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.
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.
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.
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.
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.
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!!
I feel you have hit the nail on the head sbic, as I didn't miss that little part either! I have worked in units, and know that nurses will give a med, and will get an order for it later. Most experienced unit nurses will have the cofidence of the docs they work with, and they have no problem writing a needed order., AFTER the fact! I have seen it done over and over again.
Say pt had order, and the order needed to be renewed, and no one had reminded the MD, and there was a stop date for the med, but the pt is still on the vent, and or the med is still needed. Even pharmacy will send a one time dose up without an order, and say either you get the order, or they will get an order from the MD. And yes it has been accepted practice in ICUs I have worked in.
In fact that even goes for lab orders, that you know should be ordered, and when the MD makes rounds in the AM you tell him what you did, and he/she writes the order.
I totally realize, that no nurse aren't supposed to give a med or treatment without an order, but "I" see no reason for these nurses to have been fired! There was no harm to the pts., and this had been a long standing practice! It seems to me, that a presedence had been established, as this had been an ongoing practice. Why did this NM just now decided to do something about it???
This was evidently a long standing practice, and I find it suspect, that they're just now finding out about it. The other things is I highly doubt that any nurse would give an med, and then not get an order later to cover themselves. Then it comes to mind, why did some of the nurses get fired, and the others only get disciplined???? Why did it feel they had to fire any of them at all???
And why did one nurse say she had an order for the med, but was still fired??? Makes me think this hospital was sending a different message then the one they boasted about. I find it highly unlikely that a nurse of 18yrs, just gave a medication, and never got an order!
I think they made an example out of these nurses to send the messge, and I would be willing to bet this union thing had something to do with it. Making scape goats out of the ones they fired, and making the ones they didn't too scared to think about doing it either!
Now if you actually believe that this hospital fired a nurse of 18 yrs critical care experience, and it wasn't a scare tactic...I got a bridge to sell you!:)
I wonder how long will it be, before this hospital is hiring travelers to fill in for the 14 nurses they fired. I bet they already have their orders in! I bet this hospital is thinking these nurses are a dime a dozen, and can easily be replaced! Shame on them, and SHAME on the nurses who stay in such a hospital, as this move of their STINKS all the way up here!!!
Gosh - I guess I'm not getting it - they just started Diprivan (propofol) w/o an order?? That's bizarre and they should be fired for that! However, if they did it with a standing order, what's the problem?
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.
Good idea pretzlgl,
When push comes to shove you will never be backed up if there if something unfavorable happens. Wake them up. Save your own butt!! No need sitting in a courtroom hearing
"so...your nursing judgement said that you should give 8 mcg of diprovan...now where did this nursing judgement come from??"
Specializes in Gen Surg, Peds, family med, geriatrics.
Originally posted by Teshiee
It would have been simple to make it a standing order!
That's exactly what I was thinking. When I worked in a med/surg ICU we had standing orders for a variety of drugs including sedation for ventilated patients.
Pretty underhanded, isn't it? Union involvement can be very risky business. (and you saw it, too, brownie;))
I wonder if there will be much made of this? I'd hate to see these nurses not receive some type of retribution if this is as it seems to be. This could turn into a big deal for all of us, if it isn't resolved properly. Beyond what seems to be happening in this case in Kentucky, if this sets a precedent, then we had best be very cautious about considering anything resembling "T.O.'s" (telepathic orders) !
This is another one of those cases where the idealistic rule will be enforced to the degree necessary if it is to the benefit of the corporation. No doubt there were those who knew full well this was going on just as it does at facilities all over.
Repat
335 Posts
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.