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  1. WoosahRN

    Nurses charged by state health officials

    Ugh, I can never read the comments after a public article. They never fail to enrage me. And there is no point in arguing with any of them. I too am concerned. I am moving to WA probably at the end of this year and was looking to apply to Seattle Children's. Now I am incredibly concerned. Are any of these "errors" (whatever the true story may be) treated as learning opportunities or did they just immediately throw all these people under the bus? Yeah, where I work they too harvest a "no-blame" mentality....on paper. In reality, there always has to be a person to blame for such and such error whether it's simple or major. And that is because the higher ups demand it. Everyone likes to have that finger to point. Tie it up in a neat little bow with a sacrificial lamb on top (this is not to say there aren't true errors and terrible mistakes that are made due to one person's lapse). Just sad. And incredibly scary.
  2. WoosahRN

    Advice needed for coworker problems!!!

    Wow! What a great update! I am so, so happy you put your foot down. Bullying in any situation is garbage and there will always be people who do it. It will take a while but hopefully the culture will change just enough that the bullies stand out as being wrong and won't be able to run the units they work on. So proud of you and so happy it worked out for you!
  3. What ticks me off is that even if "someone" marked the wrong site (not so in this case) or didn't even mark a site (still not the case), ultimately it is the surgeon who is operating. And what really makes me furious is that the first thing they did was blame the nurse. I doubt that excuse will hold up in court but it bugs me a lot that that was her first reaction "You should have told me that I was operating on the wrong site!" If a med error reaches the patient it is the nurse's fault even though there are checks along the way (Dr writing the order, pharmacy checking the order). While I understand she probably knows she seriously screwed up and is in deep doo doo, it just shows a lack of class and responsibility.
  4. http://www.outpatientsurgery.net/news/2011/05/13-Surgeon-Operates-on-Both-Eyes-of-4-Year-Old-in-Wrong-Site-Error "After the procedure, Dr. Goodman told the family that a nurse had covered the surgical site marking on the correct eye while prepping the patient for surgery, according to the mother's account. Dr. Goodman did not immediately return a call to her office. " Is it just me, or does this seem like this is going to be another case of "blame the nurse"?
  5. First off, I am so incredibly sorry for so much loss in your life. I am grateful that you felt comforted and supported by the staff that was involved in this terrible event in your life. :redpinkhe I recently had a patient that was removed from support on my shift. His parents had made him a DNR a couple days prior but we were still doing all the cardiac drips that were keeping him alive. The dad was ready to remove support but the mom was not and there was a bit of tension beginning to build up. Both parents had acknowledged that their son was gone. In talking to the dad I begged him not to pressure the mom as I didn't want her to regret her decision for the rest of her life, feeling like she was pushed into it. He understood but they were already grieving in their own ways. Knowing their son was gone in spirit and making that decision to remove support is still a big leap. A very final decision. The situation ended with a combo of his body failing and his parents making the decision to wean some of the drips. It helped them to see that his body truly couldn't survive and they were able to make the decisions together. I have not experienced this myself and I hope I never do (as far as being on the other side of the bed) but I can only imagine that making that decision, despite what anyone may intellectually know, is never one that someone is "ready" for.
  6. WoosahRN

    Nurse suicide follows infant tragedy

    Not to split hairs here but this doesn't really make sense. Ativan is written in mgs and is a 2mg/mL concentration (in my facility, drawn up from 1ml bottles, and before dilution). So even if he had gotten 2mls it would have been 4mgs which depending on age and wt could have been appropriate (but most likely high-we do 4mgs usually in the older kids-teenagers). But since the desired order was supposed to be 0.2 mls that would have been 0.4mg which is dose I have never given (I think I have seen 1mg as the lowest, maybe, maybe 0.5mg). Also 2 to 0.2 would have been 10 times the amount. I'm thinking 1000x dose of a drug like Ativan would have resulted in respiratory failure. But I'm sure there are just some details mixed up...just wanted to clarify based off the info given. We do have double checks on majority of meds here in PICU but onbiously errors can still happen. Double checking a med only verifies what was ordered so nurses need to have an idea of what a normal order for that med is. Pharmacy is also supposed to catch this and while we have awesome Peds specific pharmacists, I don't assume that they catch everything. I have to do my own verification as well. Either way this is just a horrific and sad story. And something that can happen to any of us. So much tragedy on both sides but I am greatly disappointed that the people and company that she dedicated herself to weren't there to help her through it. I cannot imagine the sorrow and guilt she felt, and how alone she must have felt in the aftermath. I am so sad she took her own life.
  7. Trach/vent/GT kids are not the issue so that's not the new discussion. The discussion is a hospital putting their foor down in how much they can do for a futile case. The bill being questioned is the hospital bill as well as the bill to transfer him to the US and the care and financial responsiblity acrued at that new hospital. Canada has a National Health System so their bill there would go through that but not sure how it works once they want to come to US. I imagine the hospital there would absorb the cost as most of our hospitals do which is why they are all in the red. But we don't know that side of the story. Would be interesting to hear the actual medical facts (other than a journalist reporting) and why the hospital agreed to accept the case. One of my other jobs for two years was peds home care cases. In AZ, DDD will pay for hours and supplies based off of the level of care and disability the child has. So I've also seen parents keep them alive for the check and financial "benefit" (I see this in the hospital, not the home health side. Usually the ones that aren't wanted are in a medical group home or children's long term facility. I literally have a parent that brags about how she doesn't have to work anymore. Her new job is working the system while we spend millions keeping her kid alive but that is a whole other discussion that doesn't pertain to this one). And I would describe the typical cases as "GCS of 5-7, no purposeful movement, spastic tremors upon repositioning, GT/T/V dependant". Other than describing response to stimuli (voices, parents) that pretty much says it all.
  8. Fiona, you hit the nail on the head when you said "Just because we can, doesn't mean we should." Sometimes I think the medical field pats themselves on the back thinking "look what we can do" that we forget about the people involved. Where do we draw the line? I have absolutely advocated for a patients death because while I know the family means well and that this is their baby, they are also consumed with grief and cannot imagine letting go.
  9. I work PICU and I've seen situations like this happen...several times. We've had positive brain death, continuous chemical coding, basically an inevitable result, and families can't accept it (Please let me be clear, I don't even try to pretend that I know what they are going through and I try to advocate for everyone in the situation). Regardless of whether they are insured or not and the cost of the treatments, we treat to the best of our ability but when the result is futile we try to get through to the family. We don't have a lot of codes and traumatic deaths, we usually are able to anticipate death and arrange the best possible situation for the family. They can gather who they want to be at the bedside, how they want it to happen (holding child, in the bed with child, etc) and so on so that support can be removed. We do everything we can to help come to a result, that while sad, will give the family as much peace as possible. We have also had situations where the family cannot accept the inevitable result and they are being kept alive on only drips or a vent, etc. Had a case where the family wanted the child transfered to another facility to get a second opinion on his vegetative state. The facility refused but sent their specialist to consult. The diagnosis was confirmed. The parents were finally coming around, realizing that this wasn't their son they knew, that they weren't sure if they could care with him in this state (all along they talked about him recovering, being better, could not and would not accept the kind of care he would need). But they got a lot of pressure from their family members and wouldn't make decisions without all their extended family involved. We were very close to making a decision and removing support when they changed their minds and decided to get a trach and gtube. Now the kid is "living" on a vent and fed through a gtube. There have been other situations where surgeons will refuse to do certain procedures due to the futility of it and the risks associated. So I do believe a facility can have some say in the situation as I have witnessed it. But every situation is different. In this situation of taking a child home to die...while I can understand the parents desire for that the plan I'm not sure how it would work. Arrange the transport care, the nursing care and medical supplies? Transport the kid being bagged to the home and then just extubate? Would a trach be discussed (I can't imagine if the goal is to remove support and anticipate death). That almost seems more traumatic and stressful for everyone involved. Having medical people in your home as your child dies just seems like an environment change and I'm not sure any more peaceful but that is just my personal opinion and they do have the right to request this as their plan for removal of support. I don't want to pretend I know all the details of this situation. I had a friend comment on how horrible the hospital was for trying to kill this child. I had to calmly explain that there is a lot more to the story and the hospital cannot comment on it due to the privacy and ongoing matter. So I know there is so much more to this story on both sides and so much emotion involved. My heart goes out to the parents and I hope that they can get the closure and peace that they need.
  10. WoosahRN

    What does high acuity mean to *you*?

    Interesting topic/project... We use an acuity guide in our PICU but it mainly helps to justify a 1:1 patient (or even 2:1 (?) with 2 nurses for one patient). Top to bottom categories (neuro, resp, CV, etc). I don't have it in front of me but it is based off of interventions, drips, lab draws (how many in a shift), lines, tubes and procedures in a shift. For example if you are putting in new lines or taking a road trip (CT, MRI) that bumps it up. That patient obviously takes more time and requires more attention. Our ratio is 2 patients per RN and they could both be vented and busy but a "stable" critical, if that makes sense. A 1:1 would be that train wreck patient that is admitted, gets intubated, central line placed, sedation drips started, cardiac drips started, foley, OD, CT, cultures, Q2 labs, med orders, multiple xrays, blood products, electrolyte replacement, etc. Usually any patient on an oscillator is a 1:1 but they can sometimes be stable 1:1's and in that case can be paired. Usually several cardiac drips will get a bump to a 1:1. Any kid on CRRT is a 2:1 due to one nurse needed to run the CRRT machine. I did have one patient that had three nurses to her. She was on every cardiac drip there was, multiple blood products, multiple meds, lab draws. One nurse took assessments and interventions and I took lines, lab draws (Q2 labs draws, Q1 accuchecks), and IV meds/blood products (so imagine managing multiple lines and drips and confirming compatibilities and timing blood products). We both ran our butts off and we added a third nurse because she ended up going on CRRT that same shift. Not to hijack, but maybe along the same lines...do any of you have tools at your facilities to gauge staff based off of skills and experience to help with assignments? A way to ensure consistency in assignments and rewarded skills and experience (allowing staff to grow, not having same people get assignments)? I know of one facility that uses a ranking system. You had to test to get to the next rank which allows you to take higher acuity patients. The only problem is that a lot of the highest rank nurses were getting really burned out and ended up leaving for other places and the other ranked nurses didn't want to test up to the highest level (only getting the train wreck kids that they see for months on end, always running super busy).
  11. WoosahRN

    Advice needed for coworker problems!!!

    Also, get letters of recommendation from the NPs, Docs, and other RNs that work WITH you, that see you in action as a person and a nurse. These can speak to proof of your character and reputation. I had a co-worker who was wrongfully terminated. She had a very busy, critically ill patient. Several people were helping her and a piece of equipment was set up wrong. She did not set up but admits she should have noticed it as she reported off. But again, very busy night, several people in room, this was just unfortunatly not noticed. The NM has always been out to get this RN and she used this to get her fired. Since no one else came forward she said she was going to use her as "an example". This RN never got to talk to Risk Management or HR. The NM talked to them both, so she (RN) was never able to represent herself or her side of the story. All of a sudden she was unable to get a copy of her emplyee record, etc. The NM then goes further and reports it to the BON. Well, the RN went from heartbroken to fired up! Now this NM was going after her license. So she was able to get letters of recommendation from the Intensivists we worked with as well as the Neuro Surgeon that was in the room who also stated that the equipment caused no harm to patient and did not change patient outcome (pt died several days later due to illness). The BON goes to do their ruling and realizes that something just doesn't seem to fit (due to RN's reputation as conveyed by the letters and her own records of events). So they are doing their own investigation which is a benefit to this RN. Just saying, it's a great example of how getting letters of recommendation, by people that were there during your employment and can speak on your character, work ethic, safety, etc, as well as having your own proof and records can help you if anything does happen to threaten your employment and/or license. In addition, keep climbing the ladder. If your NM isn't listening (obviously she part of the problem) go above her. If that person doesn't listen, go above them. If they are going to make your life hell, give them hell right back. Yes, there will be retaliation but you are already getting that. Keep fighting and get mad! If not for you, for the next person and for the patients. If you have to go to the hospital director or even the board in charge of your hospital or chain of hospitals, do so. But go with a strong argument and proof!
  12. WoosahRN

    Advice needed for coworker problems!!!

    I didn't read all of the posts but saw a couple that mentioned keeping your own records. I absolutely support that. Write down every interaction, keep all emails, keep track of phone calls, etc. Also, most workplaces have a Zero Tolerance to bullying. Look into it and ask your HR department about it. I recently found out about our hospital having a Zero Tolerance policy on Bullying due to an incident that happened on the unit BUT it was funny because our manager was trying to convey the seriousness of it....problem is...she is the number one bully! The whole aura of the unit would change if she left but one can only hope. I truly hope your situation gets better (and I will read through the rest of the posts in case I missed any updates). As you have realized you need to do everything to fight for your license and no one is going to do that better than you! Good luck! :redpinkhe
  13. WoosahRN

    Pet Nurse?!

    I usually don't mention the area that I work in unless asked because people tend to focus on the sad part. But was at dinner at one point and was asked about what I do and what area I worked in (RN, PICU). Was asked some questions about it and mentioned a few situations that I had recently experienced, etc. Then conversation shifted when someone asked another guest how she was doing. I'm not sure if she took my conversation to be a challenge but she said that she too was busy at work. She was a vet tech and was currently taking care of some kittens in the "Kitty ICU". She made sure to elaborate on how she was nursing the kitties back to health and trying to get them to bottle feed and that she worried about them constantly. It was just an odd and awkward transition/comparison in conversation. And I was picturing my ICU with Kittens instead of Kids. P.S. I am an animal lover and not putting down animals or those in the animal science department (My cousin is in vet school right now and I will certainly be seeking her advice with my critters). This was just a particularly amusing situation and individual. :)
  14. WoosahRN

    I finally moved on and THANK YOU

    Wishing you happiness and peace in your new transition.
  15. WoosahRN

    It is the management

    I'm in the same boat. Done what I can to raise a stink. 100% agree with "Most people quit the boss, not the job". Good luck to you Jules!