Fired nurses in Louisville, Ky

[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

[Rocknurse, MSN, APRN, NP]

I don't understand why the hospital didn't take the opportunity to devise a protocol that made things very clear, and used the opportunity to educate and streamline the experienced staff they already had, rather than firing everybody for a practise that was obviously an accepted one, albeit an incorrect one. So much for progressive and supportive management.

Where I worked in England we were allowed to start Diprivan without an order, and were responsible for titrating it as per needed, as long as we got a sliding scale limit and an order as soon as we could. We were encouraged to use our initiative, something I find missing in my experience as a nurse in the US. It seems that nurses are encouraged here to blindly follow orders without being able to tap into our wealth of experience and expertise.

I think all ICU nurses working with sedation should have regular courses and the effect and duration of various sedatives, and learn more about care of the airway and reversal procedures with all drugs, and then be encouraged to use our inititative more. There is power in knowledge.

[Sheri257]

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.

I totally agree. Last year, two southern California nurses gave a patient pain medication without a doctor's order. They argued they were simply trying to relieve the patient's excruciating pain, and they too were reluctant to wake up the doctor in the middle of the night.

So, they gave the unauthorized medication and the patient died within hours because of it. Both nurses were charged with negligent homicide/manslaughter. Needless to say, their careers are over. No second chances in this case.

I'm really surprized that anyone would try to argue, much less justify administering meds without a doctor's order. I don't care about union or admin politics. If you do this, the hospital is right to fire you.

The "everybody else was doing it, and some even got away with it by lying" excuse doesn't cut it.

[nursek86]

Just to clear things up a bit. No pt died from giving the diprivan. These pt were on vents (of course). Diprivan was not used freely. This practice had been going on for probably 5 yr +. Management was well aware of the practice as well as the DR. Diprivan was given as a last resort when all of the pain meds and versed were used and the vented pt continued to be aggitated. The reason this came to surface was a nurse in the OHU was giving his pt diprivan all nite. (I can't figure why, a little dab will do ya) anyway apparently he was also haveing b/p problems. When the day shift nurse came on, she ? him about it. he didn't do anything about the b/p and proceeded to tell he about giving the medication. No one cared much for this RN. So the Dr got mad and wanted to know why he did it. He said that everyone was doing it. OHU everyone DID give it. and to appease the Dr the hospital decided to have an investigation. So the whole thing snowballed. Even the Ky Bd of Nursing felt that this was an internal problem and a slap on the wrist and change in policy would have been enough.

[nursek86]

Just to clear things up a bit. No pt died from giving the diprivan. These pt were on vents (of course). Diprivan was not used freely. This practice had been going on for probably 5 yr +. Management was well aware of the practice as well as the DR. Diprivan was given as a last resort when all of the pain meds and versed were used and the vented pt continued to be aggitated. The reason this came to surface was a nurse in the OHU was giving his pt diprivan all nite. (I can't figure why, a little dab will do ya) anyway apparently he was also haveing b/p problems. When the day shift nurse came on, she ? him about it. he didn't do anything about the b/p and proceeded to tell he about giving the medication. No one cared much for this RN. So the Dr got mad and wanted to know why he did it. He said that everyone was doing it. OHU everyone DID give it. and to appease the Dr the hospital decided to have an investigation. So the whole thing snowballed. Even the Ky Bd of Nursing felt that this was an internal problem and a slap on the wrist and change in policy would have been enough.