pseudonym87

I’m imploring all of my colleagues to settle down. The OP should feel free to have a forum where she can anonymously ask questions like this. After all, it’s better to be berated online than in person or behind your back my colleagues. OP- here’s my guidance, if in your heart you believe it is your obligation to report to the BON, then do it. Most of us on here believe that would be an overreaction and you could potentially destroy someone’s career and reputation over a small infraction. Whatever you do re this relatively minor infraction, I would personally do it anonymously. Yes you’re a professional but at the end of the day you’re a person in an environment that has its own distinct culture and perhaps people, even management, may “mark” you if they determine you’re a snitch who needs to be removed from the group. here’s a quick story- I once observed a consistent mistake every nurse was making with a specific ICU procedure. This mistake could have led to patient harm. I immediately verified through literature that I was correct and started letting my colleagues know the correct way to do it. My colleagues were so grateful and encouraged me to take it to shared governance so we can make a more formal education plan. I also discussed it with my manager. But she hated this. The fact that an error so flagrant was occurring on her unit and she didn’t catch it but I did threatened her. She came to me and said, “I don’t know what your intentions are but I’ve got my eyes on you.” she made my life a living hell and ultimately I ended up leaving. Ultimately, it’s all about politics, so for your own sake, carefully think about your next steps and the potential repercussions on you and your life. just my 2¢

Personally, I would only report colleagues to the BON in instances of neglect, prescribing without a license, going outside of your scope and actual or potential harm to a patient due to someone’s actions. I would always first report to hospital management in person and recap via email (to protect myself). Then, if the incident was in my opinion so grave, then I would report to the BON. For all other practice issues or minor infractions as the one the OP describes, a verbal conversation with a nurse manager with a follow up via email should suffice. Keep in mind that if she is well liked, her buddies may retaliate against you so sometimes it’s best to report it anonymously through the ethics line or safety hotline.

I had a similar experience in nursing. After 4 years of the nonsense, it felt like I was constantly in a battle to simply get the resources we needed to care for our patients. I quit 1.5 years ago and I haven’t looked back ever since. Every now and then I’ll miss the patient care aspect, but that feeling lasts for about 30 seconds and I come back to this thread to remind me why I left.

In my previous comments I had more sympathy for the nurse. I’m fact I assumed that there was some sort of short staffing issue that may have led to this. But after reading the legal documents and the nurses own confession, she clearly was grossly negligent. Vanderbilt had the policies in place that I would have expected- the only two modifications I would ask the hospital to make is to add a computer for medication scanning purposes and to revisit their policy on nurses administering medications outside of their unit, I.e. during Transport or at CT / pet / MRI. Perhaps it more appropriate to have the radiology nurses designated to administer all medications in these areas and prohibit nurses from administering meds outside of their areas.

The beautiful thing about nursing is that there is a plethora of opportunities away from the bedside. Nursing is a beautiful profession, but at some point, some of us, need to step away from the bedside. Dont start hating the nursing profession. Continue to love it. Take your skills and experience that you have gained over the last 6 years and enter the medical device or pharmaceutical industry as a clinical specialist, educator, account manager, etc. Believe me, the nurses are highly sought out in the medical device industry. I was having similar challenges as you and entered the medical device industry and couldn’t be happier. Be proud of your nursing career and make a change that will not only capitalize your experience but will improve your quality of life and earning potential.

First, I want to address the fact that you’re making valid points regarding the mistreatment of nurses by management and physicians. I’ve experienced it and dealt with it and is one of the contributing factors as to why I left the bedside. The other, and major contributing factor, is the lack of minimum nurse patient ratios. Everyday I felt like there was a situation where if it were taken to court, either myself or one of my nursing colleagues could have been held responsible and usually it was associated with short staffing or unsafe ratios. I think it’s great that you love your patients and are willing to do what it takes to promote positive patient outcomes. Documentation, although not obviously critical to your day to day activities as it relates to the current admission, is extremely critical when another dose of medication is ordered or another practitioner needs to make a decision based on documentation. So although management stresses documentation because of the legal implications of not documenting accurately, it can in fact contribute to outcomes in a negative way. The most concerning statement, however, is your comment regarding potentially overdosing on your meds or someone else’s. I understand that you’re most likely making a joke, but in my opinion, in our line of work where we have open access to controlled substances, jokes like that are not professional. With that said, even if there is an ounce of truth in that statement, I would highly suggest that you reach out to your hospital’s Employee Assistance Program (EAP) or seek out help from a qualified mental health professional. Believe it or not, despite the challenges in nursing, about 50% of nurses never face the mental anguish that you are describing. Therefore, I think it’s essential for you to reach out for help. Feel free to private message me and I have no problem connecting you with the right resources. You seem like you’re experiencing the textbook definition of burn out. This is not your fault but is a symptom of moral distress. More medical errors are made when nurses are experiencing burn out. So my concerns are for you and your patients. Please seek the help that you need and reevaluate whether or not the bedside is the safest place for you right now. Maybe you just need a break, or a different hospital or specialty, but you definitely need to do something ASAP before you hurt yourself or your patients. Best of luck! (Btw, I meant it when I said you can private message me if you want.)

I'm not a school nurse, but after reading the consistency among all of you in your responses, it makes me really glad to see you advocating for the students and not allowing your position to be used in unethical manners! You guys rock!

vec was removed from Pyxis at 1459, code was called at 1529. During this 30 minute period is when the vec was administered.

Beautiful said! @MunroRn

How does it not make sense? It's proven in the literature that organ with blame-culture yield to under reporting of incidents.

Susie I agree with you. I'm not concerned with the consequences of being fired on the individual nurse. Instead, I'm more concerned with other nurses being afraid to speak up or document incidents if they see punivitive solutions to medication errors. We should want to promote a just culture. That will prevent future deaths and will protect the right of every patient to remain free from harm while under our care. Oh and yes, while I do have an agenda it's not a personal one. I believe that we can be better a profession and that starts by accepting, to err is human. I understand that she ignored basic safety rights. She needs to be written up, suspended without pay, etc etc. Termination, however, will lead to a lot of messes being brushed under the rug.

Unfortunately, to err is human. That's a fact of life. We can either use this as a lesson to make sure this never happens again or we can be vultures and breed a culture that promotes keeping secrets instead of reporting yourself. If we want sentinel events like this to happen again, then remain punitive in how we handle medication errors.

I see the point you're making and I agree with you. When someone comes to work impaired or diverts drugs even once, this person's license is subject to revocation. Usually, however, the Board of Nursing allows second chances. You should read your boards quarterly report on disciplinary actions and the fact is most of the actions are consent orders, administrative fees, suspensions, remediation, and/or completion of a supervised program. The Board of Nursings take their job as protectors of the public seriously and they also don't take license revocation lightly (and neither should we). The Board of nursing will generally provide due-process to the nurse. Unfortunately, some people on this blog apparently don't believe in due process. I believe in accountability. If you look at my first post you would have seen that I wrote the nurse is at fault as is the system, the pharmacist, the doctor, etc. all at fault and all contributed to varying degrees. All should be held accountable- policies and processes need to be changed and all involved parties including the nurse should get remediation. The nurse should be suspended by the BON, required to take classes in patient safety, medication safety, and the nurse practice again and also complete a probationary period with restrictions on IV-push medications.

I agree. Absolutely gross negligence. The entire person needs to be assessed- her work performance evaluations, previous incidents, etc. Using The Whole Person method, she can be appropriately disciplined and absent any evidence pointing to a PATTERN of gross negligence or misconduct, remediate and reintegrate the nurse.

Texas law further explains violations of the NPA as Providing information which was false, deceptive, or misleading in connection with the practice of nursing; By adjudicating action against a nurse without having all of the information a Board of Nursinf would request, you are being deceptive and are therefore in violation of the NPA. Other states has vague statutes that provide broad powers to regulate every aspect of a nurses life. With that said, it's still a violation. Now, just to clarify, I have no connection to any of the involved parties at vanderbilt. The solution of firing someone and revoking a license should occur after it has been proven that a pattern of behaviors have led the board to believe, that it is in the best interest of the public for someone to no longer be allowed to practice. This one incident, although a horrible outcome, is not a pattern. Why can the hospital provide a corrective plan and be allowed to stay in business but the nurse can't be placed on a PIP? The reason why I am even concerned with the nurse is because I care about our profession. Yes we must keep the public safe. We also must hold ourselves accountable but in a way that doesn't create a blame culture and promotes a just culture. We're professionals. And just to address your rude assumptions- I'm lucky to have never been put in a situation where one of my patients were harmed because of my actions. We're all human. I, however, as a supporter of nurses, supporter of unions, and former union delegate would fight for this nurse because I promise you she didn't walk into work saying, "I want to hurt someone today." She's not a criminal- she made a series of stupid mistakes and she should be held accountable and placed on a PIP.

Right- but let's say she did the right thing and stayed with the patient, she would have most likely saved the patients life.

Of course I was ICU trained. I was going to take the post-code patient on the unit but the sup called up to start caring for the patient on the floor until patient was able to be given a room (pretty sure I mentioned this in my initial post). I recalled the policy from my previous hospital that you should not transport a patient after a fresh intubation until placement is confirmed with CXR. After this situation, I investigated, and the same policy was in place at this facility as well. The portable x-ray team had not arrived yet, co2 capnography was not used during intubation and I sure as heck wasn't moving that patient unless I was certain that I had a secure airway. Sorry, breath sounds don't cut it and I would say airway trumps cooling measures (I continued caring for this patient finally in the ICU until the end of my shift and cooling was not indicated. Just a few vasoactives, fluids, a-line, central line. There were no delays in care. Your red flags seem to ignore the potential for an unconfirmed airway to lead to respiratory arrest en route. My point is that you have to stand your ground. Maybe this nurse was summoned to the ER urgently and made the stupid decision to save time rather than to be safe. Instead, she should have properly administered the versed and stayed with the patient. She should have stood her ground and not be rushed to the next task. I'd like to know if a supervisor was aware that she was going to administer versed and then rush to the ER. There's something missing in this story.

It's unprofessionalism which also violates the nurse practice act. You have not seen everything the board of nursing will weigh in their determination to take action against her. To think that you can adjudicate on someone's professional licensure based solely on a review of content released to the public without taking account other evidence is unprofessional and this violates the Nurse Practice Act in all states. Of course I take issue with the errors made by the nurse, the physician, the charge nurse, the pharmacy, etc. She ignored basic checks but we need to determine if this is a pattern of behavior or an isolated incident before we revoke her license in the court of public opinion.

How dare you even say that a nurse should lose her license without knowing her, her work ethic, the quality of her work throughout her tenure, and without knowing all of the facts. The CMS report does not address the nurses experience level, whether or not she had received the training and competence to be a Resource Nurse, and does not address other patient situations that may have led to her being rushed. With that said, I've heard of resource nurses providing coverage for a specific unit. I've never heard of a resource nurse for the hospital. Typically, when an RN is providing coverage for a hospital it's usually as a SWAT nurse, IV nurse, etc and the requirement always remains to not move on to the next patient unless you've made sure as a RN you're leaving the patient in a safe situation. The nurse who administered the vec immediately went to the ED to care for another patient. I'm sure someone told her, "after you give the versed, head to the ED, we need you there." So while the nurse is the one who injected the medication, many people and departments dropped the ball here. I'll tell you a story of my own. I was called in to go to work- there was a call out. When I arrived, I was told there was a code and I would be taking care of the post-code patient. The nursing supervisor called and asked me to come to the floor to care for the patient during transport, imaging, etc etc. I had no other patients and even though my charge nurse didn't want me to go to a unit I wasn't trained on, I still went. Essentially, I used the nurses and aides as my gofers while I cared for the now intubated patient in a non-ICU. We were ready for transport- portable vent, monitoring, code meds, ambu bag, everything was ready. But, a CXR to confirm placement was still pending. The doctors, and the nurse supervisor, were pressuring me to go straight to the ICU and we can confirm placement there. Although I was newer to this hospital, I remember from my previous hospital to never transport post intubation until we have a CXR conforming placement. Well, it was my patient so I told the sup and the MD that I'm not going anywhere until we get the CXR and if they want to move the patient, then I need to endorse the patient to another nurse. We waited for the CXR. I guess the point of my relatively uneventful story is that many times, supervisors and docs will pressure us to do things that are not safe- that go against best practice and we always 100% of the time have to stand our ground and respectfully tell them to F off or bring another nurse. To say a nurse should lose her license without even conducting an investigation is unprofessional and quite frankly, goes against the Nurse Practice Act of every state and territory of the USA.

Generally speaking 2 nurses. The only time it was acceptable as 1 nurse 1 aide is a pre-op unit that hadn't been opened yet. But that's a no brained, lol. In the event of a code, 2 RN's for sure at minimum.

I've worked at several different hospitals in New Jersey and Arizona. I've worked for fortune 500/US News Rated Level 1 Trauma Magnet facilities to a med-tech startup. The one theme that has been constant at all these organizations have been their obsession with patient safety. At the hospitals, the obsession extended to the safe handling of medications and the administration policies of such drugs. There is an insurmountable agreeance in the Pharmacist-world on the guidelines required for safe administration. In fact, many of the policies implemented in hospitals regarding medication administration comes from the Pharmacists themselves. When we think about the vecuronium-related death that is going viral on social media and nursing-blogs, the very fact that it is "news" is a testament to the rarity of such major incidents. But they do happen, and that's why these conversations need to happen. Some people will argue that the nurse is 100% to blame. Some will question why an outpatient test is being performed as an inpatient? And that the versed would never have been ordered in an outpatient setting. Why did the physician feel the versed was more appropriate than Xanax? Others will say it was system error that failed the nurse! After all, to err is human. But what I will argue, regardless of who is to blame, is that this nurse should not have been fired. It's very clear- from the CMS report that I read, the nurse made several mistakes: The order was verified by the pharmacy prior to her arrival at the Pyxis and was present in the patient's profile. She searched, "versed;" Instead of also searching Midazolam to remove the correct drug from the patient's list of approved medications. This points to her lack of knowledge in the generic and brand names of the drug. She then went on to override and searched "ve." She then pulled out vecuronium. She then reconstituted it. Never did she question that versed should not be reconstituted. She also has an orientee, 1) if you're orienting someone, then you should in general have enough nursing experience to be familiar with versed and 2) you should be talking to your orientee and explaining the purpose of the medication, how it works, side effects, and major nursing implications 3) You should also be teaching the orientee how to reconstitute properly. During this process you should note the warning labels on the vial. When reconstituting, she should have read the label to see the dose of the vial and determine concentration of the final mixture. Why did she not verify the correct drug again at that point? After administering the drug, she immediately left the room. Let's assume, it was versed. You're administering IV sedation and at the minimum need to connect the patient to pulse oximetry which would allow for remote monitoring by an RN at the RT station along with oxygen and rescusitation equipment. Clearly, she's not familiar with versed. She dropped the ball. She was negligent. Discipline along with remediation is necessary. However, to fire her, is to place all the blame on the nurse. That action does not hold the pharmacy to account for allowing an override of a paralytic without a second nurse verifier. It doesn't hold to account that the hospital used a nurse untrained in moderate sedation as a resource nurse. It doesn't hold to account the lack of policies requiring incremental assessments. It doesn't hold to account those who used inpatient resources for an outpatient procedure. Further, if this is the nurse's first medication error, why is she being terminated? Why don't they allow the nurse to accept full responsibility, suspend her, and require her to go through a series of classes focused on medication safety, moderation sedation, and the Nurse Practice Act and reintegrate her into the organization in a slightly different role. This would be more akin to how Professionals respond to error vs how technicians respond to error. And as nurses, we are professionals. We hold ourselves accountable and we also believe in looking at the big picture.

I know this is an older post, but in case you're still looking, I'd say just keep applying. Definitely work on getting your nursing certifications and become involved with QI committees and projects to bolster your resume. Networking is key. As mentioned above, play nice with your vendors. Apply for jobs online and be willing to relocate if needed. Consider working for medical device startups to get your feet wet if you're having trouble with landing a position one of the bigger companies. Most of these positions on job sites are listed as "clinical sales specialist," "field Clinical Specialist," & "clinical applications specialist." Feel free to message me if you have any questions.

Sorry you got kicked out. I'd suggest doing a deep dive into investigating whether or not nursing is the right career for you. Not because you failed pharm, but because sometimes, things in life happen for a reason. Talk to tons of nurses, see if you can become a CNA or Tech and make sure you truly want to be a nurse. If you do want to be a nurse- then there's no way in hell anyone can stop you. How did you do in your nursing core classes other than pharmacology? If you did well, I would suggest taking a pharmacology class at a local community college, get zan A, and then reapply to every nursing school in a 50-mile radius. Heck, if you want to become a nurse that bad, look into nursing programs all around the country. Look into online programs like chamberlain which blend clinical programs to give you a BSN. If you retake pharmacology and get an A and potentially retake A&P and also get an A- nursing programs will see that you have matured and they won't turn away a dedication person. Remember, most members of admissions committees are nurses, and although we act like we're tough (which we are), as nurses, we are generally compassionate and tend to lean towards giving people second chances. Dont give up on your dream. If nursing is your passion- keep trying, work on your study habits, and don't give up.

There are varying opinions in the nursing profession regarding snow days and nurse safety and I would like to address them here. As a nurse, we have an obligation to our patients. As a human, we have an obligation to our selves and our families. Sometimes it can be tricky to find a happy medium. To those nurses who have the opinion of, "you must make it in to work at all costs and be prepared to eat whatever that is availability and sleep on the floor if need be and stay at the hospital for however long is necessary," I respectfully disagree with you. If it is expected from my employer for me to come to work earlier than my scheduled time, then they must pay me by regular hourly pay for the time they want me to come in early, provide accommodations (and no a cot is unacceptable), provide hot healthy food and not just fried chicken wings, provide a place to shower, and they should pay me time and a half for any hours worked past my scheduled shift if I am mandated due to an internal disaster code being activated. As nurses, our obligation to our patients begin as soon we are endorsed their car. Any other opinion is simply a "cult" mentality that nursing administration has cultivated among nurses. Administrators know that most nurses will do anything and they leave nurses to judge, fight, and quarrel amongst one another when the real issue here is with management. The hospital is also aware of the weather issues ahead of time. Why not book a bunch of hotel rooms in advance? Why not hire an agency to cover gaps? Yes- as nurses our responsibility to our patients is while we are caring for them. But the responsibility of 24/7/365 operation of a BUSINESS is the responsibility of the employer. Many will disagree with me and many will quietly agree with me. I love my patients and I'll give them my everything with they are under my care. My safety is always and will always remain my number one priority.