Alex Egan

As others have said the biggest thing is to not bill the visit. The lost income is a drop in the bucket to what might land if the powers that be decide its suspicious and go digging through your entire agency looking for issues. I assure you they will find them if they look hard enough. The management should take the loss and move on.

I can endorse this advice to call the labor board. They really are in your corner and have the regulatory bite to really get action. Get a new job, you're not going to make friends, but when you need action you need action. I had a dispute with a very well known university over late pay. Just the threat of the labor board was enough to get the issues solved within two hours of my threat to call

This. Look out for other worrying signs. Supply shortages, loss of coffee in the break room, limiting of overtime. If you start seeing payroll being late or missing overtime RUN the whole thing is going under!

I was asked this recently at a special event I was staffing. My answer was an emphatic no. I chose not to for a few reasons. 1. Narcan is a secondary first aid treatment for an overdose. Airway management and rescue breathing is the most important and immediate action when encountering these patients 2. 911 is on the way anyhow let them do it. Even with the prolonged response time at the event, I would rather sped 30 mins rescue breathing than the alternative. 3. Mixing and matching drugs is common. Narcan, in my experience, often results in puking angry people when they are just on opioids. When the victim is mixing drugs suddenly removing the calming opioids can leave you with a raging methed out person. If I have a BVM and a set of airways I plan to just relax and wait for the cavalry.

What state are you in. That’s the most important question. In PA you cannot be mandated to do more than 16hours (18 in a declared emergency)

Congratulations! As a long time resident of the state I am floored that you didn’t have more trouble. I’m glad for us both that the BON seems to be digging itself out of the quagmire of the new computer system

Call a lawyer. Do not deal with the BON on your own, is the best advice and your already there. I went through something way worse, and it sends you to a dark place. You feel your entire future is slipping away. You think every other nurse knows and has judged you guilty. So steps to take 1. Find another job now, you don't have to disclose and investigation unless your employer asks directly. Lay down an excellent work history so if you end up with restrictions the employer will be more likely to work with you. (I recommend dialysis because they are more familiar with restrictions than most industries in general) 2. Find sanity. I couldn't work due to my troubles. I managed to find a free clinic that would take me and that saved my life. Getting up and doing SOMETHING every day gave me a sense of normalcy as the days dragged on and my finances fell apart. It gave me a place to be when they put the for sale sign in my front yard and kept me from drinking during the day. 3. Use spin control professionally. Reach out to old bosses and trustworthy coworkers. Have lunch with them catch up. When what's happening now comes up get your narrative on record first. These are the people you're going to use for references after this is all over, so you need their support. You want them on your version of events, not the complainants. 4. No matter what when it's all over put it behind you. I went back into the same industry, with a lot of the same bosses and coworkers. It was hard because you don't know who believes you and who thinks you're nurse scum. I just had to move on and publicly not think about it. Privately I was a damaged person, for years. You can PM me here if you need someone to talk to. It hurts I know.

It sounds like your talking about in patent dialysis. Most of what I gathered by talking to the in house folks is that the work isn't bad besides hauling the equipment around. The real issue is the call schedule you may end up doing a lot of call and more back to backs then you like.

I have been with agency's that insist on the meet and great. I like to turn it around on them. Before I take my time to meet and great I want to see a 485, speak to the clinical manager, have a quick call with one of the regular nurses. Then I decide if it is worth my time and effort to go put on the song and dance. I also let them know I don't mind just being thrown in, I'll figure it out. Once I put more work on them, the number of meet and greets decreased. Agency work is way more people skills and games then it used to be. That said that's how the business is run, I am working in that business, so I play the game.

I first experienced this when I was an EMT. As I moved into nursing I continued to find this. Nursing at heart is about making a difference. Nursing in practice isn’t. When good old Flo N went to the Crimean War. The woman she took and the things she did made a difference, but to the day to day nurse it probably felt a lot like cleaning up, feeding people, and changing bandages. The big picture changed but day to day it was drudgery and death. I imagine lots of this woman went him feeling as if they didn’t save a single life, even though the statistics show they did.

You should be worried. PA is crazy backed up and is taking a very long time to process things. Get cozy once a week and call the BON. Be nice explain your situation and hope someone will review and approve it on the spot. Be aware most of the time they will simply tell you “it’s all there pending review, they are reviewed in the order received” the only check you can’t speed up is the finger prints. The child line can be done instantly in Harrisburg (I know that doesn’t help you much). State police is online and pretty quick.

This is also an excellent resource for making your apologies really hit, and be less cringeworthy. https://www.google.com/amp/s/www.psychologytoday.com/us/blog/the-squeaky-wheel/201311/the-five-ingredients-effective-apology%3famp Seriously they should teach this in school.

Ok. Basic damage control principles. (Honest version) 1. Minimizing. This is not a big deal. It feels like it and even if you get fired. You screwed up, got a lesson, it’s done. What did you learn not what did you do. No one died, nobody got sent to jail, and no property was damaged 2. Address involved parties not the audience. You already talked to the doctor, the director, manager. When and if this comes back they already know about it. That’s way better then them not having a clue and being blindsided. 3. That’s old news. If anyone brings it up to you who isn’t in charge of you you put it in the past. “That was a mistake and I’m moving past it. Why do you bring that up? I would rather not discuss it. 4. Rumor patrol. Ask friendly coworkers to shut down conversation regarding your gaff if they hear them and keep an eye out for a particular person driving a narrative. Expect a bit of chatter but if one person is stirring the pot you have to nip that immediately 5. Realize you are going to feel this way more then others. Situations of public shame hang in our heads. I realize this is all you can think about but everyone else has their life in their head. They really aren’t thinking or talking about you as much as you think.

Salt makes the ice colder and increases risk of injury. See the salt ice challenge. I have better luck with vinegar. Just a bit and a shake. Now no one wants your ice.

It’s all how you frame it. Try this way. “Hi Dr X this is RobertJo RN. I’m calling at the request of Mr Crabapple I’m at a bit of a loss for options on this situation and was wondering if you could help?” basically. This guy is demanding I call, I have no suggestions, please help!

This is not what you want to hear, but let’s go. If your lawyer is telling you to take the deal take it. Assuming you have a lawyer who is proficient in this area of practice. Lawyers are professionally and legally obligated to advise you in your own best interest. If this guy has experience with such matters, and he’s telling you this is a good deal, he’s right. Look, I’m just some guy on the Internet. I don’t have the particulars of your case, or know the way the board of nursing usually rules on this type of complaint in your state. Your lawyer does. The BON is not out to be fair, there is no assumption of innocence or consideration of mitigating factors. It’s job is to punish nurses, and that’s what it does. If you go in front of that board you’re going to walk away with discipline, the only question is what you get.

Please state the nature of the medical emergency

I agree here are the facts of the case which I have considered carefully. Please read it and reflect. This is the TBI investigation and interview. This is the evidence submitted to swear out a warrant for her arrest. It’s mostly a summary of HER INTERVIEW. This is not a reporters interpretation it is source data https://ewscripps.brightspotcdn.com/3d/46/feb995d34e9782f9ae33e37391c0/0716-001.pdf

I understand some of the mitigating factors BUT the patent was on life support until the next day. This wasn’t a doctor calling the code and then picking up the phone. The error had to be known at that point. Intent is hard. I agree that the doctor most likely didn’t INTEND to mislead an investigation. However...they did just that. The intent only shades the level of the charge the crime itself persists. If an inexperienced doctor was making that call and unsure they needed to find someone with more background to do it. If the doctor who had care of the patent had not been briefed on the circumstances of the incident, but the hospital lawyer had, that’s conspiracy. RV is IMHO guilty of negligent practice resulting in death. If that makes her a criminal or not I don’t know. However something stinks at that hospital and I bet we start smelling it as the discovery process starts for this trial.

I’m constantly and often harshly reminded in this business that I can’t care more about a child’s health and future then the parent. If I do I just end up stepping on toes and getting told to stay in my lane, which is often good advice. It seems like every year or so I get a call into the office or make someone upset trying to push. I try and keep my perspective but it’s hard. I’m sympathetic and empathetic to wanting to be the best nurse you can be. Unfortunately I usually experience the intentions are good but they approach is wrong.

Here’s a bit of an article on the hospitals response. It was less than stellar but mostly not criminal. If I was the doctor who signed the natural causes death certificate though I might be giving my malpractice insurance a heads up. (although I remember reading it somewhere I cannot confirm that the death certificate was botched. I apologize if I’m wrong on that) https://www.google.com/url?sa=i&source=web&cd=&ved=0ahUKEwi8ia6fzczhAhWKZd8KHdm1C38QzPwBCAI&url=https%3A%2F%2Fwww.tennessean.com%2Fstory%2Fmoney%2F2018%2F11%2F30%2Fvanderbilt-patient-death-medication-error-medical-examiner%2F2155152002%2F&psig=AOvVaw0aWn-EREyHK9GK2Wp5Yntg&ust=1555228894064999

Fair. A little hyperbole from me. However a death certificate is a big deal to screw up.

The legal precedents for this are fairly new but do exist. The arrest and conviction of Dr Christopher Duntsch in Texas was really what this case set to mind for me. The hospitals were covering up the botched surgeries, the medical board was unable or unwilling to make an investigation. In the interest of public safety, the prosecutor filed charges to stop him from crippling people with incompetence . I have read the CMS and TBI reports and I’m shocked that someone could practice so recklessly. However I think the need to bring criminal charges seems more justified in the fact that the Tenn BON has not disciplined this nurse at all. When someone screws up the job bad enough to kill, you can’t give them a head pat and tell them it’s ok. I’m not saying throw them all in jail either, but nothing TBON! That’s the real issue for me. Additionally the doctor and anyone involved in the coverup of the death should be at least put on the exclusion list and disciplined. I’m upset that hasn’t happened. This is the nursing equivalent of a traffic stop for an out tail light that ends in a man shot in the back. You expect discipline and charges for police officers when they behave unsafe in a manner not consistent with their training, or the standard of their profession. Why should nursing be different?

The job postings for nursing homes LTC never go away because they are meat grinders taking in nurses and spitting them out a year or so later. Some Nurses are really meant for LTC but they aren't enough to fill the positions. You have options but as a new grad your competing against all the nurses who are on the other end of that grinder. They have more experience and are more marketable. You should start networking NOW. walk around job fairs at local health systems, a lot do use LPNs in specialty clinics, and no floor procedure areas. Dialysis clinics will sometimes hire, depending on your state. You have to go and look for them, but they exist.

You may find some more general info in the Privet Duty forum as that’s what pediatric shift work is usually considered. Home Health more commonly refers to visits. Anyhow. Here’s the deal. If you’re in a new grad position they should be treating you like a new grad. EXTENSIVE in office education. EXTENDED orientation on a range of cases with different veteran nurses. Then a solo case that is basic and well established for at least a month or so. If you’re getting dropped on a trach vent case with one shift of training. You re not working, you’re being pimped, someone is putting you in a bad situation with no support and then taking the lions share of the money you earn even though you have ALL the risk. Watch out for other Pimp behaviors like normalization of this bad situation, threatening consequences if you try and leave (bad reference) and making your lack of magical abilities to handle a situation completely outside the realm of your experience somehow your fault. Repeat after me: ventilators are life support. Tracheostomy’s are advanced Airways. Let’s not be causal about their care or emergency preparations or someone will die.