Nurses Call the Governor of Tennessee

mtnNurse., BSN · Feb 17, 2019

On 2/11/2019 at 8:44 PM, mtmkjr said:
Now it is probably not "PC" to suggest that, but there is a chance that she was not having a day like some assume she was.
Then again, it may have been exactly as they described I just don't think that anyone should defend her actions based on what is unknown.

I agree we don't know what kind of day she was having, and those that defend her from criminality are giving her the benefit of the doubt. Nobody has defended her actions. Most have expressed that she is accountable for her failings. We just disagree on whether she should be found guilty of criminal charges. Why shouldn't we give her the benefit of the doubt that she wasn't in a high alert, focused state of mind when this happened?

Susie2310 · Feb 17, 2019

1 hour ago, mtnNurse. said:
Our brains are subject to fail because we are humans.

You keep making the point that nurses brains are subject to failure because we are humans. By your logic all workers in all types of occupations should never be charged with any crime due to their negligence unless they deliberately intended to cause harm to the public.

Following your logic airline pilots brains are subject to failure at any moment during an 11 hour flight, and the plane could crash if the pilot gets overwhelmed or distracted. Think of all the many, many flights that take place all over the world, just in the course of one day, yet planes aren't crashing all over the place every day. Should we conclude that airline pilots brains function better than nurses brains? Or do airline pilots practice to higher professional standards? Nursing isn't the only profession with a lot of stressors, distractions, and responsibility/accountability.

I just had a licensed electrician work perform some work for me. Should I assume that he/she may be under extraordinary stressors and be unable to perform safely? I never thought that he/she might actually have been incompetent is his/her practice or might make a mistake that would lead to him/her ignoring basic electrical safety procedures. That perhaps he/she might be negligent to the point that I will get electrocuted. Oh, well, I guess I will just put it down to brain failure on his/her part. In which case, what is the point of professional licensure? If a licensed electrician can't perform their job safely why should I bother using his/her services?

Why bother to have any professional standards for any professions at all? Why bother with licensure? If the public can't trust that a licensed professional will be able to perform to industry standards of safety, why should they bother using the services of a licensed professional? Then we don't have professions, because everyone does the job equally incompetently/unsafely.

If you believe that nursing is a unique profession with extraordinary stressors such that nurses are unable to concentrate on their licensed activities to the point that they are unable to perform safely and must excuse themselves due to brain failure when they inadvertently harm or kill patients due to not being able to perform safely, why should anyone have any confidence in nurses ability to perform safe care? Why should the public go to hospitals?

You are saying something quite terrible, that perhaps you don't realize you are saying, and that is that the public shouldn't expect to rely on licensed professionals to meet industry safety standards. You are saying that licensed professionals shouldn't be held criminally liable for failing to meet industry safety standards; that as long as they did not deliberately intend harm they should not face criminal charges and that their lapse of judgement/unsafe performance however caused should not result in criminal charges.

I ask you a question in return, why should the public have confidence in licensed professionals? Why should I receive nursing care from you? Do you see where this goes? If the general public loses confidence that they will receive safe nursing care, do you think you can take for granted that they will continue to come to the facility you work at for their care? Do you think you might lose your job?

Licensed professions rely on the confidence of the general public. The reason licensed professionals get paid is that the general public trust in the standards of the professions and place their trust in the licensed professionals. If you can't provide safe nursing care why should I come to the facility you work at for my care? If a licensed airline pilot can't fly a plane safely, meeting industry safety standards, why should I fly with that airline? If the problem is endemic to the airline industry, why should I fly at all?

Anonymous865 · Feb 17, 2019

21 minutes ago, Susie2310 said:
I just had a licensed electrician work perform some work for me. Should I assume that he/she may be under extraordinary stressors and be unable to perform safely? I never thought that he/she might actually have been incompetent is his/her practice or might make a mistake that would lead to him/her ignoring basic electrical safety procedures. That perhaps he/she might be negligent to the point that I will get electrocuted. Oh, well, I guess I will just put it down to brain failure on his/her part. In which case, what is the point of professional licensure? If a licensed electrician can't perform their job safely why should I bother using his/her services?

Interesting you should use the example of the licensed electrician - an electrician was charged with reckless homicide because he didn't properly ground a bumper car ride and a child was shocked and died.

https://www.ecmweb.com/contractor/man-convicted-amusement-park-electrocution

mtnNurse., BSN · Feb 17, 2019

8 hours ago, Wuzzie said:
You’re talking out of both sides of your mouth. You first say you know what I think then you say you don’t. Well, to clarify...you don’t and I’d appreciate if you’d not use my name specifically in your examples. As I have said over and over. The override and wrong medication is the least of the issues here. RV did not monitor the patient appropriately for the drug she thought she gave. If she had this patient would not be dead. All it would have taken is less than 5 minutes of eye-balling. That is 100% on her. We are ultimately responsible for each of our individual practices. Nobody is going to make me do something that I know is wrong. Nobody. It’s called ethics.

I know what you wrote but I can't claim to know what you think. Anyone who wants to see can look back as well, but it was along the lines of what you just wrote which is that her failure to monitor is 100% on her. I disagree with that.

As I have been trying to explain, many people know how unsafe working conditions in hospitals can be and how those conditions can lead to prudent nurses making deadly mistakes. This includes conditions leading to brain failure. Brain failure is not the same as somebody making you do something that you know is wrong, as you say.

mtnNurse., BSN · Feb 17, 2019

1 hour ago, Susie2310 said:
You keep making the point that nurses brains are subject to failure because we are humans. By your logic all workers in all types of occupations should never be charged with any crime due to their negligence unless they deliberately intended to cause harm to the public.

Here is one quote where I wrote my opinion about where should we draw the line for criminality:

Quote
Then let the limit be this. If a nurse is working in a safe working environment, given a safe work load, and safe work expectations, and if being a "good worker" means the same thing as being a "good nurse" in the facility -- if all that is the reality, and yet the nurse errs in a way that she is solely to blame...Well, then perhaps. I'm of the mindset that we should find remedial solutions rather than criminalize non-violent people anyways, but that's another topic.

mtnNurse., BSN · Feb 17, 2019

On 2/13/2019 at 2:15 PM, mtmkjr said:
how many here who are opposed to criminal charges would support legislation that health professionals (because we can't single out nurses with special protections) cannot be criminally prosecuted for any reckless or negligent action whatsoever?

I'm opposed to criminal charges and would support your stated legislation when the nurse is not proven to have intent to harm and when the nurse is attempting to be a good worker at a facility that makes "good worker" synonymous with "good nurse".

mtnNurse., BSN · Feb 17, 2019

Thanks to who posted this link: ISMP article link !!!

I hope people will read it if they want to know more opinions of why this nurse should not be charged criminally. Quoting a piece of it below:

Quote
Even some professional associations11 and licensing boards12 have taken exception to the criminal prosecution of human error, citing that, if warranted, the licensing boards can adequately protect patients from reckless or incompetent actions of a healthcare practitioner by limiting or revoking licenses. (No action has been taken by the Tennessee Board of Nursing on the license of RaDonda.) Safety experts and many licensing boards agree that the criminal system need only be invoked in rare cases when harm is purposeful or knowingly caused without a justifiable benefit.

Susie2310 · Feb 17, 2019

27 minutes ago, mtnNurse. said:
I'm opposed to criminal charges and would support your stated legislation when the nurse is not proven to have intent to harm and when the nurse is attempting to be a good worker at a facility that makes "good worker" synonymous with "good nurse".

Nurses are held individually accountable for their practices by their state Boards of Nursing. Nurses are held to legal and professional standards of practice. My state BON doesn't permit me to violate the Nurse Practice Act and accompanying regulations in order to be a "good worker."

TriciaJ, RN · Feb 17, 2019

11 hours ago, mtnNurse. said:
I agree we don't know what kind of day she was having, and those that defend her from criminality are giving her the benefit of the doubt. Nobody has defended her actions. Most have expressed that she is accountable for her failings. We just disagree on whether she should be found guilty of criminal charges. Why shouldn't we give her the benefit of the doubt that she wasn't in a high alert, focused state of mind when this happened?

Actually, I don't know if anyone believes she should be found guilty, just that it's not necessarily inappropriate that she be charged. At this point we see how it plays out in court. There may be all kinds of extenuating circumstances we aren't yet aware of, and we all come away with sympathy for her. Or it turns out she has a history of egregious practice and has coasted until now. Or something else.

I'll certainly be watching with interest.

Editorial Team / Admin · Feb 17, 2019

12 hours ago, mtnNurse. said:
Well, I'm glad no circumstances such as understaffing could cause you to skip the rights of medication administration. I hope we all become as flawless in that way as you are. She wasn't a new grad but still did not have a heck of a lot of experience IMHO.

I never skip the rights of medication administration. Never, not even when I have a patient on the OR table who is struggling to come off bypass. I work with potent medications- I know that one little slip can cause death.

These rights are drilled into nursing students' heads from day 1. It takes mere seconds to check the label of the drug. It takes mere seconds to read the order. It takes mere seconds to verify a patient identity. The fact that you use understaffing as an excuse to skip these is mind-boggling.

TriciaJ, RN · Feb 17, 2019

16 minutes ago, Rose_Queen said:
I never skip the rights of medication administration. Never, not even when I have a patient on the OR table who is struggling to come off bypass. I work with potent medications- I know that one little slip can cause death.
These rights are drilled into nursing students' heads from day 1. It takes mere seconds to check the label of the drug. It takes mere seconds to read the order. It takes mere seconds to verify a patient identity. The fact that you use understaffing as an excuse to skip these is mind-boggling.

I agree with this 100%. Being busy is absolutely no excuse to skip any of the five rights. In fact, a hectic environment makes it more crucial to take the time to get it right. Accuracy counts at least as much as speed.

I don't call this "flawless". I call it conscientious. And safe.

LilPeanut, MSN, RN, NP · Feb 17, 2019

5 minutes ago, TriciaJ said:
I agree with this 100%. Being busy is absolutely no excuse to skip any of the five rights. In fact, a hectic environment makes it more crucial to take the time to get it right. Accuracy counts at least as much as speed.
I don't call this "flawless". I call it conscientious. And safe.

I have to agree. I don't administer meds anymore, but always always always verify against the order and patient. It's one of those things that just is non-negotiable in your brain. Whenever we have codes, I am always very happy to see the RNs and pharmacist labeling every syringe that comes out of the code cart. Once you give yourself "permission" to skip it a few times, it becomes easier to skip other times. When you work with meds that can kill very easily, you have to make that a priority.

I left a hospital once that didn't have great safety practices. I made complaints and incident reports and when those went unheeded, I made plans to secure a new job. At the end of the day, it's my license on the line and if I got sued for malpractice and was violating national standards, they're not going to care much if local standards are different. (as an ordering provider at least). I didn't like bouncing jobs, but I was not willing to practice in a way that made me feel that I was not safe and doing the best for my patients.