Thank you for that advice but does minimum force necessary, whatever that means, apply only to nurses? We're not talking about hitting a man when he's down. As far as the law goes one is allowed to use the maximum force necessary to protect life and limb and that of others. Can you imagine someone attacking another nurse with a knife or a gun and one has to decide how much force to use? You move towards a police officer with a pocket knife and you're dead. So why are we held to a higher standard? I guess because we've been trained in Israeli martial arts at nursing school. I'm practicing my karate moves with my fingers right at this moment on the keyboards. Self-preservation first, I say.
I think I can take a stab at this one. (Punny)
As non trained persons we have no escalation of force rules when defending ourselves and are not held to a higher standard. The concern will be from an evaluation of the aftermath by the police and possibly a DA. They will evaluate and determine if what you did was reasonable for the circumstance. In any case you may be the subject of a grand jury and that will not be a good day. Deescalation and conflict resolution are better tactics If possible.
The trained person is held to the higher standard on EOF. Police can kill for the above mentioned knife but generally when ~21', that's the distance a knife can be used to kill before you could draw a firearm and use it to stop that threat. Lookup:Tueller drill or the Tueller Rule. They will not shoot someone holding a knife while on the other side of a glass door. They will for a gun though... see?
AFIK, If someone was being attacked with a knife, that's deadly force and a reasonable person can use whatever force up to and including deadly force to defend another life.
Best,
W
Disparity in reporting is a reality as evidenced in post #19.
The unfortunate reality in this fact can be attributed to sales revenue (money), and that is simply the way it is.
The issue for us is our personal safety and that of our patients and visitors in these public buildings. What we can do as Nurses, is advocate for effective prevention of such increasingly common events. Effective prevention taking the form of discovery and seizure of weapons in all public buildings as opposed to armed security as a deterrent.
I have to disagree with this proposed solution to increase workplace safety.
'Effective prevention taking the form of discovery and seizure of weapons in all public buildings': I believe to 'advocate' for the disarming of all for the hope of safety will lead to more violence, not less and is thus a disservice to the goal of safety. Not to mention I think it's morally repugnant to seize a weapon from a free person.
This is a simplistic solution to a complex problem that removes the best answer to predatory violence and that is protective violence. Yes, violence can be good, remember, the police one calls to handle an active shooter such as the subject of this thread are in fact prepared to commit the worst kind of violence. There are many other legal weapons in society other than police related, why place barriers between them and a potential threat.
'as opposed to armed security as a deterrent': There cannot be enough armed security and generally, I believe a person that is determined to commit harm and arm himself is at least capable enough to slip past that obstacle. Reaction is always slower than action and help is only minutes away when seconds count. (That's an old one but very true.) Also, the true deterrent to such violence is not the visible resistance to a planned attack, it's the unknown that prevents it. Violent crime is down in the US consistently since the passing of concealed carry laws in 48 of the 50 states. Criminals are unsure who is armed therefore confront fewer victims for fear of encountering an armed one.
As health care workers we are not trained combatants, we control things, things don't control us. WRT Violence, We tend toward the Feel safe rather than Be safe solution of No Weapons signage to feel safer at work. Fact is, weapon free zones are only free of legal weapons as those inclined to commit violence with them are the same people inclined to disregard posted areas. That help we holler for has been attenuated when we post a sign making a rule only you would follow. Why prevent a trained and proficient co-worker or a visitor from intervening if they choose to? I believe the reason is based on hoplophobia and dealt with by the defense mechanism of projection. that we fear what we cannot control may be the root of the issue..
Please keep in mind, this post is not intended to diminish the good intentions of the offered solution, just my opinion based on ~20 years of Hospitals from the ER to the Helipad and all floors in between, once being injured by a deranged family member and being cased for mugging twice.
Workplace security is a concern for me as a manager and it does not include futile No Weapons rules.
I just had a patient sent home to a small home on a farm. Flies by the Millions, Tree Roaches under foot, both solid gloss black and the usual brown, 2". Filth 'German' roaches on the walls, pt's bed and ceiling, little fat mini ones scurrying all over the floor. They were coming down the wall to the tray of cat food, No fear of people.
As Carl in Starship Troopers said: "It's simple numbers. They have more."
The reason given for not dealing with the infestation(s) was the 75 or so cats might be harmed. There were Dozens of roaches in view at any one time.
I saw a roach in NYC on the sidewalk stop and LOOK BOTH WAYS for traffic before crossing.
I chased it and KILLED IT so it couldnt pass on any GENETIC KNOWLEDGE.
Boy I do hate them.
It looks like the POC has to include these meds as if we don't provide them, they will not be sourced by the family and we'll loose the pt.
Management wants to know what meds we will cover for any Dx so I guess I'll have to get a formulary and Med Use Guideline started. I may have to create a Policy using drug classifications with examples, by each med will be impossible.
We all know though, that if a med is ordered, and the MD wants it given, then we give it irregardless of the policy and cost.
Thanks for the replies, very helpful to know I'm not totally off here.
__________________________________________________ _
Just Thinking out loud. Technically, for a pt that has an Admitting Dx of Lung Ca, Hx COPD, Smoking and Arthritis with opiate Tx. It looks like these pain meds are not hospice provided as tehy are not truely related. (But try telling that to an MD that the pt goes to see about pain while in a Hospice and see how that goes over.)
And there is a case to be made that the previous COPD maintenance meds are not the hospices' responsibility. (Again, try telling that to an ER doc when your Lung Ca pt is in the ER for SOB.)
But, as I can't seem to make anyone truely understand, these are related and the referring MD could just as easily have offered all these Dx as why they are appropriate for Hospice and then they would be all ours no matter what, if we took the pt, as if we would refuse to care for him over this.
Personally though, as a clinician, I can't remove the time component from the equation. Those same health issues that were unrelated to the actual Cancer, are now co-morbidities going to exacerbate the Cancer symptoms and impede comfort. Also .. what Shrinky said. How are you to separate the Lung cancer SS from the COPD SS from admit onwards? The prudent thing is to include these complicating Dx and meds into the POC for the patients sake.
Anyway it sounds to you that there a lot more but only God is my witness. Thanks again for all of you who have contributed
Actually I can believe you could have been failed arbitrarily. There were many such fails in my school. Some were given two fails for no other reason than being men. They're quick to choose someone to fail, there has to be a number fo fails to keep the image up. If everyone passes then they might be seen as an easy school. [Thats what they said in private.]
One man they failed twice threatened legal action on them personally and they took back one fail to let him go through. It's hard to justify a fail if you have the grades and meet the objectified standards.
They failed at least 10 nurses that year. Many were ousted as they were not nurse material, i.e. Psychotic or 'off', Male and Female. Some were given enough rope to hang themselves and they did, others were just diismissed out of nowhere.
The best thing you can do is object in writing citing clear examples of how this action is based on things unrelated to the established standard. Prejudice has no place and Opinion has little place in the decision to harm you.
You may have legal rights so seek the help of an attorney and get a truely objective opinion. Think "Righteous indignation" and act to save your career, your patients need that spirit.
For a public forum and generally, the details aren't as important as your reaction to the events. Sorry you are having coping problems. Good that you are getting help.
Sounds like you're carrying around some weight that is not yours to carry, as the error was not in your control.
I like white scrubs. The throwback to earlier times is not a bad thing either. I sometimes wear the black bar too. Older patients like it. Don't do it on peds.
I applied to one school once. They sent a letter of rejection and cited the simple reason that other people had volunteer hours to their credit. I did not take this well. I would have prefered they left out that reason.
Many more applied than could be accepted, including some that washed out, so I did not really expect to get in. BUT telling me that I was bested by others for their volunteer experience was too much. I met these people during the testing, they were all 10 years younger than me and fresh out of highschool.
Letter in hand, I marched back over there and gave them a blast of **** for sending me that letter. I was quite angry, I even had on my nasty hospital cleaning clothes. I was filthy with grime and got to speak with one or two teachers that did the testing. They aparently don't get many regectees coming in to complain.
I told them I'd been working literally every hour possible to keep my car in gas, rent paid and to buy food and clothing. It was in a tough economy full layoffs and union strife so this was different than say,.. a highschooler living at home, duh. I told them I thought excluding me from my chosen career path for some wet behind the ears highschool kids and tell me I didn't measure up was insulting. That I'd like to see anyone they gave more credit to volunteering at anything after 70 hours work.
I also told them I thought volunteering by itself is not the true test of character they respect. Working 16 hours a day at hard labor at a job you hate to save for when you are in nursing school is a better indicator. i told them I didn't qual for student loans either, I was 100% on my own, no parents to live with while in school, etc. I told them some not nice things about the whole selection process and said seeya, I'll go to mechanic school and thanks for nothing. {I left before getting arrested}
Well a few days later I got another letter stating something to the effect of "On further review...we recinsider and you are a Studient Nurse"
I later learned my objections traveled far and were on target, Bullseye actually, with more than the required % in a special meeting over my unanounced visit.
So I was on the path of Profession over Trade and I've not looked back.
How do you ever than someone for speaking up and arguing for you?
I've been a manager of nurses and other HCWs for years, This pre-aranged phrases stuff is a form of people control that I'd be embarrassed to implement.
Maybe I just don't get it but it sounds unprofessional and it's demeaning to make a registered professional do this.
As non trained persons we have no escalation of force rules when defending ourselves and are not held to a higher standard. The concern will be from an evaluation of the aftermath by the police and possibly a DA. They will evaluate and determine if what you did was reasonable for the circumstance. In any case you may be the subject of a grand jury and that will not be a good day. Deescalation and conflict resolution are better tactics If possible.
The trained person is held to the higher standard on EOF. Police can kill for the above mentioned knife but generally when ~21', that's the distance a knife can be used to kill before you could draw a firearm and use it to stop that threat. Lookup:Tueller drill or the Tueller Rule. They will not shoot someone holding a knife while on the other side of a glass door. They will for a gun though... see?
AFIK, If someone was being attacked with a knife, that's deadly force and a reasonable person can use whatever force up to and including deadly force to defend another life.
Best,
W
'Effective prevention taking the form of discovery and seizure of weapons in all public buildings': I believe to 'advocate' for the disarming of all for the hope of safety will lead to more violence, not less and is thus a disservice to the goal of safety. Not to mention I think it's morally repugnant to seize a weapon from a free person.
This is a simplistic solution to a complex problem that removes the best answer to predatory violence and that is protective violence. Yes, violence can be good, remember, the police one calls to handle an active shooter such as the subject of this thread are in fact prepared to commit the worst kind of violence. There are many other legal weapons in society other than police related, why place barriers between them and a potential threat.
'as opposed to armed security as a deterrent': There cannot be enough armed security and generally, I believe a person that is determined to commit harm and arm himself is at least capable enough to slip past that obstacle. Reaction is always slower than action and help is only minutes away when seconds count. (That's an old one but very true.) Also, the true deterrent to such violence is not the visible resistance to a planned attack, it's the unknown that prevents it. Violent crime is down in the US consistently since the passing of concealed carry laws in 48 of the 50 states. Criminals are unsure who is armed therefore confront fewer victims for fear of encountering an armed one.
As health care workers we are not trained combatants, we control things, things don't control us. WRT Violence, We tend toward the Feel safe rather than Be safe solution of No Weapons signage to feel safer at work. Fact is, weapon free zones are only free of legal weapons as those inclined to commit violence with them are the same people inclined to disregard posted areas. That help we holler for has been attenuated when we post a sign making a rule only you would follow. Why prevent a trained and proficient co-worker or a visitor from intervening if they choose to? I believe the reason is based on hoplophobia and dealt with by the defense mechanism of projection. that we fear what we cannot control may be the root of the issue..
Please keep in mind, this post is not intended to diminish the good intentions of the offered solution, just my opinion based on ~20 years of Hospitals from the ER to the Helipad and all floors in between, once being injured by a deranged family member and being cased for mugging twice.
Workplace security is a concern for me as a manager and it does not include futile No Weapons rules.
Best
W
I just had a patient sent home to a small home on a farm. Flies by the Millions, Tree Roaches under foot, both solid gloss black and the usual brown, 2". Filth 'German' roaches on the walls, pt's bed and ceiling, little fat mini ones scurrying all over the floor. They were coming down the wall to the tray of cat food, No fear of people.
There were Dozens of roaches in view at any one time.
As Carl in Starship Troopers said: "It's simple numbers. They have more."
The reason given for not dealing with the infestation(s) was the 75 or so cats might be harmed.
Just Wow.
that is all.
It's not you.
Every nurse will have these things come by throughout a career.
It's likely just life throwing a curve ball to you.
Cry no more.
T
Change jobs or voice concerns to those that can make it happen.
When management makes life difficult, I look for a better job. I've been in control of P&P development for years now because I hate bad policy.
These scrtipts are the worst though. To be told what to say to a patient like some mindless automaton.
It looks like the POC has to include these meds as if we don't provide them, they will not be sourced by the family and we'll loose the pt.
Management wants to know what meds we will cover for any Dx so I guess I'll have to get a formulary and Med Use Guideline started. I may have to create a Policy using drug classifications with examples, by each med will be impossible.
We all know though, that if a med is ordered, and the MD wants it given, then we give it irregardless of the policy and cost.
Thanks for the replies, very helpful to know I'm not totally off here.
__________________________________________________ _
Just Thinking out loud. Technically, for a pt that has an Admitting Dx of Lung Ca, Hx COPD, Smoking and Arthritis with opiate Tx. It looks like these pain meds are not hospice provided as tehy are not truely related. (But try telling that to an MD that the pt goes to see about pain while in a Hospice and see how that goes over.)
And there is a case to be made that the previous COPD maintenance meds are not the hospices' responsibility. (Again, try telling that to an ER doc when your Lung Ca pt is in the ER for SOB.)
But, as I can't seem to make anyone truely understand, these are related and the referring MD could just as easily have offered all these Dx as why they are appropriate for Hospice and then they would be all ours no matter what, if we took the pt, as if we would refuse to care for him over this.
Personally though, as a clinician, I can't remove the time component from the equation. Those same health issues that were unrelated to the actual Cancer, are now co-morbidities going to exacerbate the Cancer symptoms and impede comfort. Also .. what Shrinky said. How are you to separate the Lung cancer SS from the COPD SS from admit onwards? The prudent thing is to include these complicating Dx and meds into the POC for the patients sake.
[/stopping thinking outloud]
__________________________________________________ _____
Thanks!
One man they failed twice threatened legal action on them personally and they took back one fail to let him go through. It's hard to justify a fail if you have the grades and meet the objectified standards.
They failed at least 10 nurses that year. Many were ousted as they were not nurse material, i.e. Psychotic or 'off', Male and Female. Some were given enough rope to hang themselves and they did, others were just diismissed out of nowhere.
The best thing you can do is object in writing citing clear examples of how this action is based on things unrelated to the established standard. Prejudice has no place and Opinion has little place in the decision to harm you.
You may have legal rights so seek the help of an attorney and get a truely objective opinion. Think "Righteous indignation" and act to save your career, your patients need that spirit.
How did this turn out? Interesting mix of pain meds and where was the pain reported to be located?
For a public forum and generally, the details aren't as important as your reaction to the events. Sorry you are having coping problems. Good that you are getting help.
Sounds like you're carrying around some weight that is not yours to carry, as the error was not in your control.
Best to you.
I like white scrubs. The throwback to earlier times is not a bad thing either. I sometimes wear the black bar too. Older patients like it. Don't do it on peds.
I applied to one school once. They sent a letter of rejection and cited the simple reason that other people had volunteer hours to their credit. I did not take this well. I would have prefered they left out that reason.
I was quite angry, I even had on my nasty hospital cleaning clothes. I was filthy with grime and got to speak with one or two teachers that did the testing. They aparently don't get many regectees coming in to complain.
Many more applied than could be accepted, including some that washed out, so I did not really expect to get in. BUT telling me that I was bested by others for their volunteer experience was too much. I met these people during the testing, they were all 10 years younger than me and fresh out of highschool.
Letter in hand, I marched back over there and gave them a blast of **** for sending me that letter.
I told them I'd been working literally every hour possible to keep my car in gas, rent paid and to buy food and clothing. It was in a tough economy full layoffs and union strife so this was different than say,.. a highschooler living at home, duh. I told them I thought excluding me from my chosen career path for some wet behind the ears highschool kids and tell me I didn't measure up was insulting. That I'd like to see anyone they gave more credit to volunteering at anything after 70 hours work.
I also told them I thought volunteering by itself is not the true test of character they respect. Working 16 hours a day at hard labor at a job you hate to save for when you are in nursing school is a better indicator. i told them I didn't qual for student loans either, I was 100% on my own, no parents to live with while in school, etc. I told them some not nice things about the whole selection process and said seeya, I'll go to mechanic school and thanks for nothing. {I left before getting arrested}
Well a few days later I got another letter stating something to the effect of "On further review...we recinsider and you are a Studient Nurse"
I later learned my objections traveled far and were on target, Bullseye actually, with more than the required % in a special meeting over my unanounced visit.
So I was on the path of Profession over Trade and I've not looked back.
How do you ever than someone for speaking up and arguing for you?
Not an unusual happening in nursing. Were the two fails warranted? Is there an appeal process?
I've been a manager of nurses and other HCWs for years, This pre-aranged phrases stuff is a form of people control that I'd be embarrassed to implement.
Maybe I just don't get it but it sounds unprofessional and it's demeaning to make a registered professional do this.
JMHO
Back to my cell.