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!
As a nurse manager of a LTC facility, I can tell you that not ALL LTC is that bad, but I too have worked in some. Think of this experience as a blessing to those patients :) You really should call the state, and yes, you can anonymously. I have in the past too for places like you have described. And as one poster said, you can tell a lot about a place by its staff, if it's run mostly by agency.....there's a reason! Only when someone with the knowledge and moral grounding such as you enter these places do the patients get what they deserve. PLEASE call the state on this facility and DO NOT GO BACK!
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?
BTW i was scared the night shift people wouldn't keep on top of his K so I came in on my day off to a. make sure the pt was alive (he was and said he felt great - most of the drugs he received incorrectly - their half life point had passed so I felt better) and b. to make sure they were treating his K correctly. It was actually low but they hadn't ordered replacement so I caught that. I also 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!
Okay I feel the need to address these things, and there are multiple things. You could have been describing my current full-time workplace, except that we don't use the pyxis system.
1. tubing expired, picc dressing not done or overdue: I think that I would like to know what kind of patient loads the nurses have had. If they had too many patients there is a good chance those things were overlooked. I certainly understand it is frustrating to come in and have to change all your tubing. In my facility on short days, the first time I hang something for my shift I carry an IV tubing with me out of habit. Then I will see if I need more.
2. potassium and insulin. In my facility they are supposed to check it and most people don't. The way you protect yourself (at this point, when you find yourself anywhere just protect yourself first for the shift and worry about the whole facility later) is to get someone to double check with you and there, you're good. I am used to hearing the agency nurses say "look I always double check this, will you sign with me?" and I sign for them, no problem. I want their help so I try to play nice.
3. People sitting in poop. How many nurses assistants work there on days? On Nights? do they do a "last round" at six each shift to make sure this doesn't happen? Does the nurse double check that the help is helping? Or does the nurse have six patients and maybe she cleaned the other three herself?
4. I really would like to know what a black box disposal is. You got me there.
5. For things like chemo drugs, (is that what the black box is for?) TPN, etc. we have had to educate ourselves, and not depend on the facility to necessarily do what is right. One of our PRN nurses works oncology and she alerted us to the problem with chemo, so protocols were obtained, written and put into place. With TPN, we had to collectively raise a stink over which filter we know we should use, so that they would buy the correct filters. And we had to band together to teach the new grads how to do it right. So I feel your frustration on those things, when I see things that big places do right, and the LTAC seems to be ignorant of...
6. Don't get me started on pharmacy. It seems like ours can't do anything right some days. Two profiles? Seriously, I think the charge or DON should be emailing the pharmacist, along with writing up an incident report because that's just not funny. LTAC tends to get like nursing homes after a while, if the patient is there for a long period of time you will find the nurses know the patient and don't check armbands. This is, of course, the thing that gets us in trouble, either the new nurse has a fit or the family gets upset, or someone gets the wrong medication. I'm not making excuses, but that's what people do. Rules don't allow for common sense, and people with common sense tend to try to follow the rules anyway.
7. One thing kind of creeped me out about your post. You showed up on an off day to inquire if the patient was alive and if they treated the potassium problem? Really? You know that you are an agency nurse right? On a day when you aren't working there, the details about the patient are none of your business per federal law. I would be second-guessing your motivation if I worked there and this happened. Let's picture that: I come in on a day shift, after a few days off, and some chick I don't know shows up to ask about someone's potassium and did we order a replacement, etc. I would be asking you some pointed questions, like who are you, are you their relative, do you work here, and if I found out you were an agency nurse who had worked one shift I would not be thrilled, and you would not be coming back, and there might be a problem with you trying to violate federal law. I understand you don't want to go back to that place but there are other ways to do that.
Also, if you are worried about dead patients and having to testify in court over what you did and did not give a patient, what I tell you will apply to any facility: CYA. Do your job, it sounds like you know how to do it right, and have someone sign your high risk drugs with you, like potassium and insulin. Chart well and have a good insurance policy, that's all you can really do no matter where you work.
I would point out that if you do go back, everything is probably going to be a big mess AGAIN and you will be scrambling to make sure your MARs are correct, etc.... Your a.m. meds probably won't get passed till noon again because you are so busy making sure you aren't making a mistake.
Maybe things were in a mess because of the holiday? If you tried once more.... I don't know. You don't want to loose that license you worked so hard for- no matter what the pay is.
I was just trying to be a patient advocate. I really bonded with this patient and really felt scared they were not going to get the proper treatment. I didn't show up "just to" "check their chart" and barge in - I am well versed in HIPPA law. I had to go in anyway to have my time sheet signed and I wanted to follow up about filing an incident report. While I was there having a conversation with the charge nurse about my shift the previous day - she said, "I wonder what the K came back as last night" and she personally pulled up the labs NOT ME (because it was the same charge nurse from the day I worked). They seemed happy to have me involved with the plan of care, didn't seem put out at all that the "agency girl" was "back" and in fact my agency called me saying I had "glowing reviews" from the client. When I'm old, I would want a nurse to care that much about me.
What alterior motive would I have going back there? It creeps me out that you would even think of anything besides me just being a concerned patient advocate. If the charge nurse didn't bring it up, I would have put a little bug in her ear to try and ensure someone followed up. There is no federal law that says I can't do that. There isn't even a policy at my agency that says I can't go back to client sites as a conerned private off duty citizen.
I didn't go through their chart again or anything, I didn't even go into the pts room. As we were leaving the unit we walked by the pts room and the charge nurse asked the pt how they were feeling from the doorway and I observed them saying "i feel great" from the hallway.
BTW, the patient asked if I could come visit again (because like I said we really bonded and they don't have any family and since it was Christmas I spent a lot of time with them since they seemed depressed). So the patient gave expressed permission for me to be there anytime I wanted to be there. So the details about the patient are most certainly my business since the pt has given me permission.
I was just chatting with the charge nurse about the previous day and the charge nurse followed up with ensuring the K was under control in my presence. So no, I did not violate federal law and I did not have an unsolicited conversation. Jeez. Oh and at no point did I inquire if the patient was alive I'm more professional than that... lol "Hi... is this patient dead yet?" LOL ya right! Why is that the crux of your response? Scary.
I know you are probably quite defensive of LTC since you are part of the system and by your post there seems to be serous issues with staffing and education. The only thing I will say is you should be more welcoming of agency staff because they have the knowledge base to provide some education that by your post you are obviously lacking. I am also concerned with the "this is just the way it is" attitude. I know tubing changes sound petty to you but infection control and BSI's on top of the diagnoses these people already have will def cause increased LOS and mortality.
I'm also confused that you said you don't regularly practice the five rights of medication administration. I don't care if I recognize the patient - I always perform the 5 rights.
I hope you are able to perform the care those people deserve and that no adverse or sentinel events ever happen at your institution. I also hope that your license stays safe. Good luck to you.
7. One thing kind of creeped me out about your post. You showed up on an off day to inquire if the patient was alive and if they treated the potassium problem? Really? You know that you are an agency nurse right? On a day when you aren't working there, the details about the patient are none of your business per federal law. I would be second-guessing your motivation if I worked there and this happened. Let's picture that: I come in on a day shift, after a few days off, and some chick I don't know shows up to ask about someone's potassium and did we order a replacement, etc. I would be asking you some pointed questions, like who are you, are you their relative, do you work here, and if I found out you were an agency nurse who had worked one shift I would not be thrilled, and you would not be coming back, and there might be a problem with you trying to violate federal law. I understand you don't want to go back to that place but there are other ways to do that.
I have worked agencies on off for ten years. It use to be great! Quality jobs and assignments mostly. However the last time
I came back, beginning of 2010, I was shocked beyond belief. I encountered the worst situations! Patient nurse ratio insane...medication sheet chaos, sometimes having a patient and not even a MAR for that patient. really really crazy.
45 pts? who has time to read dr orders??
There is not enough space here to account all I have seen.
I will just say that the world is changing as we write and read here.
Your question of will you be sued? perhaps or have your lic suspended or revoked....maybe that too. will patients, are people, harmed in these places? could only imagine yes....how could they not be harmed in these chaotic situations?
I do not have the answers, I just know I was sent to enough places to realize it is happening everywhere.
Not a nice picture nor good outcome.
The greed, the owners, the corp's they certainly are not going to take the hit.
So for now I am poor and not working....at least I can sleep at night. Don't know where in few more months, but I can sleep now.
Mention calling the State out loud....oh dear do not make that mistake!
In my 2 1/2 years of nursing I have only once worked someone where I feared I would be called for a deposition as a witness in a lawsuit due to the rampant nurse and physician neglect I saw where I worked. I high tailed it out of there, the high salary and excellent benefits wasn't worth it.
I guess all I have to do now is never get old and require LTC...
Seriously though, I would NEVER go back there. I would report everything I could to the state--those are patient lives at risk. What if it was your grandma?
Why is that the crux of your response? Scary.
Pappilli0n
70 Posts
Ditto! Ditto! Ditto!!