OMG will I get sued if I continue to work here?

[sunshineyday]

I recently decided to start picking up shifts in a long term acute care hospital with an agency. I worked Christmas day. AMAZING MONEY BUT...

OMG!!! All of my tubing was expired AT LEAST by 24 hours, there was one PICC dressing that was dated 12/14 (so it was 4 days overdue for a change), nothing was labeled, they don't double check potassium or insulin or any other high risk drug, they just check narcs. Oh and 3/5 of my patients were sitting in their own feces for IDK how long. Oh and another nurse didnt have the TPN hooked up to filter tubing AHHHHHHHHH

There was also a patient on cellcept but they didn't have the correct PPE and they didn't know that pregnant workers should not be around this med, and the nurse from the previous shift was pregnant! Also no black box disposals...??? what the heck?

The MARS were horribly messed up even though night shift does the "chart check" what a crock! One of my patients had TWO profiles in pyxis with different birthdays so when I did the double check at the bedside - his MRN, DOB, and Account# were off. Now, here's where my question comes in.

I advised the house supervisor of these problems and it looks like the previous shifts were using the incorrect medication profile. Interestingly, the medication profile under the pts room number was the incorrect med profile. I called the doctor and got everything squared away. Oh btw their "pharmacy" was closed for xmas.

But he was given a few incorrect medications. By incorrect, I mean someone else's (not by me by other nurses).

I asked about incident reports and the house sup just said, "we are too busy to deal with that right now...welcome to (insert name of hospital here)" and I felt that incident reporting was frowned upon? But I got a really weird vibe from him.

And another patient ended up having an EXTREMELY high K level. The person in the bed next to him was on an ace inhibitor and potassium replacement and my patient with high K was on spiranolactone. I know when these things are combined it can cause really high K. The pt never had high K before, had no renal issues, was not on any maint. fluids with K so I have a suspicion that a previous nurse gave the wrong meds to the wrong patient (it was a double bed room)? How can you even prove that?

I am just venting it was a frustrating day and I need to make some sense of it all. Is this how long term acute care rolls?

I didn't get all of my 9 am meds passed until around noon!!!! That has NEVER happened to me before.

I have some general questions because I am scared to work there again for fear of being called into court someday.

1. If a pt has an adverse med reaction and expires - do they do the toxicology to see what drugs are in his system and if there is something askew do they look at what other patients were taking to see if a wrong patient med error occurred? Surely, the toxicology doesn't screen for every chemical under the sun? If so, can they pinpoint what nurse it was? I don't want to be held accountable for some other nurses med error. I mean everyone excretes medications at a different rate. Same with PICC lines, incorrect TPN. Do they call every nurse in who signed the MAR or chart to a court case?

I really need extra money but idk about working here again. Does anyone know how I can protect myself if I do continue to pick up shifts here?

I have asked about filing incident reports again but they said they would have a supervisor call me and of course nobody called me.

Ugh.

The people here are really understaffed, I'm not trying to say they are idiots but OMG I have never been somewhere so messed up!

[Peetz, BSN]

WOW. All I can say is CYA. Document every move you make, don't give a med unless it is totally matched with the original MD orders, not the MAR, those can be messed up by someone in between. If you really feel that strongly don't ever accept a shift there again and contact the appropriate agency before they kill someone. PS. YES if a tox screen is called for it will be done. Some drugs are not detectable in the system after half life but most are. Also it would have to be in question that the wrong drug was given that killed them. I feel your pain, nothing sucks worse that to work in a place like that.

[bill4745, RN]

I don't care how much you are making. I would not go back to that place.

[shoegalRN, RN]

I'm with the previous poster. I don't care what amout of money they are paying you, it's not worth YOUR license! I wouldn't go back there if I were you.

[ocean waves]

Hello. The problems you are discovering at this facility do seem to be a big "yellow flag" for concern about patient safety and potential legal problems. My pal who is a director of nursing at a high quality long term care facility says that writing incident reports and solving meds problems immediately is the good way to go for patient safety and to maintain good accreditation rating for the facility. Since you say you are a new employee at this institution, one constructive option might be for you to kindly ask your nursing supervisor if you could help work on an in-house nursing task force to help immediately tighten up policies and procedures for patient safety. If your nursing supervisor is not open to important patient care safety improvements, it might be legally wise for you to protect your nursing license by giving a professional two week resignation notice and then "jumping ship". Best wishes!

[sunshineyday]

Hello. The problems you are discovering at this facility do seem to be a big "yellow flag" for concern about patient safety and potential legal problems. My pal who is a director of nursing at a high quality long term care facility says that writing incident reports and solving meds problems immediately is the good way to go for patient safety and to maintain good accreditation rating for the facility. Since you say you are a new employee at this institution, one constructive option might be for you to kindly ask your nursing supervisor if you could help work on an in-house nursing task force to help immediately tighten up policies and procedures for patient safety. If your nursing supervisor is not open to important patient care safety improvements, it might be legally wise for you to protect your nursing license by giving a professional two week resignation notice and then "jumping ship". Best wishes!

Unfortunately (and actually fortunately lol) I am just an agency person and not actually on their staff. I just talked to my agency and let them know I don't feel my license is safe working at this facility. Moving on!

[casi, ASN, RN]

I would put in a little call to the state...

[sunshineyday]

I would put in a little call to the state...

Can I do that anonymously?

[shoegalRN, RN]

Can I do that anonymously?

You should be able to. This facility needs to be investigated.

[interleukin]

Absolutely notify the State. But do not play the whistle-blower hero. Clearly, this facility is a disaster and anyone reporting them should receive a commendation. But politics has away of turning the whistle blower into the enemy Definitely, notify them with detailed specifics, but anynomously. If they blow it off, it is a reflection upon their professional incompetence and has nothing to do your moral obligation--which you rightly fulfilled. Well done!

[Zookeeper3]

I am so sorry you found yourself in this mess!

You will get sued, you won't loose your license because you are an EXCELLENT nurse... who already knows that the cost of walking away from this is worth the winning lottery ticket.

From you post, I'm gathering you are a VERY skilled nurse that knows on your last shift, you need to call the state regulation boards and you not only need to do this because it is right, but because these patients depend upon you to do so.

This is blood money, they just chose the wrong... ahem... "right" nurse that needs to start the process.

UNFORTUNATELY, I've been in situations like you, and when it comes down to it... my internal MORAL CODE... spoke more to me than the $$$, it was FORTUNATE that I had that internal code to break apart broken systems so I could protect the patients... and it was not easy in anyway but it HAD to be done, even at my own demise at times.

It was the only way I could look myself in the mirror the next day. Those that are there and are in such a bad system that allows this to continue, hopefully will learn from your actions that this is NOT acceptable care. PLEASE think hard about this, we are all in tough financial positions.

The real cost to you, will be more than loosing this job. Please consider my words. I wish you the best.

[TheCommuter, BSN, RN]

It seems that there are multiple reasons why this facility depends on agency nurses. High quality, well-run facilities usually can staff their units without the help of agency.