Mr Ian

I was going to post what I remember about Lithium titration and testing (been a few years since I did in-pt acute so I had a quick read up) - but I found this PDF file instead which might be of use to the OP - and is much better than me making a dill of myself getting it wrong. http://www.clinicom.cpft.nhs.uk/LinkClick.aspx?fileticket=i9sBvmvQyBk%3D&tabid=469&mid=1032

jjohnny - informative post; thx As for the general debate: I've long had a problem with the sledgehammer approach to sleep issues. My local medics (non-psych rural hospital) have a standard practice to prescribe Temazepam to everyone with a sleep problem - doesn't matter what the problem is; onset insomnia, early wakening, broken sleep... Temazepam 10-20mg PRN. What would be better is to have an increasing pathway like childpsych said - and a thought about what jjohnny said on environment - rather than just giving a major tranq/hypnotic. And I'd start with warm milk and cookies.

It would indeed be a RM issue. The risk factor being an incompetent doc. I'd be wary of the nurse manager not wanting to report the issue and your colleague should get something in writing to that effect with perhaps a clear indication what they intend to do about the highlighted risk. There ought to be a clinical management pathway for the introduction of high risk drugs. Clopine/Clozapine is a classic example of how this (tho not sure what the USA protocol is - Aus and UK are very similar 12 week strict monitoring).

To hopefully clarify the legal point - it would be the union's practice to exhaust all non-legalese avenues before engaging their legal services. This is common as it seeks to reduce the use of legal services that might not be required. However, the union should support you with an experienced representative in order to get your stuff together and present in a good format. They should represent you on both matters. There is nothing - and no-one has the right to advise you - to prevent you getting other legal advice if you so wish. The only thing would be that, if you retain private counsel, the union may withdraw their legal services. Which means you'll be paying private for legal advice as opposed to being covered with your union. (This is my general understanding - tho matters may differ country to country and state to state)

oh you young 'uns :vdgmg::grn:

Not a clue. But I had a look about. Found this on Hansard of you hadn't seen it before - http://hansard.millbanksystems.com/commons/1980/nov/11/rampton-hospital And there was a page with a follow up story called The Rampton Report in 1980 too. (YTV) http://ftvdb.bfi.org.uk/sift/title/326397 But 1979 - that was before VCR wasn't it??! I'd write to the producer - if he's that busy he'll have an exec support officer who will probably complete your request. I'd give it a go - what have you to lose?

You're probably not far wrong that the U/M is intimidated by your union status. Most places function as adversarial with unions - which is a pity. They function much better when they are mutual goal directed - and the purpose of a union is to preserve the integrity of the workforce. You'd think an employer would welcome that but most are narrow minded and see them as 'interfering' with their 'good management'. But I'd be cautious about over-stating the union position. You are foremost an employee and the employer has a responsibility to treat you fairly. ReNewed One: Tho I have had problem following the nature of events - I'd suggest the OP is not liable to disclose all details for the benefit of others. I am more than aware there may be issues afoot that we are not advised about (as with any nurse who frequents here to complain +/or seek support) - but the nature of a support network for nurses is to 'support' - not judge or prevaricate. TGM may have made an error for which they are responsible. They may even be one of those militant mendacious union reps who makes trouble for the employer just cos they can. I'm not concerned with that as much as I am simply hoping that the "nurse" who writes here feels supported by their peers. Any anomolous behaviour will no doubt be brought to attention of those charged with making a decision on the matter. Fortunately, that is not our business nor responsibility. So personally, I remain sure there are things not fully clear - but that's not what a nurse support network is about and I'm not interested. I've never been wrong in my judgement and I've always been victimised. At least, that's what I like to believe about myself and my nursing. Even tho I know I've done dodgy stuff, or simply wrong, on times. When I'm feeling that way - I'd like someone to just step up and support me - not judge me. Details are superfluous.

I'm not a lawyer - (INAL) - but.... If the U/M has written you up repeatedly for things others have done - getting that evidence together may serve you well after these shenanigans. It's not uncommon once a manager has started such a process to pull out every last detail of every last event and attach your name to it as culpable. They think they're making an 'airtight' case - but they're actually demonstrating their childish petulance - as well as a subtle fear that they're not altogether 'in the right'. Not sure on US legal terms or constructs etc but UK/Australia has a concept of 'constructive dismissal' - whereby an employee is forced to tender resignation by unscrupulous behaviour of an employer. This is a frequently cited complaint of the Industrial Tribunals. I hope your grievance included the words 'harassment' 'bullying' and 'the inequitable and preferential treatment of others'. Also sounds like your Union is crap. Even if you were completely culpable - you pay for them to assist you in industrial matters; not for them to decide if they're going to bother or not. My union failed to support me (tho I only joined them after the event occurred - so there was no contractual obligation to do so on their part, even tho I had to back-pay a full year's subs in one go) so I am no longer in a union - but that's my personal choice. I strongly support all nurses having a union membership. I also encourage nurses to make sure the union represents them - and not the union's own agenda.

I understand your frustrations - I was in a similar position 3 years ago - and one prob 5-6 years before that about clinical judgment. It is not pleasant and management tend to target scapegoats with emotional venom rather than attempting to resolve the problem(s). I'm a bit slow piecing things together - but I get the impression that the medication you made up was for pt A - but was given to pt B instead - or something? And that the medication was recorded erroneously which you later went to amend when you realised/were told about the mistake? Administering meds is like the 'chain of evidence' used in criminal law - there must be no room for 'mistakes' in handling or the evidence becomes tainted. In medication, it is similar because what is meant to happen is not always what does happen if the 'chain' is broken - as is so in this apparent case. And have they identified in the 'violation' what exactly it is you are culpable for? It sounds as if they are making you responsible for the medication being made up - and then taken to the wrong patient and administered - based on the fact that if you hadn't made up the medication and left it in the room then it wouldn't have been wrongly administered. If there is a policy about that - then I'm sure it equally effects the senior RN who took the unlabelled medication and instructed another RN to administer to pt B. What is also important is what steps were taken after the error was identified to rectify or remedy the matter. Have you retained any official representation yet on the matter? I would have hoped so and don't wish to impede their counsel. My only advice would be to accept you are now in 'due process' and to focus only on the resolution of your predicament. Once that's done - perhaps you can do as I did - I raised complaint against all 8 people maliciously involved in the process - which was trimmed down by the decision-maker to just one culpable person - and so I dropped the complaint, before sanctions were made against him, with a "higher moral ground" letter stating they were being as unjust and unfair to one person as they had been to me. But anyhow - that's for later. Something to remember - the managers who have underwritten this complaint - still have managers above them (unless this is a one-off stand alone hospital and the administrator has determined/approved this course of action) - and their managers will not be impressed to see erronenous management tactics - especially if they come back and bite them in the preverbial. Don't regard the actions as being the 'whole' of management or your employer - they are simply one or two wanky bosses who think they can do this to people. The BON - If they can be bothered to make a case of this - I believe they will identify your small part in the error and look for evidence that you recognise where you had a part to play; express regret and remorse and have sought to improve your practice. The employers - who cares what they think. Don't resign. That's playing right into their game. Do start looking for another job to fill in with - there's no reason you can't be employed elsewhere on a casual level (PRN); if you're suspended on full-pay, do some voluntary work - and let the employer know you've got other employment so they can't stiff you on that one too. Personally, once I'm in the clear, I'd stay with them - just to annoy them. :angryfire (That's what I'm doing now - and have been for the last 3 years.... )

So what are they pulling you up for? Some medication adminstration error? And reporting it to the BON? From that scenario it sounds as if you made a lesser mistake than charge RN. Tho it is wrong to make up and leave meds (they should go pot to patient without interruption) - it does sometimes happen. Labelling meds is a complete no-no - but in this instance you state you didn't have opportunity to breach that practice anyhow (I know it's a common time saver and have done it myself in the past). However, the charge RN who took the unlabelled med and passed it to the next nurse with instruction to adminster must have been satisfied that the med in the cup was the right one. The adminstering nurse should be the dispensing nurse - but in necessary times things have to adapt. If this is the total scenario - and you relay this in your synopsis to the BON - they are likely to ask many questions about the practices at your employment in order to gain an overview of the general workplace scenario. Has your employer given written notice about their reason for suspending? And a copy of what they sent to the BON?

Not really before - but then I didn't know I was interested in mental health nursing til I finished the 3 year course (in pure Mental Health Nursing!) Since then I've toyed with the idea - but that's cos mental health nursing is poorly recognised or subscribed over here (Oz). It's all generic nurses doing psych - like the US version.

Sounds like what we call Director of Nursing. Chief Nursing Officer is a title they give here (Oz) to the lead senior nurse - also in the UK - who act as advisor to the government. Incidentally, I am neither. But I have a staff of 4 and a water machine to manage. How can I help?

Any book that reduces nursing to being "incredibly easy" - is obviously missing some text :wink2:

Well again I'd love to help - but what is a CD unit? All I could find was Communicable Diseases.

In the most litigious country in the world - I'd like to see an employer force an employee to be exposed to a carcinogenic and feel perfectly safe about that.