Here.I.Stand

Wth no.... COVID+ nurses should be at home resting their bodies. ?

Wait, WHAT????

Anecdotal story here, but I saw my PCP maybe 2 years ago because I seemed to get sick if I even thought about germs. I came back vitamin D deficient. I’m going to get rechecked because I’m getting sick again, a lot. Since my last check I have started covering for religious reasons... except for my face and hands my skin literally never sees the light of day.

You can research ODD if you want to gain knowledge, but I wouldn’t take it into consideration when deciding to report or not. It doesn’t matter. Thug’s defense attorney can choose to use it as a defense if they want... YOU (or the victim) don’t need to make that determination.

If I would report it outside of the hospital I would report it inside. ACTIONS determine assault... not the location of the assailant.

That sounds dangerous... the pt’s BP is normal BECAUSE they are on whatever BP med. Plus diuretics are frequently (usually?) not for BP but to avoid a CHF exacerbation... or a beta blocker can be used post MI or as an anti-arrhythmic. I’ve known some physicians to be quite tolerant of a low BP because the benefit of the med outweighs the risk of a soft BP. Besides the resident lives on these drugs. A regular dose isn’t going to randomly tank someone’s BP when they’ve been on it months to years. If in doubt they really should be calling to clarify

My Korean ex-husband says the skinning alive thing is not true. Eating dog yes... and this is different than eating a pig or a goat how?

If your staff is giving pushback, it is your responsibility to listen to what the objections are and have a concrete plan that you will support for mitigating those objections. Mine would be: shift overlap is 30 MINUTES. It’s not 45 because pt has requests or because you have assignment changes or because donning/doffing PPE takes extra time. If it is impossible to give/receive report on the assignment the charge nurse makes in 30 MINUTES.... it won’t happen. End of discussion. Your manager’s pet initiative is not my schedule’s problem. I imagine in a med/surg setting it would be very challenging to get it done in 30 minutes; you would at the very least have to have the same ratios budgeted for days and nights so one nurse is communicating with one nurse. Tall order I know... but shift overlap is 30 MINUTES. They must be supported in ways to budget time per patient. So 5 patients is roughly 5 minutes per patient—the nurses MUST be supported in keeping that to 5 minutes. That might affect pt satisfaction scores that their nurses spend no longer than 5 minutes in bedside report per pt and don’t get a full bathroom trip and PRN meds during report — doesn’t matter! Shift overlap is 30 MINUTES. If you try it and it doesn’t work FOR YOUR STAFF, you might need to find your Ernest Shackleton leadership backbone and push against the “hard place.” Your staff is your highest priority after pt care.

If this is happening in your workplace absolutely it shouldn’t be tolerated. Neither of my managers are white though so if that was an issue in my unit wouldn’t be able to point to them

I took the OP’s use of the word “BLANK” was to avoid putting the real info on a forum. Not that she put blank spaces or whatever into the legal document. She said she made the note after speaking to someone in the hospital about what had happened post transfer.

Exactly. Even if it was a typical routine human error “med error” that resulted in harm, I don’t compare that to the homicide of Mrs. Murphey... Not sure if you’re aware of the death of Kim Hiatt (you’re in Australia if I’m not mistaken?) but she made a calculation error with some calcium ?gluconate which resulted in the overdose and death of a baby in the PICU. She wasn’t criminally prosecuted but was fired, and was so distraught she committed suicide. Based on what I know of that case, I don’t think I would have indicted her. It was an arithmetic/algebra mistake in an urgent situation, and the baby’s little body was compromised to begin with. (I believe she had some CHD things and sick enough to be in a PICU.). She immediately realized what happened and reported her mistake, and clearly felt tremendous personal responsibility. RV bypassed multiple safety checks including 1st semester nursing school “five rights.” She didn’t miscalculate the dose of an ordered medication; she gave a med which can never EVER be given without mechanical ventilation. No matter how physically healthy a person is, there are exactly zero people who can tolerate a paralyzed diaphragm. Then she left that patient unmonitored. Had she stayed after what she believed was pushing Versed, she would have seen that she was desatting and could have started bagging immediately, and could have saved that poor woman. I’ll say it again, she was reckless which caused Mrs Murphey’s death... reckless homicide is criminal; why should she NOT be charged criminally? She doesn’t get to commit reckless homicide and face no charges, if anyone else would face charges. If anything as an RN I think she should be held to a higher standard... but definitely not a LOWER standard because well she’s a nurse and nurses are human and who hasn’t made a med error and who orders Versed for a scan anyway and hospitals will always throw the nurse under the bus and this could set a scary precedent and oh the humanity........

There are med errors and there is reckless homicide.

Her recklessness resulted in the death of a woman... the very definition of reckless homicide. She doesn’t get a pass based on her then-profession. I think that NOT holding her accountable for the reckless homicide of Charlene Murphey — denying that poor woman and her family a chance at justice by bringing it to a jury of her peers — would show the criminal justice system’s lack of control

Exactly... I don’t know this pt’s story but unless this is a new and minor thing (say, rolled his ankle when he got up to ambulated) I would offer the non-pharm things as an adjunct — not as an alternative. Especially if the pain is unrelieved after several shifts of PO pain meds... if that’s the case, is ice and elevation alone REALLY going to be effective? Unlikely. Sometimes people really do just know what works for them... I’d rather give a “seeker” the benefit of the doubt than torture someone who truly needs pain relief. It’s not passing the buck to involve the provider — you don’t have prescriptive authority. If the pt wants to leave AMA that’s his right. As long as he’s made aware of the risks he’s running by leaving, he has that right. A few years ago a patient left AMA just after receiving tPA; she was given it at an outside facility and transferred to us. When she found out that no the ICU can’t accommodate her smoke breaks she flatly refused... this was after talking to both the resident and attending neurologist, and the nursing supervisor. She made a potentially really bad choice and I hope she did OK after leaving, but competent people have autonomy and are free to make bad decisions. As far as being respectful, I keep my tone and words neutral and not judgmental. Let him know that per policy here’s the form I have to go over with them, risks of leaving and things to watch out for/please seek attention for. So say it’s an infection he’s needing IV antibiotics for.... sorry I don’t remember this pt’s story (read your post a couple days ago) but infection is ringing bells. There’s a difference in respect if you say “this is a bad decision and your infection is just going to get worse” and “the risk of leaving now is this infection won’t be adequately treated; you should call your PCP for a/b/c sx — or go to the ED for x/y/z sx. Do you have any questions about that?” Again just neutral, factual wording and tone.

That’s very true... you make very valid points there. I’m guessing Mrs Murphey would get swifter justice too had the reporting all been more timely and thorough