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14 Nurses Fired and 9 disciplined in Kentucky

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Norton Audubon Hospital in Kentucky fired 14 nurses and disciplined 9 other nurses for sedating patients with Diprivan without an order. The hospital has also notified the Kentucky Board of Nursing of the matter.

For additional information see http://www.courier-journal.com/localnews/2003/10/04ky/wir-front-nurse1003-5433.html

As nurses we have to make sure that we are practicng within our scope of practice at all times, regardless of the practicing setting (home health, ICU, med/surg, etc). Practicing outside your scope of practice (LPN, RN, APN, etc) can lead to employment (disciplinary action taken in the workplace), administrative (Board of Nursing investigation), and/or criminal (practicing medicine without a license/certificate, which is a felony is some states) investigations.

gwenith, BSN, RN

Specializes in ICU.

Sounds like there is more to this story. No offense nurse attorney but there has to be a reason.

why would you risk your career and livelyhood, and risk a lawsuit, and even safty of a pt all so the dr can sleep.

Personally, I'll call the dr, he can yell at me all he wants as long as he's yelling the orders for the meds.

"She said when they're (patients) pulling their tubes out and acting combative, you have to act fast, and that's what they (nurses) were told to do," Ziegler said. "She said everybody did it," including some who haven't been disciplined.

Ziegler said one of the nurses acknowledged it was a mistake to not have called a doctor, but said she was reluctant to wake up a doctor in the middle of the night.

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Good grief! This one deserved to be fired due to sheer stupidity!

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 28 years experience.

Gee, so many nurses doing it. Seems like it was just institutionalized that they all just took it as a standing order, but how did they document? I guess they didn't. So technically they practiced medicine. They really don't have a defense. But I do think it's a shame they got fired.

Just goes to show you. Get your own malpractice insurance because the hospital is only going to cover their own butt, not yours.

Plus, "One of them confirmed that nurses administer the sedative for the benefit of the patient so doctors can sleep. " Is rediculous. As a long-time night shift nurse, I laugh at that.

This had to have been institutionally sanctioned. Obviously, the Diprivan, which I understand is pretty expensive, had to have been getting charged to the patients, just to mention one issue. This investigation needs to go beyond just firing nurses. I want to see administrators and doctors with their butts on the line.

It does sound like somewhere down the line they were either told or encouraged to just give the Diprivan if a case like this rather than wake the doctor at night. I've seen nurses encouraged to give prescription medications without an order for the sake of convenience numerous times (myself included). Many times you *know* that if you give the med the problem will be stopped, but it will be your butt on the line if something comes up about it later. I can pretty much guarantee you that nobody will recall advocating the practice.

Personally, I don't think these nurses have a leg to stand on. It is a bad and unfortunate situation. There really isn't any way around the fact that all nurses (I hope) know that you can't give medication without an order.

The precious doctor that is going to lose sleep over a nurse calling him at night is being paid to be on-call. I'm sure he is being paid quite well. Who cares if you have to wake him up; if he didn't want to be on-call he shouldn't have accepted the position.

It would have been simple to make it a standing order! Or why is it tha MD's feel like they can't be called for an order of a certain med during the night? That is where the issue really is a nurse should not feel intimidated, pressure to call a MD during the middle of the night because he/she will become belligerent! Especially to the point where your license can be revoked! It is not worth it. I wish one of those nurses thought of just getting an order for diprivan then this wouldn't be an issue!!! Nurses usually don't have a leg to stand on the rules state not to give meds w/o a md's order clear cut. I think in the future some managament needs to post that calling your MD is not a federal offense!

I agree with Teshiee. In most ICUs, there is a standing order for SOMETHING to give ventilator patients who are "fighting the tube." As a matter of fact, as an OR nurse, I know the anesthesiologist usually WRITES an order for that very reason, or the ICU intensivist can write it, or whoever is writing ventilator orders can write it. There has got to be more to this story. ICU nurses are pretty savvy--I can't imagine they would put their licenses on the line just to let a doctor sleep. Was there a standing order for a different med--like Fentanyl--and they chose to use Diprivan instead? Did they plan to ASK for a standing order for Diprivan, and one was never actually put in place, except perhaps verbally? I don't get it. Something is missing in this story.

I agree. There has to be something being left out about this. That is a lot of nurses breaking a basic rule.

Sounds to me like it was an institutionally accepted practice, and the nurses are getting it in the neck (again). Where are the supervisors - have they been fired? Haven't read that yet, although they should have been right there with their employees.

i THINK THE SUPERVISORS WERE SLEEPING TOO. lol Just kidding, but seriously there has to be more to the story than what was actually told.

no matter what is going on who pulls out diprivan to give to a patient without orders? this doesn't make much sense to me. there seems to be more than what is being told.

sbic56, BSN, RN

Specializes in Obstetrics, M/S, Psych. Has 24 years experience.

But two of the fired nurses and officials of the Nurses Professional Organization, which is trying to unionize the hospital, said the nurses worked in the open-heart and intensive-care units.

Definitely something fishy going on here and I think this almost undetectable sentence in the article may be the crux of it all. I think some of the nurses involved wanted the union in. Healthcare facilities will go to extremes to keep the union out. I'm willing to bet the 9 nurses disciplined weren't for the union while the 14 who were fired were thought to be for the union coming in.

Wow, good call Sbic - I bet that is part of it. Diprivan is very expensive and there is no way they could just give it and not document it. If they can then their charting and charging system stinks. Someone knew about this - and the nurses are once again the scapegoats. Where I work - in the ICU - we are encouraged to let the docs sleep and use our "nursing judgement" and write verbal orders for meds. But of course there is no policy for this - just word of mouth. You can bet that I will never participate in that again. I am printing this article and taping it everywhere at work.

gwenith, BSN, RN

Specializes in ICU.

Sbic I think you have called it corectly there is more here than is being reported. It would not be the first time employees were victimised for trying to organise a union. This is bad - with the way this was reported those nurses are already prejudged - guilty!!

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