Innocence Lost

[lilbosheep]

I have had the misfortune of running into the BON for the first time in 26 years of RN duty. I have worked in most all hospital departments, and started out my medical career as a surgical technologist so I have been blessed with many experiences. Recently have been working for a Travel Nurse Agency. Came about a 8 week contract with a specific facility in which i worked 6, 12 hour night shifts in a row every 2 weeks for length of the contract. I am very confident with my nursing skills, experience and knowledge, in fact have worked mostly ER for the past several years, and felt that an 8 week contract on a very busy ortho/neuro unit in a large hospital in a capital city, would be no challange to me and was eager to learn from this experience.

I have worked 26 years and have had never a complaint or accusation brought against me. I don't have any addiction problems, and I rarely drink alcohol.

During the course of my rotation at this facility, I was introduced to the hand held computer, which scans medications and arm bands to record the administration of medications. My orientation to this unit was approximately 3 minutes. This was my very first encounter with this type of unit in all the 26 years I have been in practice.

This unit was a very busy unit, and I found that the staff was amazing, busy and burnt out. They remained allot of fun to work with, and i still share communication with a few of the today!! My purpose in this contract was to help them so they wouldnt have to work short of staff while orientating new staff.

Not TRUE.. We worked short 95% of my shifts, which meant I would often have 6 critically ill, some fresh surgical neuro patient, kidney transplants, ect. I would hang blood in one room, FFP, Lipids, MVI, among doing much of the understaff work if my patient had vommitted, or experienced loose stool in bed, ect, all this, steady all shift, in addition to the heavy requests for narcotic pain medications.

During my contract I had 2 impromptu performance evals from my supervisor, who indicated "they wanted to keep me there", nurses were reporting that I was an awesome nurse, dependable, knowledgeable, and fun to work with. One of the ladys I worked with wanted to help me find an appartment there!!

The good time, and learning experiences I might have encountered are now over shadowed with frustration, anger and left me feeling like I don't want to be a nurse anymore.

While working my 5th night of my last week, now this has been a near completed 8 week contract, I finally made a med error. It wasn't fatal, but I had given the wrong patient the wrong medication. He was suppose to get percocet, and I gave him vicodin.

Medications do come from a pixis system. ironically, I was approached by staff caring for one of my patients who had been in an atv accident and told he had requested something for pain. Upon retrieving this medication and going to give the pill, I found this patient was up in the bathroom so I informed him I would return with his medication as soon as he was done.

Upon leaving his room, my staff who were caring for a lady with a hip fracture in the room next to him, informed me that she would like something for pain. After putting the medication in a locked cart that I held onto for the patient in the bathroom, I removed the pain medication for the lady with the fractured hip. As luck would have it, upon entering her room staff were changing her. Great, so now leaving this room staff reported to me that the patient who had been in the bathroom was now back in bed and was waiting for his pain medication.

So I hurriedly into his room with the pill in my cup and scanned his armband, gave him the medication assessed his status and left the room, only to find a hot headed pharmacist on the phone waiting to yell at me unporfessionally about over riding a medical order????? I hadn't even realized what I had done yet, and to be accused of something in that manner was over whelming and then to sick feeling in the pit of my stomach!! OMG, not to mention, my blood should be done in one room. then to follow with 3 iv antibiotics, make sure the lipids had infused alright, while keeping a mindful eye on the young 23 year onld with severe hypertension and abdominal pain. Wow, thankfully all worked out well except this medication error.

As per hospital policy, I contacted the patients provider, filled out a varience form, alerted my supervisor, and spent several minutes discussing this with the patient and his family, which relieved me when they told me he had taken this medication for years for chronic back and hip pain. Whew!!

It has ALWAYS been my practice when administering narcotics, I start off with only the lowest ordered dose. Unless subjectively, or physiologically their pain in worse than I am identifying. This rule has saved me, and applied to my every practice for 26 years. It was no different at this facility.

It was while I was asleep that next morning in prep for my very last 12 hour shift with this facility, did my recruiter phone and wake me to say, the facility did not want me to return for my last night shift. According to the complaint, the pharmacist who was so rude and unprofessional with me on the phone the night before had decided to do a print out of all my narcotic activities since I had been onstaff with them. They found I had 23 narcotic descrepencies throughout my time with them.

To me, this was crazy. I have made up to 3 errors in a year when I first started nursing many years ago, but I am proud to say that for the most of my career, I have been blessed with the intense desire to avoid error and that may mean if I encounter something unfamiliar, I will fully prepare myself with the appropriate journals to make darn certain it does not interact with any medications previously given, verify dosing, route, pharmacological intention, and so forth. I am always prepared to explain medications to the patients thouroughly should they want that information.

They have accused me, of this horrible crime, without contacting me directly to see if I had any explanation to this. Refused my demanded drug screen and submitted these discrepencies to the BON.

Several of these medication errors where such as, I had an order for 2-4 mg IV of a specific medication for pain. As I stated earlier, I will give 2mg initially following assessment of pain level. This would result in wasting the additional dose. This was done correctly with 2 RNs wasted and acknowledged. However, the 2 mg I had given the patient wasn't recoeded on the electronic mar. The errors included some that were verified as taken out of the pixis, but again, not recorded on the electronic mad.

I should of demanded better orientation with the hand held unit. But who would of known. While visiting with the BON, they accused me of drug diversion! Are you serious?? I had correctly administered over 200 narcotic medications, both oral and IV during my contract with this facility and 23 times are not recorded appropriately. Thankfully in many of my nursing notes I have referenced medications given and follow ups, but quite frankly my shifts where to busy to document every little thing. I can certainly say, my large electronic PDA for medication monitoring may have gotten left ontop of my nursing cart 23 times out of all the medications I had delivered to patients during my time with them.

BON wanted to suspend my nursing license for 2 years..... Nope, not gonna happen. In all the years I have been a RN, and out of 26, I have maintained a unblemished lisence in this particular state for 17 of them without every a discipline, I have never been in trouble to BON in any of the states I have worked in, my lisence is squeeky clean, now because of this, you are immediately going to throw the book at me??

I say to them, why did pharmacy not inform me of these errors before my 8 week contract was up?? How long is a nurse allowed to practice without being informed she is doing something wrong, or they suspect diversion?? I had completed a med varience per policy, contacted physician, informed supervisor and visited with family as well as follow up on medication interaction, pain relief, why would I have not done that in any other situation had I known.

All I can say for sure about this is that if a medication was ordered for any of my patients whether it was pain medication or a blood pressure pill, I can guarantee you, they got it. Could I have forgotten the computer on my med cart since I was not use to using it, have never been exposed to this type of system, it is large and bulky when carried in scrub pocket, not to mention, this system is 10 years old, I would have to change the battery in some of the units 2 times a shift. Yes, I am guilty of this. But you would think that with all the educated people in the world might evaluate this type of complaint, compare it to previous, if any, other interactions with BON, or disciplinary actions, and start there. Not me, suspend my livelihood for 2 years for this. ITS NOT ALL MY FAULT!!

I hired an attorney, and though he cost me my last contracted position, he was able to get the board to provide a lesser disciplinary action. I was not happy, I wanted nothing!! I did nothing wrong, and am being falsely accused, having to pay for an attorney, loss of a 3+ contract position that was near my home, wouldn't have to travel far. I though I was ready to just die. I have certainly had doubts about my future nursing career. If this is how its going, I don't want to be a part of it.

So now my attorney managed to get the BON to reduce the disciplinary action right, however, their stipulations of my future employment opportunities don't work well for travel nurses, especially when the recruiter has to tell them the BON is involved.

At this time, out of work, on unemployment, getting far behind in bills, becoming more depressed and angry at the system and the people who are making decisions like this without regard to entire situation. It is humuliating, and degrading. I am a grandmother to a 5 yr old, and 7 mo. old boys. I love scrapbooking, spending grandma time with my boys, had total of 3 children, 1 married with my grandchildren, 1 in college, and a jr in high school. I have worked 26 years as a RN, and many of the patients I have cared for over these years if asked to reflect on me as their nurse would say, "I was glad she was my nurse", I know this because they have told me themselves.

I know that finding work now will be difficult with these unwarrented BON charges, and I am aware of what effect it will maintain on my liscense forever. ENCOMBERED, what ever that means. It could just as well say ENTOMBED!

With this I say, there isn't many days I don't cry. God still hasn't given me a sign as to what lesson should I learn from this. Financial devestation is all I see. I made up to $6000. monthly while travel nursing, now am home getting less than $400. week in unemployment. I am very depressed, resentful towards all involved in this circle who remain free of consequences at this time, go on living their lives without interuption, paying their bills on time, college tuition fees, ect, while I sit here and try and absorb the fate of this entire mess.

I will say, I have reported this pharmacy to the BOP and they are investigating their procedures for orientation towards hand held electronic monitoring systems, and also there medication monitoring. As a nurse in general, we all know that it should not take 8 weeks for a pharmacy department to inform you that your r making mistakes. I am quite confident this particular pharmacy will find more than they want to when this happens there as they were very unreliable, made several errors that I had to notify them of during my contract, not to mention, the numbers the other nurses have to report on them. Errors from pharmacy??? Oh yes, I can tell you my 2nd day on this job I was given a very sick patient returning to care for a bowel obstruction following a gastric bypass. Room full of company, children, patient very sick. In allot of pain, Had 4 IV pumps running, antibiotics, lipids, TPN, isotonic saline. Adbomen open, healing via 2nd intention. After I had completed my physical assessment, I began sorting out her IV medications and lines, pumps ect. To my horror, on pump is running in Fentanyl.

I professionlly approached my supervisor immediately and informed her that I could not care for this patient. When she inquired why I couldn't, I informed her that I was not comfortable with her Fentanly drip, not being regulated in a PCA unit. I informed her also, that with the amount of traffic in her room, her physical assessment update, and all the infusions that she had going, I did not feel it was safe for the patient, and certainly not for me, as once again we are working short, and I would no way be able to check this pump every 5 minutes. She agreed to switch patients with me, and the patient with the unregulated fentanyl drip was placed immediately in a room right accross from the nurses station. I do believe she had words with pharmacy, but I was never priviledged to what ever became of that. This is sloppy and thats how this pharmacy operates, I was witness to it on several occasions.

Thank God for nurses who save the upper crust of health care!! Ive never been one to pass blame, and figure, its my job also to make sure my patients are given the right medications. I found in this facility, the pharmacy did not share my devoute intentions.

Excited now to hear from BOPharmacy regarding my complaint towards them not informing me sooner of their suggested errors so I could of cleared this up before it destroyed my life.

Oh and, my attrny is on stand-by for this one.

[xoemmylouox, ASN, RN]

I am so sorry that you went through that. It is awful the way that nurses are treated like criminals. I have to say that it seems drug diversion is a huge problem. I have wanted to travel in the past, but stories like this have changed that. This should be a warning to those who do travel to make sure you understand a system well before you start the floor.