listeningangel

more info re: your situation would be helpful in order to help you. is this your private prescribing MD for your healthcare or works for your employer to determine your fitness for duty? big difference. under HIPPA you are entitled to your privacy unless you give written consent for your info to be shared. under HIPPA if this is employment related your employer is entitled to your medical information... read more on the US fed govt website for specifics. if you feel this health provider is violating your privacy rights you can file a complaint right on the US govt website and they can investigate the situation. check which forms for consent you signed for your employer related to your situation. you can also see a different provider and get an independent eval if employment is your concern that says you can do your job and are being treated for your condition. as for any RN participating in calling the police due to your labs and prescribed use of meds, clearly outside the scope of an RN license in all 50 states. consider a formal complaint on the individual's license to the state licensing board. I support you not signing any of these forms until your situation is clear to you how this affects you. consider also a license complaint to the MD board in your state regarding this office calling and reporting you to the police. healthcare providers should not be involved in using healthcare to "punish" patients. it is not criminal to use controlled substances, generally a crime to obtain them illegallyand behaviors that are criminal. hope this helps.

Hey Deyo, I would be concerned also, about the ankle monitor interfering with OR equipment. The technology varies and continually changes with the ankle monitors. Different facilities purchase different types of ankle monitors. It should not be incumbent upon surgical staff to determine if the ankle monitor would put OR equipment interference at risk or risk consequences to surgical staff. Surgical staff should not be expected to take any risk at all. Law enforcement is not qualified to make that determination of interference, it is a mute issue. The surgeon can write an order that it is to be removed during the surgery and send the order to the Cheif Medical Officer of the correctional facility. Facilty medical and custody administration can work it out from there. Custody can determine if an officer needs to be in attendance with the prisoner at the hospital. It is highly unlikely that a court would override the surgeon's order if it was necessary to obtain a court order to remove the ankle monitor during surgery. Any prisoner with an ankle monitor is generally a low security risk to begin with. High security risk prisoners don't wear ankle monitors. Hope this helps.

sounds like a good option.

no kidding, it's there for a reason. that's understood. however, compromising a person's health is a decision made by the physician's. Judges recognize that the law allows for these determinations to be made. it's a case-by-case determination. it has to be weighed and balanced within the law. it's not helpful to medical folks when law enforcement intimidates them and spreads fear about the safety of medical staff who work with people in custody. Hey, the law is the law and it's about balance and good decision-making. No matter what the crime, believe it or not, medical staff get sued all the time for making bad decisions under intimidation from law enforcement who are with the prisoners. It's not law enforcement that they sue the majority of the time. So, generalized comments from the authority of the badge force medical staff to risk their licenses, that's unfair; there's alot more at risk than the immediate safety of everyone involved. These small and large decisions turn out to be very costly (taxpayer's money), when things go wrong. If both sides do their job well, then the outcome is usually good, which is what I encourage. If both sides respect each other's function and expertise it's works out better for all involved. This kind of power struggle is really "bad for business". Most of the time, medical staff make good decisions and take safety and security very seriously and do what ever is possible to achieve both objectives. Thanks for 'weighing in', it's an important discussion. Take care.

great question..not so easy to answer. I've had patients that were transferred to hospital , ended up in the OR with officers in the OR with shotguns as necessitated by security determined by law enforcement. a patient with an ankle monitor is ordered by a court and that's the issue frrom the law enforcement side. from the medical side.. is the ankle monitor interfering with the surgery and could it cause the patient harm? (infection, the surgery hampered by the monitor, many other issues to consider). If the ankle monitor is interfering with the care the patient should be receiving in the OR, then what needs to be adjusted? The surgeon can evaluate whether the monitor is interfering with care the patient needs and law enforcement can obtain an emergency order from the court to remove the monitor during surgery. there are options..

This makes me sad...a nurse with a dream turned into nightmare. I guess what bothers me is that in taking responsibility for your actions you have decided you have no recourse. it's so traumatic, what happened to you. there are so many views of this... having worked in many settings, there are so many issues in your situation as a nurse with this patient that raise my red flags as a nurse with some legal education and experience...here's what flags are getting raised in my mind: there is shared liability here - the nurse, the charge nurse, the MD, the nursing supervisor, the hospital orientation "don't call the MD at night". restraining the pt. sounds appropriate from what you describe because the pt came in with a fall, complicated by confusion, electrolyte imbalance, age, telemonitoring, at the very least. the restraints prevented another fall which is a huge issue here and in my state an obligation for the bedside nurse. when management has a policy, they share responsibility for verbalizing "but don't call the MD", they should be supporting bedside RN's trying to do the right thing. sounds like an undermining and contradictory culture has been going on there for awhile of the nursing policies. there's alot more to this than meets the eye... what bothers me is that you have resigned to a conclusion that you were wrong and they were right in such an absolute manner, i.e. the policy said and I didn't....that's is not how it works from a larger perspective. there are standards of care for fall prevention, use of restraints and the RN's actions and nursig management has a few 'absolutes' here, too, which are silent. Managers have alot of responsibility, too..for training and continuing education of staff nurses who incur these most difficult and complex patients, especially the elderly in hospital settings when their behavior and condition changes in the middle of the night; for supporting and providing avenues of continual communication between all staff caring for a patient and I could go on and on. there are many standards of care involved here. this smacks of 'what was convenient' for other decision makers about this patient and certainly the 'accusation' of abuse, which triggers strong reactions without adequate review and fairness to you. this also smacks of a lack of factual review upon the part of the admin in terms of the patient condition...what pops into my mind is - was there any harm done to the patient due to the restraints or were the restraints preventative of further harm? now your career has a 'black cloud' hanging over you. sorry to go on at length. my compassion for the harm to you is why I would continue to encourage you to find out more, not give up your dream and hope you defend yourself. you sound like a compassionate, competent nurse who tried to do the right thing to me. breaks my heart to see another nurse suffer such severe consequences without fairness and adequate review not only of your actions but all the others involved, also. Review of the actions of the other staff involved in the situation is suspiciously absent here. Maybe a resource would help, contact The American Association of Nurse Attorneys and ask.... I just want to support you. Nursing is so difficult for practicing nurses caught in a complex and rapidly changing world in which we practice. please don't give up, I think you are worth it. keeping you in my prayers..and now I will shut up.

tbrd's research is not biased..the points he wants to discuss are well documented from many credible sources accepted in the correctional healthcare industry. We have over a 100 years of history in the U.S. of the "mindset" tbrd describes. California's penal system,for example, the largest in the entire world, was seized by a federal court due to the unconstitutional and inhumane abuses throughout the system regarding medical and mental healthcare. It is the largest and only seizure of a US prison system, in it's entirety, in the US history of our penal systems. The US Supreme Court Rulings regarding California's prison system describe the same things that tbrd talks about. The comments and the lack of comments on this subject reflect alot......

most attorney consultations are free for the first hour and sometimes can take the case on a contingency and you will not be out of pocket the money.

I am not sure what state you are in, but here is my best advice... you must and should contact an attorney and discuss a wrongful termination action to clear your name for your future or this will NEVER go away with future employers. There are many other factors that should be reviewed in the situation you described, i.e. what did the MD prior to your shift know and do about the electrolyte problem; what was being done to correct it; were other diagnosis' evolving or unidentified;what were the actions of charge nurses and nursing supervisors before and during your shift; many other questions. From what you describe, sounds like you were the easiest one to blame as a new nurse and it solved the hospital management's problem with liability and from taking responsibility if they should have. It's the easiest and quickest way to resolve an accusation from a family member of "elder abuse". There may have been no actual abuse by you as it is legally defined. There's alot more to this that you have any idea and the restraintissue alone is very comples in the elderly; it's hard to say without knowing much more about the situation. My point is, don't hesitate to find a lawyer and defend yourself and clear your name. An attorney can find out the extent of what really happened and advise you of your situation. Even better to get an attorney (labor law) who is also an RN. Call your state bar association and ask for a referral. I can tell you with certainty you will regret this for the rest of your nursing life if you don't get an attorney and take action. State law describes the amount of time from the incident that you have a right to take action or you will lose the right to take legal action, if you are past the time line. There is, unfortunately, no other way to clear yourself and protect your future work life than to take legal action. You may be surprised at the possible outcomes for yourself, your future and your reputation as an RN. Good luck to you.

I think that violence is one of the underlying problems that does contribute to the mindset you talk about, tbrd. People react to it when they deal with it as part of their environment, work or personal. Now it's a daily reality in our world. I hope people from all perspectives can talk about it, especially those in corrections who deal with it so much. We could learn from others and perhaps be healthier and gain insight into how to cope and continue to live our lives in this increasingly threatening world. I love to hear the voices, opinions of nurses, whether it's just expressing, ventilating or anything else. Nursing has a unique perspective. I learn alot from others and often find their thoughts and opinions to be inspiring.

P.S. Kudos to the health facility administrator for communicating the appropriate role of the nurse. Facility health administrators are also responsible in their capacity to know the legal role and scope of nurses, both RN and LPN, and unlicensed nursing staff. Gook luck to you, hope you give this serious consideration.

According to all standards for nurses in corrections, nurses are health care providers and should not participate in security functions such as you describe. Basically, you cannot serve two masters, in other words, you cannot punish and heal in the same person under your nursing license. you are legally bound to your state nursing license laws above all else. It is your individual responsibity to act ethically as a nurse under your license. There is no law that I am aware of that allows the federal government authority over the legal authority of your license. If you were ever caught in a situation where you had to defend your actions under your license, basically, the law would expect "you should have known".. It is a violation of the nurse-patient relationship to perform security functions. Nurses observe facility security regulations, not perform them, there is a big difference. Law enforcement personnel in security facilities have no legal authority whatsoever to determine what nursing functions should be, including the federal government. I agree with the other responses that you should educate yourself; best source is the National Commission on Correctional Healthcare standards,(check their website) and the standards for nurses in correctional facilties published by the American Nurses Association. You are responsible as an individual under your license to stay within your scope of practice. I can see where this may be a huge problem working in a federal facility as nurses think that whatever law enforcement invites them to do is OK. but it is far from OK. This problem has been going on for along time which is how these standards came about. They were developed over more than three decades by experts from medicine, nursing, legal and law enforcement personnel. Every nurse who continues to blindly act in this manner undermines decades of work to establish these standards and undermines patient care and the rights patients' retain while incarcerated. They are incarcerated patients to healthcare personnel. Federal facilities are not exempt legally fromthese standards or state licensure laws.

Sounds to me like you did the right thing. Hopefully she made that phone call. Your concern is admirable and probably prevented subsequent hi-risk behaviors. Compassion for others is so lacking and you deserve alot of praise for your actions on her behalf.:redpinkhe

I can attest to the careful scrutiny CNA utilizes in their expenditures...alot of integrity. union bashing seems so politically popular now. I'm amazed at the lack of focus on California govt and hospital administration salaries, bonuses, etc.; seems bashing takes away the focus on Whitman's billions; association with a company that we the taxpayer's had to bailout and her zero experience with public service which she now wants to govern by buying it. Seems like twisted facts to me. gosh, no California budget yet... another billion so far that the politicians think we can afford. Aren't those folks PAID to get a budget done on time? gee...back to Arnold's leadership....and Meg to follow in the same path? OUCH.

OK tbrd, so you are not a nurse... I am so impressed with your insight and research about the correctional environment and thecultural mindset of it all. You touch on many important issuesthat I have experienced in that environment. thank you for sharing your thinking, it rings true in my nurses' heart.:redbeathe