Just to be clear, none of the allnurses Admins have posted their opinion regarding the RaDonda Vaught case. We are just providing coverage and updated links to the latest news and videos. Members are welcome to disagree as long as they respectfully express their opinions.
In this video, Janie Garner from ShowMe Your Stethoscope who attended the arraignment gives an account of the proceedings as well as a recap of the situation.
A couple of things stand out:
The TN BON has not taken any disciplinary measures against RaDonda's license
The ANA posted a statement on their website which includes the following:
RaDonda Vaught Pleads Not Guilty
I also love the activity stream and the ability to see only the content that I am interested in!
I love being able to search the Emojis.
I love that you can press and hold text in a post and have the option to quote just that portion right there next to the text.
One thing that would make it even better in my opinion: the ability to "clean the slate" when I marking as read, so that when I click what's new, it would only show the threads with new content. It was possible on the old site. As it is I have to scroll past a lot of read threads to get to the new content.
Another thing that I've noticed is that when I am reading a thread if I am far down on the page there's no way to see what the thread title is unless I scroll back up to the top.. It would be nice to have some sort of header. (Of course I may be the only one who forgets what thread I'm reading...!?)
I hope someone can make some kind of sense out of my questions!
The long term care industry (a.k.a. nursing home industry) employs a large share of new and experienced nurses in the United States. Furthermore, the number of nurses who secure employment in this specialty is projected to increase in the next ten years as the oldest members of today's upper middle-aged Baby Boomer cohort reach their 70s.
Questions regularly arise regarding the topic of charting. In other words, many nurses who are new to LTC are sometimes unsure about the whats, whens and whys that revolve around documentation in the nursing home setting. Here is a starting list of events and situations that would generate the need to write a nurses note in LTC.
Changes in Condition
Always write a detailed nurses note describing a resident's change in condition, along with a description of the prudent actions you took. Interventions can be as simple as administration of a PRN medication, repositioning, notification of the attending physician, implementation of new orders, or transfer to an acute care hospital.
When a nursing home resident receives a new order from a physician or mid-level provider, record it. Make sure you notify the family or responsible party. For instance, this sentence will suffice: "New telephone order received for oyster calcium 500mg orally BID with meals; responsible party Chris Taylor (son) aware."
Response to Initial Doses
Always document the patient response to initial doses of medications within 24 hours of receipt of the first dose. "Received initial dose of oyster calcium 500mg with supper; no side effects or adverse reactions noted at this time" will be sufficient. Some facilities require documentation every shift for up to 72 hours after the initial dose of a medication is administered.
Antibiotic (ABT) Charting
ABT is shorthand for 'Antibiotic Therapy.' In many states, the nurse must administer the initial dose of an antibiotic within four hours of receipt of the order from a healthcare provider. Many facilities have policies requiring nursing staff to document the resident's response to ABT every shift and up to 72 hours after the last known dose was given.
Document after every single fall. The vast majority of facilities require the nurse to notify the attending physician, complete incident report paperwork and make the family and/or responsible party aware, so be sure to follow the procedures of your workplace. The physician or mid-level provider on call may order x-rays, CT scans or pain medications, so be sure to include any new orders in your nurses note.
Do Not Mention Incident Reports (EVER)
Never document the existence of an incident report in your nurses notes. The incident report is an internal document intended to facilitate improvement of processes and systems at the facility. If a nurse records a note mentioning that an "incident report was done," this internal form is now subject to discovery by external attorneys if litigation arises in the future.
Write a nurses note after spotting a skin tear that wasn't there previously. Prior to writing the nurses note, ask other staff members if they know the origin of the skin tear. Many nursing homes also require completion of incident reports for skin tears of unknown origin. In addition, the nurse might need to notify the physician and obtain orders for dressing changes, application of steri-strips, triple antibiotic ointment, or another treatment that seems appropriate.
Many facilities require staff to write a nurses note regarding bruises that were not previously present. In addition, facility policy may require the nurse to prepare incident reports on all bruises of unknown origin.
Residents sometimes refuse showers, treatments, meals and/or medications. To cover your behind, always document every instance of refusal. Some facility policies may require notification of the attending physician and the responsible party. This is helpful if the resident begins to physically decline after refusing treatment because your notes prove that the physician and/or others are aware of the refusals.
If a resident's primary payor source is Medicare, nursing staff must document on the medical record once every 24 hours. Some facilities require a nurses note on Medicare residents once each shift. A sufficient Medicare note should include a recent set of vital signs, the reason why the resident is receiving skilled services, and a succinct description of his/her condition today.
Admissions and Discharges
Always write a detailed note at the time a resident is being admitted to the facility. Always document at the time a resident is being discharged from the facility. Include the circumstances surrounding the admission / discharge.
Sending Residents to the Hospital
Document the circumstances surrounding the change in condition that led to a transfer to an acute care hospital. Chart all interventions, the time EMS was called, and the exact time EMS removed the resident from the facility. Do not forget to obtain a physician's order to transfer the resident to the hospital. Always notify the responsible party when you send a patient to the hospital.
Residents Who Go Out On Pass
Chart the approximate date and time each resident goes out on pass. Most facilities will require the resident or responsible party to sign in and out with each pass. Once the resident or responsible party has signed out, the facility and its staff are no longer legally responsible for any poor outcomes that occur during the time away.
Unfortunately, some residents will engage in behaviors that make others cringe. Some residents smear feces, masturbate in front of others, fight with roommates, spit on the dining doom floor, and engage in other unbecoming behaviors. Document these behaviors and notify the resident's attending physician. Many nursing homes will also require notification of the family or responsible party. Always remember to maintain safety if a resident is starting physical altercations.
Generate a nurses note when you schedule an appointment. Something to the effect of "Appointment with Dr. Skylar of orthopedics made for Monday, March 3rd at 2:45pm; facility van driver will transport to and from doctors office" will work just fine.
In addition, chart when the resident returns to the nursing home. "Pt. returned from ortho appointment in no observed acute distress; new orders received for weight bearing as tolerated to both lower extremities and tramadol 50 mg orally q6h PRN pain. Responsible party Jane Simmons (niece) aware."
Seen by Physician or Mid-level Provider During Rounds
Some residents are forgetful and will claim that the doctor never sees them. Moreover, some troublesome families will claim that the doctor never sees the resident. To minimize trouble, write a quick note each time a resident is seen by a provider during rounds. "Pt. seen by Dr. Clark; no new orders received at this time" is adequate.
Response to PRN Medications
Residents take PRN medications for a variety of issues such as pain, constipation, itching, spasm, fever, and so forth. Document the response: "Dulcolax 10mg orally given this a.m.; resident had large, soft BM after lunch." Documenting the response to PRN medications will cover the facility and the staff in case an accusation is later made that "those nurses did nothing to help my grandma!"
Routine Dialysis Appointments
Some residents leave the nursing home for dialysis appointments three times a week at regularly scheduled times. Document their departure, arrival, and your quick assessment of the thrill, bruit, and appearance of the vascular access. Several years ago a doctor accused the nurses at my former workplace of failing to send a resident to her dialysis appointments. Our documentation protected the facility. In addition, the resident's daughter recalled when we sent her mother to the dialysis center using our facility's van.
Critical lab results require immediate notification of the doctor or provider on call. Document that you made this notification, including orders received. Some lab results that are slightly out of range, such as INRs, will also require prompt notification and a nurses note.
I have been a nurse for only seven years; however, certain events and situations will remain embedded in my memory for the rest of my life. One of these events took place during my first year of nursing practice when I was employed at a long term care facility.
A 'code blue' was announced through the overhead paging system, along with the room number. Since the facility had no designated 'code team,' any healthcare employees who were located nearby were expected to respond. I dutifully ran to the room and entered a scene that was filled with disorder.
An elderly male patient was lying on the floor adjacent to his bed in a supine position. His body was cyanotic, but still warm. His nurse states that she had been chatting with him less than 30 minutes ago. No rise and fall of his chest was noted. All pulses were absent. This clinically dead man was a full code, yet the multiple people in the room were moving with a disturbingly unhurried pace. I immediately started chest compressions.
A nurse with more than 20 years of experience glanced at me with a smile and sternly said, "Give it up! Don't waste your energy! Wait until EMS gets here, then act as if you're doing something in front of them!" She ended her statement with a quiet giggle as the house supervisor stood over me, grinned, and nodded in agreement.
I continued pounding on the man's chest and could feel his osteoporotic ribs cracking with each compression. EMS personnel and the city fire-rescue squad arrived less than ten minutes later to take over the resuscitation efforts. Approximately 30 seconds before EMS staff entered the room, my coworkers began putting on the show and pretended to exert an all-out effort to save the patient (a.k.a. the 'show code' or 'Hollywood code'). Since EMS has their own documentation, I suppose my peers wanted to appear busy to avoid potential liability later on down the line.
Do situations arise where a slow code would ever be justified? Are slow codes ethical?
A 'slow code' is defined as a cardiopulmonary resuscitative (CPR) attempt by the healthcare team that is deliberately carried out in too slow of a manner for any viable chance of resuscitation. In other words, the members of the code team are purposely not putting forth their full effort to revive the patient. Some anonymous physicians and hospitalists have offered several explanations for conducting slow codes:
Although I am a firm believer in end-of-life options such as hospice and palliative care for patients with terminal prognoses, I also feel that no ethical justification exists for slow codes because they infringe upon the patients' rights to have input in their treatment plan. The slow code also serves to breach the trust that patients and families have in the healthcare team to provide swift resuscitative efforts with a sense of urgency. In summary, if the patient has decided he wants everything done, we should fulfill his request.
The survey will be open for 3 or 4 weeks so people can participate and share their information. After the survey is closed, it will take a few weeks to analyze the data. The results will be rolled out via articles addressing various aspects of the data.
While you are waiting for the 2019 results, you can view the 2018 results.
2018 Nursing Salary Survey Results Part 1 - Demographics
Safe Staffing: How Does Your Workplace Stack Up? 2018 Salary Survey Results Part 2
When and Why Nurses are Leaving the Workforce - 2018 allnurses Salary Survey Results Part 3
How Much Do Nurses Make? - 2018 allnurses Salary Survey Results Part 4
Purchasing Power of Nurses Across the U.S. - 2018 Salary Survey Part 5
What I do like is the overall layout. I like that the top banner has space for site announcements like the warnings when updates are in progress.
I like the ability to filter out the student posts, no offense to the students but gee whiz! All those posts with questions about specific nursing programs were a lot to wade through.
I also am growing to like the activity stream. It's a lot easier to see new content now and it's was easier to see new content within a thread so thank you for that.
While I do like the increased types of reactions, what I don't like is putting a daily limit on them.
Something I’d like to see is related threads. Case in point: the Vandy nurse. There’s at least 3 threads if not more- the one with the poll should she be charged, the one about calling the governor, and the newest about the arraignment. Would be nice to see them linked somehow.
A group of nurses plans to appear in their scrubs at Vaught's arraignment hearing on February 20th show their support. Included in this group is Janie Harvey Garner, founder of Show Me Your Stethoscope.
For those who are interested in showing their support by attending the arraignment, here are the details:
Wednesday, February 20 @ 9:00 AM
Justice A. A. Birch Building
408 2nd Ave N,
Court Room 6D
Nashville, TN 37201
Judge: Jennifer Smith
What is Arraignment?
Once the accused is represented by counsel, the more formal part of the arraignment, the reading of the charges, takes place. The accused is expected to enter a plea: usually guilty, not guilty, or no contest. The no-contest plea means that the accused is not admitting guilt but will not contest the charges.
What is the verdict going to be???
In the following video, Janie Harvey Garner talks more about the arraignment process.
Nurse Gives Lethal Dose of Vecuronium Instead of Versed
Nurse Charged With Homicide
Nurses Call the Governor of Tennessee
You struck a cord with me with this and I'm sure it will "trigger" (our new term we just learned) some females out there...but my Sweet Petunia grew up in a house full of girls. She married up with me and became the mother of 4 boys followed by our adoption of a daughter. She will tell anyone willing to listen the effort associated with parenting a girl collectively outweighs the effort associated with parenting 4 boys.
I entered nursing school as an OldDude and I saw a lot of the stuff itemized above; Fortunately, I recognized a lot of it and didn't go there...it's certainly alive and well, and as you reference, I think it permeates through human nature.
This was a good, comprehensive list, thanks.
I personally don't think nursing school causes this. Instead, it is human nature. Call it original sin, if you like.
And, disagree if you like, I find many of these traits more common in the the female side of the human species. For me, a natural born tomboy who preferred the simplicity of playing with the boys, I found the complexity of female society daunting when I entered nursing. Over many years I learned to play the game better, and survived.
After a few weeks, we hope that the veteran users of allnurses.com have settled in and found the wealth of new features within the web site. If you’re a relatively new user, we hope that you’ve found the revamped allnurses.com welcoming and full of exciting new features.
Maybe you’ve become addicted to the Activity Stream. Or maybe you’ve got some great ideas on how to make a really cool poll to go along with an article you’re currently writing. Maybe you love that you can embed social media content in posts and comments. Or you may have fallen in love with how much you can customize your profile. Maybe it’s one of the dozens of other features I didn’t list…
Whether you’re a veteran or rookie user on allnurses.com, we want to hear what your favorite new feature is. Everyone who comments will be entered into a drawing for an amazing allnurses.com prize pack. Not ready to comment and enter yet? Don’t worry, we encourage you to take a few minutes to explore the plethora of new features and come back to comment and win!
Don’t wait too long, though. The “allnurses.com Grand Re-Opening” feature contest ends Sunday, March 3rd.
This gal's been on allnurses since 2013 as a lurker. Overall, I think the website looks great in comparison to the old design. Also, I love being able to use it on my mobile device with ease.
Great job, allnurses! 😀