paigeRN1962

Regarding making copies of the proof of use records.....as a health oversight agency, HIPPA Law 104-191 allows these records to be copied without prior patient authorization when used for audits and investigation when making a legitimate complaint against a nurse. Therefore, these copies of records will be turned over to the BON and not kept in my possession and will be filed with a formal complaint.

I start a new job next week. However it is a violation of the nurse practice act to not report the unsafe practice of a nurse providing patient care. I feel it is the only way to protect myself from being targeted later. If I wait until this place gets audited, and didn't report them first, I am as guilty as those involved for not reporting it. It is a very bad position to be in. I am just thankful to be out of there with all my limbs.

Yes I was a new employee on probation and I realize they don't need any reason at all however it is clear to me that I was fired for knowing too much.

Yesterday I was fired. Not for anything I did or did not do or for incompetance but simply because according to the office mgr. "you just don't fit in." :angryfire Drugs weren't signed out. Proof of us records don't exist. Wastage not witnessed. I start a new job on Monday. Plan to report this to the board of nursing and the DEA.

I work for a plastic surgeon where we do office-based surgery and see this practice done everyday. I am not sure what, if any laws have been violated due to the lack of regulation of doctor's offices in general. Nor am I sure what MA's are able to do legally. Basically. the antibiotics and pre-op sedatives are placed 1 per cup on a counter and given to surgical patients by the receptionists, medical assistant or myself (an RN). The other RN in charge sets all this out prior to the start of the day and whatever isn't used, gets put back in the narc box at the end of the day. I feel very uncomfortable with this. If meds can be passed to patients by a CMA in a nursing home, I suppose the powers that be where I work see no problem with this situation and no reason not to continue administering meds to surgical patients in this manner. The med is charted and a box is checked on the chart as to time and date. I am not taking responsibility for the MA who is giving these pre-ops nor am I delegating nursing duties to her. The MD states she works under his supervision and he accepts the liability. I don't like any of this but am having trouble finding anything in the Nurse Practice act to back me up in the physician's office. If the patient has a reaction, if there is an error, if the MA is found to be at fault, she has no license to be concerned about. I am worried about where I could be held liable. I do not set up any of the morning pre-op meds for these surgery patients....the nurse in charge doesn't "allow" me to do any of that or touch any meds..........I am basically working as another MA although have been a nurse for 15 years. Yes, I know this is bizarre......I am searching for another job.

I absolutely agree that competancy and proficiency is something you can't put a price on nor do RN's have a corner on the market. But there are policies and laws we must as RN's or LPN's follow. I once worked at a hospital who demoted all the nurse managers to staff nurses who were not BSN educated....some of these were long-term employees, with over 20 years of experience and very seasoned. In their place, because of policy, new managers were hired with the right initials after their names but hardly comparable in their hands-on experience. I am an ADN nurse, now in my 40's and seeing myself get passed over for promotion in spite of 15 years of experience in the OR as well as an additional 9 years prior to that as a surgical tech. This past year I had to answer to a DON superviser who had no surgical experience but got hired over other, more qualified applicants because she was friends with the VP of Clinical Operations. Within 3 months, after making everyone's life miserable, she resigned, realizing she was over her head. Her resume came across my desk where I am now employed and I was appalled at the blatant lies she was telling about her extensive surgical nursing experience....we put it in the circular file. Now, again, I find myself with a supervisor who is also an ADN, barely 3 years out of school, no other nursing experience in the OR except the present job where she is now doing conscious sedation and some circulating. Unfortunately she is very intimidated by my coworker and me as we both have extensive OR and nursing experience. My co-worker and I cannot believe that we are being supervised by someone who is not even aware that she doesn't know what she doesn't know. Instead of allowing us to work as a team, this supervisor is not interested in letting us all learn from the other. Instead she is sabotaging our work, taking credit for what we do, telling the physicians that the other nurse is "a trouble-maker", and basically creating as much drama as possible to force us to resign. She has already offered to write us both a glowing letter of recommendation. The other nurse and I have got her number and are not allowing her to get away with this and have made the physician aware of what he has been suspecting for a long time.....that she is poisoning the staff and behind all the turn-over. He has assured us he will take care of the problem. I am waiting to return to work this week and find out how that went. My feeling is that experienced or not, an LPN cannot legally supervise an RN and there are good reasons for this in the clinical setting. However, as we all know, corners are being cut everywhere in the healthcare industry and I would bet that it's part of the reason some places are allowing this to happen.

I've just started working in an office-based plastic surgery center which is certified by the AAAHC. Before I started working there, all the narcotic records were co-signed by the physician in time for the inspectors however none of the discrepanies were noticed or reconciled. I'm not talking about a small amount either. Conscious sedation is used here and multidose vials are used, leading to hundreds of cc's unaccounted for and unreconciled. As another vial is opened, the RN just added it to a running total which of course is totally bogus.....no way does any of it add up. No daily counts are done and it took me about 30 seconds to see the mess and made me wonder how the glaring lack of narcotic accountability could be going on without anyone figuring it out during the certification process. Obviously the physician either doesn't want to know or doesn't care that he co-signed counts that don't reconcile and have huge discrepancies. I have refused to administer narcs or sign my name to anything having to do with these drug. I suspect that there is drug diversion going on but have not witnessed anything out-right. The nurse who hired me and one other nurse is unwilling to let either of us carry the keys, is the only one giving conscious sedation and is unwilling to allow any patients I've recovered have any pain medicine. The other day,the CRNA drew up a very small dose of Demerol for the patient we were recovering and I documented that she gave the first half and I the second half to this patient. The RN I suspect of diverting acted like we were ridiculous and I got a big eye-roll for giving 12.5 mg of Demerol. I have very uneasy feelings about this place and am looking for another position.

Absolutely, there are red flags all the way around and although I want to quit, I am a single mother with 3 mouths to feed and cannot leave without finding a new job first. It took me almost 3 months to get this job due to blacklisting by a former nurse manager. I have over 2 decades of experience and it shouldn't have been so hard to find a job....but that is another story. This doctor's office I have written about has another physician who recently came on board and under the circumstances he will probably not be staying unless there are some changes made. I am going to ask him for a letter of recommendation. There are so many concerns... the whole place scares me....the bottom line is that the pre-existing nurse is not happy at all to have 2 new nurses hired who expect protocol to be followed and accountability. She has already stirred up so much drama that after my co-worker and I compared notes, we figured out that she was trying to coerce each of us into resigning by pitting us against the other, lying and defaming the doctors behind their backs. Both doctors are now aware that she is poisoning the practice and one of them wants her gone----am not sure about the other. They both are concerned about the toxic environment and how it may affect patients and other employees. I was told I was hired to raise the standards of the office to a professional level along with the other RN who was hired with me. If we're not going to be allowed to do this, I am out of there. I am going to see an attorney and tell the office manager (who has been there only 3 months herself) that I will sign the contract after I get legal advice (am buying myself some time to find another job). I also plan to record any meetings between myself and management in case things get ugly before I leave. Regarding the ADA, counting the 2 doctors, we do have 10 employees and there are plans to hire more nurses by the end of the year so asking me to sign away my rights does leave me with a bad taste in my mouth. I don't think an employment agreement which violates federal law is enforceable but I think the immediate and bigger issue is the lack of narcotic counts, discrepancies and absence of standing orders or any kind of orders. Medical assistants are making medical and nursing judgments/decisions without getting the MD's verbal OK. Blank signed prescription pads are used daily for the doc's convenience for scheduled drugs and antibiotics. Am I just naive or is this kind of thing typical in a doctor's office that does outpatient surgery? For someone who seems paranoid enough to want me to sign an agreement with a non-compete clause, confidentiality agreement, life insurance agreement,etc.....he seems pretty cavalier about letting his medical assistant make medical and nursing decisions which could land him in court or worse. He is a young (in practice only 3 years) hot-shot plastic surgeon who has a big head and a growing practice and thinks he is smarter than the rest of us and his patients and isn't going to get sued. All patients must sign a contract agreeing to binding arbitration if they sue for malpractice or he doesn't take them on as patients. I've heard several surgeons I've worked with in the OR talk about this being the way medicine is going----weed out potential "problem patients" by making them sign contracts like this. Anyone else seeing this trend?

I have purposely not listed my real place of residence and changed certain identifying details to protect me and the employer's privacy...to decrease chance of liability and retaliation against me. I do not wish to embarrass my employer, or jeopardize the reputation of the business or jeopardize my job until I can find another. The contract also states that should I become permanently disabled, whether physically, mentally or otherwise and unable to perform my job duties, that I will be terminated. I thought the American with Disabilities Act protected against such things and that reasonable accommodations can be requested and made. I have no disabilities at this time. But I am not sure about the legality of all this.... this is a very small office and does not accept medicare/medicaid patients and is very unregulated. Hence, I need to either resign or see an attorney ASAP.

>THEY'LL be in breach of it, not you. Of course, I'm not sure how it would >work without the supervisor's (authorized) signature, but that's a question >for the lawyer. I've thought of doing this however there is a clause stating that any ammendment or modification of the agreement will only be binding if evidenced in writing signed by each party or an authorized representative of each party. There is also a statement that unless a court of law proves otherwise, "the employer and employee acknowledge that this agreement is reasonable, valid and enforceable." No mention was made of any written agreement when the job offer was made to me and I accepted. The other physician has not asked the nurse who was hired at the same time to sign anything like this however she is his personal nurse and as such, he pays her hourly wage. Because my clinical manager is feeding the staff contradictory information about what the doctor has told her and what the rest of us have heard and what is actually going on, I have reason to believe she is the reason behind excessive turnover. I will not be doing anything until I make an appointment with an attorney. The more I know about things, the more I know I have reason to watch my back and look for another job. For instance, no references or licenses were verified before the other nurse and I were hired.

I agree that the rationale behind this contract has to do with "nothing personal, it's just business." But, yes, the unprofessional way this was handled is concerning. This employer doesn't offer his employees any disability or life insurance and because this is a small office with less than 10 employees, this does not come as any surprise. Neither I nor the other RN who was hired at the same time was asked to submit to a pre-employment drug screen or physical. This has been a 1-nurse office until now with 2 MA's. My co-worker and I have refused to give any controlled substances until there is documentation in place to sign drugs out and do a daily narc count. What we've seen so far are significant discrepancies in what is charted and what is actually on the count sheet. The count sheet is something I can not make head nor tails of because they are using multi-dose vials for narcotics (given for conscious sedation, PACU). The physician and nurse have covered for each other by co-signing this sheet however this still does not reconcile where these doses of scheduled drugs went because nothing adds up. The nurse that has been in charge of carrying the narc keys seems in no hurry to do anything to change this pattern and wants to maintain the status quo because she seems to feel very threatened by the idea of 2 new seasoned nurses on board who aren't willing to jeopardize their licenses by being a part of this. I apologize for getting off the subject but obviously I am concerned about what I may have gotten into and I will not do anything which may implicate me or my license.

Thank you all for your feedback and suggestions. It appears that the doctor whom I work for cut and pasted this on his computer. I believe this is a contract he is trying to make as a "one size fits all" to cover any and all issues, potential or real, now and in the future, The state I work in is not a right to work state. I can be fired, as can anyone else, at any time for any reason or no reason at all. The employee handbook reiterates that at least 4 times. Even the receptionists signed the same 12 page contract that I did, as did anyone else that is an hourly employee. I think what bothers me is that the business manager handed it to me blank, which makes me question some things about her. And that, as I said, I don't generate revenue for this doctor and as such, I feel like it is pure greed to expect me to let him insure my life for his benefit. And lastly, I feel that it is an invasion of my privacy to ask me to submit to a life insurance exam, to prove evidence of insurability. I have some health history that, when a previous employer became aware, discriminated against me and this affected my career, evaluations and privacy. These kind of things are very hard to prove but my last nurse manager gave me a 0.22 raise and the lowest and most negative yearly eval in the whole department of over 50 employees. I files an ethic complaint and my suspicions were confirmed.......I resigned 4 months later after being there 6 years and never having been evaluated negatively or had a complaint made by a physician in the whole time I worked there ......4 other employees came with me and we all started working at a new job (not the one I am at now). I guard my privacy and no one at this new job knows anything and I plan to keep it that way.

First a few background facts: I just finished my second week working in a private physician's office as a staff nurse. It is an office based surgery center and has recently added another RN and surgeon. I am still in orientation however no mention was made of signing a "contract" when the offer of employment was made. I took a significant pay-cut to take this position however the idea of no call, holidays or weekends was too good to turn down for this single mom. After I came back from lunch today, a 12-page contract was sitting on my desk with a post-it note on it telling me to sign it. Here's where it gets interesting: 1. the contract had none of the blanks filled in (rate of pay, start date, etc) 2. the contract states there will be a 90-day probationary period, however I was told by the office manager when I accepted the job offer and rate of pay, that it would be only 60 days and then have a re-evaluation. She made it sound that my pay would be adjusted at the end of that time frame 3. the second page of the contract states that, "the employee is a valued and integral part of the employer and the loss of her services to the employer would cause sever(sic) hardship and economic loss to the employer.............employee agrees to permit employer to insure his/her life under policy of life insurance........name the EMPLOYER (!!!) as sole beneficiary.........submit to all necessary physical or examinations to effect such policies of insurance." I am a nurse and as such, there is no loss of revenue to my employer in the event of my untimely death and no justification for him to insure my life and be the policy's sole beneficiary. He could simply place an ad in the classifieds and replace me with another nurse. Is it just me or is this bizarre? The other employees who signed this are in their 20's, uneducated and I have to wonder if they even read what they were signing. Who in their right mind would ask someone to sign a contract like this? Especially when all the blanks are not filled in by the employer? I understand signing "at-will employment agreements", "non-competition clauses", "confidentiality agreements" and the usual legalese..........but this other stuff doesn't seem legal and I have a feeling if I don't sign it, I will be terminated. I didn't think I could be made to take a health exam after I already accepted an offer of employment and started working. Where would I find information regarding employment law for something like this? Wouldn't this also violate HIPAA? revealing my medical information would be a condition of continuing my employment due to this employer's demand to take out a life insurance plolicy on me and make himself the sole beneficiary?

I am in the same situation..just started a new job....scary.....physician-trained "medical assistants" who scrub and circulate in a plastic surgery ambulatory surgical center. I am orienting and seeing things I question but am not familiar with what are state regulations for an ambulatory surgery center. The doc says he does the assessments, no need or a nursing assessment and he takes on the liability however the RN completes the paperwork and signs the operative record and in many cases, gives conscious sedation. I am not comfortable taking on the liability for something I haven't been in the room to see nor have I ever taken care of patients I haven't assessed. The sponge and needle counts are not routinely done and if they are, their technique is inconsistant at best. Drugs on the back table aren't labelled, sterile technique is a joke....saw one of the scrub techs giving a visiting surgeon a back rub while they were supposed to both be sterile and scrubbed in. The RN was in and out of the room and trying to do 10 things at once.....this is why we are adding more RN staff. I have no idea how we are going to reconcile the narcotic count when there are umpteen mgs unaccounted for of Fentanyl and other scheduled drugs in multidose vials. No written orders for PACU pain meds--- just verbal and not written later and co-signed. I don't feel I can criticize as I have been there only a week but I also feel there has got to be some tighter controls within the OR or I am concerned my license will be in jeopardy. I am not going to administer any narcotics without a narcotic count which isn't even being done once a week and I know it needs to be at the begining and end of each day. I've spoken to the other nurse that was hired with me and she is as nervous as I am and we want to do the right thing but it's hard when egos are involved and we are new (15 yrs of nursing experience though). Where can I find standards for office surgery concerning narcotics and supervision of UAP's? The nurse in charge has only 3 yrs of nursing experience and has been bulied by the doctor to cut corners and ignore protocol.....we want to back her up and the 3 of us stand together and do the right thing however I an see this is going to take some very careful negotiation because the surgeon is extremely controlling and doesn't see the problem because "this is how we've always done it and had no problem" .....which is not entirely true. Sometimes I miss the hospital where I didn't have these kind of problems...however there certainly were many others to deal with!

I am an OR circulator with over 18 yrs exp. working in a new ASC since the doors opened 6 weeks ago. I am one of 2 circ. and spread so thin as to affect patient safety IMO. Yesterday I was called on the carpet and formally written up for not completing documentation and having 2 absences in 2 months. The day before this write-up, I worked 11.5 hours straight without a break, sat down once to use the restroom, and took care of 9 patients having surgery, 4 of which were under 5 yrs old, 3 were laser cases. I circulated without so much as a 10 min. break or any help whatsoever from my DON. Her only contribution to my day was to come into the OR 3 times, while I was in the middle of lasering, to demand I answer her RIGHT NOW, as to why we were running an hour behind. When asked to wait for an answer because I felt the patient, laser and surgeon at hand were my focus and prime responsibility, she got huffy and said DR. Bigshot was on the phone and wants to know RIGHT NOW. I said, Sorry but he will have to wait, this patient and this doctor is where I have to put my focus, I will deal with explaining late turnover time later. She wrote me up for this and said I was disrespectful and inappropriate to her. I told her and the administrator that I stand by my judgement call and that unless the hospital is on fire, I am not going to deal with her phone call issues while I am circulating a laser case by myself and that I will tell Dr. Bigshot the same thing if he were standing right here and that I doubt he was aware of what I was doing when he called and asked these questions. I am trying to respond in writing to these issues because it will go in my personnel file and I feel I am being put in an impossible situation. I have pointed out some safety issues that jeopardize patients and my license and these still haven't been resolved. Such as lasering with one nurse in the room; being told to pre-chart to get my documentation done; not having an adequate amount of instruments to open a patient should there be complications during laparoscopic surgery (perforated bowel, hemorrhage, etc). I feel this has led to retaliation towards me. My DON is extremely defensive and is unable to circulate and unwilling to come out of her office long enough to learn. She tells me I am clueless as to all the responsibilities she has yet she is unwilling to hire or assign a charge nurse. This DON is very young, inexperienced and manages through intimidation---threatening to fire anyone who calls in sick. I have worked in an ASC before and never experienced such chaos or lack of follow-through----just lots of blame and finger-pointing. We are constantly out of basic supplies and cases are improperly scheduled by a temporary inexperienced scheduler. The other nurse I work with as well as the techs are all overwhelmed and each been to the administrators office to complain to no avail. I don't want to resign yet because I've put a lot of effort into getting this place going and yet I feel my DON is so intimidated by me that she would cut off her nose to spite her face rather than fix any of these problems because she didn't see them first. She tells me she thinks I am an excellent nurse, very good with patients and know my job but on the other hand, has put me in an impossible situation where I am spread too thin to take care of patients safely. To be written up for failure to complete documentation after the 11 1/2 hour day I just described, makes me feel there is nothing but frustration ahead. How can I possibly be expected to work under conditions like this and still get all the documentation done (2 pages plus more on the computer, plus update preference computer cards and doctors orders, to name a few) All my patients had good outcomes, no errors were made and the doctors were the reason for late start times it was later determined. Anyone have any advice to help me defend myself and not feel so beaten down? Also where can I find information regarding the laser safety issue and the issues regarding inadequate instrumentation to do laparoscopic surgery? Thanks for any help and sorry to ramble on so much but I am tired of going home exhausted and in tears almost every night.