Frustrated with Hospital Disregard for RN and Patient Safety

[Ioreth]

I think I just felt the straw that broke the camel's back. This is going to take some time to unpack.

TLDR version is: I'm frustrated with my hospital's continued disregard for nurse and patient safety and want to leave this hospital system for the local competitor, but I want to tie up some loose ends and I'm worried that the next job won't be any better.

When Covid started, the Other hospital system in town started testing all admits for any reason for Covid. My hospital did not. On my floor, patients often discharge to a rehab facility, and all require a Covid test to be done before transfer. Many, many times we have had patients Surprise! test positive for Covid when we are doing this test right before setting up transport.

Edit: I wanted to add that I don't mind caring for Covid patients. We've seen less than the other floors but we have had many. I am happy to do my part in caring for these patients. However, we must know their Covid+ status to protect ourselves and our other patients.

So this month, as we are now 2 years into the pandemic, we all got an email from corporate headquarters that all patients admitted to the hospital will be tested "so they can be treated appropriately". No mention of avoiding cross-contamination or protecting direct patient care staff, but I'll take it.

We saw this policy go into effect last week, but it was ugly. All patients admitted from the ED were tested, but not patients admitted under observation status, even though these patients are roomed on the same floors as general admission patients. Patients were also being tested only on admission to the hospital, which meant that this test was the last thing that was done in PACU as surgical patients were to be admitted. We had 4 surgical patients to our floor that afternoon after this policy went into effect and 3 were surprise positives. 

So instead of moving the Covid test to before surgery (wouldn't the surgical team want to know a patient was positive?) the hospital panicked because PACU can't isolate patients. They required that PACU testing be stopped immediately. It doesn't exist if we don't see it, I suppose.

I found out about this a few days ago when I admitted a surgical patient from PACU and a warning came up on my computer that this patient had not been tested. I ordered a test per protocol and let my charge nurse know that a patient had come up without being tested. I was then told to cancel the order and there's no protocol (despite the email from corporate headquarters?!), so it was an inappropriate order. My manager then let me know the changes to PACU not testing. So we are not even testing these patients after they arrive to the floor. Again, it doesn't exist if we don't know about it.

I'm furious, and I am done.

[MunoRN, RN]

9 hours ago, Rose_Queen said:

As am I. Intubation/extubation are both aerosol generating procedures that place staff in the room at risk. If patients came to pre-op without a test, they were treated as infected until a rapid test came back negative or outright cancelled. The only exception was life and death, and if there wasn't a test result we treated them as positive.

The premise of intubation / extubation and other procedures as "Aerosol Generating" is an embarrassing remnant of recent scientific history.

There isn't, and never was, any evidence that intubation or extubation produce aerosols, in particular that they produce more aerosols than coughing, talking, or even just breathing.  

The premise came about due to a serious of poor understandings of the science of viral transmission.  When Covid first started, there was a disturbingly common belief that it likely spread mainly through surface vectors, and that respiratory tract-to-respiratory tract transmission was unlikely.  This was despite extensive research on Coronavirus SARS transmission from the 2003 outbreak being widely available.  

So when it was noted that, oddly, some direct respiratory transmission seemed to be occurring it was assumed it couldn't be just because that's how coronaviruses spread, so alternative explanations were sought.  

Transmission from patients to HCWs were examined, which showed a clear correlation between the proximity / duration of exposure to a patient's exhaled air that certain procedures caused, and risk of contracting Covid.  But instead of recognizing that the viral-vector assumption was wrong, they ignored that most obvious explanation.  And instead simply assumed that these procedures must be creating some sort of mystical droplets.  This was despite high risk procedures, which were presumably AGPs, included obtaining a 12-lead ECG and inserting a Foley catheter, of course neither of these have a mechanism that would produce droplets smaller than those normally produced through common physiological processes, and neither does intubation or extubation.  

[ladedah1, BSN, RN]

11 hours ago, LovingLife123 said:

So every patient in the hospital is in negative airflow?  I guess I’m not understanding.  If you use covid precautions on every patient then you don’t need to test.

My concern was that nobody was being tested and so you didn’t have to take precautions.  We extubate in pacu.  Everyone though is tested so we can isolate and wear appropriate PPE.  Covid patients still need surgery but I also need to be able to protect myself and my family.

No. I didn't mean everyone hospital-wide, just everyone in OR and PACU.  If they're not testing pt's pre-op, then sending them up to the floor without testing (yet testing all other admissions), the only logical reason why pre-op wouldn't care if their patients were tested, would be if they just use precautions for everyone in OR and PACU.  If then sending them to the floor in such cases, testing should technically still apply like with all other admissions.  Probably an oversight in policy, if that's the case.

[brandy1017, ASN, RN]

19 hours ago, Ioreth said:

Thank you all for the responses. It helps to know that I'm not the only one that finds this situation alarming. I don't know why I hadn't thought about reporting it to the state. I will be looking into that.

In my hospital though, I have frequently voiced my concern about this lack of testing to anyone who will listen, my manager, my manager's boss, the focus groups concerned about RNs leaving the hospital, the infectious disease department, anonymous quarterly surveys, and even the suits that round once in a blue moon. None of my proddings have gone anywhere. 

One of our Trauma surgeons recently died from Covid of an unknown source. I know of at least 2 other physicians that have died in our mid-sized hospital. We frequently have staff out with Covid, and I myself have had it twice, both times from surgical patients who were thought to be Covid negative but never tested due to lack of symptoms and both had been on our floor for several days. (On a related note, both of these patients became symptomatic later, both transferred to ICU, and both eventually died.)

This is a Level 1 trauma center in a large midwestern city, and we have over 350 beds and 16 surgical suites. And we have not stopped or even slowed elective surgeries since the early months of the pandemic. Though the Other hospitals have. This is a very old hospital and in dire need of updating key areas, including PACU which is a single open room. I don't know how they isolate PACU patients for other infectious diseases. I know from an RN that recently transferred from my floor to peri-op that they are using the same precautions that were used pre-covid. For a while, they were using N95s when intubating/extubating only, but they no longer do that either.

I enjoy the work I do, but it isn't my forever job. As I said earlier in this post and in others where I talked about possibly moving on, I would like to move into working Oncology and eventually in-patient Palliative care and/or Hospice. Right now I'd be happy just getting away from my current employer. 

You can file an anonymous complaint with JACHO but they demand a date so you would have to pick a date to choose, maybe when you got a patient that ended up having covid and then in the comments bring up the standard practice of not testing preop and definitely the surgeon death and other doctor deaths.

https://apps.jointcommission.org/QMSInternet/IncidentEntry.aspx?_ga=2.38504483.1885232200.1643059953-381780127.1643059953

[Ioreth, ADN, RN]

Thank you for the info about reporting to JCHO. It will be helpful as I figure out how to report this.

We just finished our monthly staff meeting and I brought up my concerns yet again. "We've got a focus group looking at how to comply with this guidance from corporate." I asked if we may comply with the corporate policy by testing on arrival to our floor. "No, you may only ask the provider for a test if the patient is symptomatic. But remember that you can always wear more PPE if that makes you feel safer." 

So they're suggesting that I wear an N95 because I'm the nut that wants patients tested. I'm half considering wearing full Covid PPE each time I interact with all patients. See how that goes down.

[agencynurse_rn]

On 1/23/2022 at 7:58 PM, Ioreth said:

Thank you all for the responses. It helps to know that I'm not the only one that finds this situation alarming. I don't know why I hadn't thought about reporting it to the state. I will be looking into that.

In my hospital though, I have frequently voiced my concern about this lack of testing to anyone who will listen, my manager, my manager's boss, the focus groups concerned about RNs leaving the hospital, the infectious disease department, anonymous quarterly surveys, and even the suits that round once in a blue moon. None of my proddings have gone anywhere. 

One of our Trauma surgeons recently died from Covid of an unknown source. I know of at least 2 other physicians that have died in our mid-sized hospital. We frequently have staff out with Covid, and I myself have had it twice, both times from surgical patients who were thought to be Covid negative but never tested due to lack of symptoms and both had been on our floor for several days. (On a related note, both of these patients became symptomatic later, both transferred to ICU, and both eventually died.)

This is a Level 1 trauma center in a large midwestern city, and we have over 350 beds and 16 surgical suites. And we have not stopped or even slowed elective surgeries since the early months of the pandemic. Though the Other hospitals have. This is a very old hospital and in dire need of updating key areas, including PACU which is a single open room. I don't know how they isolate PACU patients for other infectious diseases. I know from an RN that recently transferred from my floor to peri-op that they are using the same precautions that were used pre-covid. For a while, they were using N95s when intubating/extubating only, but they no longer do that either.

I enjoy the work I do, but it isn't my forever job. As I said earlier in this post and in others where I talked about possibly moving on, I would like to move into working Oncology and eventually in-patient Palliative care and/or Hospice. Right now I'd be happy just getting away from my current employer. 

Please get out of your current work situation. Self-care is important, so take the time to do some. Research your future job, policies, procedures, and level of happiness of the co-workers. 

PRO TIP: See if theyhave a facebook group and join it with a alternative account.  Message a few people in the group to see how happy they are working there. 

[she244]

I made a decision to retire earlier than planned when I actually saw Administration staff with no symptoms being tested, including bringing in their families to be tested.  Yet, those of us working directly with Positive patients while only wearing provided surgical mask were told to go over to Employee Health if we felt ill or if we asked to be tested after being in a closed room with a patient vomiting in a bucket as you are trying to start an IV on the patient. N95 mask were for the Physicians to wear.   I realized then.  They didn't care if Nursing staff, lab staff or anyone else got Covid, or infected our families as long as Administration staff who sit in a office with door closed.  Doing no patient care are protected.  It was a hard decision, but have never regretted it since retiring.  I Pray daily for all Nursing Staff and others doing hands on, answering phones, cleaning room are protected and safe from getting Covid.  

[Jedrnurse, BSN, RN]

On 1/24/2022 at 4:36 PM, brandy1017 said:

You can file an anonymous complaint with JACHO

Unless it's dealing with cutting edge issues like water bottles at the nurse's station, the Joint Commission doesn't get involved. Immediate health and safety issues would normally be reported to a state agency such as the DPH or whichever one has responsibility for licensure and enforcement in your state.

[Robmoo, ADN, BSN, RN]

Your plan A is a solid plan.  Get your vestment, earn your BSN, get your tuition reimbursement, and then get out.

[Tommy5677]

I read an article on Raw Story, yes, it's a legit news outlet, that a judge in Wisconsin, a right to work state, issued an injunction that nurses can't quit their job without notice to go somewhere else. This is an act of desperation from hospitals. For those of you who don't know right to work is a euphemism for at will. This means an employer can fire you without notice or reason. By the same token as an employee you don't have to give 2 weeks... until now. RTW was nothing but a union busting tactic which in many states virtually eliminated them. What does this really mean? It means that for nurses At Will is now a one way street. But by all means, keep voting for Republicans.

I'm at the end of my career, thank God, but if I wasn't a hospital would be the last place I'd work, especially now. BUT, as an aging Boomer, what does that mean for me if I need to be hospitalized? It's frightening to even think about.

Remember, you are being replaced with foreign nurses, most from the Philippines and India. Their nurses are better trained than ours so we need to just get over it.

I too, am just done.

[Jedrnurse, BSN, RN]

4 minutes ago, Tommy5677 said:

I read an article on Raw Story, yes, it's a legit news outlet, that a judge in Wisconsin, a right to work state, issued an injunction that nurses can't quit their job without notice to go somewhere else. This is an act of desperation from hospitals. For those of you who don't know right to work is a euphemism for at will. This means an employer can fire you without notice or reason. By the same token as an employee you don't have to give 2 weeks... until now. RTW was nothing but a union busting tactic which in many states virtually eliminated them. What does this really mean? It means that for nurses At Will is now a one way street. But by all means, keep voting for Republicans.



Right to work relates to working in a union "shop" without joining the union. Employment at will is a separate thing altogether.

[kdkout, BSN, RN]

Protect yourself as much as you possibly can. Assume everyone is positive.  Finish up getting vested in Aug and get the F out of there. Do NOT stay there. Nobody likes job hunting. Keep your reviews, phone numbers of supervisors , etc and things you’ll need for the job hunt 

Am I surprised? No

[SunDazed, BSN, RN]

On 1/23/2022 at 4:44 AM, Ioreth said:

I think I just felt the straw that broke the camel's back. This is going to take some time to unpack.

TLDR version is: I'm frustrated with my hospital's continued disregard for nurse and patient safety and want to leave this hospital system for the local competitor, but I want to tie up some loose ends and I'm worried that the next job won't be any better.

When Covid started, the Other hospital system in town started testing all admits for any reason for Covid. My hospital did not. On my floor, patients often discharge to a rehab facility, and all require a Covid test to be done before transfer. Many, many times we have had patients Surprise! test positive for Covid when we are doing this test right before setting up transport.

Edit: I wanted to add that I don't mind caring for Covid patients. We've seen less than the other floors but we have had many. I am happy to do my part in caring for these patients. However, we must know their Covid+ status to protect ourselves and our other patients.

So this month, as we are now 2 years into the pandemic, we all got an email from corporate headquarters that all patients admitted to the hospital will be tested "so they can be treated appropriately". No mention of avoiding cross-contamination or protecting direct patient care staff, but I'll take it.

We saw this policy go into effect last week, but it was ugly. All patients admitted from the ED were tested, but not patients admitted under observation status, even though these patients are roomed on the same floors as general admission patients. Patients were also being tested only on admission to the hospital, which meant that this test was the last thing that was done in PACU as surgical patients were to be admitted. We had 4 surgical patients to our floor that afternoon after this policy went into effect and 3 were surprise positives. 

So instead of moving the Covid test to before surgery (wouldn't the surgical team want to know a patient was positive?) the hospital panicked because PACU can't isolate patients. They required that PACU testing be stopped immediately. It doesn't exist if we don't see it, I suppose.

I found out about this a few days ago when I admitted a surgical patient from PACU and a warning came up on my computer that this patient had not been tested. I ordered a test per protocol and let my charge nurse know that a patient had come up without being tested. I was then told to cancel the order and there's no protocol (despite the email from corporate headquarters?!), so it was an inappropriate order. My manager then let me know the changes to PACU not testing. So we are not even testing these patients after they arrive to the floor. Again, it doesn't exist if we don't know about it.

I'm furious, and I am done.

Wow. There were times in the early pandemic that our administration refused to let exposed, symptomatic ED nurses take covid tests. That has changed since then.  But the rationale behind it was the same…. If we don’t test we don’t have to act. 
 

Your hospital is taking that to a whole new level. Unreal! I would find it hard to stay.