ForeverYoung018

There are many cases in which we do things and obtain an order later. For instance, if we go in and find a patient hypoxic, we aren't going to wait for an order to apply O2. We would apply the O2, see if sats come up, and then notify doctor and get an order. This is ridiculous and you will not lose your license. In the future, if the doctor isn't responding, just call a Rapid Response. I have done that multiple times when I don't get a response in a timely manner. I am grateful that our Rapid Response nurses are phenomenal and always have the floor nurse's backs with stuff like this.

In my 10 years as a bedside RN, this is by far the worst staffing shortage I have ever seen. I work nights where the majority of newer nurses are placed. The hospital decided to reduce our staffing grid by 1 RN on nights. My night shift crew and I felt very unsupported when voicing our concerns. We were told, "it will get better." However, every time we are sold the "it will get better" line, it only gets worse. I work on a specialty unit where there was hardly any turn over prior to Covid. Now, we are experiencing just as bad of nurse/CNA turnover as a med-surg unit. I don't know how long I can continue to do this. Every Thursday-Sunday, we are forced to do what's called "critical/secondary staffing" where we are working with the minimum amount of nurses. However, sometimes we are forced to work under our "critical" staffing grid to float nurses to other units of the hospital. This is so unsafe and I'm not sure how long nurses can continue to do this. Something has got to give.

At a former job; A nurse left a bag of Fentanyl in a patient's room. I think she had to run out real quick, but when she came back, the bag was gone. Apparently, the patient's family had been visiting and it was suspected the family took it. How you prove that, I have no idea. I'm not exactly sure what all happened to the nurse, but I'm sure it wasn't good. I totally understand the staffing crisis. We are all feeling it. Like a previous poster said; program the volume to be a lot less then the total volume of the bag or set a timer. ?

I don't find your post snarky at all. I'm literally trying to learn to become better at being able to recognize this. Yes, I have experienced the restlessness in all of my patients who were near death. I also have noticed their eyes change. They roll them in the back of their head more often. They also will stare around the room, stare at the ceiling, or just glare off in the corner. She was doing that about 48 hrs before her death. My grandpa would say that he saw all of his deceased siblings around his bed. When I asked my pt if she saw anything, she said she didn't. I truly believe looking back that that breathing before giving her that last dose of Morphine was agonal breathing. It took all of her upper body strength to get those breaths out. And I thought it was just her experiencing some air hunger. I feel bad because her sister was sleeping right next to her and I just wish I would have been able to recognize to be able to wake her sister up and say, "I don't think she's got much time left." Instead I had to wake up the sister and tell her she had passed. All I hope is that it was peaceful and I'm glad that she wasn't alone and had her sister near her even if she was asleep.

How are you able to determine when the last moments are? I haven't experienced a ton of deaths, but probably a hand full. I have found that it's always different for people. Some people will have those slow heavy shallow breathing patterns for days. My pt had that hard breathing I was explaining for maybe a couple of hours. She was declining very rapidly, though. Sunday at the start of my shift, she was very alert and talkative. Honestly, the most peaceful I'd seen her. I only gave her one dose of pain medicine (Oxy 10 mg) at the start of my shift and by the morning before I left; she was different. She had become extremely restless wanting to get up and pulling at stuff. Her family really didn't want her to get medication and she didn't either, so I was trying my best to give as least as possible. However, whenever she was awake on that last night; she was pulling at stuff and uncomfortable.

I am glad I came across this thread. I always struggle to know when the last moments of death are coming for my pts. Last night I had a pt who was comfort care. When I started my shift; she was EXTREMELY restless. Kept telling us to get her up, pulling at her gown, oxygen, and any tubes. The family was very hesitant on medications because they wanted her to be able to talk to them. I had to have a conversation with them about how her behaviors were signs of discomfort. The pt was verbalizing she was uncomfortable, as well. They agreed. I was alternating 1mg Ativan and at first 2 mg IV Morphine so that she was getting something every 2 hrs. However, I had given the 2 mg IV Morphine twice and it just wasn't helping with her hard breathing. So I decided to give the 4 mg IV instead, which helped significantly. Repositioned her for a final time in the morning. Her breathing was definitely more labored and she was using her whole upper body to breathe. I gave her the morphine again prior to repositioning as it was painful for her. I checked on her again about 20-30 minutes after giving the morphine and she was breathing easier and looked peaceful. I checked on her again and she had passed. I struggle as I feel that the Morphine I gave is what ended it. My coworkers say it wasn't, that I gave her a peaceful death. However, was that actually end of life breathing that I had mistaken for discomfort?

Yeah. After hearing all of the details, her mistake was so egregious that it's surprising she was able to keep her license for 1 year after being investigated by BON. I mean any nurse who makes an error fails the 5 checks at one point because that's how the error happens. However, I still don't understand how she looked at the vial to read how to reconstitute and to draw it up and didn't see the red top that said "paralyzing agent." I just don't understand.

Radonda wasn't part of the conversation between Radiology, the doctor, and the primary nurse who were discussing monitoring vs. unmonitoring. She was just told by the primary nurse that the pt didn't need to be monitored. She didn't know that there was a back and forth as she wouldn't because she was tasking and not the primary nurse. So everybody that gets Benzos for Anxiety has an order for Romazicon too? I never see that order in my work site and we give Benzos quite often for anxiety. I'm not saying Radonda isn't at fault. She IS and she knows that. She has never attempted to lie or cover up what she did. She has taken responsibility. At the end of the day, she ignored several safe guards and made a HUGE mistake and is paying the price. What I'm saying is that there could have been better advocacy for this patient that could have prevented this error. Vanderbilt was caught trying to cover up a sentinel event, they were caught, and she was the scapegoat. Should she lose her job and license? YES. Should she go to jail? No.

I still stand by my initial statement. The primary nurse should have advocated and said that medication wouldn't be given off the floor. There have been many instances where I haven't felt comfortable with my pts leaving the floor and I have spoke up. I don't care who I piss off or what I delay.

After listening to the specifics of this case and listening to testimonies, I do believe that she was the scapegoat. The argument that kept being made was the lack of monitoring after giving a "high risk medication." Now, I have no experience with Versed, but I know it's used for conscious sedation which requires monitoring. I'm guessing that the dose that was ordered wasn't a conscious sedation dose and just an anti-anxiety dose. People that are routinely on these types of medications wouldn't need the monitoring such as somebody that was getting it for the first time. Radonda specifically asked the primary nurse if the patient needed monitoring and was told "no." Secondly, when was there time for the patient to be monitored? She was already in the radiology department and had already been given the isotope for the scan? It sounds like the drug was given and the pt was immediately put in the scanner afterwards. The first problem I had was Radonda was not this patient's nurse. Why didn't the patient's primary nurse advocate for this patient and say," I don't feel comfortable giving this pt said drug off the floor?" Especially if Versed is such a "high risk" drug as they made it out to be in the trial. It is unfathomable how somebody could have ignored all of the warnings especially on the vial itself. Should she have called the pharmacy to rush verify the medication so that she didn't have to conduct an override? YES. She took 100% responsibility and admitted to all of the things that she did wrong. Should she have lost her license and job? YES. But to charge her? What about the system that allowed this pt to be unmonitored in radiology? There are doctors out there who have made similar mistakes and haven't faced criminal charges. Will this case make me more careful? Yes. Will it make nurses more reluctant to report errors? I think so.

I remember I was working the night shift one night on an inpatient med-surg unit. At times, we were a step down unit, as well. We were 1 nurse short, yet were expected to take more admissions to our unit. Our max nurse to patient ratio was 7:1. We were being asked to take 8-9 patients per nurse. We called administration and voiced concern over this being unsafe and that that ratio threatened our licenses. Her response was "that is a crazy thing to say." When I realized that administration did not care about the safety of our patients, I quit along with many others! Those ratios have yet to change. Sadly, this is a common scenario in many hospitals. Now what if I would have made a similar error in that circumstance? Should I be thrown in jail?

If she goes to jail; then all of the unsafe politics in hospitals needs to stop. Hospitals better start going on a hiring frenzy because there are many hospitals, who put their nurses in unsafe situations daily! Being mandated, working 16 hour shifts, high nurse to patient ratios, taking unsafe assignments. Yet if you speak up to administration, they throw it under the rug, but if a nurse dares refuses to work in unsafe conditions, they can be slapped with patient abandonment. This could have easily been me making this error on one of my MANDATED 16 hour shifts!

Radonda was the help all nurse and was asked to give the Versed by the patient's RN because Radiology was threatening to cancel the test due to a time issue. After reading the CMS report, not guilty. This was not solely her fault, but a systematic error. 1) I still don't understand why Versed was the drug of choice for anxiety for a scan. I have always given a small dose of Ativan or Valium, but not Versed. 2) If the primary RN (which was not Radonda) was familiar with Versed and that it required close monitoring, she should have; questioned the doctor's order, made sure the correct monitoring equipment was connected to the patient prior to them going to the scan, or accompanied her own patient to the scan and monitored them. 3) The Pyxis allowing someone to override a paralytic when most paralytics are kept in a separate lock box or hand delivered 4) no scanner being available in the department 5) Radonda's error. Lastly, when Radonda became aware of her mistake, she admitted it to the doctors immediately. It was Vanderbilt who failed to report the incident to the state to try to cover their butt. When errors like this happen in a hospital, a root cause analysis is supposed to take place. The hospital is then supposed to take steps to implement changes to improve systems to ensure it won't happen again. However, Vanderbilt had no intentions of changing anything until their Medicare funding was threatened. I am not saying Radonda is blame free. She made a tragic tragic mistake and she will live in Hell probably the rest of her life. Her actions were negligent, but not malicious. If she's charged and sent to jail; imagine what this will do to the nursing field.

I'm one of those nurses who always gets confused between short acting and regular acting insulin. I'm familiar with long acting as I work 3rd shift and we give it quite a bit at night. Despite the confusion; in nursing school, we were always told regardless of the type of insulin we were giving (short acting or regular) that to make sure to give it when we could see a tray in front of the patient if the patient could eat. This has always been my practice, as well at the bedside. However, I was made fun of by my preceptor for wanting to wait until a patient's tray arrived to give them regular sliding scale. I explained that this was one of the very first things we were taught in nursing school and that I don't feel comfortable giving insulin without food in front of them in case there is some delay with their tray. This is a nurse who is very experienced, so it made me second guess myself. Am I wrong?

I have definitely learned my lesson and will never post about work again.