal actions from the context they occurred in. I don't want to free the nurses involved from accountability. I want to see everyone involved, including the doctors,and administration accept accountability so that real reform can occur.

sbic56, BSN, RN · Nov 4, 2003

Grouchy

Great post! You further explain the reality of nursing. We need ideals as a guide, but the real world is never ideal.