NurseCocoBSN

I worked in a level 1 years ago who did this. Only difference was an SBAR was faxed to the floor as well. As someone who’s worked every unit in the hospital, save the OR, this is best practice. Provided the SBAR is sent. I would recommend this as something your hospital can do to improve the measure. We also got report on any level 1 traumas (we were the trauma/transplant unit, half M/s tele, half SSDU). When I went to ED years later, the pushback we got on patients was insane. Nurses will say anything to keep the admit off the floor. They’ll spend 20 minutes looking for reasons to not take the patient. I know this because it’s something I saw when I worked the floor as well. The only thing I can say is that we are all busy. But there are some nurses who think they’re the only busy one, and they take it out on everyone. I’m not saying you’re one of those people, but it’s a hard wall to hit when you need to get an ED pt upstairs. The fact is that it’s almost always safer to get the patient out of the ED and onto their unit. ED nurses are turning rooms like a waitress turns tables on a busy Friday night. They have a full waiting room, full hallways, and the endless slaughter of EMS bringing people through the door. They don’t get to review the chart and tell the ambulance “I’m sorry but I can’t take this patient right now, I have a lot going on.” The Us vs Them mentality of units is really insane to me. Everyone needs to work together to get this *** done. If you have a nurse refusing to take a patient? Do you know the amount of time it takes the ED to get a patient up to the floor can affect their ability to be reimbursed? Those minutes count. And the ED RN has her charge nurse down her throat as to why the patient isn’t gone while simultaneously fighting the floor nurse to get the patient up there. This usually happens when the ED is losing on that metric. EDs are black holes of hospitals as it is, rarely making money. Usually they cost the hospitals money. So, your administration is going to do anything they can to change that. Or at least stop the hemorrhaging. Im not saying it’s right or wrong. It just is. I’ve worked almost every system there is, and I would say there’s no system that should be taking you 15 minutes to look up a new patient. So, you guys could improve on that front. As for the ED, they need to be sending an SBAR with the patient somehow, OR they could put on in the chart. It would make a big difference. As for the ED RNs who are dumping patients on the floor covered in urine or feces? Clean them up. Stop doing it. You know who you are, and you know it’s wrong. When I worked the floors it happened to me at least once a shift. It’s so disrespectful to the patient. Just because you can do it, you shouldn’t. Also, I went to home health this year after 2 major spinal surgeries. I miss the hospital very much, but I don’t miss this stuff. I kind of love my autonomy and the ability to work alone.

I have NO doubt you’re telling the truth. It’s a little known fact, they don’t report to the BON. Which is how those trash nurses can keep practicing. The VA is the reason i don’t believe in government run “Medicare for all” because I’ve seen government run healthcare. Id rather pull my own appendix out then ever deal with that again.

And I’m sure that comment will cue the anecdotes about how great of care their VA gives, but honestly? Just because your single department is doing well (and until i heard from your patients i wouldn’t believe you), doesn’t mean that most of us veterans have horror stories to go along with our many health problems. Just because your VA threw a few vets into your staff, doesn’t change the fact that the ONLY career in the VA thats comprised of mostly veterans is JANITOR. It also doesn’t change the fact that MANY VA hospitals are harder to get into than the mafia, with many only hiring friends of the staff. It also doesn’t change the fact that most of the biggest paying jobs within VA healthcare and the VA as a whole are mostly civilian held positions. I tried to get a VA hospital job to help my brothers and sisters. That position was filled by a RN with years less experience and no military background. No 10 point preference to speak of. You know what she did have? A babysitter who happened to be the manager’s daughter.

The VA is the single worst place I’ve ever been. Not only the VA, which seems to be all that’s ever discussed when we talk about military and their health care, but the doctors and nurses who treat active duty military are also inept. I have a LONG list of service connected disabilities. So much so, that I’m rated a combined 80% by the VA. If you have any idea about how those rating work, you understand exactly how severe my case. EVERY SINGLE ISSUE STEMS FROM POOR CARE. Every single one. In fact, had the errors made by those doctors and nurses been made by civilian doctors and nurses? I’ve been told by more than one lawyer that I’d be a millionaire. Many of those doctors and nurses don’t care because they operate with no real worries about malpractice. None. There is something called the Feres Doctrine that prevents the military from suing. The VA also has a free pass until they kill someone and a family tries to sue for wrongful death. The VA shouldn’t be in the business of acute care whatsoever. All VA hospitals should be closed immediately. They’re not worth nearly what they cost. And the staff is paid entirely too much. We need to close those facilities and give veterans health insurance to see who they want to see. Truly we should get rid of all VA healthcare, but our current healthcare system doesn’t have the number of PCPs we need as it is, so i only day to keep the outpatient stuff open so vets can keep up with their primary care Honestly, and i know I’m going to have people here complain about this, but the VA should be run and staffed by veterans only. Civilians don’t understand how to treat us. They also don’t care about us nearly as much as we care about each other. Before someone tries to cry and say they care, I’m not saying you don’t. I’m sure you care. You just don’t care about us nearly as much as we care about each other. Professionally, I’ve worked near many VA hospitals as a traveler. I’ve taken entirely too many VA surgical patients in those hospitals due to the VA making mistakes and wrecking those patients. Those vets would spend weeks on my units because the simple surgeries the VA performed were done so poorly. Complications so easily avoidable you’d cry for the patients enduring those problems. I wouldn’t even send violent inmates to the VA, because even murderers don’t deserve the poor care they give. The worst part, for me, is they knew that the military docs’ negligence caused some severe problems with me. So what did they do? Continue the negligence until i ended up with a hysterectomy at 32 years old. What else did they do? Ignore me more until i had to have a major back surgery at 36. I’m only 37 and i have surgeries most people have in their 40s and 50s. While my friends are still having kids, i was told to be happy with the fact I was able to have my 2 sons. “At least you were lucky enough for that.” Never mind how many kids I wanted. Or the the fact that I never got to try for the daughter I as desperate to have. And wanted to try at least 2 more times to have. No, i should be happy with the fact they stole my fertility from me because I already had kids. They shouldn’t be held responsible for ignoring every single symptom I had, or for the numerous doctors and nurses who looked me dead in my face and called me a liar. Civilian VA doctors and nurses looked me in my eyes and called me a drug seeker. Only ONE VA doctor ever believed me; ever helped me. Surprise, surprise, it was the veteran who helped me. He was the only one who ever tried to do anything for my problems. He was the one with tears in his eyes when he told me that I’d lose my reproductive system. He was the one who said “please, please tell me you didn’t want any more kids. If you even want one more child I’m not going to sleep tonight.” That Doctor then advised me, no, BEGGED me to use a civilian doctor for the surgery. He wasn’t a surgeon and told me he wouldn’t want me in their OR. I told him to trust that I’d never let one of those “doctors” to ever take a scalpel to my body. Let alone to operate on the problem they created. I remember when i was a LCpl my tailbone hurt beyond belief. The first time i went to sick call they told me i was just trying to get out of PT and to get out. The second time i went the doc said i had a broken tailbone and he couldn’t do anything about it and to think again if i wanted pain pills. Mind you, i never asked for pain meds. 3 weeks later i was on my couch, sick. To this day i don’t remember my husband calling the ambulance, but evidently I was delirious and confused, and my temperature spiked to 104. The only thing I remember is the pain from the scalpel as the cyst was lanced in the Camp Lejuene ED because i wasn’t given any pain medication prior. No lidocaine, nothing. Turns out that “broken tailbone” was a cyst that ended up being a major infection because it was ignored for so long. They packed the wound, and told me not to touch it until my follow up. Well, i didn’t get a follow up for 5 days. So, i followed orders and didn’t touch it. At 19, with no medical knowledge (i was an avionics technician) i didn’t know you weren't supposed to leave that packing in for so long. So when i went to my follow up they couldn’t even take the packing out without my screaming, and i ended up going to the OR for an I&D the next day. It had to be left open for 2 months. I ended up on convalescent leave the entire time. I’m sure that sounds great to you, but it was hell for me. It made me look so bad, and it gave me a really crappy reputation. I was looked at like a malingerer because of that incident. People called me “broke d*ck” and lost respect for me. I couldn’t miss a single day of work for over a year to get rid of that stigma. I went to work with stomach bugs, the flu, and food poisoning once. If i was sick I’d just wear a mask and go in. After a year they finally stopped calling me that (it took the food poisoning), and my Gunny came to me and said “OK! We get it, you're not a broke d*ck! GO HOME THIS IS GROSS!!” Those are just 2 instances of their inability to treat us. I spent 4 years in, and have been out for 15 years. I haven’t set foot in a VA hospital for a few years now, and I’m better for it. Much better. My PCP takes care of all my service connected problems, i see him once a month, and I’ve gotten off of so many medications because of him. The only pain med I take anymore is the gabapentin, and that’s only because they (the VA) ignored my back complaints for so long the disc compressed my nerves and made my right foot, the right side of my right lower leg, and the back of my right thigh are permanently numb. The surgery, although it cured my foot drop and severe weakness, did NOT cure my numbness. So I’ll never feel them again, or be able to wiggle my toes. Someone here commented “if this is true...” Yes. It’s true. Every single complaint about that place is true; and more. I could tell stories for days, of my own horrors and the horrors of my friends and their family members. The sad part is, we rarely hear of the worst cases. And we only ever hear about the few people who managed to scream loud enough to get attention. As much as people “support our troops/vets!” they never seem to care about this stuff until it’s shoved down their throats. If enough civilians actually cared, this wouldn’t occur.

So what you’re saying is that you’re going into patient charts you’re not covering and checking on nurses charting?

I know that. But, seeing obvious bad vitals isn’t the same as saying someone isn’t listening to the breath sounds they chart. Unless I’m missing something, the only way to know that is to follow them into the room and see if they asses the patient. Or if you go in and ask the patient if they were assessed. Also, unless you’re following someone, i don’t see how anyone knows what anyone else is charting.

Every profession comprised of nearly all women are. At least in my experience. I was also in the Marines and can tell you that professions comprised of nearly all men are *** in their own ways too

I’m not asking this in a rude tone whatsoever, but I’m curious as to how you know whether or not that nurse has listened to the patient? Also, how do you know what they’re documenting? That’s a pretty bad accusation, so I’m just wondering how you’d be able to know such a thing. Fraudulent charting is a a huge deal. Not only with the hospital, but also with Medicare, AND the BON.

Absolutely. Hell, people who don’t have licensure also have consequences when it comes to public safety. A few years ago a contractor tore down an old building in my city (i live in one of the bigger US cities). You know how on a city block, many of the buildings are either inches apart or attached to one another. The contractor didn’t tear the old building down properly, and the following day the building next to the building that was torn down collapsed on itself. A few people died, and a quite a few people injured. The contractor didn’t intend for that to happen. He didn’t do anything to purposely cause the building to collapse. It was a total accident. However, the investigators found he had made some errors and they decided those errors were due to negligence. Because the errors were due to negligence, the contractor was charged with crimes. I don’t remember if it was reckless homicide or involuntary manslaughter or what. That’s the thing. Everyone is human, humans make mistakes. But, not all mistakes are due to negligence. When lives are lost due to negligence, you are culpable for that. Most of the time you can and will be charged with a crime. Say you're driving home from work. You’re going the speed limit, wearing your seatbelt, and doing everything you’re supposed to be doing while you’re driving. A deer jumps out in front of you, you reflexively swerve your car to get out of the way, crash with another vehicle, and the driver of the the vehicle dies. That’s a mistake, you shouldn’t have swerved into another lane. A tragic mistake. That mistake lead to the loss of life. However, you were doing everything you were supposed to be doing. No ADA would ever charge you with that death. Now. Same situation, except, you were looking down at your phone texting your girlfriend about going out later. When you look up, you swerve to avoid the deer, and kill the driver in the other lane. That mistake was due to negligence. Had you been watching the road, you may have been able to react better to that situation. You absolutely will be charged with that death, because most PDs check phone records when a MVC results in death. It’s one of the first things they check, after BAC and toxicology. Her negligence matters here. Maybe i missed it, but I’m curious if anyone thinks there is a safety measure that would have stopped her in this exact situation. Exactly what would have prevented her from giving this med? She bypassed so many of already established safety measures, and she failed to do the most basic nursing measures. Because at the end of the day, we ALL have a significant safety protocol in our own head every time we give a medication. And someone who is so fresh out of school is usually right on top of those rights. I mean, everyone I’ve ever met has been that way. I’ve only been a nurse for 6 years, so maybe there’s something i don’t know. But, having been a nurse for 6 years, i *still* do my rights. I still do it 3 times. Maybe it’s because i worked for a speciality cancer hospital that was still paper charting and giving meds from paper kardex. I was so hyper aware of how easy it is to make a mistake on paper, so i turned 3 checks into 33 checks for the first 6 months i was there. Thankfully i worked in the ICU and step down because if i had a full patient assignment i wouldn’t have ever gotten work done. I’ve made 2 med errors in my career. The first was a route error. I was giving octreotide to a liver patient, and i gave it SQ. It had been ordered IV push. Thankfully it can be given either way, but it was an error regardless. Even during my checks i kept saying SQ and not IV. I was behind, busy, and very overwhelmed. I saw IVP numerous times but for some reason it just didn’t register. I immediately reported it to my manager, who thanked me for my honesty and then laughed me out of her office. I was like 2-3 months off orientation at my first job. Never made that mistake again. If a med is commonly given in numerous ways, i will check it and say it out loud when i do my med rights checks. My second error is kind of weird. I had a diabetic patient, and was waiting for the PCAs to do sugar checks while i did all my other work. I went to the desk, and my PCA had left a paper there that had the room numbers listed and blood sugars written down. I looked at the papers and there was no time listed. I asked around to see if anyone knew when it was from. Someone said “oh she just did those.” So i checked my room number, grabbed the insulin, and gave the med. the patient was NPO after midnight that night, and around 0400 or so the patient called me and knew her sugar was low. It had dropped to 40. I gave her an amp of D50 per the hypoglycemia protocol and called the doc to change her to IVF with sugar. I just assumed it was because she was NPO. When i came to work the next day i was called into the office and asked why i gave 2 units of insulin to a patient whose sugar was 89. I had no idea what they were talking about. Well, turned out the list of blood sugars i used to base my dose off of was from the day shift. That place was on meditech and the accuchecks were old. It took forever for the values to download into the system so i never bothered to check the number. I should have found the PCA myself and not listened to someone at the desk. Never made that mistake again. We’re not perfect. But still, i think this case is much different than a run of the mill med error.

It sounds like the last position let you go because they didn’t like you. I’m not saying that to be mean, i literally just lost my dream job because they didn’t like me. I got injured, didn’t qualify for FMLA and even though the hospital offered non fmla leave they told me they weren’t going to offer it to me. The worst part about that was i KNOW i was doing damn well in that speciality. I was picking it up, and it was everything i had hoped for. I had given up a per diem on another unit in that hospital that i enjoyed, but made the move because i had always wanted that speciality. I don’t think I would discount your skills at this time. Let me ask you, did you LIKE working on the floor? I’m a little confused about this last job, though. Was it a rehab? Transitional care? Regular med surg? A ratio of 6:1 without knowing shift could mean any of those. I know plenty of people are trying to push you out of acute care in this thread, and maybe I’m reading it wrong, but you don’t sound like you want to leave acute care yet. I truly think a regular, med-surg/tele or tele unit might work for you. Tele in a lot of places usually has better ratios because the patients are monitored. As someone who did travel nursing and has worked everywhere from med surg to the ICU, while occasionally some nurses do ok with an immediate specialty, most do not. Or they only ever do that one speciality until one day they can’t and they have no actual basis to go from. Also, generally, they’re not up to par with their peers. Straight to specialty nurses also fall the heck apart when they’re pulled to any other unit, without fail. And? There is such a thing as being OVER prepared. You cannot plan your day out. You can think, ok “go in, meet patients, grab meds, assess and pass med, NEXT !” But aside from that? You can’t plan your day until you see an assignment. You need to prioritize based on that assignment. If youre not in a 100% nursing care facility, if you're on orientation you shouldn’t be spending 30 minutes in rooms with falls risks. That is what you PCTs are there for. When you’re not on orientation, different story. I don’t think you should give up on acute care yet. I think you’ve got it in you.

Safe harbor is Texas and like one other state right? Can’t remember which. But, if you’re in an at will state? Probably no. I don’t think claiming safe harbor makes you a protected class or a whistleblower, so not sure there are any special protections. Plus you’d have to prove she said it. *what i mean is, you won’t be entitled to the protections of safe harbor because you didn’t actually file for safe harbor. When it comes to that, you either need to follow through or say nothing. You cannot get the protection of a law you didn’t invoke. There was no true retaliation because you never invoked SH. Your best bet is to call a lawyer who specializes in employment and get a consult. My gut says it’s not going to matter, but I’m not a lawyer. You should get an answer from one of them.

I couldn’t tell you 1 personal detail of a single med student I’ve ever met. Maybe the med schools where I’ve worked have kept med students and nursing pretty much separate, but that’s my experience. They’re people i would see sometimes. Not at all like the relationships you develop with residents. I’m not sure why you would be close enough to any nurses to discuss your personal life. In your residency? Sure. That’s something that’ll come up when you’re night float one month. As a med student, i don’t think it’ll fly well on the floors. I can just see so many nurses wanting to trip someone like you up. I’d personally keep it tight to the chest until my residency as well. Even more so from other med students. Med school is highly competitive, and i do have long time friends in it and who have since graduated and are now docs I can see your however many years of clinical experience and knowledge making some people mad. Congrats to you. This is no easy feat! Just to be accepted is huge! Best of luck in your journey!

I think it’s not just here. It’s here and every platform it can be discussed on. It just happened to hit me here. But between the nurses in the courtroom, the endless Facebook discussion, and everywhere else it just hit me. The hospital has a part here, but in my opinion it’s completely separate from the nurses part. We were given ways to check ourselves passing meds that we will never need hospital protocols to use. And she wasn’t someone years out of school who maybe didn’t think of it, or someone who had some old way of doing things. This was someone fresh out of school who had those things beat into their head.

This is exactly my problem with the entire thing. Had she done a single patient med right check, had she LOOKED at the vial and known which med she was supposed to give, had she printed a MAR to verify, or even if she had just STAYED with the patient after giving the WRONG med none of this would have happened. Thats also why i haven’t fully decided as to whether not the charges are warranted. I want to see what the state presents.

Also, my problems with the comments associated with this case have nothing to do with the nurse in question. I see a really, really tight closing of the ranks here. No one is willing to admit this nurse made *many* mistakes. I see a lot of people blaming the hospital, nearly solely. There were too many basic nursing rules ignored. Completely outside of the hospital’s safety protocols. I see this “thin blue line” thing happening and it’s disconcerting to me. While yes, nurses should have each other’s back, it should never be at the expense of patient