steven007

Workers compensation rights aside, this nurse has a clear case of negligence against the hospital and this is the bigger fish to fry. The hospital administration implemented this new equipment without formally training the staff. The administration sent an e-mail detailing the efficacy of the equipment but ADMITTING that the staff did not have training. I do not have the full e-mail, but if the hospital did not explicitly state "DO NOT USE THIS EQUIPMENT UNLESS YOU HAVE RECEIVED TRAINING" and/or failed to make training available, the hospital is grossly negligent in this case. The hospital's risk management department must have done their math, clearly they felt that this nurse was more of a liability to keep than to just fire, because I am sure they realize that they are going to have to pay her out a settlement if and when she sues. They likely are anticipating a lawsuit but hoping that she does not sue and at the first moment she does sue, they will throw a settlement (likely half of what she would be entitled to should she go through a court case) and hope she settles out of convenience and desperation for an income of some sort, seeing as she is too injured to work and thus will not have the financial means to drag out a long court battle.

Hallo Mein Freund! So, disclaimer in advance, I am not an American nurse and can't really speak to the particulars of the type of nursing you do in the USA, BUT I hope to address your insecurities about not feeling like a "nurse" because you haven't done IVs and such in a long time. The type of area you work in currently is recognized as a specialty area of nursing (in Canada at least). The area here (Canada) is called Dual Diagnosis Psychiatric Mental Health Nursing (Dual diagnosis for short). Now, a quick look on google shows that this area exists as well in some states of the USA. So, you would technically be classified as a psychiatric nurse. Your skills are highly specialized to this area. You may not think this is psychiatric nursing, but believe me, this is psychiatric nursing. It is normal for you to feel "out of place" in an area such as ICU when you have practiced for the last many years in an area that is unrelated to ICU. But trust me, your skills are very useful, valid and important in this day and age with mental health getting more recognition. If you are considering changing to ICU and more acute care nursing, perhaps you can take a re-orientation course or a specality course that prepares you for this area of nursing. These exist in Canada and would almost bet they must exist in the USA (as the USA tends to have better educational initiatives for nurses). Hope this answers some of your questions and addresses some of your insecurities! ?

Thanks TriciaJ for the comments! And interesting to hear from a previous member of the SRNA!! I just wanted to correct you on one thing that I don't want people to be confused by, Canada DOES have a constitution. If we didn't, we wouldn't exist as a country (and my law school course load would be MUCH MUCH easier without the "Canadian Constitutional law" and "Advanced Constituitonal Law" courses hahaha). While some countries don't have a formal "constitution", such as the UK and New Zealand who has an "unwritten constitution" that exists only in case law and legal mores, Canada does have a written constitution that was founded in 1867 (termed the BNA Act). The Charter of Rights and Freedoms which you speak of is codified within the Canadian Constitution. It is an extension of the constitution and exists as a constitutional guarantee. And Rionoir is correct, Freedom of Speech extends beyond just "not going to jail". It means you are free to express your opinions without recourse by Government agencies. The SRNA is a government agency. But otherwise, yes, there may be social consequences to your speech and even employment consequences. But when your employer is part of the government, there can be no recourse (unless you are a public servant). Hope this clarifies and thanks again for your opinions :).

That is so interesting! Canadian courts have found that kind of thing to be unconstitutional. Any statute that talks about moral values or religion is not considered constitutional in Canada. Its so curious how two neighboring countries that share so much in common can be so different. I find that super fascinating, I would like to read one of these statutes!!

Yes, I wasn't necessarily referring to the sexually explicit material, I was referring to the discussion as a whole of how regulatory bodies have stated, in the USA, that your off duty conduct can merit discipline. The one that stood out the most, at least to me, was the nurse that pulled the gun on a random person who started to charge at her in a parking garage. She didn't fire or anything, and there were no charges laid, but she was called to answer to her conduct with her BON, for self defence! I agree that things like theft and other criminal activity would merit disciplinary action or pure revocation of your license, but these things such as acting in self-defence while off duty, or the case of the teacher who was disciplining her son, I think regulatory bodies go too far to dictate our conduct off duty. I think Hoosier_RN, MSN makes a good point, regulatory bodies are attempting to prescribe their own moral views on their members.

This has already happened in America! https://www.statesman.com/article/20130210/NEWS/302109767 The theme is concerning for sure and I think nurses internationally need to take notice and speak up about this kind of thing.

Just over a year ago, in April of 2018, RN Carolyn Strom lost her court appeal contesting disciplinary action that was taken by her regulatory body (the Saskatchewan Registered Nurses Association “SRNA”) for a comment she posted on Facebook about the care her dying grandfather received in a hospital. Strom’s Facebook post read as follows:“My Grandfather spent a week in “Palliative Care” before he died and after hearing about his and my family’s experience there (@ St. Joseph’s Health Facility in Macklin, SK) it is evident that Not Everyone is “up to speed” on how to approach end of life care ... Or how to help maintain an Ageing Senior’s Dignity (among other things!) So ... I challenge the people involved in decision making with that facility, to please get All Your Staff a refresher on the topic AND More. Don’t get me wrong, “some” people have provided excellent care so I thank you so very much for YOUR efforts, but to those who made Grandpa’s last years less than desirable, Please Do Better Next Time! My Grandmother has chosen to stay in your facility, so here is your chance to treat her “like you would want your own family member to be treated”. That’s All I Ask! And a caution to anyone that has loved ones at the facility mentioned above: keep an eye on things and report anything you Do Not Like! That’s the only way to get some things to change. (I’m glad the column reference below surfaced, because it has given me a way to segway into this topic.) The fact that I have to ask people, who work in health care, to take a step back and be more compassionate, saddens me more than you know” While Strom was not employed by the facility and was, in fact, not practicing nursing at all (she was on maternity leave), the nurses at the care facility took notice to these comments and filed a formal complaint against Strom with the SRNA. The SRNA launched an investigation and found Strom guilty of professional misconduct, namely that Strom engaged in “conduct that is contrary to the best interests of the public or nurses or tends to harm the standing of the profession of nursing” and “not following the proper channels”. Strom appealed this decision to the Court of Queen’s Bench for Saskatchewan where Currie, J. upheld the administrative decision of the SRNA. In his judgement, Currie, J. holds that the judgement by the SRNA was “reasonable” and ordered Strom to pay the costs of the investigation, as well as a disciplinary penalty totaling $26,000 CAD. It is likely that Strom will appeal this decision; however, as it stands now, this rests as valid case law and sets a precedent for nurses to be charged and disciplined for “off-duty” misconducts. Removing our Constitutional Rights to Freedom of SpeechThe precedent set in this case permits a regulatory body (such as a BON) to limit one’s constitutional right to freedom of expression. In his judgement, Currie, J. acknowledges that this was a breach of Strom’s constitutional rights to freedom of expression, but holds that, so long as a regulatory body “proportionately balanced the right to freedom of expression with the objectives of the [Nursing Act], in the context of Ms. Strom’s circumstances”, it is acceptable to limit freedom of expression. Currie, J. goes on to state that “The [SRNA’s] balancing of the rights and objectives is not required to be correct. It is required to be reasonable.” So what makes it reasonable? Currie, J. holds that the decision was reasonable because Ms. Strom was granted other avenues of expression, namely, she was able to report the nurses providing inadequate care to the SRNA or the hospital administration. This is in fact what is recommended in the code put forth by the SRNA. Omitting Pivotal Case LawWhile Currie, J. holds that Ms. Strom was able to express herself in other avenues, he ignores holdings from previous case law where the form of expression (or the avenue chosen for expression) can only be limited if the location or method of expression removes the protection of freedom of expression (see: Montréal (City) v. 2952-1366 Québec Inc., [2005] 3 S.C.R. 141;). While Currie, J. and the SRNA holds that Ms. Strom should have followed the methods outlined in the Code, Currie, J. and the SRNA did not apply the test as outlined in the case of Montreal v 2952-1366, where the method or location of expression can only be limited if it conflicts with one of the three values of freedom of expression (i.e. Self-fulfillment, truth-finding and/or democratic discourse). Currie, J. and the SRNA omitting this vital aspect of freedom of expression analysis has paved the way for bad precedent. Therefore, Currie, J. did not address whether the SRNA could in fact limit one's freedom of expression by law, as this step of the analysis was overlooked. ImplicationsWe now have this precedent standing that will for sure give a carte blanche to regulatory bodies to arbitrarily discipline their members for expressing anything that the regulatory body opposes. This will only hamper the ability of professionals (the ones arguably best suited to advocate for change in a system they are fluent in) to advocate for change and to speak out against bad public policy and other ill-doings, for risk of being reprimanded by their regulatory bodies.

Great article! It really does touch an a huge issue in healthcare as a whole. The idea of huddles is great! The reality of huddles, not so much. Huddles should incorporate all members of the healthcare team, pharmacy and other allied health, nurses and physicians/NPs. The reality of the situation is there are too many units and too many hurdles for these pertinent people to attend, and therefore it ends up being nursing and physician heavy, with very few members of other significant professions (i.e. pharmacy, social work, etc.). Competing demands and the general lack of resources (hospitals are more frequently turning to fewer pharmacists and allied workers) makes allocating time for huddles impossible if these professionals are to get their primary duties done. The other issue with huddles is the lack of structure. Many times, huddles become toxic ranting parties that become more about venting and less about patient care. I think proposing a model for huddles and for effective communication strategies is absolutely pertinent in healthcare today, as well as proper allocation of resources. But it all comes down to money in the end.

I have to admit, as a nurse manager, I have done this before with candidates I have interviewed. At my hospital, we usually interview candidates with a couple of managers from different units (in the same general discipline, for me its psychiatry but I will have the manager for the, say, addictions unit interview with me as well). We will interview and if we like the candidate, we sometimes match the candidate with the unit they are best suited for based on their strengths in the interview and their previous work history. We won't refer them for a follow up interview, we will just tell the manage rof the unit "hey, we interviewed this person and we think they would be a good fit" and then hire them accordingly. But this is done when people don't really stress their desire to work in a SPECIFIC area. So, in the interview, if the person didn't stress "I really want to work in ADDICTIONS" or "I really want to work in adult mental health", then we generally just consider them available for whatever their area of expertise is. I would just reach out to the interviewers and stress your interest in working in that specific area, asking if they would have preferred to see any additional education or anything you could do to improve your chances of landing a position in that department. Don't take it personally. When we do this, we generally feel like we are doing someone a favor, matching their skills with a unit they would be most comfortable with. But not always! Sometimes people come forward and say "well, I would really have preferred to work here instead" and then we see what we can do to move them and apologize for the misunderstanding. I don't think it is malicious and I think they are doing it thinking they are being supportive. They probably just didn't realize that you really wanted to try something different! Reach out to them and see how it goes! Keep us posted!!

This is unrelated to your topic and I'm afraid I can't offer insight into the questions you are asking, but this is a question I have always wondered; what is the salary like in los angeles? And places like Silicon Valley? These are considered among the most expensive cities to live in and I would assume that they would have to stay competitive to keep nurses employed and fed in the area, so I am curious? Need nurses to keep those tech geniuses at google and youtube alive and healthy.

I agree and this is a very valid point! However, where I disagree is that it is actually a valid defense in court. Its called undue duress and has been argued quite successfully in cases here in Canada. If your employer places you under undue duress, you can absolutely get off the hook. I'm a law student and I volunteer for a nursing union to gain first-hand legal experience. I have used this argument before with great success, albeit with an arbitrator (not a judge). All the nurse has to prove is: 1. Others who spoke up were disciplined, reallocated or fired to the point where the culture was "just go with it" 2. They had extenuating circumstances that did not give them an option to leave (i.e. supporting a family, children, etc.). 3. They attempted to mediate the situation (i.e. by finding other employment). If those 3 factors are met, you have undue duress and a valid defense. Obviously, I don't know the whole story and I am sure some of the nurses involved likely wouldn't meet this defense and willingly participated in this nonsense. But I am sure, there is probably one poor soul, one inexperienced graduate nurse, that really felt that there was no other option. And for that person, my heart goes out to him/her.

I don't want to be the cynical one here, but I am having a hard time seeing how this really meaningfully impacts new nurses? Part of the issue is that I am a Canadian nurse, but Canada now uses the NCLEX as well. I have taught the nursing program and most of the students had no idea what the nursing process even was! The emphasis of the particular program I taught in was Henderson's theory. No attention was paid to ADPIE. Now, I am a strong proponent of ADPIE. I use it in my daily life. It is how I chart my end of shifts documentation notes, I use them as headings. But I don't think that it is the ONLY valid and applicable framework to use. Also, while I agree with most of what BrentRN, PhD says, I disagree in the emphasis on validation. The nursing process, while heavily used and discussed in the research, is not a "validated tool". There is no metric to validate. It is a subjective FRAMEWORK used for a subjective ASSESSMENT. It is by no means a valid scale that is measuring any meaningful data. There is really no research that I could find on the nursing process being any more effective than just using common sense. There is nothing about the nursing process that can be operationalized into a numeric scale that can be statistically tested. So the argument of validation is completely irrelevant. Furthermore, most senior nurses and even new nurses I ask don't even know what the nursing process is! They have no idea what ADPIE is. I think, at least in Canada, most schools just pick a nursing philosophy they like (i.e. henderson, oren, etc) and go with that. There is no real emphasis placed on using a framework. On that note, I do find the nursing process very intuitive. It is basically just common sense, you assess, diagnose, plan, implement and evaluate. It couldn't be any more straight forward! I think replacing it with a more convoluted theory/framework is counter-intuitive and unnecessary and serves no real purpose. If it isn't broken, don't fix it. I'm curious as to the rationale of why they are doing this now? Bearing in mind that times change, culture changes and society changes. I find that, at least in medicine and nursing, they try to find new ways to conceptualize old theories and it is just pointless and a waste of resources that would be better spent on theorizing on more meaningful and pertinent topics.

You remind me of when I first started nursing! haha The mistakes you are making are common sense mistakes. You are completely ignoring common sense and over-thinking every situation. This is almost certainly because you a) lack confidence and b) are still very inexperienced. The interactions you are having with your preceptor and not feeling welcome are only compounding your feelings of lack of confidence and insecurity which are perpetuating these types of errors. Fortunately, these errors will improve in time. As you gain more confidence you will become better at not making these small mistakes. However, it is really hard not to gain confidence when you have a hostile preceptor or work environment. Unfortunately, not much can be done about that except for you to ignore it, and try the best you can! If there is really a perceived conflict between you and your preceptor, I would address it head on. Pull him or her aside and address it there, in a non-judgemental, non-confrontational and open manner. Once you feel supported, I am sure you will see a huge reduction in these small mistakes. The other reality of the situation is, you are going to make mistakes regardless of how long you have been practicing nursing. Its just a given. Don't sweat it. Admit when you have made an error and ask for assistance when you are unsure. Don't let other people bring you down and always go in knowing you did the best you could! You will find you will improve with time!

This is ridiculous! "Now that they don't want any life saving measures, let's just off them so we don't have to waste a bed on them", is the thinking that comes to mind. And I am sure that this was supported by the hospital administrators. Sick. What I also find sick is how quick they were to fire and blame the RNs and RPNs/LPNs that administered the medication. I hope that these nurses sue the hospital, too. I am sure the ones that protested the high dose of medication were either let go, reallocated or disciplined for "insubordination", yet the ones that chose to give in to the pressure and administer as ordered and save their job to support themselves and their families are the ones to be reported to the BON and have their whole lives destroyed because of this angel of death? Its ridiculous. Not to perpetuate ideas of victimization, but nurses always seem to get the short end of the stick. Dammed if you do, dammed if you don't. These nurses that were let go should sue this hospital too for their blatant negligence and recklessness. The firing of staff was simply a PR tactic to make it look like they were taking this seriously and these fired staff were scapegoats in the tactic to save the reputation of the hospital. Its sick.

No problem! Just wanted to provide any info I can. Best of luck! It is a really interesting job!