RiskManager

If the question is can nurses find employment after completing a substance program ordered by the state BON, I have encountered many such nurses. Clearly, it is very state dependent in terms of the BON temporary or permanent restrictions on licensure and monitoring. It is also dependent on the willingness of the hospital/employer to give the person a second chance. A major factor in the decision is what type of practice the person will be doing. For example, if the person is an anesthesia clinician and were diverting at work, it will be very difficult for that person to continue working in anesthesia and they may have to change specialties to be working at all.

Your employer should provide liability insurance for the employees, and it does not hurt to ask for the details.

https://allnurses.com/general-nursing-discussion/one-healthcare-risk-999441.html As noted in the above article, I generally recommend it because it is so cheap, but be aware of some significant coverage limitations. People buy it because they think that if the BON investigates them or the hospital is sued, their own insurance will provide them with a lawyer or defense, and that is generally not true. Read the article for details. Apply appropriate filters to risk management advice given by people with no training or experience in the profession.

I see it every day in our facilities and clinics. Is your VA facility too small to have the VA Police? I have some friends who work at the Seattle VA hospital and the VA Police are a very visible presence there. Not too sound too much like a geezer, but I think the problem has gotten worse in recent years, compared to when I started 35 years ago.

We can't do it without YOU!

https://allnurses.com/general-nursing...sk-999441.html If you decide to get your own policy, the three major writers of nursing malpractice insurance are CNA (sold by NSO), Liberty Mutual (sold by ProLiability), and MedPro (sold by affinity marketing of this site). CNA is by far the largest writer of this type of insurance.

Don't worry, Mr. Bear. RiskManager will fix everything.

Proud member of the ZPac for many years now.

Can you be terminated? Absolutely. Are you likely to be terminated because of this? Probably not. RiskManager would however be paying you and your staff a visit to talk about proper medication administration and how meds should be managed. Were I in your shoes, I would be asking the clinic manager and/or administration for some assistance with training and organization. Some careful thought should be given to a root cause analysis as to why these things are happening, and what systems can you put in place to minimize the chance of them happening again. If I am working with a clinic and they continue to have problems despite adequate intervention and process redesign, that is when I get a frowny face and start looking deeper into what staff dynamics are contributing to the problem. I empathize with the reality of a busy ambulatory clinic, but we need to make time for the 5, 6, or 7 rights of medication administration to avoid these errors (pick the number of medication rights that corresponds with your era of training).

The Good Lord willing and my 403(b) performing, I am thinking about retiring in five years, when I hit 62 and can start taking Social Security. The difference between the monthly benefit at 62 versus my full retirement age of 67 is only a few hundred dollars per month, and my 403(b) fluctuates several hundred to a few thousand dollars per day. My wife will be 65 then, and as a teacher, she gets an actual pension while most of us in healthcare do not. She can pick up substitute teaching gigs if she gets bored while I have a lot of bicycling and reading to catch up on.

I used to be on a local search and rescue team, I was a paramedic, and we had several other health professionals on the volunteer team: physicians, nurses, a physical therapist and some others. Probably the single most important and useful medical training one can have for search and rescue is one of the wilderness medical certifications: Wilderness Medicine Training Center - Wilderness Medicine Training Center Home to teach you care in austere conditions with only the supplies you pack in. Most of the care is basic to advanced first aid to stabilize the patient while awaiting the helicopter or while packing the patient out on a litter because the weather has shut down aeromedical evac. I am not aware of a whole lot of paid positions on SAR, other than government employees, such as the military or Forest Service rescue personnel and the county Sheriff SAR team leaders.

^^^I was just thinking about putting covers on my TPS reports! And wearing at least 15 pieces of flair.

As a risk manager, I have the opportunity to do a lot of apologizing on behalf of the providers, staff and organization. I like to say that years of marriage have made me an expert in apologizing for things that aren't even my fault.

I like to say there is no "I" in team, but there are two "I"s in idiot.

Thank you for your input. You are a valued member of the team!

I cannot point to any studies, since I have not done the research, but my anecdotal experience of working in healthcare for many years, and going all over the country to do risk consulting leads me to think that PAs often tend to gravitate to inpatient and NPs often gravitate to ambulatory care. I wonder if there are studies on this.

Of note, in the Seattle area, there are many more NPs than there are PAs practicing. I suspect a major reason for that is that the state has one PA program and seven NP programs. The large primary care clinics and integrated health systems in the state are snapping up as many NP and PA providers as they can, and I don't see that slowing down any time soon.

It is never too late to file an incident/event report. We really need the reports so we can start and document our investigation appropriately. I would put in there that you were initially unsure if a report should be filed and are now doing so.

Speaking as someone who does risk management for ambulatory care, the trend nowadays is to get away from the classic full crash cart/ACLS protocol in your typical medical clinic. The drugs expire, the training goes stale and the LifePaks are expensive. Depending on your location, patient demographics and the ability of ACLS via the Medic One unit, ditching the ACLS cart can make a lot of sense. In the majority of my clinics, I have a basic crash cart and an AED. I expect my staff to initiate BLS and call 911. I would work to have the policy changed to get rid of the language about starting the ACLS algorithm. I would change it instead to something along the lines of calling 911, initiating BLS and applying the AED as necessary.

So at UCSF and other facilities with this service, is it par for the course that the patient is allowed to use nitrous oxide without any staff in the room or observing the patient? I am guessing that this is Nitronox, at fixed 50/50 nitrous oxide and oxygen.

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The interesting thing is that I also do risk management for dentists, where nitrous oxide is ubiquitous. There is not this concern for diversion in dental, at least amongst patients/relatives while receiving treatment. Staff, maybe. I have never heard in dental, of someone else grabbing a mask or nose hood to divert nitrous oxide. What does your facility risk manager say about this? When I think of all the other diversion possibilities in the typical facility for staff, patients, relatives or visitors, nitrous oxide diversion would rank pretty low on my list.

I am going to be interested to follow this. The last time I saw this used was on 'Call the Midwife' and I have not seen it used in real life in any of the facilities I have worked in. Only 200 places in the country use it. Interesting. What would be the diversion concern? Someone else grabbing the mask while it is in use and taking a few breaths?

I am glad that the OP did bring it to the attention of the hospital so that action can be taken. As I frequently point out to staff and patients, if I don't know about a problem, I cannot work on fixing it. If someone reports an incident to me anonymously, that is helpful, and it is even more helpful if it is not anonymous, or contains sufficient details that I can pinpoint the who what and when, so I can do a more targeted followup.

As the risk manager/compliance officer, this gives me the whim-whams. A hospital employee did this on the job to a patient at the facility. I wonder if the patient is going to file a civil suit for privacy breach against the hospital. Patient pictures can be considered PHI, so I have to think about if this could be argued to be a HIPAA breach as well, in which case the Feds might be interested. The nurse can certainly kiss his job good bye, and I bet the Illinois BON is not going to be amused, either.