JKL33

Well, there are painfully few facts so far (and I'm not inclined to go looking for them right at the moment). So far there are allegations of yet more of those actions that nurses should absolutely never take - if those prove to be true eventually, then the nurses will have to answer for them. In any case, I suppose those who are worried about getting caught up in badness should maintain appropriate nursing ethics and be prepared to leave if/when these cannot be maintained due to factors beyond the nurse's control.

1. Agreed. Fine. 2. Agreed. I personally think that corporate culture (the real one, not the one advertised in their version of glossies) should support your idea much more robustly! I think, as in my department, CMS should be disallowed from financially incentivizing speed. "Hair on fire" is almost always due to corporate demand, and much less often due to patient necessity. Witness any ED and my point will be inarguably proven. And I think that nurses should have recourse for that beyond "find a new job if you don't like it" and that Mr. Glenn R. Funk should be as concerned about that as he is this.

There is the scenario of purposely not doing something you know you need to do - or knowing that you are being reckless, and then there are scenarios where there is enough of a "don't know what you don't know" influence that it's plausible that a good deal of this made sense (to her) at the time it was happening. That is my belief since learning the amount of nursing experience involved here. And I highly suspected from the beginning that this was not going to turn out to be someone with 10 or even 5 years' experience. I don't think this was the "oh hey, screw it, let's just do it this way!" scenario that people are imagining. It sounds like a lack of solid experience way more than it sounds purposeful or even knowingly reckless. - This was an unusual process right from the beginning, right? This is not how we do things. ICU patients typically would never go to outpatient departments unaccompanied to wait for and receive testing. [I'm not saying it was wrong, merely that it was unusual.] - We typically do not administer IV anxiolytic medication to patients waiting unaccompanied in outpatient settings. But that's what was expected here, that's the type of medication that was ordered, and someone asked her to take care of it, as a task, because they were busy. Again, not wrong that this med was ordered for this patient in that particular circumstance, just unusual. - If you don't know that your pyxis is indexed with generic names only, you might type in VE to get midazolam. - [If you don't look at a label conscientiously and perform 5 Rs - critical error. No excuses.] - If you know basically what versed is for, but you haven't used it much or ever, there is no reason it would seem wrong that it needed to be reconstituted - If you know that no one is worried about or talking about or acting as if this is a (conscious/moderate) sedation scenario, then you can believe that monitoring is not required. No one's talking about any anesthesia consents or any of that. And when you don't know what you don't know, you can make it make sense: No monitoring is required and that's why someone asked you to swing by and give it on your way to the ED....

For the sake of every other patient in a hospital in this country, I hope CMS and the general public understand that she has not done any one single wrong here that hasn't been done innumerable times. I bet every one of them has happened at V in the past 8 hours. - Failure to conscientiously read a label - Fail to ensure 5Rs - Use override function on pyxis - Failure to monitor according to SoC **** Many, many people have done #1 and/or #2. Usually when they do, we all say, "Don't be so hard on yourself!" Either that or no one ever even knows about it because it didn't lead to an actual mistake or if it did, there was no obvious patient harm If you've been a nurse since before auto-profiling, especially in certain departments, there's a good chance that #3, using "override," is (or fairly recently has been) SoP in your work area. That aspect of this makes me particularly sick because the entity in question is using the override thing to make this look particularly evil. And actually the override wasn't the major problem here. But if you don't claim it was the (utterly reckless) major problem, then eventually you might come around to some of the other factors, like the idea of a newer nurse who clearly was not prepared enough for this role to be familiar with either of these two medications or the required monitoring, being in a role of roving help-all while orienting someone even newer while being sent all over the damn hospital (or to at least two different outpatient departments, in one of which there were no other clinical/nursing staff present and no tools for nursing care), to do these various things, neither of which were urgent or even necessary, so that she could medicate the patient of a nurse who couldn't medicate her own patient because she was busy watching two full assignments' worth of patients in the ICU. You might not think so, but you've probably done #4, too. If you've missed a set of important vitals, if you haven't reassessed as quickly as you should after giving pain medication, if someone took your patient off the monitor and didn't put them back on, if you delegated a monitoring-related task that was then not completed in a timely manner (vitals, blood sugars, etc., etc., etc.) The most unfortunate and egregious thing was not reading the label, and that's the bottom line. But what she did NOT do was "bypass a hospital safety measure *in order to* gain access to the lethal drug used to to execute inmates on death row." ** Oh, and she is also charged with impaired adult abuse. Which I'm guessing, to avoid "inadvertently" sounding like something isn't, would have been better written, "impaired-adult abuse" (IOW, the patient was impaired secondary to the medication).

They (people who put others in this position) aim to make it appear that one was indeed in a position to be adequately able to oversee the process such that s/he can vouch that it was done correctly. That is the purpose of this practice. Good luck saying, "but they knew I had no way to directly observe it...." should you ever be called to account for something. The answer will be, "Then why did you sign it? What did you intend your signature to mean?" It doesn't matter how management explains it. Their purpose is to make it appear that an RN has vouched for the information contained within. (Although asking them to explain it might be a first step in getting the process changed. In utopia). It also doesn't matter whether some EMTs and LPNs are/could be fantastic at triage. If that were a legit thing the hospital wanted them to do, the policy should allow them to do it.

And, FTR, I do think the OP has some issues that need examining, as far as how this is being portrayed and looked at.

Honestly I'm not in favor of our society's trend toward making sure that pain is exacted upon everyone who makes a mistake such as the one we are discussing. Report this, report that. Write it up. Throw a fit. Make sure people lose their jobs. Make sure they are appropriately humiliated. Exaggerate and conflate in order to make them seem like a criminal. Declare all mistake-makers degenerates who deserve to pay. I find it fairly pathologic given that we are all human beings and all DO make mistakes, fail to consider another's perspective sometimes, and the like. So then it's just a matter of how vindictive the person (minimally) affected by our gaffe is. Well, vindictiveness spreads. You don't learn to care about others and extend grace by being smacked down. And if you're the one always howling, what is it that you yourself deserve when your time comes? We will regret this. Besides, it's interesting when nurses and aspiring nurses receive this treatment but are expected to learn to treat others with principles of acceptance using a holistic, therapeutic, humanity-affirming approach. What a ginormous double-standard! There is a lot of ground between "letting it slide" and "imposing out-of-proportion punishment." I think there are several assignments that might have helped this student see the error, for example.

^ Yes. I would find that mentally intolerable. I'm a fan of letting other people accept responsibility for their insane choices - and in this case I'm not even talking about the patient, I'm talking about the idea that I would continue to hear the employer's angst about something like CLABSI while they tolerate this absolute circus. I understand their position isn't easy, either, but they aren't helping themselves.

Yeah, "discharge planning issues," I would say so! Wow. Sometimes ridiculous situations like this are purposely overlooked knowing that there is no good answer and there are really no advocates for these patients who are going to make a stink over the way their care is delivered. Regardless, this is a disaster. I've worked in an acute care situation where a few certain patients came and went according to their pain medication schedule. I wouldn't do it again today and I certainly wouldn't stay where violence is tolerated. Not to mention the issue of drug abuse/ODs being at the forefront. I don't think this is going to end with staff unscathed (even if they don't get stabbed!)....

I would pick at least one diagnosis that is related to the primary (admitting) diagnosis unless that is truly no longer an issue and the only reason the patient is still in the hospital is because of the other issues that have cropped up. You have a lot of choices for this patient.... Impaired gas exchange Altered nutrition Risk for fluid volume deficit Risk for infection Acute pain (Possible) activity intolerance Risk for ineffective therapeutic regimen management I realize you wrote this on Wednesday - - what did you end up doing with your care plan?

Under what admission status are these people being housed, out of curiosity? I don't understand. Does this facility have some beds that are designated as something other than acute care beds? Anyway, this sounds like a complete disaster.

No. They are mostly good for fooling people into poking at spider veins and other superficial vasculature. And in really difficult situations they aren't the thing that gets the job done.

If that's what was said, it wasn't very professional, obviously. I assume your friend is as upset about the termination as she is about others possibly finding out about it. A coworker or two might have reached out to see if she was okay even if nothing had been said. The manager also could have said, "she no longer works here," and others would assume termination. And when nothing is said, everyone assumes termination. What I'm getting at is, although I've heard things phrased better (she's decided to move on, she is pursuing other opportunities, etc.) your friend's anger about this issue is a defense mechanism (sort of unhealthy attempt at coping, understandable as it may be). It's a major focus on a relatively minor side issue. I get the adding-insult-to-injury aspect of what you're saying, but unless she is being slandered there is just nothing here. Even then, one would have to decide how much life to waste on dealing with it. I would probably encourage her to move forward, and regardless of anything else, this focus is not going to take her forward.

Hope, can you give an example so that we can understand the nature of what you are experiencing? There is disagreeing or not caring or being self-absorbed...and then there is gaslighting. I honestly think you may be struggling with an inability to separate self from others. I wont claim this concept is easy to accept and integrate, but here it is anyway: We (almost always) have at least some power in the whole scheme of how others make us feel - - that is, how we allow others to make us feel. Or, how we allow ourselves to feel about what others do. Are others' petty behaviors wrong/unfortunate? Yes. But the reason ^^ this is important is because we can't control or change who others choose to be or what things they do. That's not up to us. So at some point we have to stop focusing on them and how they make us feel, and start focusing on developing a healthy sense of self and a positive outlook. In case clarification is necessary, I am not talking about situations of abuse or targeted manipulation/bullying/etc., I am talking about a basic framework for the interpersonal interactions we all need to have every day. We all have to learn how to deal with others and (to some extent) decide how we are going to be affected by the day-to-day choices others make. It sounds like too much of your perception of yourself is based in others' crappy behavior. You don't have to live that way or, as Persephone said, let them steal your joy.

The problem (suspicion) has been reported to the company before and it doesn't sound like they were in any way interested in protecting this child's best interest. There are professional-boundary-crossing aspects to staff's relationships w/ the mother, and a culture of gossip and distrust within the company. This isn't a matter of jumping to any conclusions. It's a matter of knowing that people will go to lengths to protect their own interest in a threatening situation and the OP should at least be prepared for that. It wold be naïve to think this isn't going to get complicated in one way or another. Yes, the failure to report this to LEOs and CPS the instant it was realized that the med was tampered with and diluted is a big problem at this point. I'm guessing the BON wouldn't be happy to hear about a scenario where there is an ongoing hx of administering obviously-tampered-with medication to a patient, either. Suffice it to say there are things to consider here. And a lawyer is not a dumb idea for at least a couple of different reasons.