Patient Abandonment

[PMFB-RN]

For the last 20+ years I've been casual at a tiny (12 bed) rural critical access hospital. I mainly work there because its a lot of fun and I'm often the only RN on duty.

The hospital has an attached small nursing home. It's usually staffed with one nurse, usually an RN but sometimes an LPN at night and 2 or 3 CNAs.

Last week my phone rang in the middle of the night and it was the DON of the hospital/nursing home calling me from out of state where she was on vacation. She asked my to come in and cover the nursing home for a few hours as the LPN on duty couldn't be found.

One of the CNAs went to talk to the nurse and couldn't find him. After a search of the bathrooms and other usual places failed to turn up the nurse the CNA called the DON, who called me and the police.

I know NOTHING about nursing home nursing. I've spent my whole career  in critical care and ER but I agreed to go in to "just be there". I arrived at about 3AM, the LPN had been missing for about an hour. 

The only deputy sheriff on duty in the (very rural) county showed up and conducted a search of the surrounding area that also failed to find the missing nurse.

About an hour before shift change (so absent about 4 hours) the missing nurse strolls in through the front door and was very surprised to see me there. I called off the cop and also let the DON know her missing LPN had returned. I questioned him and he didn't hesitate to tell me that he had left to spend some time with his girlfriend and, even more shocking, admitted that he often would visit her during his shift and didn't understand what the problem was "everything was quiet".

The DON asked me to inform him he was fired and collect his badge and keys from him. She has since been in contact with the state board of nursing and is fully confident he will lose his license. I sure hope he does. I had to write a report of the discussion I had with him when he arrived back to the NH for the board.

I'm blown away that a licensed nurse would see no issue with leaving his patients for hours when there was no other nurse in the building. 

[amoLucia]

3 hours ago, Jedrnurse said:

I was more anticipating repeats, especially considering that the night nurse is now fired...

Understood!

[PMFB-RN, RN]

4 hours ago, 2BS Nurse said:

Wow, do you have standing orders to do all of the above with that 12 year old? I suppose in a small town it wouldn't come back to bite you.

Yes, and protocols. Except for giving fentanyl and versed. I did that on my own confident that the physician would back me up with orders when she arrived, and she did.

    As mentioned I have a very long relationship with this hospital and its staff.  

    I'm a Level II OOORAM (out of operating room airway managment) certified provider and intubating is a normal part of my job both at the little hospital I talked about, and in my main, full time job as rapid response team RN. 

[PMFB-RN, RN]

22 hours ago, Davey Do said:

WOW! PMFB-RN, great stories!

I, too, worked in small 19 bed rural community hospital with an attached 40 bed LTC facility in the early '90's. My one life-saving ER story pales in comparison to yours, so there's no way that I'm going to steal your thunder!

 

I'd love to hear it though. 

[Davey Do]

11 minutes ago, PMFB-RN said:

I'd love to hear it though. 

Gee, I'm almost embarrassed to tell it, and this happened nearly 30 years ago, and the details are rather boring, but basically because of my decision & actions with an elderly man in respiratory distress the Doc said, "We saved his life".

I said my ER life-saving story pales in comparison to yours, PMFB-RN, but now it seems more to be as cyanotic as the elderly man in respiratory distress.

You know, in recalling my decision and actions, I was guilty of patient abandonment. I was the  floor RN and left, not only the floor but the building, in order to assist with the elderly man in respiratory digress whose son had driven him to the hospital.

Every other of the four total staff hospital members were in one of the two ER rooms dealing with a screaming kid who had a bug or a rock in his ear, I forget which.

Please don't tell anybody about me abandoning my patients. I don't know what the statute of limitations is.

[2BS Nurse, BSN]

PMFB-RN, why aren't you a NP?

[PMFB-RN, RN]

1 hour ago, 2BS Nurse said:

PMFB-RN, why aren't you a NP?

Honestly, severe dyslexia.  Writting for my BSN program was absolute murder. I had to hire someone to edit my papers. While the content of the program was unchallenging, boring and in my opinion useless, writting papers for me is murder.

    Plus, I made $137k last year not counting overtime. That's more than most of my NP friends make.

[Tweety, BSN, RN]

I have a couple of online friends that work in critical access facilities and they literally have to do it all...ACLS, birth babies, ER...on and on.

Hope that nurse does indeed lose their license to practice.  That's dangerous.

[PMFB-RN, RN]

3 hours ago, 2BS Nurse said:

PMFB-RN, why aren't you a NP?

Also wanted to add, I've found a niche in nursing where I have the autonomy I desire. In my main job the four of us full time RRT nurses are called "expanded roll RNs". We are privileged to do things on our own authority that are pretty unusual in American health care. For example I can order just about any lab or non invasive diagnostic test I think is appropriate. Through an extensive list of standing orders, protocols,  and hospital policies we can intervene directly in emergent situations.  For example in our respiratory distress protocol I can give O2 with any device, order c-pap and bi-pap, ABGs, nebs, oral and nasal airway, and preform trachial intubation to protect the airway on my own without direct provider involvement.

     In our sepsis protocol I can fluid recessitate up to 3 liters of IV fluids on med-surg or step down wards. We are also the ones that decide if a (stable) septic patient can be treated on a ward, or needs to be transferred to ICU. Step one of the sepsis protocol is "calls RRT to discuss appropriate level of care". In practice this means the residents call us and we let them know the most appropriate level of care and it is so ordered.

    We have protocols for most things. We also run all code blues, stroke codes, and STEMI codes and supervise the trauma response team.

    We also teach classes like The First 5 Minutes,  ACLS, PALS, TNCC and run the Sim lab scenarios for new docs and nurses. We will occasionally fill in for the ICU educators teaching classes like hemodynamics or pharmacology to the nurse residents. 

    Many of my NP friends are kept on a tighter leash.

[Stillcare23]

 The CNA most likely got fed up with it. Imagine how long he’s been doing that? Why was she looking for a a nurse? Did anything happen to patients?  How sad! Disgusting! 

***We even have staff that says they go out on break , they gone for 2 hours and “no one seems to know anything”.  Staff impaired, nothing done, we actually had a staff overdose at the nurses station on an ETOH and Detox dual diagnosis unit. Somehow jacho never came for that. I tend to wonder if risk management ever notified. 

Sick system,  and everyone is “friends” so long as your “in” then supervisor picks and chooses who they will protect. 

I am staying out of healtcare for a year now I need a break.

[PMFB-RN, RN]

1 hour ago, KKstillcares said:

 The CNA most likely got fed up with it. Imagine how long he’s been doing that? Why was she looking for a a nurse? Did anything happen to patients?  How sad! Disgusting! 

***We even have staff that says they go out on break , they gone for 2 hours and “no one seems to know anything”.  Staff impaired, nothing done, we actually had a staff overdose at the nurses station on an ETOH and Detox dual diagnosis unit. Somehow jacho never came for that. I tend to wonder if risk management ever notified. 

Sick system,  and everyone is “friends” so long as your “in” then supervisor picks and chooses who they will protect. 

I am staying out of healtcare for a year now I need a break.

It was Saturday night/ Sunday morning.  The two CNAs who work every Saturday night are both high school students. One 16 and one 17. 

     They have never worked with that nurse before. But I am wondering about the regular night CNAs and wether they have been covering for him.

   Near as I can tell there was no nurse in the facility had no nurse for about an hour. Once I arrived first thing I did was pass some PRNs that the residents had been asking for then round on everyone .

[Stillcare23]

You did your job. Wouldn’t want anything to do with that place good relationship or not. Not protected ever. Bottom line what happend if you couldn’t go in? Do they use you for DON coverage? 
if you couldn’t get to site…. Then what? You? Liable? Very sneaky, twisted sick systems. 
What is the policy for that? They call you? Do they have others too they can call if no DON? Weird and I would cut ties, period. People will find a way to drag, twist snd turn. You did right, pt saftey first then reported that. Howver turns into a massive hunt to blame. Can’t they call the police insight if missing “persons”. Leaving the bulging not permitted usually at night. Least around here it is. Either way Pt saftey snd care was compromised and awful to hear. Awful. I

[londonflo]

I thought rural access hospitals had some federal funding to help staff the hospitals with RNs so that they can do the follow through with assessment, intervention and most importantly (this applies to the RN role only) evaluation. Staffing with an LPN only does not show the hospital really understands the different roles of each licensure.