14 Nurses Fired and 9 disciplined in Kentucky

EastCoast · Oct 11, 2003

Originally posted by sbic56

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.

could not state this more clearly. this sums it up perfectly

sjoe · Oct 11, 2003

I agree with teshiee. "It would have been simple to make it a standing order"

A number of nurses who work in ICU, ER, even psych, have said to me things like "I just go ahead and give it (or order this or that test or procedure). The doc will sign for it when he/she comes in tomorrow. He/she knows I know what I am doing and will always cover for me. We always do it this way."

Well, this may be so at times, but when a facility has a secondary reason to pressure or fire or discipline nurses, has a new doc who isn't part of "bargains" such as this, or some new hot-shot administrator who can't see beyond the "hard facts," it is the NURSE who is left flapping in the breeze.

Everyone ELSE in the healthcare chain is protected ("I didn't write such an order," "I didn't tell the nurse by phone to do that," "There is no standing order," etc.) from liability or even criticism when something goes wrong or when the "system" is discovered by someone else.

The question is really, do we as individuals wish to take this kind of risk in order to:

1) feel important, more knowledgeable than the docs, that we are the "experts"?

2) avoid waking a doc at night or annoying the doc during the day or waiting endlessly after paging the doc 5 or 6 times ?

3) speed up dealing with the patient's problem ?

4) save time and steps ?

5) feel you are part of a cooperative "team"?

6) whatever else?

"If it ain't in writing, it does not exist" is the beancounters' and attorneys' motto. The same kind of thinking applies to telephone orders AND to orders that the nurse professionally judges to be harmful.

As many people have written on these forums, "It is YOUR job and/or YOUR license that is on the line."

sbic56, BSN, RN · Oct 11, 2003

Originally posted by EastCoast
could not state this more clearly. this sums it up perfectly

Thanks, EastCoast. You must be seasoned, too.

Brownms46 · Oct 11, 2003

Originally posted by sbic56
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) !

I still believe that this had nothing to do with T O's! I can't believe that the manager of this unit, wasn't aware of a long standing practice! And I still question why some were disciplined and other were fired! What did the ones who got disciplined do??? It just plain smells!

EastCoast · Oct 11, 2003

Brownie, I am sure that the manager knew of this practice and either was not equipped in discipline or had perhaps been guilty of this her/himself in the past. As someone said perhaps union talk and now let's go after the ringleaders.

We recently had an questionable nurse that the staff repeatedly reported to no avail. When I went to the manager and said that actually the staff now felt that allowing this nurse to continue to do charge was a direct reflection on her inablility to manage he was suddenly pulled from charge and put back to staff where he could be observed. Often times manager know full well what is going on and are ill-equipped to know how to deal with it or just don't want to. Easily, this problem could have been avoided by telling the staff that this was unaccpetable practice and illegal. I don't think all these 'sheep were led to slaughter' without someone in a higher position silently allowing it.

Brownms46 · Oct 11, 2003

And do you really believe that all of these nurses actually gave this med, and didn't get an order to cover it??? And that NO doctor questioned this med being given to their pts????

I'm sorry I just don't believe it, as I find this hospital guility of grand standing on the necks of these these nurses. But I will hold my peace until more pops up about this, ...if it ever does But thanks for the viewpoint. :)

Pretzlgl · Oct 11, 2003

Originally posted by Brownms46
And do you really believe that all of these nurses actually gave this med, and didn't get an order to cover it??? And that NO doctor questioned this med being given to their pts????

I'm sorry I just don't believe it, as I find this hospital guility of grand standing on the necks of these these nurses. But I will hold my peace until more pops up about this, ...if it ever does But thanks for the viewpoint. :)

I'm with ya - I don't believe it either. It was something that had been done for a long time - and they finally got called on it. And, unfortunately the buck stopped with the nurses.

ANnot4me · Oct 11, 2003

I am an experienced nurse and I have not and would not give any medication without an order. Furthermore, I would not take a colleagues word for it or not investigate hospital policy. If these nurses were giving medication without an order they should be fired -- whatever the reason. They were willing to gamble with their license and compromise their practice to work in a dysfunctional organization and they lost. I don't know the full story and maybe these were special circumstances, but I don't compromise my license or care for anybody.

Brownms46 · Oct 11, 2003

Originally posted by Pretzlgl
I'm with ya - I don't believe it either. It was something that had been done for a long time - and they finally got called on it. And, unfortunately the buck stopped with the nurses.

Thanks Pretzlgl:)! And you're right the buck did stop with the nurses. I sure would like to read a follow up, and or even talk to one of these nurses. And as for their rationals printed in the paper, I view that just as skeptically. As I have had something I said printed in a newspaper, and if my name hadn't been above it, I wouldn't have recognized it as anything I said! So I would rather hear it from them.

chase · Oct 11, 2003

There is doubt that the nurses is wrong about administering the Diprivan without an order, and disciplinary actions should be taken, but at a hospital level, considering the length of time that some of those nurses worked at that facility. It appears that the underlying problem here was that the nurses were heading down the path of being unionized, and Ms. Gruebbel (Vice President for patient care) found an opening to get rid of these long timers, again I do not condone what the nurses have done, but I think that along with the nurses Ms Gruebbel and the Manager of the said Unit who reported the incident, and the Pharmarsist should be fired. It appears that there are no check and balances in this Hospital or as the nurses stated it a common practice known by all parties concern, so if you are going to clean house start from the top, and let us not exclude the Physicians who has been signing these orders for years. The root cause analysis indicates that this is a system wide process flaw, but as usual only certain participants is being singled out.

mattsmom81 · Oct 11, 2003

Wow. Agree with ya'll..these nurses took a chance giving a drug without a standing written order...and the hospital found a way to 'get' them....as they were attempting to unionize. Been there.

I have been told many times by docs to 'just write the order and I'll sign it in the am'. Even with a good relationship with the doc, it is indeed a risky practice and we must be aware that this can turn on us in an instant. Whenever a 'somebody' wants it to.

carcha · Oct 11, 2003

fools!