JKL33

I believe it is probably truly difficult to present certain material in an attractive, attention-sustaining format. The thing is, it doesn't have to be entertaining, per se, but respect is required. I'm not saying that you two don't get this but a lot of people apparently do not: This kiddie game stuff is disrespectful, especially when it is everyone's go-to for how to engage nursing staff. If it were merely a change-up that happened now and again, people would never have come to despise it so much. People can tolerate a topic that is less-than-exciting. Just level with them/us and do your best. Allow for discussion whenever possible, that way people can share their experiences and ask their questions. I have really appreciated times where questions were asked during such sessions, the educators did not have the answer, but within days or a week or so, they had obtained an answer and sent it out to attendees.

What is the larger context of the assignment? Any stipulations/parameters, etc? Is this a single assignment or will you be expected to build upon whatever topic you choose? What kind of a question are you supposed to be answering? (See pgs 7 & 11 of this document )

Make it stop. Okay, I do have something productive to say, but that was my first reaction and yes it was in regards to the constant barrage of commentary on this topic. I have some major issues with the ANAs tackling of the subject. First, I completely disagree that "incivility and bullying" issues should be comingled with that of violence against nurses/HCWs. VIOLENCE. It is ridiculously irresponsible and I think it should be obvious why it is - this article provides examples. On the one hand you have people who bring weapons into care areas or who become violent in care areas even without weapons, and on the other hand you have Joe Blow who thinks Susie Q may have rolled her eyes. I will be blunt: *THIS* apparent inability to discern and to discuss issues clearly and tackle them reasonably and factually and without constant exaggeration-to-the-point-of-disingenuousness is embarrassing. It's such a trainwreck handling of the separate issues and a really funky way to focus on low-level employees and conflate only their behaviors with violence. I mean, this is so trainwreck that even in trying to explain it I feel "all over the place." Well, that's because it is. It's "all over the the place" in a very convenient way, though. This is an utterly opportunistic theft of a serious issue in order to further an agenda. What it boils down to is that, although nurses and HCWs may be subject to physical violence and threats in the course of duty, we are going to conflate that with eye-rolling behavior, and we're also leaving the employer out of it for the most part - - their job is to have more policies and make it look like people have a voice, and to tell people about their policies. They aren't even remotely implicated as having more to do with this than that. Sure, they're supposed to treat every episode of "violence" swiftly and the same regardless of who is involved, but since they don't see themselves as being involved, they're off scot-free while nurses read and do millions and gazillions of articles, papers, power points, posters and projects about huffing, sighing, eye-rolling, cliques, exclusion, pressuring, threatening, "failing to help," withholding information, and anything else that individual low-level employees can be blamed for. My statements are not to be taken as an attempt to defend selfish, jealous, catty, mean, or otherwise impolite behavior. Just the same, nearly all HCWs are working in conditions that involve at least some compromise that could be considered serious or ethically troublesome. Is there any good reason on earth that we can't discuss that and people's reactions to it, and then also (separately) make strides to control and utterly not tolerate things like punching, kicking, scratching, pinching, spitting, shoving, slapping, and use of weapons (at times) - you know, guns, knives/blades of various kinds, home implements, against nurses/HCWs?? VIOLENCE. Check Maslow.

I can't give one cohesive opinion, but here are some principles and ideas that you may be able to apply to your situation: - There is no point in destroying your soul with problems for which other people are responsible - A heavy personal burden for situations where really wrong things are going on but you don't have the power to stop them is a source of significant moral distress, which has links to burnout and can even involve PTSD symptoms. You are not obligated to subject yourself to that based on having walked into such as situation. - You may be able to make a difference in lives of the residents and possible even be a force that eventually improves the culture of caring, but (in my humble opinion) you do not have an individual moral obligation to do so. It is a choice that only you can make a decision about, or if you want to look at it this way - a risk that only you can decide to take, and others cannot tell you that you have to take it. - I say "risk" because in situations that are troublesome like this, you may be subject to others' jealousy or dislike of your actions/caring. If your intolerance of the situation poses any risk to higher-ups and their sense of security, you cannot control the ways in which they may try to rid themselves of the threat you pose. Examples: Tarnishing your employment record through inappropriate disciplinary actions or unjust termination, making accusations that have legal implications, etc., etc. - If you are surrounded by people who will generally seek to malign you (tell lies about your work, your actions, your interactions with residents), you have no moral obligation to remain in that situation - OTOH, occasionally people sooo don't care, that they are willing to 'live and let live' - in other words you may be able to do the work in ways that meet your own standards for personal satisfaction without too much trouble from others. But this seems kind of unlikely because, if nothing else, your own internal compass might not let you feel satisfied with "only" doing your part. Don't you think it will very quickly become intolerable if no one has done x, y, z, [like washed Alice's face or changed Joe's soiled sheets] since the last time you worked? - You already know their approach is not better - If you are expected to compromise the care of residents or in any way treat them in an unethical manner in order to (appear to) get the work done, that is not acceptable. - If you are expected to defraud anyone in any way, falsify anything, etc., that is also never acceptable.

In the spirit of keeping us all out of trouble (not nitpickiness... ) We cannot ask about the nature of the disability. These are the two questions I referred to earlier. ^

Ordinarily even if a situation is goofy I prefer to take a crack at developing a good rapport. It often works out okay. However, there's no point in asking the two allowable questions; the employer is going to be skittish about offending this guy even if his answers don't indicate that the animals are service animals. Because of that and several other variables, I would probably just skip all the super-nurse stuff and just get admin staff involved. I have no tolerance for hearing one single iota about stuff like this after the fact. I like to get MMQ-type people involve pronto - that way if wrong ends up being done, they can blame themselves instead of acting holier-than-thou about a difficult situation someone else hand to handle. BTW, it isn't so much about "pit bull" - it's about the fact that these dogs have a hx of aggression and the patient himself has been wounded by them.

The "incidental disclosures" thing arguably may cover some of this - otherwise a thousand and one more things would have to change, which, maybe they eventually will but right now no one big is pressing the issue. Even with incidental disclosures, though, they are to be minimized whenever possible. Use the partitions, speak with the lowest volume that can be heard by the patient, do everything humanly possible to maintain their bodily privacy, consider moving them to a more appropriate area whenever possible, especially for sensitive convos or sensitive care. I routinely move patients for exactly these reasons. It's one thing to have a run-of-the-mill sprained ankle or sore throat in the hall, but it gets dicey as soon as you get much more involved than that. Even more than HIPAA, my motivation for moving people comes from trying to respect/maintain their comfort, dignity, and sense of privacy. If you don't even have enough partitions/screens or something like that, I would raise the concern. I think overall the issue is one that doesn't get pressed much because no one has a perfect solution to the overcrowded ED.

brownbook, with respect - I have to disagree. As far as general information/education/health promotion, that is one of our major roles. Pharmacists are in the medication realm - shall we not do medication instruction/education, then? Physical Therapists are specialists - should we not educate about activity limitation or promotion as appropriate for our patients' conditions? Respiratory therapists have their realms - can we instruct about inhaler use, smoking cessation, use of I/S, or any other number of things that could cross into their territory? Etc., etc. If a nurse doesn't have time for any education/health promotion, there's a problem. The amount of things we are expected to do that don't directly involve interacting with patients is a problem. If what you mean is that you don't think it's appropriate to spontaneously promote a particular diet based on personal beliefs or preferences, I would agree with you. But other than that I think you have overgeneralized a little bit.

Hear, hear! Yes, patients are almost always better than these clowns. Actually, clowns don't deserve that comparison. Experienced it multiple times. When you look around the room and see how many people are being paid for stuff like this and calculate the general cost of such an endeavor, it's not very funny. Just the same, I stopped feeling insulted by recognizing that this has nothing to do with me. It is 100% about the individuals who don't know how to properly interact with other adults.

I would report the practice. Even if they have it squirreled out one way or another that what they are doing is technically legal, whatever it is they're doing isn't safe.

Is this the Rockstar from DaveyDo's Comic's Comics, too? Well, either way there's a Jason who needs to get his act together. He should be accountable for his actions forthwith and henceforth, both. Henceforthwith.

....sounds like an excellent option. Not one ounce of sarcasm intended.

I hear you. It's rotten that they didn't even ask any questions about that, though. If nothing else, what kind of an investigation is that? If nothing else, why was this apparently 100% inept individual inside this facility, regardless of role? I am not sure if I agree that something is always NBD just because it is SOP - that's kind of like kids trying to make wise decisions based on what their friends are doing. Although I will concede that it was not the major determining factor in this situation as far as my interpretations based on the known facts. ********** I just still feel this situation is not okay separate from RV and her missteps. I think there's so much goofiness here that it can't possibly be "all that" on that floor - that's why I tend to think there was chaos and/or very loose practice involved. For example, you don't just have RV, you have at least one other nurse who knows dang good and well she just sent her patient out of the department off monitors (which was fine d/t downgraded status), but then casually sends someone else to administer IV sedative after basically discrediting another department's concerns/requests. So, there's two people who are very comfortable with not doing the right thing. Sounds kind like typical cowboy crap to me - and that is a culture that, often enough, is a poor/wrong/unfortunate manifestation evolving out of necessity. And by necessity I mean either literal need or else expectations. And...just as the actions of RV speak for themselves, the actions of any and all personnel who were supposed to refrain from tampering with what was clearly an ME case, and who clearly knew they were supposed to report the incident - all of that also speaks for itself. It's impossible for me to believe all is well in that place. Impossible. I think there are a lot of very relevant concerns being expressed on the thread, although I stop short of believing that they should have exculpatory bearing upon the outcome of RV's personal situation going forward.

Obviously I can't say for certain but it would make sense if the ED patient was going to be admitted up to their unit and they were just getting the swallow eval done ahead of time or if that unit's nurses are the ones who do swallow evals in the ED.

I get why the speed of BON action might be cause for concern, but realistically in this case 11 months were lost due to the cover-up which was under way.

Your time would be best spent by working and earning what money you can while you have no other major responsibilities like nursing school. Put away/save as much as you can. Making wise financial moves will affect so many of your life choices including those you make about future employment. Best wishes ~

It does seem likely that they didn't learn about it in a timely manner. Thanks for taking the time to post all of that info @Anonymous865.

See I think you should've slowly raised your hand, then uber-seriously and meekly replied, "....more pizza, maybe...?" Tip: Always carry a resignation letter in your bag, just leave the date blank so you can fill it in quickly if need be, like in case you just get fed up some day and pull a stunt like that ^

Trigger warning: Just say trigger warning every time you speak, to cover yourself.

You make a good point and I do think it is reasonable to believe that the order itself would have listed the generic name. She may still have searched VE but might have been jogged to try MI if her first attempt didn't bring up the med.

I hadn't noted anywhere that it said whether she looked at the order at any point or not. That issue is not addressed specifically unless I overlooked it; it kind of appears to me that they didn't ask her that specific question. But if she did start this whole process without looking at the order, it's another thing I can't fathom. I am familiar with different utilizations of the override function - not based on my own decision-making but because of the way its use has evolved over time.

Too bad they're stuck on the same boogeyman they've always been focused on: The Evil Physician. They act like there's nothing to watch out for on behalf of the patient except what those uncaring, greedy doctors might do. I think they missed the memo that, for the most part, doctors aren't the ones running the show now...

I think it is a plainly clear and common idea that a nurse might have every reason to believe a medication was entered as STAT when a patient is already in a procedure area waiting for the medication. If you would like to talk about whether it was literally emergent or not, I agree it clearly wasn't. No way. And I can't defend her actions. Just the same, the topic of whether it was actually emergent or not gets around to my assertion that fake emergencies (or imposed time pressures) have become a serious problem in acute care. I mean, that is this situation. We have several people up in arms about a downgraded ICU patient, unattended and off monitors, who needs something for anxiety right away in order to obtain an utterly non-urgent PET scan...

Was this reported to the BON upon her termination?

I don't know what to say. The whole quote regarding this is an ambiguous sentence or two from someone who may or may not ever touch patients or these machines, whose team performed an analysis. Okay. I'll just quote the report (quote is from the MAPST, Manager of Adult Patient Safety Team, p.22): My point is that we do not know the status under which the medication was ordered (STAT, NOW, Routine, PRN, etc). I have not been able to find that. She may have had reason to believe that it was entered as a STAT order since the patient was already down in radiology waiting for the med. But what we can't assume is that it wasn't entered STAT just because the situation was not in fact a dire emergency. It may indeed have been ordered STAT. She may have had reason to know that in such situations where the med is wanted sooner rather than later, it would be entered as STAT. You see what I mean? So the wrong med pops up, somewhere on the screen is the override button, which has a warning saying it is for STAT orders. Given the perversion of the use of STAT/NOW order status, she very well may have believed that it was a STAT order. Or she may have overlooked the 'red box' (whatever it was) like she overlooked everything else. The thing is, aside from RV, if you (we all) are interested in keeping patients safe, it does matter how override is commonly used, off the record, in that facility. Not how I use it or how some other nurse uses it, but what the tenor of its use is in that facility. This could be a situation that was utterly out of the ordinary with regard to the use of override, or it may be that she was doing a very common action and it went wrong only because of other serious mistakes she made. From a strictly patient safety standpoint, the minute details of this do matter. That's why it's a second, or third or fourth freaking crime that such things seem like they aren't even being looked into. You know - that, and well, the whole cover-up thingy.