Triage24

Basically what you are referring to as a Never Event is what the majority of your Colleagues call a Sentinel Event. First of all as unfortunate as these are they do happen. Yours was not the first and sadly it will not be the last. I have been in Nursing over 20 years. Worked on Step Down, Critical Care Units, Emergency Room Nursing (CEN, CPEN) Hospital Nursing Supervisor, Med/Surg and Pediatric Nurse Manager. Why do I tell you this? Simple, because I like others have seen these before. They are very serious but they intent and goal of them. It's to identify what went wrong and why and how do we address and fix it. That's it in a nutshell, Why would it be brought back up. Because it's a lesson learned for The Unit and Facility. Not to attack anyone, in this case you personally. This incident has clearly affected you, now what did you learn from it? Sometimes our best lessons are the hard lessons. Hate it happened to you but I'm willing to bet something valuable was learned. That's called experience. You don't get that in school. Now ask yourself do you need a change? Maybe it's time to work in a different area. Nurses are not trees we can move and it's often beneficial to do so. Even in the same Hospital. Sometimes see a Counselor is very beneficial. I have always liked that approach and have in my career used it, recommended it and have referred Nurses to it if need be. Wishing you the very best.

Call Corporate Compliance. Call your offsite number. You may remain anonymous. Also have others with knowledge of the incident do the same. Risk Management is OK in some situations others not so much depending on The Administration of your Facility. They will not bite the hand that feeds them as a Rule. Takes a Strong CEO to hold Physicians accountable and a Facility Culture that is enforced. Also I would encourage this Surgical Tech to File Charges. Do not in anyway Tolerate this.

We are scheduled 12 hour blocks. Day is ruined if not called in and worse if called in. Many times we are called in not because of a true need but due to patient satisfaction, and scores. Also keeps Management away from the bedside if staff weren't on call. Not like the old days when Management wasn't just a nurse in name only. Still some of those out there but more and more they are the exception to the rule.

We work three 12 hours shifts. Then are on call 2 times a month. We are paid time and a half if called in. I see it as a slick way to impose mandatory overtime that most nurses, including this one does not want and its unsafe to staff with tired nurses.

What are your thoughts on Mandatory Overtime in Nursing in General and ECC in Particular?? How about if it's called something else such as On Call to disguise the fact that it's Mandatory Overtime. Where you are on call for twelve hours. Losing a day off that you have earned and deserve. Get paid less than $15.00 for call if not called in. When called in you are working types and unsafe. Both you and the patients are getting cheated. How do you fight this practice?? How do you stop this?? What organization is the best at standing up against this?? I feel Administration does not care about staying levels or patient safety. Many in Nurse Management these days are so far removed from hands on nursing they are clueless to what is happening out there in the real world and worst they don't care to know. I have nothing against The ENA or The ANA but it seems to me they are just to passive for the most part. Who else is our there and what is their track record.

Curious, is this a older Dr?? Years ago we used this combo frequently. It has falling out of favor in the ER that I work at the past few years. I always liked it but have not used or seen it in over four to five years. It should be noted that Inapsine comes with many Black Box Warnings. This is one of the reasons we no longer use it.

I am the older nurse (51). I have the IV experience and have worked as a CCU nurse and ER nurse for years. That does not mean that I or anyone else hits them 100% of the time. Being older or younger has nothing to do with it. It is an experience thing not a age thing. If any patient is getting that many IV sticks on a regular basis and is that hard of a stick perhaps it would be a good idea to talk to the Dr about a Porta Cath. If someone is that hard of a stick and gets IV's on a regular basis you can bet the nurses know the patient too. I wished I had a dollar for every patient I had that told me I was a hard stick, my viens roll, or I'm scared of needles. :hdvwl:I would be writing this post from the Bahamas this morning. I am professional and always nice with my patients but at the same time we still have to have the IV and bloodwork.

Administration and Management these days for the most part are a joke. Would you want one of these so called leaders with you in a tough situation. I would be amazed if many of them could identify the difference between a blood pressure cuff and a stethoscope, much less how to use it. Yet, the amazing part is they know how to tell us what to do and how we should do it. Many of them don't even round on units, They depend on consultants and stats to tell them if they are doing a good job or not. There is to much Smoke and Mirrows such as Press Ganey and Studder that has replaced common sense. Here is a consult for you. Come out of your glass palaces, come out to the unit and show us nurses and patients just how good you really are. Lead from the front and lead by example every once in a while. Many of you talk the talk, but fewer walk the walk these days.

Worked Utilization Review and Case Management for a several years. What you are describing is a social issue much more than a medical issue. Adult protective services is the correct route. What seems to have happened here is the first time the ER did not see a broken hip on X-Ray. This would justify not be admitted as it does not meet the severity of illness/injury criteria. The second time the break would have met and he could have been admitted. Sometimes, right or wrong Dr's do social admits. In this case they did not. The wife is using you guys as a makeshift home health nurse. I suggest Adult Protective Services involvement. They can take custody of the patient if warranted. If they do they will have the responsibility to see that he is taken care of. Would also suggest that you do not enable this situation further. There is always the potential for liability even if you are acting in good faith. The law sees you as Nurses with a duty to report and accountable for anything you do.

There is no advocate for nurses unless you are in a union. The only advocate you have is you. Human Resources is like going to the fox in charge of the chicken house.

So what would happen one of these days if every nurse and I mean everyone of us just stopped taking it. Intresting thought. Have a nice day.

I agree with cherrybreeze. I would have documented it pretty like that. I would kinda of on purpose wrote my note so that it left no doubt the cardiologist knew and took no action on the Na+ level. That I paged the attending and got no response. That I notified the charge nurse of the situation and continued to monitor the patient. :)

Sounds like you need a change and a challenge. You want autonomy. I would suggest the ER. Good luck to you.

If they continue to do this take a picture and slide it under the Nursing Directors door. LOL.. Problem solved..

I am a male nurse and I am very upset with this post which not only displays a discrimatory sexist view but makes me wonder how in the world can someone like this be a nurse in the first place. It makes my stomach turn to know that some poor patient has to have this kind of nurse to care for them. I wonder if they feel the same if someone has a different religion or is a different race that them. If you are going to be biased, sexist and prejudice you might as well be good at it. Right?

If they have not terminated you continue to show up and work. Most states will not allow you to collect unemployment if you quit. What you are describing is a case where they want you to resign by intimidation or coercion. This will allow the hospital to be off the hook for any unemployment. You have no control over whether they terminate you or not. But do not under any circumstances resign unless you have another job waiting on you. This is the oldest HR trick in the book. Please know that you did yourself no favors by trying to leave a department during orientation. This puts a chain of events in motion that is hard to stop. The director tells the DON or CNO whichever one you have and a decision is made on your future. HR is notified and it's cheaper to let you go than to keep you. Of course it's easier if you resign in their view than to be terminated. Ball is in your court. This is why you don't resign. Make them terminate you or let your work. Make it their decision and choice. In the meantime look for another job and conduct yourself in a professional manner at all times. Good luck to you.

Have been a nurse for 16 years. I can tell you it depends on the group you work with. Most of my background is ICU/CCU and ER. Dr's for the most part are not to bad. Love the group I work with in the ER. The nurses there are more like a family. I have always, always, always made a point to be in an enviroment that once you are well enough to complain it is time for you to move. That is why I like the ER best. I am not dealing with the same patients day after day. I will admit that we have our regulars though. Got to love them . LOL

Involve yourself in your work. Don't dwell on the time. Time always seems to go faster that way. Good shoes are a must. Many nurses will not agree with me on this, but I eat as late as possible. I always in the last 4 hours. Have done so for years. That way when I get back to work after my lunch break I am pretty much done.

I am sure that you are not the only nurse that this CNA has come in contact with. What are the other nurses saying? Have the night supervisor or anyone else ran into a problem with this CNA? Document everything, I mean everything. If the CNA just wants a paycheck without working for it then write him or her up. Do not back down and report this CNA to your manager ASAP. Do not be intimidated at all. I was a CNA many years ago. They have a job to do period. Most are very, very good at it. Just as nurses they are a few that need to find employment elsewhere. If that is the case here, help them right out the door.

Life as a ER nurse. What could be better. :wink2: So let me see, let me get this right Your child has been running a fever most of the night You didn't give any Motrin or Tylenol before you came here. Couldn't afford it you say as you talk on your cell phone held to your ear. You can't afford any medicine for this child Yet you are wearing designer clothes that are the latest in style. Your cell phone for texting I see is the latest and greatest thing. And just look at your nails, and all the fine jewelry you wear, fitting for any queen. The Temperature is now 100.2 What on earth is it that we can possibly think of to do. The Dr will get an X-Ray, labs and a blood culture or two. A complete work up just for you. Of course nothing is found as we can all suspect. The child is now playing and seems darn near perfect. Lets try a little Tylenol or Motrin before you go. Wow ! The fever is now gone what do you know. Now the ER bill will soon be due. No big deal, me and the taxpayers are paying it just for you.

I am a former UR nurse in S. Carolina. RAC will provide a list of who, what, why they are recouping any money. Appeal everything possible. You must have people looking at these charts who live and breath Interqual. People who can quote Interqual to you. Go into it with a clear understanding that you will not win all appeals. Your goal is to win as many as possible. Appeal has to be based on Interqual criteria. The record must show Severity of Illness and Intensity of Service. They are not intrested in anything else except that. Remember they are contracted to recoup money they get a peecentage of how much they recoup. The less you appeal the more they get. Iin summary appeal, appeal, appeal

We have standing protocols for starting IV's and drawing labs. If chest pain, critical or we know we are going to need one, we line and lab them.

We have hourly rounding in the ER were I work. This is a waste of paper and time. While this may be a good idea on a floor setting this is not pratical or smart inm a ER setting. This is the kind of things the folks who live behind a desk with fancy degrees think of. While they would struggle to identify a blood pressure cuff from a stethescope it is intresting how they always seem to know what me and you need to be doing at the bedside. Think about it, would you want them working beside you in a busy ER.

thank you. i have some more that i will post soon.

I have been in nursing 15 years. Have background in CCU, and ER. Have been a Hospital Nursing Supervisor twice and Med/Surg manager. What you are going through is normal. If i had a dollar for everyone I have seen in your shoes, including myself, I could retire. The first step is to relax, learn what you can and remember that the experienced nurses were at one time where you are now. Learn the rythms one at a time. It starts with Sinus Rhythm and ends with Asytole. Then build from there. Add Sinus Brady, and Sinus Tach. Now try a few blocks. on and on from there. Don't make it any harder than it has to be. Sign up for any rhythm courses. Look them up on line, easy to find on google. If you like what you are doing you will do fine. Tie in with a nurse you trust and are comfortable with. You can learn a lot from them. Everything is not always learnt from a preceptor. Make sure you and the preceptor click well. If not ask for another one. Remember you staretd late June, some of them have done this for years, Don't compare yourself to them. Good luck to you. :)