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Content by HomeBound

  1. Doesn't matter which model, both of them do one thing---bill to get paid. Yes, a certain amount of care has to be provided at reduced rates or free--in order to qualify for government subsidies--but these corporate entities, even the "non-profit" hospitals...are now pouring every ounce of energy into scrabbling for that last dollar. I learned something outside of my usual ER/ICU world. Interqual. Look it up. Take a look at how these people coach providers on "how to chart" in order to maximize reimbursement. There's a powerpoint online that states, "Avoid saying ______" say it this way instead "________" How to avoid ordering "high ticket" tests like MRI or PET scans. They call it "decision support" using "evidence based practice". How to word a progress note to make it seem that the "intensity" of a patient's illness is more than what it actually is in order to be compensated at a higher rate. The manipulation alone is making me question every single thing I do now. Is this really what this doctor thinks is best for the patient? I can disagree all I like---even use this vaunted evidence based practice that is allllllll the rage now in nursing--- and it don't mean squat. This isn't about patient care and hasn't been for a very long time. I'm truly annoyed and it just chaps my a$$ to have been listening to these unit managers and educators harp on this evidence based practice thing when doctors and administrators don't even give a rat's rump---it's all about how to word the charting so we get the highest compensation from insurers. And you wonder why everyone above the ones actually doing most of the work are soul crushing tyrants?
  2. HomeBound

    Another Tragedy at Vanderbilt

    From The Tennessean: "Both of those errors were deadly (*referencing the vecuronium incident vs. the kidney stent incident), but they still don't carry the notorious reputation of a "wrong-site surgery," which are among the rarest mistakes in modern medicine. The U.S. Department of Health and Human Services says these "vivid and terrifying errors" occur once in every 112,000 surgeries and at individual hospitals maybe once in every five or 10 years. Federal officials classify wrong-site surgeries as "never events" and say these errors are often signs of "serious underlying safety problems” at hospitals, according to a safety primer published by the federal agency earlier this year." (emphasis mine) This is apples and oranges in some ways, but it still comes down to Vanderbilt's (and most other enormous "teaching" hospitals) culture of laissez faire when it comes to basic safety. I just spoke to a former RN from Vandy, who actually gave money to RV's "pay my legal bills for me" fund. He doesn't believe in her. Not at all. He thinks she should lose her license and then be sued into next Tuesday civilly by the family. No, he gave because he doesn't want the supposed "backlash" of the outcome negatively effecting-----him and his practice. I am about done with everyone who is defending these mistakes---like ZDogg did--not because it's wrong, or patients won't benefit---but because it might effect the profession--meaning, people are going to have their feet held to the fire on their performance. Can't have that. This physician will have his feet held to the fire. Just as any other physician that has had this "never event" happen to them. What you don't understand is that physicians can't get malpractice insurance after an even like this--and that is actually worse than having their medical license revoked. They literally have the capacity to work, but cannot---because no one will hire them, and no one will insure them even if they get hired somewhere. Hospital risk management steps in on these cases. Then the families can go after the MD in civil court and ruin them financially. Yeah, crappy doctors work. The old joke goes again---what do you call the person who graduates last in their medical school class? Doctor. What do you call a nurse who graduates last in their nursing class? Nurse. Which is why I don't comprehend this overarching support, without any logic, is being thrown behind RV---there are bad nurses and bad doctors and bad policemen and bad priests and bad school teachers and bad horse jockeys. There is a percentage of the population that are sociopaths, psychopaths, borderline, functional alcoholics, functional drug addicts---and do they all live homeless under a bridge so we can all identify them? No. They don't. They go to and graduate from prestigious schools and move forward to prestigious places. Vanderbilt has a serious problem with their culture. I was told point blank---the crew is green, because Vandy wants to pay the least for the most. You want our name? You do what we tell you to do. My friend told me that he was CHARGE NURSE on a step down unit within 6 months of graduating, while working at Vandy. Here's another point. I've worked for big, hulking "teaching" "magnet" "level 1" hospitals. I would not go to even one of them to have a surgical procedure. Not one. Because of this crap TEACHING thing. The hospitals allow attendings to prance in at the last moment, while everyone genuflects---to do 3 minutes' worth of whatever it is---then prance out--- forcing the residents, fellows and other "still in school" (technically) to do the hard work. You know.....the time-outs and the site marking. Anesthesiologists send their residents to do consenting. Surgeons send their PAs or NPs to do the legwork. In surgery, I've seen 5th year residents doing practically the entire procedure--- where is the attending?? It's the culture of these big, ridiculous "magnet" "teaching" hospitals that provides the rich breeding ground for "doing whatever" because there is no oversight. But hey. They've got great sports teams! What a great name to have on your resume! I was told by another large southern system---you want our name on your resume? You will take what we give you. You say one negative thing? We will make sure you won't work in this state again. /rant over The question you posed, Beth, is insulting. I thought that the first time you posted the vec vs. versed thing was really to inform. Then it kept coming---trying to stir up sympathy for this nurse not because of the facts of her negligence, but to instill fear into nurses that "this might happen to you if you let this happen to her". Now this "us vs. them" thing. The physicians are held responsible. Did this doctor come in and literally say..."HEY! I have an idea! Let's forego the time out!!" (overriding the pyxis) and then "HEY! Even though that rad tech took the xray and it says LEFT and not RIGHT, let's just dig into the right kidney anyway!" (overriding the warning about paralytics, reading the label and ignoring it, reconstituting-showing inexperience/ignorance of her own job) There is a huggggggggggggggggggggggge difference between what RV did and what this MD did. Where was the circulating nurse? Where was the resident? Where was the anesthesiologist? Where was the surgical technologist? Where was the surgical nurse? If the MD is held responsible, so should everyone else in that room. Including the nurses. Again.....there are bad nurses and bad doctors. Vandy's culture is such that they will hire anyone that is willing to do exactly what these other enormous teaching hospitals demand of their hires----you work cheap and you shut your mouth or else. It's our way or the highway with a big black mark on you for daring to criticize.
  3. HomeBound

    kaplan exit exam bank?

    You mean that qbank that costs $99 to order from Kaplan? If you want "free" go to quizlet or some other "study cards" website and download the content people put up for public use. Asking in an online forum for access that you didn't pay for, to proprietary information...isn't really a good start to your nursing career. Unless you're planning on selling the qbank to others, which is another bad idea. Just sayin'.
  4. HomeBound

    Help with ACLS

    Yeah, I agree with Meriwhen. Once upon a time, full grown men would be sweating bullets and on the verge of vomiting during ACLS scenarios. It's crept (thankfully) in that you are rarely alone during a code. They want you to know the material, yes...but they also are acknowledging that the team isn't just standing there like automatons waiting for you to give the correct command. Practice is the only way to keep it fresh--reviewing the acls website, reading your manual and having someone quiz you if you have someone to help. If you're really stuck, go to your nurse manager or someone on your crew---have them do a mock code or two with you--it even shows that you are trying and really serious about learning how to run codes effectively. I had a supervisor on nights when things were slow...."HEY! Let's do a MOCK CODE!" or "Let's pull out the Level 1 and go over MTP!" ...far better than sitting on fakebook or shopping for chainsaws online. It's also team building. So...maybe suggest this in your unit if it's possible?
  5. HomeBound

    Any way you could stay over and work a few hours

    Passing meds is a different skillset--yes---however---are you seriously going to tell me that somehow doing CRRT is the equivalent of passing the 0700 docusate and life saving tylenol to bed 2? Yeah, no. meant what I said. A Nurse Manager hasn't lost all of her wits that she can't read a MAR and apply the 5 rights. I would stay over my daggone self if my patient needed CRRT and the only person between that procedure getting done and my patient dying is an RN Mgr who has a. never done CRRT or b. hasn't done it in 18 years. Passing meds is not "easy", by any standards, but there is zero equivalency here between difficult and technical procedures and giving tylenol.
  6. HomeBound

    Tennessee Nurse RaDonda Vaught - Legal Perspectives of Fatal Medication Error

    Um.....its hyperbole, not an actual event. Please. With the over the top emotion. I think you may want to save your outrage for something really scary, such as drunk drivers, high drivers or road rage. Geezus.
  7. HomeBound

    Tennessee Nurse RaDonda Vaught - Legal Perspectives of Fatal Medication Error

    "If you find yourself of the opinion that “yes”, RaDonda should be criminally prosecuted, keep in mind that this could be you!" This could apply to driving my car, then. I shouldn't prosecute the guy who is distracted texting and kills my kid. Because it might be me next time, i text and drive sometimes too. Not. A. Legitimate. Argument.
  8. HomeBound

    $750 CA RN License??? No way!

    Thank you. Just a few on this thread with some actual experience living and working in CA, as you and I have had. Gotta love armchair "experts" with QVC cred to chime in about how they know because....sitting in front of google. I can say....maybe....75% of the nurses I worked with in Sac were foreign born---but had been here for more than 20 years, working as nurses. At UCD, foreign born, at least in the ED, were a rarity. I worked PRN in northern CA at several other places, and the smaller the hospital, the larger percentage of foreign nurses. I never heard or saw any shenanigans as far as licensing--but I do know that several of my Philipino colleagues would definitely work management on an applicant that they had in mind--and it was usually a family member or friend that had emigrated. There is absolutely no illegality or "unfairness" about it-it happened all the time where I've worked with US trained nurses. My RN Mgr had his daughter hired in as unit secretary on another floor. His wife worked in registration. It is what it is. Call it nepotism or protectionism---the VA practices a form of this as well as other places "we only hire from within" until no internal applicants are found, and then the job is posted outside. Explain this, expert poster. We only hire from within. Meaning....all you people out there? You're not welcome to apply for this job, because we only offer these jobs to our own. But noooo. This is "discrimination". I think someone may need to take that expert knowledge and file a class action suit against California, The US Government, any employer that has internal postings, most countries with immigration laws---and just sue the pants off them all....because she googled it. And she knows. Back in 1995, there was a huge influx of Irish and Philipino nurses who were willing to take the night shifts that supposedly could not be filled with US trained nurses...that was in Philly though. I have no idea what the rest of the country was experiencing. I was grateful to be employed, frankly, as the situation back then was what the situation now is approaching. Tight, tight market---and yes... The very definition of "filter" and "selective"---is protectionism. An employer, state, country---makes it's own rules about who to allow in, based on criteria that they are legally allowed to use. Think immigration. This country only allows those who follow the process, and even then, they may not get in. Australia would not allow (when I wanted to travel there as a nurse) anyone that wasn't on the "critical need" listing that they put out (yet another thing dr. google can educate even the most expert here on)---to come and work. They protect their own workers. Canada does the same thing. Their rules and regulations are such that you have to have a BSN, and you have to pass their exams, even though you've passed them here. There are fees that are absolutely exhorbitant to be a nurse there. If a fee filters out workers, then there is more of a chance that nurses that are already there, or nurses that will simply bite the bullet and pay (a revenue generator)---are going to apply. I can tell ya....when I paid for CA, the license was $100. I'm sorry for those nurses who are going to get whacked with $350. That sucks. Renewal for me is going to be the same as renewal for you, but...the initial is steep. It may have given me pause if I had to pay $350. I may have thought...meh....I don't really need to travel to CA. The license process is tedious and very fraught with mistakes you can make that prevent you from being licensed. If your verification "expires" before all of the other paperwork comes to them? It gets kicked out. And they don't tell you. You find out 4 months later when you sit on hold for 4 hours (if it doesn't go to vm) and find out you did it wrong. California can be a beastly license to get---and I have renewed mine every time---because of that. Here's a simplistic example---but my dad was a Teamster, working in steel mills in the late 70's. Protectionism is what a business does in order to keep jobs local---with local people working there. We do what we have to do in order to keep our jobs for our people, tax revenue stays here, because there are families and roots being set down. As far as the totally ignorant of the actual facts poster that doesn't seem to understand how to interpret statements correctly-- California requires a transcript to be sent---because they have a standard to which all nurses must be trained (yet another way to filter applicants out and protect those that are trained in CA)---why doesn't the ignorant person who claimed this isn't true---apply for a license in CA and see for itself? I did---and I submitted my application---it took 12 weeks, on the dot to the day that the Board said they were processing my submit date. I had to give them an original school transcript (not one that is sent by you, even if its official. it must come from your nursing school or the clearinghouse that handles your school transcripts) Two other travelers in my group were denied because of the "MicroBiology with separate Lab" requirement. The CABON was amazingly nice when I went there in person--two people in line--I paid my $100 for a copy of my CA verification to be sent to another state for processing. Some states require a verification---and most people have licensure that the NCSBN handles--CA is not on the quick verify list. You have to go and pay CA $100 (it may be more now, because....oh....you know.....revenue needs) to send the same verification that the NCSBN handles for most other states. So by this thinking---you're saying that employers that require a BSN for you to be hired---are all discriminating against ADNs? Employers, landlords, countries, states---all have the right to put into place rules that they feel are necessary in order to achieve whatever goal they have in mind. If it's a staff of all BSNs? Then that is what they are allowed to do. If you want on the staff there? Then you pay the price of admission---get your BSN.
  9. HomeBound

    $750 CA RN License??? No way!

    And yes. I agree Jed, it's protectionism. Each state is now implementing more and more stringent requirements for nurses that are trained and licensed outside of their state. They want to train and keep the nurses that they have. California has an educational requirement as well---denying US trained nurses based on a microbiology w/lab and other minor courses a license there. Is this "discrimination" Jory? How about the fact that other countries also have very, very, very stringent requirements for foreign (read: US included) nurses--and will only permit work VISAs with sponsorship, yearlong residency of the country without a job, retaking their equivalent of the NCLEX?
  10. HomeBound

    $750 CA RN License??? No way!

    CALPERS is 1 trillion dollars in a hole for pensioners. SF just instituted a new tax....another one....on top of the city tax if you work there and the highest income taxes in the country. This has nothing to do with "discriminating against foreign nurses". They raised the licensure by endorsement for US TRAINED NURSES as well. https://www.rn.ca.gov/pdfs/regulations/isor1417-2.pdf So are you saying they're discriminating against us too? No. It's and easy revenue generator. The fires in California have wreaked havoc, the rents and property taxes are at the upper limit for the poor schmucks living there and stuck-- do your homework on California before you say something as inflammatory and ignorant of the facts as this. Race and nationality baiting is not cool. When I worked in CA as a traveler....the nurses who were licensed there are the ones who are willing to pay the licensing fee. That included Philipino, Chinese, Indian---all nationalities and ethnicities were included.
  11. HomeBound

    Already feel like giving up

    Yes, way too soon to give up. There simply may be more experienced nurses applying for the job. Unfortunately, in this business, internal applicants don't always get the job just because. If I, coming in with 20 years of ICU, apply to the job you, New Grad with no experience, wants? They'll most likely choose me. I agree you need to work on anxiety issues. Practice with your family members or other nurses/friends. Get a list of questions for "interpersonal questions". You don't have a lot of stories, like when they ask you about a time when you had a conflict with a coworker or an irate family member of a patient....so you need to find stories from when you were a student, and customize them for the question being asked. I do believe that the common lag between school and first job is 3-6 months. I know residencies take months to navigate just thru the application and interview process. You are an employee, correct---but you have to consider who you are up against for that position from the outside (or even co workers). This may be as simple as, we have an applicant that doesn't need to be trained. Try to stand out with your answers. Recall all of the crazy stories you had from your clinical days and tailor them to these standardized "so tell me about a time...." questions. You'll get there. If you don't get something in your own facility within a reasonable amount of time, perhaps going to another facility---explaining to HR at your facility that you would "love to stay" but you cannot continue to wait--and maybe that will spark someone to consider training you in a unit.
  12. HomeBound

    Hospitals paying for your stay?

    LOL...yeah....I didn't work FTE for anyone in the UC system, I was travel. I heard it all from the employees---and it wasn't in the SF area, but they had the SF "union contract". It was astonishing to me that every time I walked into any area where more than two RNs were talking---they were talking about money and how to game the UC system in order to get more in their paycheck. SF has a tax for just working there... So. Federal Income tax, marginal, is 25%--that is the bottom. If you make more, expect your tax rate to go up up up very quickly. CA state, local, and city sales tax rate for SF is 8.25% https://smartasset.com/taxes/california-tax-calculator CA state income tax is the highest in the country. Marginal is 8%. SF has a city income tax as well of I believe 5%? The gas taxes are the highest, I paid $4.00/gal when the rest of the country was paying mid 2's. Rents are some of the highest in the nation, all over CA, not just in SF. In Sacramento, a 1BR apartment in a verrrrrrrrrrry sketchy (and it's literally one block is okay, next block a shooting gallery, next block is okay....) area is around $1700/mo. The union dues for the CNA are $120/mo. Parking is an automatic $48/pay whether you park there or not. It's to help them pay for their overhead. "just in case" you ever park there. There is zero parking available if you don't have it attached to your rental. None. Zip. Unless you want to live in one of the inland cities, you are not going to own a car or be able to get around effectively. SF has almost gridlock traffic. Read up on Oakland crime and that's a stone's throw from where most of the hospitals are located. Getting to "the beach" from outside the coastal areas? Hours. Hours and hours and hours and hours of sitting in bumper to bumper traffic to get there---and if you want to spend the weekend? Expect to pay $500-600 per night for a hotel room miles from the beach. The fires in the summer are legendary--and this past summer is just an example of how bad they are getting. PG&E is going under, filing bankruptcy. Two of the other utility companies are in trouble. Because of the fires. Infrastructure is being destroyed very quickly and the money isn't there to rebuild it. The rates will be going sky high, and rolling blackouts like last summer will be the norm--from the fires. It's 105 degrees during the summer routinely anywhere but the coastal areas. I couldn't go outside if I wanted to in that heat...my pets suffered horribly and I couldn't even ride my bike without feeling like my brain was boiling. People didn't go outside unless it was midnight. Even then, it was in the mid 80s. If you live in an apartment, chances are that water is not included in your rent. I saw multi million dollar homes in the Monterey/Carmel area built and standing vacant, because they are on a list for water rights. The owners cannot live in them because there is no water allowed to go to the home---there is a limit to the amount of water each municipality is allowed---and once that is reached, homes cannot be occupied. CALPERS is almost 1 trillion dollars in a hole. They cannot and will not ever have any type of ability to pay for those pensioners and they know this. I was there when the word was coming down that the nurses that are starting now and a few years ago---will never see that money as a pension. I was offered and I refused--I made more as a traveler in the UC system--and that is actually the exception to the rule in California. Most of the time, the staffers do come out ahead of travelers. It's a weird thing. Anywhere else, we make double what a staffer makes. Not so in CA. Except at the UC system....you make more as a traveler---several female nurses that I knew---they were broke, hooking up with guys just so that they could move in and have a break on rent--moving in with parents and friends, living on couches---and their base pay was $64/hr. I saw the paychecks of those staffers--because I wanted to know what I'd be getting into for that "high rate of pay"---and effectively, their income was cut by 51% with taxes, union dues, parking fees and other miscellaneous fees UC managed to tack on. So the hourly rate was cut to $32/hr. Now live in one of the highest COL areas in the country. I can live on $32/hr in Ohio. I cannot live on that in CA. That was my point. I applaud you for being able to command a much higher rate of pay as a NICU NP. You worked hard for it and that is really a great thing for you. However. You admit that you live in a very tiny space and "maybe can retire someday". I want a house. And a yard. I don't like paying thousands of dollars for someone else's mortgage in order to live cheek to jowl with some crazies that call the police for your dog peeing on their petunias. I also don't like drug addicts sitting in the doorways of the street where I walk, and nobody does a thing. I also don't like when my door gets kicked in, in a "nice" expensive (for me) neighborhood---and the police tell me that they won't investigate because "you weren't raped or murdered". I am all okay with not paying with my life, my health and my savings account in order to just see sunshine. The idea that I am "trapped indoors" because it snows? I am from a state with feet of snow---l learned how to snowboard and ski. There is no reason to be trapped just because it snows. Too hot, on the other hand....California is on fire most summers...and the Valley had the worst air quality in the WORLD, even above Shanghai, China. People were wearing masks when going outside. Trapped inside? Yep. Just my take. This is a primer for those who would just take a job because of money. If you want quality of life, you need to assess all of the factors.
  13. HomeBound

    HIPAA and "Hallway Patients"

    Nurses are being bombarded left and right with rules and regulations that, if broken, can mean the end of a career and perhaps potential financial ruin. My questions are simple, as the trends are seemingly "from the top down", and blame/responsibility lands squarely on the nurses. What about hallway beds? I've worked at three facilities so far that "hall" patients for their entire stay. No curtains, no privacy. I am required to care for them, discuss their care/diagnosis/prognosis/aftercare/appointments at discharge--in full view and hearing of every single other patient in that hallway. I'm required to (at times) perform embarrassing procedures like foley placement, by pulling a flimsy "screen" around their bed, because no rooms are available. I'm required to perform the 5 Rights, stating their name/DOB with other patients and their families in full view. Where is the hospital's responsibility for the "sacred" keeping of patient information? I've had patients and their families eavesdrop on my conversations with other patients---and comment to me...."Isn't that awful? That poor man. He's got cancer! What will you do for him?" I've even had a patient defend me against another patient who was threatening to turn me into the board for enforcing a doc's order to cut her off from her dilaudid. He volunteered to go to my RN Mgr on my behalf! The onus should not be solely on the nurses. The hospitals are placing us in this ambiguous "Do as I say, not as I do" position. If the hospital isn't responsible for affording patients privacy even at the lowest level (on a gurney in the ER), then how it is that nurses can be prosecuted for HIPAA violations that the hospital actually creates? What are your stories of privacy issues that were created by the environment in which you work--and what is your unit's policy on these issues?
  14. HomeBound

    Hospitals paying for your stay?

    Keyword being "should". I've known a lot of nurses and other healthcare providers that are shocked...shocked I say...that they cannot make it in Fresno at $75/hr. Never thought about....oh....that CA state income tax is the highest in the country practically. Another shocking thing to some is that an employer will unilaterally take parking or union or retirement--whether you want it or not. The UC system does that--you can't even fight it--they have to have that pyramid scheme for Calpers going strong, so they need new blood coming in to pay for the retirees. The bottom line is--if the offer sounds too good to be true, especially for a NEW GRAD? I probably is--check deeply and thoroughly. Don't be afraid of boundaries and breaking points. If you know you will be living paycheck to paycheck, one broken down car away from losing your rental? Don't do it. Getting something on your resume is laudible--if you have a year that you can spend on something truly fabulous that will just be the golden ticket for the rest of your life---go live like a frat boy eating ramen noodles until you get that year in--but a career? You cannot go to these places with high taxes, high rents, and "reasonable" payscales. There are always hidden costs--you just have to screw your head on straight and find out what you're willing to put up with to get what you want.
  15. HomeBound

    Hospitals paying for your stay?

    Greenville is also a very expensive town to live in, remember that if you think it's such a cool thing. It's a college town with a huge teaching hospital. Try and look at the rentals there and see why they'd offer anything like this---and then remember---the starting pay at Vidant is around $23-24/hr. Parking at Vidant is....how shall I say it nicely---well, I can't say it nicely. They will spend an entire day on threatening you about parking. Boots on cars, tickets, etc. There is also the "bait and switch" there--they offer high salary for "Tiered PRN" schedules---and say you will get a $40/hr Tier for committing to a certain schedule, and then yank it out from under you at the last minute--saying there are "no more positions of that category left"---and tell you that they can offer you $29/hr for PRN. Then there's the predictive testing--PBDS--that has you going through vignettes of patient scenarios...you have to write down everything you see, what your diagnosis is of that patient, what labs you would anticipate being ordered, what diagnostics, etc....and it's timed. There are 8-9 of them. Plus some version of the BKAT and an arrhythmia exam. They assure you that this is all just to "see where you are" and how they can help. Not so. A friend went all the way thru the weeklong orientation, and was told that her offer was rescinded because of her poor performance on the predictive test. This was, by the way, for a Med Surg position. These are questions that you need to ask ANY prospective employer, New Grads---what are the requirements? What is the schedule? What about rotating? How about floating? Do you get a solid, permanent preceptor (not 5 different ones, depending on who shows up that day)? Is there a structured teaching program for you as a new grad orientee? What about parking? If my shift is an off hour one, will the bus be there to take me to my car? What are rents like in the area? How about state income taxes? Reasonable hourly rates can turn very quickly into minimum wage jobs if you aren't paying attention. It's always so cute and romantic to live in downtown NYC or SF---but when the reality hits---you are either being recruited to a HIGH COL area for a seemingly "high rate of pay" or a toxic hospital where locals or internal candidates can't be found because they've caught on.
  16. HomeBound

    Hospitals paying for your stay?

    Same here. I interviewed at a place in NC--flight was paid, nice nice hotel, and a car. NC and the Southern tier states seem to be famous for this "but you don't like snow. you should pay us in order to work here!" and it doesn't pass by me that they are all red red red states, longing for the labor laws of the 1900s and as rabidly anti-union, anti-worker's rights as you can possibly get. It would have been the job from hell. I could not have sat down and penned a more horrible schedule or pay package if I had tried. 4-10s or 3 12s, solid week of call every three weeks, you work your 10 or 12 hour shift, go immediately on call (it was cath lab so ....you're staying)--do all cases after your own shift, and then....surprise!! you get to come back in the next day. you don't get a day to rest. In other words, in one week, you may likely have been working 36-40 hours straight with no rest. All for the bargain price of $24/hr. "Because this is the way it's always been done here. The nurses here do it, so why can't you?" Uh....this is why they had to recruit 3000 miles away--nobody in that area, and there is a huuuuuuuuuuuge number of new grads who would have jumped at that job---will take it. They were so desperate, there was an RT, and ARRT and an RN on staff. Not even all nurses. It was, literally....the job from hell. I wasn't a new grad, but the thing that you need to remember is---if a hospital is willing to fly you out, bypassing a skype interview---and pay the airfare/hotel and maybe relo? It's a toxic place to work. Nobody in the immediate area will touch it. They have to recruit from far away....and they want to lavish gifts on you to butter you up---I was offered at the end of the "shadow" shift. They wanted an answer right then and there. It's a guilt trip after all of the expenses they lay out and they know it. I negotiated relo in my most recent job--$5000---but it had a rider that if I left before 2 years is up, they get a pro-rated amount back from me and can hold my last paycheck in order to assure they do.
  17. My question is---if RV didn't do anything actionable, why did Vandy fire her? Why did the new hospital suspend her? Seems to me that Miss Well Liked is a liar too---she didn't reveal why she was fired from Vandy to her new employer. Perhaps she knew she wouldn't be hired? Qui bono. Who benefits most? Who had the most to lose by publicizing this girl's actions? Think Vandy doesn't have board members, committee members and shareholders that had a serious stake in keeping a lid on this---covering it up and smoothing it over? Think that the BONs are just an island unto themselves that they can't be as inept or corrupt as any other regulator? Stroll on over to "recovery" and ask them about their experiences with the BONs and how torched their lives are over a momentary "brain fog" on their own time, in their own home/car--talk about a stupid mistake---and yet their licenses are suspended for five years or are revoked altogether--drug tests, ETOH tests--all on the nurses' dime...this is the BON. I worked in the South. It's the Good 'Ol Boys' Club with a wink and a nudge for the rich corporate types (like Vandy). You can't swing a dead cat without running into the "six degrees of separation" phenomenon. My first warning when I moved there? "Be careful what you say. You never know who is someone's cousin, and they're all related somehow." Healthcare is big business. BONs are part of the state legislatures. You think politics had nothing to do with this?
  18. HomeBound

    When Nurses Make Fatal Mistakes

    and here she hits the nail squarely on the head. "The difference is---one nurse recklessly (and in Vandy case, WILLFULLY) does not follow procedure---and the other makes a mistake despite doing so (follow policy/procedure) I'm not quite sure why people here can defend someone who...oh....forges signatures, charts something done when it wasn't (and it ends up in harm to the pt), purposefully bypasses safety checks in a pyxis, purposefully bypasses reading a label (while reading other parts of the label?!), purposefully defies policy on procedures... Well...all I can say is that since some here have zero problem with me forging signatures---and that I can just get off with a slap on the wrist---can I borrow your blank checkbook? Because in reality---that's a felony.
  19. HomeBound

    How to be a Perfect Nurse

    I like MtnRN. She's quite passionate in something she believes to be true. However, there just doesn't seem to be a middle ground with her. It's one extreme or the other...case in point. If you follow the rules and are trying to hold someone accountable for their rule breaking, you believe you are "perfect" and the implication is, that some of us feel that since we've gone >10 years with no med errors...we believe we're better in some way. It wasn't the point, MtnRN, and this diatribe really does speak to how the extremes never help a situation. I was middle of the road. I fell on the side of unemotional, factual and lawful critique of Ms. Vaught's individual situation...as all crimes should be considered on a case by case basis. I did read your manifesto. I think that having a clean as a whistle record (mine) for as many moons as I've been in the profession...as well as those others who have done the same...by following the rules...YES...every. single. time. (are you advocating for following rules only sometimes...because it makes you an arsehole because you're just so uptight about those rule thingies?)....is something to do a little chest thump about---because it's stressful, time consuming, and takes aaaaaaaaaaaaall the damn fun out of using work as a social tool.
  20. HomeBound

    Nurses Call the Governor of Tennessee

    Beth, I respect you. I really do, and I will agree to disagree on this subject with you, any day--- however. Be very careful what you wish for and advocate. The nurses and anybody else who is a professional who agree that she should be charged and judged by a jury of her peers can also call the Governor's office. Just a thought.
  21. HomeBound

    Nurse Charged With Homicide

    1mL? She reconstituted 10mg of vec with 1mL of NS or SW? Or did she actually take the 10mL of diluent that is supposed to be used, and then give 1mL? Because I call b.s. on that. If she reconstituted with 10mL, then that meant she read the bottle. If she reconstituted with the range amount, which would have been 1-2mL, then that meant she gave 5-10mg of vec, depending on how much she really infused. Here's the thing. If she reconstituted with 10mL, would that, right there....not be a huuuuuuuuuuuuuuuuuuuge red flag that this isn't the drug she wants? Induction dosage is .05mg/kg for general anesthesia adjunct with sux. For relaxation it jumps to .15mg/kg. This is for intubation with airway kit standing by. Say patient weighed 150 lbs. That's 68kg. That's 3.4 - 6.0 mg of vec in order to paralyze for intubation. If Ms. Vaught drew up 2mL of diluent, reconstituted the 10mg of vec, pulled 1mL and gave it? She gave Ms. Patient 5mg of vecuronium. More than enough for an average sized woman to be induced for intubation. If she gave 2mL? She gave enough to paralyze a 200 lb person at the low end. If she diluted the vec with 10mL? She read the label. In other words, she's lying that she gave 1mL---because holding a 10mL syringe of versed? I don't think so. The other thing that is really ticking me off is the deletion of her twitter, facebook, snapchat and all that social media-- her lawyer is advising her well. Why? Because they can and will pull every single social media post of hers, and perhaps even get hold of her phone---to see if she posted anything in the minutes preceding or directly post infusion, when she should have been WORKING. Put the phones down, folks. Just a word from an old timer. It's getting really, really disgustingly annoying to those of us who turn the phone off and do the job--to see you all on your phones. It's going to be a big thing at this point, that when a nurse is involved in these mistakes, their social media crap is going to be entered into evidence. IT SHOULD BE. If Radonda is found to have been diddling on her phone during the hour this woman was dying? Maybe THAT is exactly what tipped the prosecutor's office to charge her. Just a thought. put the phones away.
  22. HomeBound

    Nurse Charged With Homicide

    Although I understand your emotional response, allow me to ask you---should we have laws then, that only discern whether you "intended" on harming someone and if you say you didn't "mean to do it", should you be automatically absolved? The law is complex for a reason. There are varying degrees of culpability, and the law recognizes that. The nurse that drew up the CaCl was not prosecuted, she was fired. For a medication calculation error and resulting death. Yes. I feel sorry for her. I found it horrible that she could not recover from her trauma of the incident. Med calc errors happen quite often, and nobody is the wiser. I see nurses do it all the time. Draw up 10mL instead of 8mL of some "harmless" drug. NS can push a HF patient into resp arrest. I've watched nurses slam a 1L bag because the doctor ordered it---and never once looked at the chart to see....oh....can that patient take it? do i need a pump? It's why we have Pharmacy at every code now. Every single one. Even intubations. THEY draw up the meds and hand them to me. They are clearly labeled. I ask to see the bottle. Sometimes, I watch them pull if I have enough attention to spare. I use closed loop communication. "Is this vecuronium?" "Yes, that is 20 of vecuronium." "20 of Vecuronium being given." "20 of vecuronium is in." Fifteen people get to listen to me talk and ....is there a word for 15x checks on my math? This isn't even close to the case at hand...she pulled this drug up on her own, with NO CHECKS WHATSOEVER. None. Not one. No reading the label she held in her hand while she reconstituted it (and any nurse in a Neuro ICU or anyplace near "resource" nurse would know....VERSED doesn't NOT NEED TO BE RECONSTITUTED), no reading the order, no basic safety protocols for sedation, no re-assessment, no monitoring after administering a benzo. When my unit orders me to bring ativan to MRI? Guess who gets to plug a monitor on that pt and sit her butt down for an hour? Because it is common sense as well as safety protocol. I learned the common sense part in nursing school when they said.....don't sedate a patient and then walk away....no breathing is a bad thing.
  23. HomeBound

    Nurse Charged With Homicide

    Thank you, Wuzzie. For goodness sake....she isn't being charged with murder. And to whomever it was who said..."where is the precedent to charge her with this crime?" Um.....you do not need a precedent to charge someone with a crime. You simply need an incident that....oh....you know...BREAKS THE LAW. It's emotional and I get it. I just watched ZDogg, who I really think is an amazing person for what he does with his podcasts and such---and he is a RABID defender of nurses---he just did two rants on this, defending Redonda Vaught... His arguments were NOT legally based. They were emotional. "What about the smidgen of morale left in healthcare if we start making lethal mistakes a crime??" This isn't about emotion. This is about the law. In TN, "reckless homicide" is the same as in some other state that charges someone with "involuntary manslaughter". The definition is the same. YOU DID NOT INTEND ON KILLING SOMEONE, but your actions were negligent to the point that the person died. Everybody agrees, no matter how they dance around it, that Ms. Vaught bypassed the BASIC safety protocol of MAKING SURE SHE HAD THE RIGHT DRUG IN HER HAND BEFORE SHE PUSHED IT THROUGH THE IV. How complex is this? I read the label twice. TWICE. Before I give anything. When I am in a procedure with a doc? I put the bottle up to their face, and make them read it before I allow them to puncture the bottle. I learned this as a student in my other healthcare job, when we would do myelograms and were sticking needles into someone's spine with lidocaine and oil based contrast material. READ THE DAMNED LABEL. I don't care if she was a nurse of 2 years or 200 years. She didn't afford that patient the basic rights of being sure of what drug she was being given. The patient died. The idea that you cannot slow the hell down and read a label while you are pulling from the pyxis...that you are literally running with your hair on fire FOR A CONSCIOUS SEDATION PATIENT THAT IS SITTING AROUND, BREATHING , NO DISTRESS---and you cannot take the time to read a label? That is the definifition of negligent, and according TO THE LAW, "reckless homicide" is when you are AWARE (and being a nurse, if she was not aware that every single damned drug she ever gives to anyone is a potential to be lethal...and she doesn't get it that she needs to....oh.....ASSESS EFFICACY....she needs to not be a nurse) that your behavior may endanger another, and you do it anyway. She was aware that even had she given Versed....the sedation effects on a person with a brain bleed (THIS WAS NEURO ICU, folks.) are profound and need to be monitored. "Horrible, bad decisions" isn't that...oh....a mistake? When I decided to rob that bank because my grandma needs her cataract surgery---and I don't hurt anybody---do I get a pass for having great intentions, but bad judgement and a bonus gold star for not shooting anybody? What people here are getting so hot over is that they don't feel that nurses and doctors should be held to a higher standard. WE ARE, and WE SHOULD BE. We are doing things to these patients that are incomprehensibly difficult and complex. We need to know what we're doing and why. Would you allow a Med Student to do your brain surgery??? The excuses I am hearing is, she's a newbie. Then she shouldn't have been precepting. She shouldn't have been a float nurse (resource). I know my limitations. I would no sooner get onto a chopper and pretend to be a flight nurse than I would going into the OR and pretending to be a First Assist. I AM NOT QUALIFIED NOR AM I EXPERIENCED. Ms. Vought, if the apologists here say that hey....she was just inexperienced. she didn't know. Did you learn the 5Rights in school? I did. I know she did. Then she knew. If she wasn't experienced enough to be a resource nurse, which seems to be something that nobody gets---you need EXPERIENCE to do that job. You need to be knowledgable on so many levels---and she was not. She should have known that....and I bet she did. I read a few of her NOW DELETED instagram and twitter comments about the dangerous life she likes to lead----"Rock out with your glock out"?? Bad judgement goes from A to Z with some people. I don't even have a facebook page, let alone Twitter, SnapChat, Instagram...and I certainly don't publish my life for all to see---only to have to feel like I need to go an delete everything because now---the world gets to read my verbal vomit on the internet. Just because you passed Nursing school doesn't make you a wonderful human being, or one with good, trustworthy judgement. It's not a testament to ALL nurses---but nursing is simply a microcosm of humanity at large. There are good ones, and there are not so good ones. She clearly didn't practice anywhere near the standards that are required of this positon.
  24. HomeBound

    Nurse Charged With Homicide

    Again, emotional reaction does not equal "lawful". If I went out, celebrating my graduation from nursing school, got drunk (willfully), got in my car (willfully), drove home drunk (willfully and in full knowledge that my actions may harm myself or others)---and ran over you or your kids and killed someone? Reckless homicide? But I'm a nurse. I worked hard at nursing school and I was tired and overworked. I deserved to be able to drink---yes, maybe it was bad judgement that I drink and drive, and yeah, I knew that it's against the law, and yes...I did flout the law that says I am not allowed to do that, because it risks my own life and the lives of others... but I'm a nurse. I get a pass. No, I don't.
  25. HomeBound

    Nurse Charged With Homicide

    Reckless homicide is a crime in which the perpetrator was aware that their act (or failure to act when there is a legal duty to act) creates significant risk of death or grievous bodily harm in the victim, but ignores the risk and continues to act (or fail to act), and a human death results. Just a clarification. Emotions are not involved in the law. I understand that she was overworked, etc. We ALL ARE. However. That being said. She was trained as a Nurse, along with the rest of us, at a school that is accredited and she was drilled on the 5Rs repeatedly. Like the rest of us. She was aware, as are the rest of us, at all times, that any of our actions can result in the death of another, which---gives all of us, the constant reminder that we need to be conscious of every single thing we do that involves drugs and patients. She was aware, that she bypassed more than just 1 safeguard. She bypassed SEVERAL. Ergo, she was aware that her act created a significant risk of death or grievous harm in the victim, she ignored the risk and continued to act, and a human death results. As much as people don't like the law when it "seems wrong" or might be applied to their own actions in a case of mistakes---people are jailed every day for "mistakes". I don't think parsing how badly we feel for her applies to what the law states, nor is it helpful to imply that there is "COLLUSION" between golfing buddies. If this were my grandmother....or my mother....well....I'm not as altruistic as some here, who claim that they'd just forgive and forget. Sorry. The law is in place for a reason.