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.
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.
I have to confess my dangling my license in the air many years ago. I worked with a trauma doc whom a few of us charge nurses would write for things like tylenol, maalox and other antiemetics. One nurse would even write for narcs, which I never did. He faithfully signed every order. I only a few times wrote an order, knowing he would sign it, without calling him. But once he turned on me. He signed the order, didn't make a big deal of it, but said "I didn't order this. I didn't want this. That nurse never called me, on and on." Never one to shy away from calling a doc when a patient is in need, I called him all the time, with him saying "you didn't have to call, just write what you want"....yeah right, so you can stab me in the back. I'm lucky lucky lucky those couple of times I wrote orders without consulting him, that he signed and I never got in trouble. How silly I was then.
I would wake a doctor up in a heartbeat for whatever a patient may need. Why should he/she sleep? Are we nurses sleeping? Heck no..we're wide awake 24/7 taking care of the "I need some sleep Doctor's patients". Soooooo.....wake his/her azz UP, and don't stutter through what you need to ask him/her when it comes to their patients because they wouldn't be sleeping so nicely as docs if they had zero patients to keep them in business now would they? Nope! Patients should fire doctors who don't tend to their needs 24/7 as nurses do. Patients don't pay nurses salaries, but patients pay their docs very well. I'd much rather piss off a doctor regarding his/her patients needs than to do anything out of the realm of my practice as a RN. NO DOCTOR is worth losing my license for. :)
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!
Yes, Brownie, you are right. Where is the manager in all of this? There is a lot missing from this article. My guess would be that the nurses may not have a formal standing order, but it may be a situation where they give it and then get the order in the am. And the docs have probably said not to wake them for that.
Why there isn't a written order is rather questionable, but maybe it's like some things--it's done so often and it's been done for so long, that everyone assumes there is an order and it's unit policy.
And it is odd why only these nurses were disciplined. Surely you can't keep this a secret--the drug is considered a narcotic, isn't it? Don't you have to sign off for it?
There is a lot missing from this story. I just can't swallow the idea that these nurses are just so nice and sweet that they can't bear to disturb a sleeping doctor--and are willing to just prescribe on their own. If anything, you'd think they'd get a prn order at the beginning of the shift, while it's still early and the doctor still likely to be awake.
My mom was in the ICU there for a month (on a vent, none the less!!). They kept her so snowed and she had bouts of combativeness as well (normal occurence for a vented pt). I had to email the story, thanks for the info!!!!!!!
Hope these nurses have a good lawyer...I will be following this story. I have a good idea what they deal with at their facility.
I work with several abusive groups of docs who are coercive, abusive and sneaky. They write orders on the chart like "This patient self extubated last admission...do NOT let it happen again". then order NO sedation for a wildman on a vent...
They set up vent protocol meds then bytch if we use them ...gee wasn't that the plan?? I think it's a real phenom today....the angry, passive aggresssive doctor....
Also they gossip about night shift to day shift and badmouth us...one pulm doc told day shift the other day "Tell those night nurses if any of them call me I'll get their salaries cut in half".
If we don't call we're wrong...if we call we're wrong...no winning with these types...
Are some of the timid nurses afraid to call them? YES. Because these are the docs who intimidate and complain and make lives miserable.....
But...administration cowtows to them.
And NicuNsg...some patients on vents desperately NEED to be sedated...they use all their energy fighting...and none healing or breathing effectively ....please don't judge so quickly.
OK...and people wonder why there is a nursing shortage? This needs to be made available to every nursing board in the World. The accusations and the responses on the nursing sites.
Plus someone should make our responses available to the public along-side the accusations.
Let everyone see the whole picture. Hey Readers Digest did the ICU nurse story....lets get them involved in this one!
You never know what a doc will do about signing a telephone order. I called a ped once about a newborn I had just placed under an O2 head hood. I was given orders, but the baby recovered quickly and was sent out to mother/baby care the next morning. When I checked the chart that night (was surprised the babe had gone out so fast), the order sheet had disappeared. No mention of the O2 on the progress notes, either.
I rewrote the orders. Luckily it was his last week!
Guys, just a little aside about unions - this same hospital just lost a huge settlement with theNational Labor Relations Board. They were found to have unfairly dismissed a nurse because she was a union organizer. The case went on for years, but they ended up having to pay up.
Business » News Wednesday, November 6, 2002
4 nurses in union win $270,000 from HCA
Separately, Norton Healthcare is told by NLRB to pay worker
The former owner of Norton Audubon Hospital, HCA Healthcare, has paid about $270,000 to four nurses to settle charges they were demoted or lost their jobs because of union activity.
And in a separate case, the National Labor Relations Board has ordered Audubon's owner, Norton Healthcare, to pay back compensation to an employee it says was denied a job because of her union activity.
The two developments are the latest in a long-running battle by the Nurses Professional Organization to unionize nurses at the Louisville hospital.
Audubon's nurses aren't unionized, despite NPO attempts since 1989.
''We're very happy that there finally is some justice'' for individual employees,'' said NPO organizer Kay Tillow.
''The problem is that the justice comes so late that it doesn't have any real impact on the employers committing unfair labor practices. . . . We are still very far from gaining the right to freely choose to have a union.''
The four nurses' case dates to the mid-1990s when Columbia/HCA, now HCA, owned Audubon. Norton, which bought the hospital in 1998, informed employees of the settlement Friday.
The largest settlement, about $172,000, went to Joanne Sandusky, who lost her job as a lactation specialist in 1994 when HCA moved some infantcare positions from Audubon to another hospital.
Other nurses in the infantcare unit were offered a chance to move to the other hospital, but Sandusky wasn't. The NLRB eventually found Audubon had discriminated against her because of her union activity, and ordered it to offer her the same job or an equivalent one.
Sandusky's settlement amount was based on the difference between the pay Sandusky would have received at Audubon and the amounts she got in other jobs after being discharged.
Like the other nurses, she also received interest and make-up contributions to 401(k) and pension plans.
The other three nurses -- Patricia Clark, Ann Hurst and Terry Hundley -- lost their jobs as charge nurses at Audubon in 1996 when the hospital launched a restructuring that reduced the nursing staff. They remained as lower-paying staff nurses.
The NLRB ruled in 2000 that Audubon demoted them because of their union activities, including speaking out against staffing shortages. Clark and Hurst are officers of the union.
The NLRB also ordered the hospital to offer them charge-nurse jobs, which it did. But Norton, by now the owner, declared the jobs to be supervisory, meaning the nurses would lose their union rights.
The NLRB still is weighing whether Norton's offer was appropriate and whether it must pay the nurses any back pay beyond what HCA paid.
In the other NLRB case involving Audubon, the board ordered back pay for Wilma McCombs, a housekeeping employee who is a member of the NPO's executive board.
The Sept. 30 order upheld a ruling last fall by an NLRB administrative law judge, which Norton appealed.
McCombs was one of 300 housekeepers working at Norton when it hired an outside company to replace that department in February 1999. She faced a pay cut from her Norton salary of $8.80 an hour to $7 with the new company.
Norton promised that anyone from the housekeeping staff would be given first consideration for jobs at other departments in the hospital. But McCombs, who spoke out against the decision to hire the outside firm, was turned down several times for other jobs.
She became a Norton employee again when the company brought the housekeeping function back inhouse in 2000.
In his ruling last fall, NLRB Administrative Law Judge Irwin Socoloff found that Audubon had illegally held McCombs' pro-union activity against her. A three-member NLRB panel upheld the ruling.
Tillow, the NPO organizer, said she didn't know how much pay and benefits are due McCombs.
The panel also upheld Socoloff's ruling that an Audubon manager violated labor law through conversations with two nurses in 2000.
After discussing nurse Maryann King's performance evaluation, a nurse manager asked her why she was wearing a union button, if she was unhappy with her job and other questions about the union. Socoloff said that questioning was ''coercive.''
He also said the manager discriminated against the union by telling nurse Martha Ann Hurst not to talk about the union during work time, while permitting employees to discuss other non-work matters during work.
Upholding Socoloff, the board ordered Norton to post a notice at its hospitals telling employees they have a right to support a union.
In addition, it ordered Norton not to interrogate employees about their union sympathies. And it told the company not to forbid employees to talk about union matters during work while allowing other non-work discussions.
A Norton spokeswoman said the company hasn't decided whether to appeal the order.
My mom was in the ICU there for a month (on a vent, none the less!!). They kept her so snowed and she had bouts of combativeness as well (normal occurence for a vented pt). I had to email the story, thanks for the info!!!!!!!
I hate it when I see a patient on the vent who is combative. There is no reason to be awake and that agitated. It is extremely bad for you physiologically and emotionally. Not to mention the risk of biting through the ETT> If your mom was snowed and combative her sedation was probably inadequate.
I believe if a patient can not maintain some degree of calm while mechanically ventilated they should be sedated until able to wean.
I also can't believe your mom was on a vent for a month . I hope she made out okay.
Hey Eastcoast, I can top that. This spring/summer my mom had a perforated ulcer and was in ICU for two months and on a vent for 2 1/2 months--4 months total in the hospital. I understand that she needed to be kept from fighting the vent, but when I visited--she was 800 miles away--she was so drugged she didn't flinch from an ABG draw. I do think they overdid the diprivan. I think that if my stepfather hadn't agitated to get her moved from that hospital and closer to home to a Specialty hospital, she'd be dead right now.
As for the KY nurses, there may certainly be more to this than meets the eye, especially given Norton's history, but they were really stupid for going along with this unwritten protocol. I was discussing this case with a young L&D nurse who's in one of my classes and she said they gave meds without orders all the time. I hope I scared her enough that she'll stop doing it, but I think she's more afraid of the known danger (irate docs) than the unknown danger (losing her license, getting sued, causing harm). Unfortunately, there was another KY case where a psychiatrist and two psych NPs have been arrested for writing illegal scripts for oxycontin. Why are people so stupid?
Lucianne, Probably right about your mom needing to move. Lucky she didn't end up with a trach or a nasty noscomial infection.
Re: the nurses is kentucky. I still think that someone must have known this and made them think this was okay. How could such a large group go along with this and no one says 'hmmmm maybe this isn't such a good idea'. I believe they felt this was SOP in their unit and when for some reason there was something going on (union as someone elluded to) they were strong armed. However, this should enlighten anyone who thinks that a good doc/NP/PA will cover an order that was enacted without their knowledge.
Soooooo.....wake his/her azz UP, and don't stutter through what you need to ask him/her when it comes to their patients because they wouldn't be sleeping so nicely as docs if they had zero patients to keep them in business now would they? Nope! Patients should fire doctors who don't tend to their needs 24/7 as nurses do. Patients don't pay nurses salaries, but patients pay their docs very well. I'd much rather piss off a doctor regarding his/her patients needs than to do anything out of the realm of my practice as a RN. NO DOCTOR is worth losing my license for. :)
Tweety, BSN, RN
36,337 Posts
I have to confess my dangling my license in the air many years ago. I worked with a trauma doc whom a few of us charge nurses would write for things like tylenol, maalox and other antiemetics. One nurse would even write for narcs, which I never did. He faithfully signed every order. I only a few times wrote an order, knowing he would sign it, without calling him. But once he turned on me. He signed the order, didn't make a big deal of it, but said "I didn't order this. I didn't want this. That nurse never called me, on and on." Never one to shy away from calling a doc when a patient is in need, I called him all the time, with him saying "you didn't have to call, just write what you want"....yeah right, so you can stab me in the back. I'm lucky lucky lucky those couple of times I wrote orders without consulting him, that he signed and I never got in trouble. How silly I was then.