This is the first time I let out a pure personal venting on this site.
My facility is undergoing a stressful stage of preparing for re-survey, so consultants are often hanging around with hawk-eyes. I was followed by one today. One of the many mistakes I made: I drew several syringes of insulin, labeled by their room numbers as trays were being passed. I was caught with handful of them. The consultant said, "What are you doing? What's that in your hand? Go show them to your DON." I meekly opened my hand and showed those syringes to my DON who was sitting nearby. She looked at me and asked "Who oriented you? Is this how you were taught?"
To feel like a child caught doing something naughty, at my age...
Now, I love working there. I still can proudly say I don't regret a thing after working there for several years. However, the nursing practice as I envision it as opposed to what I'm expected to do from the corporate, there's so much disconnect that I sometimes want to say "The hell with it all!"
Is any of you working in LTC capable of doing everything by the book when you're responsible for the number of residents under your care? It's an open secret that we all take shortcuts. Do you actually take BP before every single BP meds every single day? Do you check placements of GT every time? Do you give meds to GT patients by gravity every single time?
For the 30-something number of residents I'm responsible for, it would be a miraculous day if I finish passing meds in two-hour period, doing all those above. And of course there's always something happening with residents that require me to engage in yelling contest with pharmacy people, lab people, doctors' offices, etc, on top of the frustrating amount of redundant paperwork. Then there are your superiors constantly on your back regarding overtime.
They talk of time management, so we learn to manage our time. We somehow learn how to do all the impossible things in the given amount of time. What I did -- drawing up all the insulin at once for the seven or eight people who needed coverage -- was one of them.
I worked telemetry floor prior to this job where any insulin had to be double-checked with another nurse. Believe me, I take insulin very seriously. Also, I take any med error seriously. And I'm always on guard, watching myself, second-guessing myself because I would not forgive myself if I made a med-error. So I devise my own way to do things correctly in the least amount of time.
Now, by taking shortcuts, do I make time to have my lunch? For idle-chat? To sit around? Ugh... I'm running around answering call lights, talking to the family, more importantly, talking to the residents. I have several residents who suffer from uncontrollable outbursts, panic attacks, to name a few. Every day I'm amazed how their symptoms disappear when some one-on-one time is provided, like this elderly lady who constantly calls out "Help Help!" with no apparent reason, but immediately calmed when I take her out to the patio or just wheel her around, talking.
Does the corporate want automatons of nurses who shove the impeccably prepared cups of medicine down the throats of the residents and no rapport? The perfect care plans and the correctly charted entries full of pretty words when none of it took place?
I'm not saying we should be allowed to take shortcuts. I'm saying we should be given the realistic amount of assignment for ideal nusing care, survey or not. Why must I be cornered into having to take shortcuts and then be punished for it without any real solution to do otherwise?
Thank you Wooh, CapeCodMermaid, carolmaccas. Now I see why people come here and talk about their woes. Those kind words of support really feel good! :)
Trouble is....you think you have the meds memorized...meds change. Not looking at the MAR before you give meds is dangerous. And...suppose something had happened and you had to leave the unit. The next nurse would look at the MAR and think all those meds were given. It might be time saving, but it's not good practice.
Now that I can think with a cool head, and without the emotional whirlwind, I see that it might be a good thing that things came down to this. I'm really re-thinking the way I practiced nursing, especially how I tended to thumb my nose at bureacratic stuff, all the little technical details that seemed to matter to no one but regulators... I need to stop complaining about admin and management and realize that they are a crucial component of running an insitution and I need to constructively work with them, instead of whining. As for my taking shortcuts and sloppy chartings, I need to keep in mind the rules are there to ensure safety, and it's not my place to decide what is redundant or unimportant. This whole experience is such a wake-up call for me! You can bet I'll think twice before I do something unorthodox.
It sounded like my DON wants to call me back once the survey is over and the corporate loosens its rein. On one hand, I want to continue working there. I'm too attached to the place. On the other hand, now that I decided I want to do things right, every time, I'm not sure if I can practice safe nursing in that environment. I spoke to co-workers who have other LTC experience, and I learned that our condition is quite worse than other facilities.
I was planning on cutting back hours soon anyway because I'll be starting a direct-entry MSN program in September, which I hear will be really intense. It would've helped me to work continuously until then to save some money, but oh well...
My biggest worry is that if this suspension will remain in my record and reflect badly in my future career somehow. I also worry that they might decide to fire me for good. Then, it'll definitely look bad on my record, right?
Tokebi, I won't lie this incident probably will look bad in your record, BUT I was thinking can't you write down all the stressors you were under, etc not as an excuse, but as contributing to bad practice perhaps, (we all get sloppy & complacent at times) & ask to be sent on a medication re-training course? I would ring your nurses' board and ask them for advice (that's if you want them to know). Or call your employer and ask about a med re-training/refresher course. I think under law the BON has to send you on a course, they can't just revoke your license.
I don't know what to say re this being on your record. But I do know one thing: don't lie about it at any job interviews. I know people who have & have been caught out.
So sorry this has happened. This highlights how much nurses are responsible for and the excessive stressors we are subjected to every working day - sometimes it is all too much to handle. And doing med's is hard with screaming psych patients banging on windows, door; dementias; people calling for things or emergencies to be dealt with; constantly ringing bells, Dr's & families interrupting you, & you may also have a very heavy patient load. Then you're trying to calculate dosages, get IVs made up, etc & when you do make a mistake, others act like they are holier than though! I haven't given a wrong drug or anything, but I NEARLY have due to constant interruptions, including one nurse practically yelling so loud behind me, I was startled & I jabbed myself with a clean IV line (putting it into a bag of NS). What if that had been a dirty needle instead?
Can you also see a legal respresentative citing stress as one of the problems in this situation? Wouldn't your BON supply someone?
Let us know how you get on - will say a quick prayer for you tonight.
Specializes in Gerontology, Med surg, Home Health.
The BON doesn't hear about all suspensions and certainly doesn't get involved in every disciplinary action between an employer and employee. From what I've read here, nothing the OP did warrants BON notification. I HAVE notified the BON on 2 occasions...one nurse made a horrible transcription mistake when readmitting a resident and during the course of that investigation, we noticed things with her narcotic book were hinky. The second time, the 11-7 nurse threw a phone number at the CNA, said she was too stressed - they could call if they needed anything, and left the building. People make mistakes all the time for a variety of reasons, and let's face it, when surveyors are in the building AND corporate is in the building, most people get extremely nervous. I've suspended plenty of nurses in my career. Sometimes, and I'm not implying it's this way in the OPs case, but, sometimes it's the only way for them to know the mistake was serious. Would I hire someone who had been suspended elsewhere? Probably...especially if it were for something like this.
Let us know how you get on - will say a quick prayer for you tonight.
Oh boy... you made me cry a little just now... :)
Would I hire someone who had been suspended elsewhere? Probably...especially if it were for something like this.
That gives me some reassurance. I plan on visiting my DON tomorrow to submit my resignation, and ask her frankly what exactly the repercussions of this suspension might be. I respect her a lot and I trust her not to sugar-coat things just to make it easier for herself.
The resignation letter is now submitted, and good-bye's were said... one of the CNA's was just shaking her head, "Ugh, I don't wanna hear about it anymore." You see, several nurses who've been there for a long time have left in the past weeks already.
Anyways, as for my own problems, my DON assured me I won't have trouble when my future employers check on my past employment. Furthermore, because I resigned before any further actions -- like termination -- she is able to put me under "re-hirable" category, meaning I can apply again to any of the company's facilities. (I didn't know that companies have "un-rehirable" list... blacklist of nurses, wow!)
Surprisingly, she was worried about the same thing -- that it might come to termination. Because the corporate regional wanted me written up and suspended, not her, she wouldn't be able to do anything if they decided I should be fired. So she admitted that she felt relieved in a way to receive my resignation.
It's all over now. Wow... it's pretty funny how multiple insulin syringes and pre-signing MAR led to leaving a job of the past three years, which I think is pretty long for LTC, having seen many new nurses come and go.
In a way, it irks me that the punishment was made by someone who does not know me at all and absolutely no consideration of my past performances. On the other hand, I know how critical it is for them to pass the survey and cannot allow any mistakes. And more importantly, from now on, I will not, shall not, ever never take shorcuts!
All this discinplining and firing of nurses for incidents that can be blown out of proportion really dismays me.
I have done much coordination of theatres/admin/medical secretarial work & have seen admin staff do much worse things than nurses. I worked with a woman (who knew better) who used to read off patient's private information form their file from anyone who rang up from OUTSIDE the hospital! I was horrified - these people on the phone could be anyone! If I had had a termination for example, or a very sensitive op, I would not want anyone giving out my private info for any reason. We are only supposed to release info to people DIRECTLY involved in the patient's care (ie: someone from another dep't in a hospital can't call & demand info for no reason). I complained about it & surprise, the hospital decided not to extend my contract. I also knew a senior doctor who told a patient to turn up for surgery one day, without telling anyone else! The patient had not had a pre-anaesthetic appointment, no work up, nothing, was not even on the list. Of course nothing happened to the surgeon & the patient had to go home understandably upset.
Everybody else can get warnings/go on training programs but not nurses! We do one little thing wrong (or perceived as wrong) & we are immediately shot down in flames.
I have often thought there should be a separate body (from anyone else) who can examine complaints/concerns & resolve it from there. No-one should be sacked due to a perhaps unfounded complaint (though I can understand being suspended for a pending investigation).
Seems like nurses are accountable for everything that goes wrong these days - even the most stupidest incidents that are quite often out of our control. Some people will say 'handling med's is different to what you have described' but is it really? Giving out sensitive info can cause much trouble & can ruin someon'e life. We are all supposed to act as professionals in health including admin, engineering etc & do our job to the best of our ability. But when you have constant, annoying interruptions you have to attend to, have to empty bins cos other staff have gone on strike (as I have previously done), have to run around to find linen/towels cos the linen trolley hasn't been delivered on time to do showers etc, & when you report a patient's rapidly deteriorating condition to a doctor who couldn't give a hoot, no wonder nurses are stressed and making mistakes or supposed mistakes, or being blamed for incidents beyond their control.
When I was a new RN I even had to go down to the kitchen one day because there wasn't enough catering staff to deliver the patient's breakfast - ie: needed b4 we could give insulin, & the patients were all hungry. Me a RN pushing a heavy catering trolley! Did they get someone from management to do it? Of course not, management wouldn't lower themselves to do that!
Seems like nurses are accountable for everything that goes wrong these days - even the most stupidest incidents that are quite often out of our control.
So much demand is imposed on us, but when we say we cannot, we're told we just have to.
One thing I'd like to understand is why the complaints from the nurses go ignored. Maybe the part of it is the way we nurses complain among ourselves in a gossipy manner? Maybe because we whine but at the same time accept the reality saying "well, that's how it is?"
In my DON's office on the day I was suspended, our administrator was there as well. So I tried to explain to him why so many of us resorted to doing things "incorrectly," how it was simply impossible to do med pass on time, fingersticks on so many diabetics on time, care for G-tubes properly, all the while maintaining the spirit of "customer service" he wants from us. But it was obvious that he just could not see it from my perspective. He simply couldn't understand why it was not possible. He said, "If you guys don't know how to do something, just tell us. We'll provide all the necessary education." What do I say to that? I wanted to scream, "Hello? What did I just tell you? It's the time we need, not more in-service!"
We learned how to do our job properly when we were in nursing school. How could he not see that we know how to do our job, but it is our working condition that prevents us to do so?
Is it heresy or something to increase the number of nurses on the floor? Why pay all that money on various consultants when most problems they find will be solved with better ratio? With fewer residents, we'd have more time to chart properly instead of scribbling in light-speed, we'd go through our med cart on our own to check exp date, we'd have the time to actually compare the charts with MAR to make sure everything's up to date before a med error occurs.
Oh man... I'm venting again... I need to go cool my head. :)
I am not from the USA (from Australia) so don't know every terminology listed on here. But I think many nurses in many countries perform the same duties. We have to take on more patients, more responsibility, more c**p from administrators who haven't been nurses (or as you say are former nurses & haven't touched a patient at a bedside in yonks) and, who frankly, could not care less. Imagine if we all trooped off to more training programs - administrators don't realise who is going to actually care for the patients in the meantime?!
I have even done things like gone to an old person's house to feed their dog because no-one in admin could be bothered ringing the RSPCA to get his dog cared for while this poor oldie was in hospital (only for one night). It's not that I'm a saint, it's because they lived near me (gave me permission & a key to enter their property) and because I do care. And many old people's pets ARE their family. I have also gone to people's houses after work to inform their re their elective surgery dates when I couldn't get hold of them.
Someone said to me once 'you care too much, you have to separate your feelings from patient's problems at work & go home & forget about them'. But isn't that what makes us human? We are constantly being told by media nurses must be compassionate, the hospitals etc want to employ nurses with empathy, yadda yadda. But many do not care, or if they do, this is eroded over time with stupid, non-sensical rules that often make no sense to me, so you can't talk to patients - you are too busy; you can't sit & chat to the family - you are too busy; have to rush med's/reports - cos you are too busy. I think we have all done it.
I am fed up whingeing. I am going to write out a formal report/complaint & try to get it published to present before our parliament when our new government is elected, & notify the newspapers. It may make a difference, it may not but at least I will have tried.
We as nurses should not be held responsible for every single problem in the healthcare system, as it is going that way. I know nurses who write EVERYTHING that has happened on a shift, or in their own private notepads, to cover themselves (even including what the patient has actually said) to cover themselves for an absolute fear of being sued - it has got that bad. Many people I know are out of nursing now; they can't handle the stress.
Nursing is a hard slog, and it is a hard and expensive road to GET to become a nurse. People don't realise that or don't care, cos their jobs are stressful. But I doubt they have as many legal responsibilities as we do. We are not treated with gratitude or the respect Dr's are given - and that bothers me, a lot. Do people realise many nurses have done many years of study just as much as Dr's? But because we can't give ourselves a title, we are not really seen as doing or being ANYTHING.
A Dr said to me once 'You do all the study for your own satisfaction, not for the patient' but we HAVE to do all this to still be nurses, & pay for it all ourselves, and that is really annoying me. One older nurse also said to me that all their study used to be paid for; you just applied to staff development for the money, or with CPR etc (mandatory courses) you just booked yourself into the hospital for the course, but hospitals don't run them anymore. And it's more cost on top of everything else.
I'm sick of it and I am getting out if my new job doesn't pan out after today (still waiting on reference checks), I have decided to sell up & leave to another state. Maybe I will go to sunny Queensland & try to live in a smaller place with a nice beach nearby, do watiressing again. I was treated much better in hospitality than I ever was in nursing. Or become a clinical psychologist & open my own practice.
Anyone ever notice that during survey and the med pass is being observed phone calls and interruptions by CNA's tend to slack off? Helpful employees come out of the woodwork to avoid catching the eye of the surveyor.
So much demand is imposed on us, but when we say we cannot, we're told we just have to.
One thing I'd like to understand is why the complaints from the nurses go ignored. Maybe the part of it is the way we nurses complain among ourselves in a gossipy manner? Maybe because we whine but at the same time accept the reality saying "well, that's how it is?"
In my DON's office on the day I was suspended, our administrator was there as well. So I tried to explain to him why so many of us resorted to doing things "incorrectly," how it was simply impossible to do med pass on time, fingersticks on so many diabetics on time, care for G-tubes properly, all the while maintaining the spirit of "customer service" he wants from us. But it was obvious that he just could not see it from my perspective. He simply couldn't understand why it was not possible. He said, "If you guys don't know how to do something, just tell us. We'll provide all the necessary education." What do I say to that? I wanted to scream, "Hello? What did I just tell you? It's the time we need, not more in-service!"
We learned how to do our job properly when we were in nursing school. How could he not see that we know how to do our job, but it is our working condition that prevents us to do so?
Is it heresy or something to increase the number of nurses on the floor? Why pay all that money on various consultants when most problems they find will be solved with better ratio? With fewer residents, we'd have more time to chart properly instead of scribbling in light-speed, we'd go through our med cart on our own to check exp date, we'd have the time to actually compare the charts with MAR to make sure everything's up to date before a med error occurs.
Oh man... I'm venting again... I need to go cool my head. :)
I would have told them exactly that. We need more time.. not inservices or education or write ups or people standing over our shoulders.
The whole g-tube situation ruffles my feathers. We recently had an inservice about the survey. When told that we had to crush each med separately and administer with 20ccs of water before and after. Another nurse brought up that its just not practical on a patient on 20 different meds. That would take about a half hour to do correctly. And they want us to get a medpass done in 2 hours? Sure. Keep dreaming.
If I have time tonight I have a g-tube patient on 20 meds. I will try to do her meds the way they want us to. I will let you know how long it took me.
Specializes in Gerontology, Med surg, Home Health.
We write all our GTube meds for 6am and 6pm if we can. Surveyors are out of the building. Doctor says crush them all together or use liquid. One less thing for them to cite us on.
tokebi
1 Article; 404 Posts
Thank you Wooh, CapeCodMermaid, carolmaccas. Now I see why people come here and talk about their woes. Those kind words of support really feel good! :)
Now that I can think with a cool head, and without the emotional whirlwind, I see that it might be a good thing that things came down to this. I'm really re-thinking the way I practiced nursing, especially how I tended to thumb my nose at bureacratic stuff, all the little technical details that seemed to matter to no one but regulators... I need to stop complaining about admin and management and realize that they are a crucial component of running an insitution and I need to constructively work with them, instead of whining. As for my taking shortcuts and sloppy chartings, I need to keep in mind the rules are there to ensure safety, and it's not my place to decide what is redundant or unimportant. This whole experience is such a wake-up call for me! You can bet I'll think twice before I do something unorthodox.
It sounded like my DON wants to call me back once the survey is over and the corporate loosens its rein. On one hand, I want to continue working there. I'm too attached to the place. On the other hand, now that I decided I want to do things right, every time, I'm not sure if I can practice safe nursing in that environment. I spoke to co-workers who have other LTC experience, and I learned that our condition is quite worse than other facilities.
I was planning on cutting back hours soon anyway because I'll be starting a direct-entry MSN program in September, which I hear will be really intense. It would've helped me to work continuously until then to save some money, but oh well...
My biggest worry is that if this suspension will remain in my record and reflect badly in my future career somehow. I also worry that they might decide to fire me for good. Then, it'll definitely look bad on my record, right?