Fired nurses in Louisville, Ky

mattsmom81 · Nov 4, 2003

Great posts Grouchy and Sbic...ITA!! :cool:

BadBird, BSN, RN · Nov 4, 2003

Diprovan is a great drug for patients that are wild and on the ventilator. My question is why don't you just get a order for it. Become part of a committee, make it a standard order for agitated ventilator patients. Obtaining a order is not impossible, the rest of us do it. I realize there is more to the story than this but we all know to obtain orders for any medication. I sense there is a lot of missing information.

PMHNP10 · Nov 5, 2003

Originally posted by BadBird
My question is why don't you just get a order for it. Become part of a committee, make it a standard order for agitated ventilator patients. Obtaining a order is not impossible, the rest of us do it.

Your question is certainly valid...or to add to that thought, why didn't a day nurse get an order...surely patients don't tug on their tubes strictly during the night. I propose a better question, though: Why didn't these MDs write PRN orders for their patients upon admission, in the first place? You and I and everyone else knows these patients are occassionally going to fight the vent. So now my question is: Do the MDs not care if their patients become agitated, or even combatative which could result in serious consequences? Their actions (or lack of) indicate a lack of interest in protecting their patients. I somehow doubt that this is the case, though. On a similar note, I also wonder why not 1 nurse on 1 occassion asked for those PRN orders at some time. Again, I doubt 23+ nurses were knowingly breaking the cardinal nursing rule. Definitely a messed up situation and system all around. I certainly hope justice is served.

BBFRN, BSN, PhD · Nov 5, 2003

Nursek86, I PMd you.

Grouchy, we have 19 acute care hospitals here in Louisville alone. :)

Rhon1991 · Nov 5, 2003

Originally posted by nursek86
We have standing orders for the Diprivan gtt, but not to give a bolus, besides the drug was always available on the unit and when a pt was on the gtt and it was d/c the pharmancy never requested it back. ... Needless to say we did not have an order for the bolus!!. When things get wild and crazy your main concern is the pt.

Im confused. So there WAS an order for the gtt but not boluses? Diprivan is usually ordered 'titrate to sedation' up to 50mcgs. We HAVE to bolus at times, especially after we have turned it off to assess underlying neuro status and the pt wakes up quickly (Thanks to the short half life) and sometimes very agitated especially if no pain meds have been given -if they are in pain. But its usually because they wake up so quickly and they go fast and fierce for the ETT. So thats why we use restaints also, but sometimes they still manage to get to it or damn close... (But those of us who work with diprivan understand all this)

ok, then the gtt is DC'd but is continued anyway because there is left over? That tells me the pt is still vented and thus continued by the nurse... Is the order actually DC'd or is the standing order expired? Either way, its all just confusing. Why would a doc dc a diprivan order on a vented pt and not replace it with something else? Is that even the case? Or is gtt dc'd by doc and just turned off but left hanging and only turned on for boluses for the vented pt? That doesnt make much sense either. So I will wait until I hear more details before I ask another hundred questions.

My last question would be, did the nurses actually realize they were doing anything 'illegal'??

(ok, so Im not done here)

This is really a heads up to me because I see things done differently everywhere I go and can see where 'institutionally sanctioned' can lead you to believe you ARE within your scope of nursing practice.

i'm not going to judge since i was not there. i will however like to learn from the KY situation.

nursek86 · Nov 11, 2003

I am glad that there are so many nurses out there to talk to. You all are valid in your thoughts. I think when you stay somewhere so long you get the old comfortable shoe feeling and that is not good. I will let you all know when things get resolved. As for now it will be a wait. You all are a great bunch of people and as nurses words can't express what a truly unique profession it is.

carcha · Nov 11, 2003

I have found this whole thing really interesting. Surely if the medical staff stood up for u all then it would just be a case of poor practice and communication, a slap on the wrist and a "dont do it again". So what did the docs say?

NeuroICURN · Oct 5, 2004

Ok, it's almost a year later....any updates? Can anyone tell the whole story now? why were they really fired???? what was it alleged that they did?

nursek86 · Oct 7, 2004

Ok, it's almost a year later....any updates? Can anyone tell the whole story now? why were they really fired???? what was it alleged that they did?

Well I can't believe that it has been that long. Guess I just let my mind wonder too much. Well the end of the story is.... Even tho the nurses were terminated from the hospital. we all have jobs now and I must say we came out much better. The Ky Bd of Nursing had their hearings. Needless to say they were not too happy about the whole mess. The hospital could have handled it internally and be done w/it. All the nurses were given a reprimand and had to pay a fine. do some hours in conscious sedation. The hospital wanted to get rid of some of us for a long time because we spoke out for a nursing union, which is desparately needed. Those of us who were pro union that were involved was an oppertunity for the hospital to get rid of us. So needless to say we all went. There are still some working that were involved but were pro hospital and unfortunately did not tell the truth. Guess it pays to lie. Thanks for asking. I AM SO GLAD THAT IT IS OVER. I have a terrific job and have NO STRESS and am able to talk w/well people. I have even gotten my sence of humor back. In reality I think the hospital did me a favor. Nursing is still the greatest porfession in the world. Nursek86

Dixielee, BSN, RN · Oct 7, 2004

This is the first I had heard of this story, sorry you had such a horrible thing happen to you. We give diprivan whenever we have a vented patient in the ER. Our orders are always, "titrate to effect", and bolus as needed. It takes a few minutes for the effect to be evident, so starting at a few drops per minute are not going to do the trick. I am amazed that this went as far as it did. I have to think that this is probably common practice. Glad you had a silver lining to that cloud!

NeuroICURN · Oct 7, 2004

Glad to hear that everything worked out for you. However, could you please clear up why you were fired and what actually happened?

sdmurfy · Oct 7, 2004

I agree with the comments regarding accountability. Sometimes it feels like nurses are left out in the cold because of the rude behavior of some docs when called at night. This makes doing the right thing very difficult. Although I have great sympathy for the fired nurses, I believe in following the rules. Giving medication without an order is not following the rules. How do you apologize to a dead patient or to their family? I have seen it happen and the pain for everyone is unbearable. :saint:

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.