pharmanurse11

Have you ever experienced a bedside nursing situation that you wish hadn't occurred for the simple reason that it made you appear foolish? Please do share. One night, I was working on the LTC unit at a facility where I frequently picked up shifts, so I had developed a good rapport with the residents and the staff. I check on a resident who had their call light on. He was looking for Robert, his CNA, to change his colostomy bag. Although I offered to do it, he declined. It was quite a relief for me, but not for the reason one might expect. As of that point in my career, I did not even remember having a patient with a colostomy, and the last time I provided care for a colostomy was during my clinicals. In spite of the fact that I knew how to do it, I was certain that Robert would put me to shame. A little more than an hour had passed, and the same resident had his light on and was once again searching for Robert. Because I had only seen Robert once during the previous couple of hours, I assumed that he was having a very busy night. I informed him that Robert was with another resident; however, I am able to assist him. He insisted on waiting for his CNA, but I convinced him to allow me to help him. In addition to stool, his ostomy bag was fully inflated due to gas. I REPEAT, the ostomy bag was fully inflated due to gas, and do you think I had the sense to slowly let the air out prior to completely removing the bag from the wafer? Not at all! As I detached the bag from the wafer, I heard a sound similar to removing a cork from a bottle. Behind the resident was a wall covered with you know what, including the resident's forehead and glasses. The only thing I could say was I am sorry. There was no other explanation except that my brains had decided to take a vacation at that very moment leaving me without any sense. In addition to feeling horrible, the residents' reaction to what I had done made me feel even worse. He apologized for the situation we were both in at the time. He was concerned for me. HUH?! I put at end to that real quick and immediately redirected his attention and explained to him that my brain fart was to blame. I often became this resident's nurse when I picked up a shift, which made perfect sense since we shared a bond. It was a bond that neither of us spoke about, not even to each other.

So true, I can't help but laugh. It's become a coping mechanism.

I agree with you. I don't see any changes happening anytime soon. Billion dollar corporations have deep pockets.

The nurse forgot to remove it because she was busy and understandably so. She was concerned about getting into trouble. and had the charge nurse known, she would have reassured her that it was okay. We rarely get patients with a PIV unless we are the ones that initiate it for hydration. We often get patients with Midlines or PICC lines that are on IV ABX therapy.

The floor is laid out like an X. There are 4 halls, each with 12 rooms and 2 nurses. In the middle, where it intersects, is the nurses' station. Landlines are only at the nurses' station, no phones in the hallways. Night shift is busiest between 7pm and 10pm. Meds are given, as well as treatments & wound care. Having 15 patients each is a gift and calls for celebration because more often then not its 20-25. If I am near or at the nurses' station, I will answer the phone. However, if I am with a patient or at the end of the hall, I do not run to answer the phone.

At the beginning, I found it difficult to work with my colleague with a superiority complex. It was her frequent practice to "one-up" a colleague, exaggerating her capabilities and accomplishments. She allows herself to become consumed by her need to elevate herself since more often than not, she feels inadequate, insecure, and inferior. It is sad, and I cannot help but feel sorry for her. No, I have never wanted my coworker to fail, but I have set very clear boundaries.

Many of us are unaware that there are significant differences between post acute care/snf hospitals and acute care hospitals in terms of staffing, especially during the evening hours. SNFs do not have a receptionist after 6pm, which means the responsibility for buzzing visitors in and out falls on the nurse or CNA while they are still engaged in their primary duties. SNFs don't have a unit secretary in the evening so the phones may not be answered if the nurses and CNAs are tending to patients and not currently at the nurses' station. I work the evening shift at a skilled nursing facility, and yesterday morning my patient was taken to the emergency room, and he was discharged last night. I noticed a PIV in the patient's left forearm while doing my assessment and told him that I would be removing it once med pass is completed. Two police officers show up about an hour later at the facility to do a welfare check on my patient at the request of someone from the ER. When I try to obtain details from the officers, they are also confused, but they do believe it has something to do with the PIV, but they do not have specific information. They leave without ever seeing my patient. As a result, I contact the hospital's emergency department. This is what the charge nurse said to me. During shift change, the ER nurse assigned to my patient realized she had not removed his PIV. Several attempts were made by her to speak to someone at the facility for no other reason than to inform them that she forgot to remove the PIV. When she was unsuccessful in reaching someone, a colleague of hers suggested she contact the police and request a welfare check be done. She took their advice and the rest is history. I'm still trying to wrap my heard around this one.

Hello there. First and foremost I apologize if I upset you in any way. Having been born and raised in the Philippines, my command of English isn't strong and I often find myself struggling to find the right words or how to deliver them. Hospice was the saving grace for my mother, as well as for me when she passed away. My original post was not intended to be about hospice or about this particular patient or patients. In my post I intended to discuss ethical decision making as well as Medicare waste and fraud. The circumstances surrounding a handful of hospice patients led to the discovery of unethical decision making and possibly illegal conduct. However, this is neither here nor there. Right now, what concerns me is my inability to write in a way that does not lead the reader to make assumptions about what I intend to convey. Here is where I would appreciate your assistance. In your response to my post, would you mind pointing out where you read those statements I allegedly made? And more importantly, could you suggest another way for me to convey those alleged statements. I truly believe that I will benefit from this exercise in hopes that the next time, I will be able to make myself understood. Thank you again. ?

I don't want there to be any misconception or anyone assuming that I didn't report what was going on to the appropriate agencies. I left those details out because I thought that was a given. I have received a single correspondence from the compliance dept outlining changes that were made to their programs that safeguards Medicare/Medicaid from fraud.

When a patient is admitted to a SNF, the hospital sends a D/C summary, H&P and medication list. In addition, we are not provided with the entire medical history of the patient. The hospital is not expected to have a comprehensive or entire life's medical history of the patient. It will be his primary care physician who will have all of that information. A nurse who uses a patient's EMR for the purpose of discrediting a finding is in violation of HIPAA. Not looking for any financial reward. Contacting the OIG is one of the first things I did.

In the week leading up to my resignation, I contacted compliance without anonymity. There are employers who are counting on their employees' fear of reprisal to discourage them from reporting a problem. I have never and will never remain silent. There is a great deal of vulnerability among patients, especially the elderly, and their fear is real. The majority of us will experience being a patient at least once over the course of our lives, and I am confident that most of us will want a nurse who will speak up for us when the time comes.

I have filed a report with our compliance department and the hospital's compliance department. The fact that I did not receive any correspondence from our compliance department was a surprise to me. After being charged with Medicare fraud years ago and paying over $40,000,000 in fines, I would have thought that something like this would never occur. The correspondence below is from the hospital. 7/13/2023 6:43 AM The Integrity and Compliance Office has received your concern and will engage the appropriate staff to conduct a review. You may be contacted through the hotline follow-up process and asked for additional information or clarification. Thank you for bringing this concern to our attention. 27/2023 6:11 AM Thanks for submitting your report. The Conflict of Interests Office has reviewed your concerns. Per ##### conflict of interest policy, #### is following the bi-directional recusal conflict of interest management plan as it relates to #####. If you have additional evidence of further concerns, you can submit it to the hotline and we will review any further details.

In my previous employment, I worked for a company that owned and operated skilled nursing facilities throughout the western states. My position was at a newly acquired 64-bed facility in an area that was extremely aesthetically pleasing. In spite of the fact that the Executive Director lacked experience, he was given the opportunity because his brother held the same position at another facility. His father worked as an Executive Director before branching out on his own. At all costs, management positions are kept within the organization. We use Whatsapp to communicate and someone asked if we had an EKG machine. Immediately the Executive Director replied, it's hanging on the wall outside of my office. Maybe I am being too critical, but I would think most would know the difference between an EKG machine & an AED. May 2023 marked the beginning of my disenchantment. One of our patients was referred with a diagnosis of GLF at admission. The patient had been receiving physical and occupational therapy for a week. To my surprise, he was evaluated by hospice and admitted with a dx of neoplasm of the liver. It is my opinion that he would eventually be an appropriate candidate for hospice care, but not at that time. He was prescribed MS Concentrate 20mg/mL, which was ordered to be given 0.25mL/6hrs scheduled and 0.25mL/2hrs PRN. In addition, he was also prescribed Ativan 2 mg/mL, which was ordered to be given 0.25mL/6hrs scheduled and 0.25mL/2hrs PRN. Only one nurse administered the morphine and Ativan, and she was not even assigned to him. I for one did not based on my assessment. Despite never being assigned this patient, my colleague contacted the hospice provider to inform them that some nurses were not following orders. Since the DON was on vacation, the ADON informed us that she had received a complaint from the hospice nurse. We were instructed to follow orders. MS Concentrate & Ativan dosage was also increased to 0.5mL/6 hours. This was then changed the next day to every 4 hours scheduled & 2 hours PRN. These changes were made without Hospice stepping foot in the facility to reevaluate the patient's needs. It was just two weeks ago that this feisty patient was able to perform all of the activities of daily living without assistance, had a good appetite, and was participating in therapy, and now he barely gets out of bed and barely speaks. I was medicating as per the orders at this point. After the DON returned, I sent her an email outlining my concerns and my opinion that he was not an appropriate candidate. In her reply, she agreed that he was not an appropriate candidate for hospice. His physician had called her to inform her that he had spoken to his wife and recommended that he be placed in hospice care. At the time of his death, I was on duty, and his wife was by his side. When I contacted the hospice nurse, she informed me that she was not coming to the facility. However, she would call the mortuary to pick up the remains. It was shortly after midnight, and as I walked his widow to her car, she shared memories of the life they shared. Asked about his cancer, she replied that he had a golf-sized tumor on his liver about six years ago. It was removed, and he underwent treatment, and was cancer-free. I was confused at this point. In the words of the widow, the resident was experiencing frequent falls, and his doctor informed her that it could be no other explanation than the return of cancer. Although there was no official diagnosis, she trusted what his physician said, since what else could it be? The facility was acquired in October 2022. Various acute care hospitals refer patients to us, but most of them come from one hospital in particular. Considering we are strictly a skilled nursing facility, with no long-term care, hospice involvement is quite rare. By May 2023, we had two patients in hospice, and by June 2023, we had three more, making a total of five patients in hospice. I noticed that the same hospice provider was being used. During my time at other facilities, there have been as many as three different hospice providers. I asked my colleague why we continue to use this hospice provider even though we know they provide substandard care. What I was about to hear shocked me. The hospice's founder and president is the father of our executive director. During my fact-checking, I also discovered that the administrator of the hospital we received our referral from was a co-founder of the hospice. I met with the DON who informed me that it was the family's decision to choose this hospice provider as if these families were hospice connoisseurs. My position was clear that continuing to use this hospice provider was neither appropriate nor ethical. I was having difficulty adjusting to the passing of my patient, which was made worse by the fact that he was referred by the hospital whose administrator co-founded the hospice. Whenever I was at work, I found excuses not to go in, and I felt ill every time I did. There was no doubt in my mind that it was time for me to resign.