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!
What you observed has told you all you need to know. Trust your instincts on this one. You can always find another job, but you can never get another nursing license. As long as you are working there, you might want to consider coming in a half hour early, doing rounds on your patients, then make notes of the ones who are laying in BM, wrong TPN, etc. , point it out to the nurse and insist that she cleans up her mess before you clock in, take report and legally accept responsibility for your shift. If the nurse refuses, call the nursing supervisor, show her what is going on and tell her you will not clock in and accept responsibility for the pts. until all of these issues are resolved. If that nurse doesn't get the ball rolling then call admin. to get to the floor STAT. Believe me I have had to do that a few times and when the nurses knew I wasn't going to put up with that nonsense they started endorsing the patients to me properly. I would rather be respected then liked.
Specializes in Management, Emergency, Psych, Med Surg.
I would strongly suggest that you not work at that facility again. It appears that they have some system wide problems that can cause immediate danger to the residents there. I suggest that you make an immediate call to the hotline number for your state and report each incident in detail and explain that you feel the residents are in danger of harm. Your information is maintained confidential. Once you make the complaint, it will be triaged according to the severity of the complaint. Any complaint that comes in that may result in immediate jeopardy to resident safety is considered an urgent complaint and the investigation must begin within 48 hours. It is imperative that you take this step because under the law you are required to report unsafe conditions. In addition, if this facility is not functioning in a safe manner. they should be taken to task so that the problems are resolved. Facilities can be fined, have their medicare/caid funding pulled, placed on stop placement, fined, and in rare cases..closed immediately with a requirement to remove those residents to another facility. Nursing homes have very strict federal and state regulations that they must meet. I don't know what state you work in, but I can tell you that in the state where I work, these complaints are taken very seriously and are fully investigated.
Goodness gracious Louise. Well I did come off defensive of LTAC. And thanks for clearing up how you came across with checking on the patient the next day. Just so you see, how your situation has all these variables in it from your point of view that I didn't catch the first time around, that's the way it is all around. The night shift wasn't trying to leave all their patients in poop probably, and the pharmacy ... well I can't answer for pharmacy, I don't remotely try to work that job, and couldn't if I wanted to. There are shades of grey everywhere and I have yet to find a nurse who always does the things she's supposed to do. The world just isn't black and white. Other than working for a facility that has seemed to spiral into some kind of hellhole in the last year, my defensiveness springs from a trend where I notice people painting things rather starkly. It's just not that cut-and-dried, although if you have the luxury of picking where you work, you probably should not go back where you are that uncomfortable with the situation. Calling the regulatory organizations wouldn't hurt either.
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.
Why is that the crux of your response? Scary.
indigonurse
216 Posts
What you observed has told you all you need to know. Trust your instincts on this one. You can always find another job, but you can never get another nursing license. As long as you are working there, you might want to consider coming in a half hour early, doing rounds on your patients, then make notes of the ones who are laying in BM, wrong TPN, etc. , point it out to the nurse and insist that she cleans up her mess before you clock in, take report and legally accept responsibility for your shift. If the nurse refuses, call the nursing supervisor, show her what is going on and tell her you will not clock in and accept responsibility for the pts. until all of these issues are resolved. If that nurse doesn't get the ball rolling then call admin. to get to the floor STAT. Believe me I have had to do that a few times and when the nurses knew I wasn't going to put up with that nonsense they started endorsing the patients to me properly. I would rather be respected then liked.