Aliareza

Several things: First, the fact that nurses at that time had to override anything they gave from the med Pyxis, down to the simplest bag of saline. Second, the fact that Vaught was floated to the neuro ICU and had full power to pull all of the very dangerous medications from their Pyxis. Third, that she states she asked neuro ICU nurses for help and was denied. All of these are failures of Vanderbilt to provide an environment of safe medication administration and safe practice. Any one of these things being changed could have saved this patient's life. I have a lot of sympathy for nurses working in those types of environments because I have seen patients die due to the absolutely wretched work environments hospitals impose on workers. I left the entire southeast as a region because this type of work environment is so rampant in that area (no coincidence she's from there and this mistake happened there). Nurses in these hospitals are thrown under the bus for making mistakes in an environment that directly breeds mistakes. I would like to see the hospitals themselves held accountable for their own crimes against their patients, but of course corporate accountability isn't the strong-suit of the United States.

You'll side-step it ad infinitum but you won't actually just answer the question I've asked several times so I don't know what more to say to you. There is no getting around it: The answer is yes. Yes, Vanderbilt created this unsafe environment in which it was possible for a nurse to make a mistake so egregious that a patient died. Yes, Vanderbilt had a responsibility to keep their patients safe and they failed them. Yes, Vanderbilt is directly complicit in the death of this patient.

I don't think there's anything simple about it. She made a mistake that killed a patient. There were many factors involved, her own negligence and poor practice included. There is no questioning that. My question to you was this: "Will you claim that Vanderbilt had no hand in this patient's death?"

Will you claim that Vanderbilt had no hand in this patient's death? The environment in which she worked sounds absolutely appalling to me as a nurse of ~10 years, and yet I have worked in similar environments where safety checks were routinely not present or operating as intended, and nurses were blamed for the inevitable mistakes that happened as their patient ratios and work responsibilities increased with no relief for them. Now working in a teaching hospital with a process improvement mindset vs a mindset that blames staff for any mistake and is punitive towards them, I have a much clearer picture of how mistakes like this are not all staff's fault the way money-hungry hospital systems would love for us to believe they are; there is shared responsibility when an environment of safety is not prized and cultivated.

Eh. I have mixed feelings on it myself. She was truly thrown under the bus. She was incredibly remorseful from the very start and showed that in every action she took. She immediately admitted her mistake and reported herself to the hospital and the BON as well if I remember correctly. Vanderbilt did everything they could to cover it up and it was only when the DA forcefully brought charges (because the patient's family did not want criminal charges brought against Radonda, stating that their mother was an understanding and forgiving person who would not have wanted to press charges) that the incident was re-looked into and punitive action was taken. It set an absolutely appalling precedent for all nurses when she was found guilty. Given all of the things that happened, I'm not surprised she wants to share her story. It's going to be an important one for many of us in healthcare. The very high speaker fee is what gives me pause, but I don't know much about speaker's fees. Is it high enough to be considered profiting from the dead? I'm not sure; I think that comes down to how much she actually makes from it. And what is the intent behind being a speaker? Will she advocate for nurses and safety and try to use this event for good? There are so many aspects she could choose to speak on which all contributed to this debacle; unsafe practices in hospitals, lack of support from peers even when asked, the cover-up Vanderbilt attempted after the fact, her own shortcomings, the battle with the BON to keep her license, etc. I'm left with more questions than answers.

She took a sharp turn for the better within about 36 hours of that care conference. One lung started to clear up and her vent settings were able to be turned down enough that she qualified for a trach + peg and LTAC. We did the surgery that Monday and she had a really good few days of progress until her PEG tube came unsituated during a turn. Not horribly uncommon given her weight so we went the CVL + TPN route until she could be re-evaluated via surgery for another PEG tube, which at this point she was entirely unsedated and awake and agreed with the care she was getting. She was working with PT and OT, getting stronger, able to pick letters to communicate with us and write with a big pen to practice, and be out of bed for about 30-60 minutes a day. LTAC was on the horizon. Then her trach just came out all of a sudden, 6 days after her surgery. No reason for it that we could see and we were there. She was sitting up on the side of the bed and it just... came out. She was immediately emergently intubated and we thought she would code. Her sats dropped into the 60's and stayed there for a few minutes before the vent brought them back up into the 80's and 90's. Surgery said she needed a longer trach (the ICU team was pretty upset to see she had a standard length when she had essentially no neck to speak of and it should've been obvious she needed a longer one because of her weight) and they'd order the part overnight. It took 4 days to get there and then they pushed her surgery one day so she ended up on the ventilator again from Sunday through Friday, between 5-6 more days. She never recovered from that. She started swelling up and her heart rate increased. She started dropping very quickly on her oxygen when we'd try to turn her. I've seen enough ICU patients die to know those are all the signs they won't come back from the vent. Her heart was now failing. We pulled care that Monday and let her go.

That's just it. I think part of us will wonder if we stop now would she have improved had we just given her x number more weeks to let her lungs recover? But I have seen SO MANY families cling to that hope after ventilation and do the trach and peg tube surgery and cling to it only for their parent to only partially recover before the next minor respiratory illness comes along and kills them. It is so hard to lose someone all at once but the nightmare these families don't comprehend is that it's much harder to lose their parent bit by bit watching them suffer and struggle the entire time only to die in the end anyway. I would never want that for myself and I know my mom doesn't either.

I know ☹️. It's so difficult to see her mind still there and active while her lungs stall out and fail. There is so much she's never gotten to see. She has a new grandbaby on the way via my sister, who is heartbroken that she can't even really see her due to of the huge risk COVID poses to pregnant women. I am going to get married and start a family soon and if she doesn't get through this she won't be there to see any of it. Her last wish was that the whole family get vaccinated and that we tell everybody we know to get the vaccine. She deeply regrets her decision not to.

She'll be 60 in September. She was generally unhealthy, maybe getting into pre-diabetic territory and probably had undiagnosed OSA (my sister and I both told her she needed a sleep study but she refused). Her biggest issue is that she weighed 330 lbs at 5'4" when she was admitted. She also has a calcified DVT in her leg and probably RA. She was obese most of her life but really let it go over the last five years and ballooned up into morbid obesity territory again. She did still have a lot of quality of life before this but at least for me I know her lifestyle choices were likely going to start catching up to her soon since her dad was the same way and had DM2 and mobility issues once he got older.

So to make a long story short, she didn't get vaccinated and caught COVID in early June. She was hospitalized on the 11th and slid downhill until she had to be intubated. She got a night's warning so she was able to tell us her wishes regarding the decisions we'd likely be facing in the days ahead and to tell everyone goodbye. I do have critical care and ventilator experience as an RN but left bedside before COVID so I haven't personally done acute or critical care for COVID. I worked in outpatient testing and an outpatient COVID treatment clinic, so I'm not entirely unaware of the possibilities of long term effects. Today is day 8 for my mom on her ventilator. She's down to PEEP 13 and fio2 of 55% but that number hasn't moved in a few days. Her chest x-ray showed some clearing of her right lung a few days ago but no progress since then. We've been told she'd have to be maintaining with 40-45% fio2 and PEEP 8 to try to come off the vent and she isn't there yet. We know that by day 14, they'll want to go the trach and peg tube route if she isn't ready to be extubated. The longer we go, the more things slip (fevers, skin breakdown, delirium) and I frankly don't see her making it to her goal. That leaves us with a very difficult question: do we pull support? She told us that she didn't want to live if she couldn't have a high quality life in which she lived at home independently and could essentially return to work and taking trips and go back to living a normal life. Since she's made Some progress, it's hard for me to know whether she just needs more time or if we're dooming her to life in LTAC hell until the next cold comes and finishes the job. I am in no way seeking medical advice and I don't need anyone to tell me what to do; instead, I was hoping that perhaps nurses who have worked with ventilated COVID patients might be able to tell me about their personal and professional experiences so that I can better gauge the reality of what I'm looking at. I have a decision making conference with her teams and my family on Friday to try and help us make an informed choice for her, and it's one we will have to make as her children since she's single/divorced. I know it's likely not a positive prognosis. Life after an extended ICU stay and significant time on the vent even without COVID is often never the same. Any input would be much appreciated.

Paint the back with clear nail polish (or glittery/colorful, if it suits your fancy). This is what I have to do when I get a nice necklace pendant that causes my chest to break out because of the cheap metal. It should stay on a good while, it won't be very visible to anybody giving your badge a glance, and it'll keep the metal from touching your skin. It's the best all-purpose solution I've found.

Fully agree on the usefulness of a care plan book. Not one that teaches you how to write them, just one that comes with a bunch of premade care plans. That's basically all you ever do with care plans as a nurse anyway; I type in the problem, get a list of premade care plans, pick the ones I want, and then evaluate the interventions daily. Spending time writing care plans isn't worthwhile when you can get a cheap book of them.

I have a business degree and started out in that area when I graduated. I felt horribly unfulfilled doing it and knew I hated it. Plus it was very hard to find anything with "just a 4 year degree". Everybody wanted me to go back and do my master's before I'd get one of those good stable jobs I'd always looked forward to. I said "bump that" and started looking for other things I could do. If I was going back to school, it was going to be for something I actually wanted, not just a safe bet. I never would have thought of nursing, but my sister pushed me toward it since it was what she had chosen to do. It was only two years (same way a master's would have been) and all I had to do was take anatomy I & II plus pharm to prep for it. I researched it, and I decided it was a good way to help people in a short amount of time. I was sold. Funnily enough, I think my sister only pushed me toward it because she was a little scared to do it herself. I became the pathfinder of sorts. I started working at a hospital as a nurse aide; a few months later, she drummed up the courage to leave her nursing home job and work at that hospital too. I jumped all the hurdles to get into nursing school, and encouraged her to do the same; a year later, she finally got over her fear of the HESI entrance exam and followed suit. She did even better than I did, the whole way through school! Now we're both nurses and I couldn't be more proud :).

Thank you all for the insight and input. I didn't see that last reply about processing my feelings until just now, but that's what I think I've needed to do all along. I've spent the past few days just thinking over why I'm a nurse, what I love about it, what I hate about it, and how all of that ties into codes, death, and the ICU. The conclusion I came to is that I'm more coldly clinical than I realized, and that I love this job because I'm a problem solver. I don't really care to know about the little old lady in front of me, her grandkids, her garden, etc. I'm kind, but I'm not there to befriend her. I'm there to help her solve her medical problem. There's nothing I love more than educating patients, because it's like long-term problem solving. I think the reason I got stuck on the bad feelings from that code was because it wasn't my patient and I couldn't help with the code. All I had was the awful emotional aspect of it to focus on. Despite that, I didn't cry when it happened. I knew the nurse who had that patient wouldn't be able to give his meds for that hour because he'd be busy, so I stepped in and helped with his patients. It'll always be heartwrenching hearing somebody grieve as they lose their loved one, but I'm now pretty sure that when it's my job to intervene, I will be able to do it. I'm not afraid of death, but I want people to have dignified deaths. I very well may not find my forever home on the ICU floor simply because I fully agree there are many worse things than death and I know I'll see them in the ICU. But I know right now I want to try, and so try I shall.

I'm currently working on an ortho floor at just over 1 year into nursing and am ready for a change. I love my ortho patients but we're just too short-staffed for me to properly care for them, and my manager is never going to grow a backbone and fight to change that. I'm burned out. I'd like to go to ICU, but as you can imagine, I feel pretty underprepared. I've bought The ICU Book and I'm going to study up on all the things I know that I'll need to know in ICU that I don't use now, and I have every confidence that I'll do great with the learning. The only thing I dread is becoming overly emotional. I've had several patients die on me, but never while I was there. I was sad for them, but never felt like crying or anything. Then one night, a patient coded. It wasn't my patient, but the code was pretty awful as far as codes go. It was super unexpected, it lasted nearly an hour, and the patient's children were nurses in the hospital so they were called from their departments. They stood outside the room to let the code team work, sobbing and screaming at the patient to please come back, don't leave them, the entire hour. The patient did not make it. I feel myself tearing up every time I even think about it. Whenever I hear a code called now, I immediately feel like crying. I'm the type of person who can't see other people crying without feeling like I want to cry myself. I don't know if I'm strong enough emotionally to work in ICU and keep the distance I'd need to keep in order to be a strong supporter of families in their time of need instead of just another person crying. I don't know how I could possibly do chest compressions on all these little old ladies who are full codes that we get on ortho all the time. I'd feel so horrible doing it. It's not right, but that would be my job. In short, I just don't know if ICU is right for me. I feel like I care too much and have too much empathy for it. I'm scared of it sticking with me, of taking it home with me. I already know I could never work with babies or children because of this. Any guidance would be appreciated, because my brain is like "Yes, ICU = growth and knowledge!" but my emotions tell me to stay away.