this question was sent to a patient advocacy group in the us and pertains to the deliberate understaffing issue that i was fired for revealing. it is posted here under the general nursing forum rather than the or forum since the core problem, the toxic managerial practice of deliberate understaffing and the consequences for those who speak out, is one that we are all facing hospital wide.
how long is too long for a member of the sterile team to remain continuously scrubbed into surgery?
although the public might not understand that medical professionals including the surgeon must leave the or briefly during lengthy surgery, most conscientious practitioners realize that this is a normal safety measure necessary to combat fatigue. i am trying to get a consensus of feedback from those who routinely face this dilemma in the or as to what time frame is universally accepted as the maximum period that any member of the sterile team can be expected to safely function while scrubbed into surgery without a break. although i am now in the “nifa” training program to become a first surgical assist, even as a surgical technologist, performing the “scrub” role, i had to concentrate on anticipating the surgeons needs during a case. after how long would you consider that scrub role jeopardized by fatigue to the point where i might have lost concentration and focus on the operation?
while a surgeon can, and should, demand that the person assisting him is relieved, nurses and technicians fall under the control of or management which leaves us vulnerable to the vagaries of inappropriate or coverage as determined by the hospital. as a consequence of hospital “downsizing” to cut costs redundancy of personnel has been severely limited to the point where during the off-shifts especially at night and on weekends there’s no free staff to break people out of surgery for even a brief run to the bathroom! calling in call team people to provide relief breaks is considered an unnecessary expense, despite the fact that there is a clearly established link between fatigue and medical errors. the sterile team scrubbed into surgery are trapped without food or water until they are relieved; this also represents an unacceptable deprivation strain on the body. however there are no safeguards within the existing us employment laws or ocha standards to insure that critical hospital workers, including those in the or, are not left for hours of continuous, and dangerous, practice without a break. “breaks are at the discretion of the employer.”
i was left stranded at the field without relief for 8, 10 and on the worst occasion 12 hours straight. these situations impacted my ability to concentrate as my blood sugar plummeted; each time i reported becoming sick, dizzy and faint to the point of nearly passing out. when i complained that my condition in response to this hardship presented a danger to my patients i was targeted for removal and then fired. incidents where any member of the or team is forced to remain on task for that long should be documented in an “incident report,” as an extreme of this magnitude presents an unacceptable danger to the patient. the geneva convention strictly prohibits such inhumane treatment of working pows! how many normal human beings are expected to go for 12 hours without water, food or urination?
this is an interesting reprint from a document that those who work under similar unreasonable, torturous or downright inhumane circumstances in the us should take careful note of:
43.hours of work are interspersed with one or more eating and rest periods of not less than half an hour. continuous work may not exceed five hours. the rest period in jobs which span two meal times ranges between one and four hours (labour act in force, art. 58).
there is a lot of talk about medical errors right now, but far less mention of the toxic work environment that now encourages mistakes. this situation is getting steadily worse. while “at will” employment laws silence those who dare to speak out, lack of a humane break policy condones driving hospital staff until they drop: is there any wonder that errors are on the increase? little wonder that a sponge or an instrument is inadvertently left inside the patient when the scrub is almost comatose after a 12hour ordeal in surgery. all the cross checking and safeguards are irrelevant if the hospital staff are trying to function while so severely fatigued, hypovolemic or hypoglycemic that they are at the point of either falling asleep or passing out. when will the various safety advocacy groups in the us finally address this very real problem and insist on proper protective legislation? there have been advances recently with limiting the residents working hours and trying to stop mandated overtime for nurses, but much more emphasis must be placed on eliminating unnecessary fatigue among all of our medical staff.
no one is more important than the patient unconscious on the or table. for my very prestigious maryland hospital the “nursing shortage” was a convenient excuse to justify unconscionable managerial abuse that seriously endangered my patient in the or. doctors and nurses face severe discipline when mistakes occur, but why isn’t a negligent hospital policy that condones drastic staffing cut backs ever recognized as the real culprit? in some cases administration even offers financial bonuses to encourage self-serving managers to implement inadequate staff coverage. then they fail to hold a repeatedly abusive manager accountable when they drive dedicated staff until they drop. this managerial excess is focused purely on saving money not saving lives; we need proper safeguards in place to cub this negligent profiteering strategy before patients are harmed. plus when staff are courageous enough to come forward and expose a pattern of ongoing negligent practices they must be protected from retaliation and taken seriously by accreditation agencies who’s duty is to protect the public. no medical institution no matter how iconic, prestigious or powerful should be immune to rigorous scrutiny, as this lack of oversight encourages bending the rules, ignoring regulations and cost cutting that is harmful to safe patient care.
relentlessly abusive managers are a very valuable tool in facilitating staff downsizing without layoffs; i call this the spineless approach to cost cutting, but it makes our hospital working environment extremely dangerous for the patients. the current nursing crisis has come about through this dangerous downsizing and the creation of the toxic work environment that is driving nurses to leave their chosen profession because they refuse to take unnecessary risks. the us does not have a “nursing shortage” it has a “nursing exodus.” the us healthcare industry is still consistently expecting all of our medical professionals to take bigger risks by making do with unsafe staffing practices. this issue desperately needs to be addressed so please post comments,
kim.
ps: the issue of retaliation and unfair dismissal of whistleblowers has been further elaborated upon by myself and other affected nurses on another thread:
re: retaliation for voicing concern over unsafe practices.this thread was started by an icu nurse, but the problems i have seen discussed on this and other threads represent the growing concerns of many silenced patient advocate nurses. there are some valuable suggestions on exposing patient safety issues and combating retaliation on the above thread. i will be taking further action very soon by posting a petition calling for a compliance line investigation into my case. please visit this other thread to comment on the issue there too and consider the importance of making our voices heard, many thanks.
There are many, many cost related gross understaffing issues going on in our hospitals and this is one of the worst. Could this lack of O.R. staffing during surgery also be causing the high incidence of staph related post-op infections? I think we all know the answer to that. The fact that this person said she is diabetic does not have any bearing on her position. Come on now, if you can't stand for 10 hours because of poor leg circulation or low back pain should you be tossed out of your job? Too bad nurses can't be like the coal miners.
Sorry about the double post I thought I had edited out post #12 as it contained missing chunks of text and didn't make sense in places because of this. Post #13 seems OK. I found a way to take out the junk without loosing text. Thanks for bearing with me,
there are many, many cost related gross understaffing issues going on in our hospitals and this is one of the worst. could this lack of o.r. staffing during surgery also be causing the high incidence of staph related post-op infections? i think we all know the answer to that. the fact that this person said she is diabetic does not have any bearing on her position. come on now, if you can't stand for 10 hours because of poor leg circulation or low back pain should you be tossed out of your job? too bad nurses can't be like the coal miners.
ok...steelcityrn..... explain the coal miner thing to me.
i mean....we have a system here that is broken.fewer legislative nurse friendly statutes are passed each year.thank god...that now some of the tainted votes by some of these seantors are coming to light.like how...these legislators are being paid basically for their votes.it is going to take personal examples to change the minds of these legislators....we need people in positions that can help to change this...legislators...nurses...physicians...mothers...fathers....children...who are willing to publically tell their story of how their life was touched by these issues.
post op infections.....yeah....ya know that can cost them their life..
nurses asked to stand in a 5 ft x 4 ft space in the or and worknonstop for 12 hours with no meal break...no chance to stretch their legs...no bathroom break etc etc etc are being asked to also be perfect and function as a machine and not make any errors ...even though we have no nutrition or hydration and cant even "relieve" ourselves.how realistic is this?
instead of tsunamikims manager simply adding another or tech or circulating or nurse thats duty is to simply round on each or suite and relieve nurses for breaks and bathroom. 2.5 hours on each case....and that would allow those nurses to have a quick 20 min lunch, go to the br and keep the staff there to assist that surgeon during the procedure.but.....what the problem is ...is that these managers havent cared for "actual" patients in so long...they cant see that this would improve the m/m rates and decrease infections and assist with retention of the nsg staff. these managers are asking us ...to function in an environment that we as humans cant.we ...unfortunately need food, h20 and unfortunately a bathroom break.when you bring these patient safety issues forward.....these managers...cant get ya outta there quick enough.boom...you are fired. all these patient safety and public protection acts.....are actually meant for these hospitals......but .......you have to be willing to back up your ethically pt safety complaints with the knowledge that the manager may fire you to simply silence you. it will take more huge settlements against these hcf's before they actually stop this pratice. unfortunately ...for the hcf's the trend is going up and up that judges are siding more with the whistleblowers who risk everything for these patients.they are being slapped with huge fines, large settlements and more and more and more public attention is being drawn to these prestigious hospitals that are now publically noted to have fired nurses who voiced concerns over pt safety issues. people are thinking....wondering....evaluating ....and discussing how safety conscious is the hospital where i am at...where my son is hospitalized at......was my mothers sentinel event due to these issues.etc etc etc.instead of standing behind and embracing these new safety conscious laws, standing behind theirown policies, and rewarding these nurses ...these managers are just trying to silence the nurses. it will take a stronger risk management office and a compliance officer that is willing to actually go by the laws, and their own policies...and make a statement within their own facilities by firing these "toxic" managers as tsunami kim calls them.
I will again say what I contributed on several other threads. First and foremost, nurses need to unionize!!!! There is little, if any protection for nurses, in this day and age. Second, nurses need to practice defensive employment. If you see unsafe issues, write letters to management, administration, and also Risk Management. KEEP COPIES FOR YOUR SELF!!
Make copies of policies and procedures. Make copies of all internal memos, pertinant comments in the unit communication book. Take notes during the day, or as soon as you get home, while incidents are fresh in your mind.
Write Letters to the Editor. When administration makes unfounded complaints against your nursing care, ask, "can you give me an example of that, and the date that it occurred?" That will put THEM on the defensive.
I would also call an employment attorney (preferably, a nurse attorney- call the State Bar Association), and discuss the issue with him/her. There is usually a free first consult to duscus your case. If there are others on your unit that have been harrassed, get together, and make an appointment with the senior partner of the law firm that defends the hospital. Supply him with the facts of you issues, the hospital policies that have been violated, Nurse Practice Act, the patients that have suffered due to poor care, (I would have the names to supply him with), and the laws that they are breaking- EEOC, State Labor Department. You can find these laws on "FindLaw.com" on the Internet. All state and Federal laws are on the web sites. Be prepared! Information is ammunition! Make it clear that you will go public with this information if the climate doesn't change, and also that you will contact the families of the patients, and offer to testify on their behalf. I would also contact the news media, and see if you can get some press.
It is a large burden to have to go to this extent, to protect your name and license. It would also not be a bad idea to contact the Board of Nursing, and inform them of the issues with your employer. You should get to them before your employer, to tell your side of the story. This will be a less defensive position for you, than if your employer calls the Board in a retaliatory measure by them. I hope that this has helped.
good advice that i too would give to others, but i did most of the above and still it all failed. i started to fight back through my union. it took them 8months to get the labor board to force my hospital to hand over copies of three solicited letters that were used to fire me! i couldn't even get them to read one direct quote. my former hospital calls that "transparency." this allowed the hospital managers to deliberately misinterpret what was written, embellishing and changing the accusations as they went along. the ridiculous false allegations kept changing and because there was nothing specific in writing it was impossible to fight back. when i went into hearings i was always heavily outnumbered and the whole process was so humiliating. every time there were new lies and false accusations; i started calling this crap the "accusation de jour!"
all i had were vague one line statements like "disruptive behavior in the or," no real details, no account of what i said or did that constituted grounds to fire me. my manager accused me of "verbal abuse" during a phone conversation over my work schedule. this was after being forced to take unpaid leave and i think she had hoped that my anxiety over the loss of pay would prompt me to loose my temper. i told her i thought she was being "unnecessarily inflexible" with my schedule; hell i didn't know you could get fired for such outrageous blasphemy. it brings a whole new meaning to "freedom of speech." 15months after i was fired one of the office staff who was conned into writing a letter of complaint was ask about the subjective comment she had tacked on the end. she wrote "i felt threatened," but when asked why she stated that i had my hands on my hips in an "aggressive posture" and my arms folder in an "aggressive manor." great, my entire career scuttled over what was subjectively perceived as "aggressive" posturing.
i gave a detailed written report to the hospitals internal compliance line who then tried to refuse to investigate saying they could not get involved until i had exhausted all other remedies first. they don't really explain this little quirk on their "we comply" website and i must say i fail to see how they can pretend that they protect employees from retaliation. apparently they need to see that the retaliation has succeeded in reaching its final devastating conclusion unimpeded, before they say ops; sorry we can't do anything to protect you now as you are no longer an employee! does that mean that they lied and they never protect employees from retaliation anyway at anytime or for any reason, well yes! that comes under the hospital's glowing statements about honesty, integrity and accountability. the most i managed in the way of "compliance" was to have them conduct a separate, but rather cursory investigate into the negligence issues and admit to me over the phone that there was "some truth to my allegations." as for the accountability bit they decided to "just keep an eye on things."
i made sworn statements to the board of nursing about the negligent and retaliatory conduct of four or managers. i then went to the maryland commission on human relations, eeoc, jcaho, the board of healthcare quality and meimss giving each of them sworn statements. i contacted both of my maryland senators and my congressman, submitting a "citizens opinion" on "at will firing." each time i trusted a public agency to investigate they let me down. when interviewing the witnesses i provided they all appeared to have focused on establishing my lack of credibility first and foremost so that they could protect a famous maryland icon. on several occasions damaging paperwork, mostly fabricated, was shown to these organizations behind my back: more "transparency!"
at a supposedly unbiased eeoc mediation they displayed documents to the mediator in a separate room and again i was denied access, does that sound fair to you? eeoc insist that such deceitful one-sided proceedings are standard for them; i would never have agreed to mediation if i had known this ahead of time. if an employer has just cause to fire you there is no possible motive to hide evidence of misconduct. the eeoc mediator was convinced that i had made over 50 harassing phone calls to my manager that would be grounds to bring criminal charges against me. however they had never contacted security once and they never demonstrated having taken any steps to put an end to the harassment. when the hospital's director of surgical nursing was prepared to lie to deliberately victimize me she must have seemed so credible to them. the top or manager even lied under oath at my arbitration.
i am originally from england and what my hospital did to me could not have happened in this country. i have completely lost faith in everything america stands for, freedom of what??? there is no recourse to justice and public agencies do not protect the public. my former hospital is the largest employer in the state of maryland, the most prestigious medical institution in the country, the "besthospital in america;" they are completely beyond the law. even the media will not touch them, there is no recourse, but this does help me tp speak out. my last hope is a petition i will soon post on thepetitionsite.com. it will demand that the compliance line finally conduct a long overdue investigation into my case. i hope that the interest generated by that point will force them to grow a conscience and do a proper investigation as they may be under more scrutiny by then. it is one last slim chance at clearing my name. it will be a real resource document when it is finished with links to multiple sites, that is what is taking time. i will let everyone know when it is posted and hope you will lend your support. this is a real david and goliath story and i will need all the support i can get, thanks for hearing me out,
Did you have an attorney represented you in this whole mess? If not, why not? Did you know that you can request the phone records from the phone company, and them demand to have them show you the numerous threatening phone call they claim you made. Have they shown you any concrete evidence concerning these allegations? If you had/have an attorney, you need another one. I can't remember if you belonged to a union. I might also, call the State Bar Association in your state, and speak to someone who does Labor and Employment Law. They have a specialty section, at least they do here in Washington. I would explain the entire mess to them. You might be able to get the attention of a prominent employment attorney, who carries alot of weight in the area. Hospitals are afraid of the "big guns" attorneys. I could look here in Washington, because the Washington State Trial Lawyers Association conducts an Employment Law Seminar every year. I belong to the WSTLA, and I could try to find you someone. Even if the attorney is not licensed in your state, he can sue in Federal Court. There is someone in Seattle that I have in mind. I could give you her name. Also, she might know someone on the east coast who can help you.
initially i tried to avoid the possibility of legal action and postponed this option as a last resort. this was mostly due to my belief that hospitals in general are sacrosanct if you wholeheartedly endorse the concept of universal access to healthcare as we do in the uk. i tried to resolve my case first through the union and hr, then through the hospital's compliance line, eeoc and the maryland commission on human relations. while i did have a union, they proved more of an encumbrance than anything else. the union lawyer who represented me at arbitration first misinformed me, then proceeded to sabotage and wreak my case! it is because of this lousy union misinforming me about binding arbitration that i now have no legal recourse at all. their lawyer totally bared me from presenting all the most relevant facts supporting my case and then put my guilt in writing no less than three times in his written summation which he kept from me for over a year until the ruling against me was final.
the really unfair thing is that to gain access to my own short distance phone records they must be subpoenaed for a pending case. since i wanted this evidence revealed i signed a special waiver to authorize the maryland board of nursing to gain access to my phone records. they have never indicated that they reviewed these records, but i soon realized that any vindicating evidence was very low on their priority list. once the hospital portrayed me as a "disgruntled former employee with an axe to grind," they just looked for evidence to support this claim and exonerate my prestigious former hospital of all negligence and retaliation charges. it was truly amazing how selective all of the public agencies that i contacted were with regard to what they chose to evaluate in the way of evidence. the main priority always remained the same: demonizing me to protect an iconic maryland medical institution. the battle to reveal the truth was totally futile. even after maryland bon received copies of all my employee files, i was still not allowed to see them. i do not understand how they got away with this deception as it would not be possible in europe. any employer who has a valid reason to fire one of their employees should be able to clearly demonstrate cause.
so why did my former hospital need to keep hiding everything from me, the wrongfully accused victim of retaliation for blowing the whistle on negligence? put a lie in writing and when it is refuted with a documented alibi the false accusation is worse than useless; it becomes a liability proving deliberate deceit. i also discovered that additional paperwork had been inserted into my file after my dismissal without my knowledge, but the details were sketchy as i could never review any of it. two minor rule violations were added after the fact, but i had no idea they even existed until just days before my arbitration hearing, a full 15months after i was fired. there was no supporting documentation to describe the events that had supposedly taken place, but the hospital didn't have similar paperwork describing the events used to fire me either. according to management these minor rule violations showed a "pattern of behavior" and demonstrated that disciplinary counseling had occurred, but conveniently they hadn't required my signature. nothing in writing gives an employer a distinct advantage as your file becomes a minefield of fictitious charges that others can base their decisions upon, but you are unable to refute as you have no knowledge of their existence! my former hospital calls this tactic "transparency" in the uk we call it fraud and defamation! two minor rule violations showing a "pattern of behavior" convinced the maryland commission on human relations and others of my guilt!
i have consistently asked to see any relevant hospital security records that would demonstrate that not one contact to security was ever made; however, this evidence is not incriminating, so it still remains suppressed. if hospital employees feel threatened or receive harassing phone calls they are supposed to contact the security dept. considering the volume of incidents my managers claim occurred there should be a file a foot thick on my behavior, but there is nothing, so they try not to mention its conspicuous absence. neither the hospital's internal compliance line nor a single one of the public agencies who have supposedly "investigated" my case have explained this missing security file: it doesn't exist, but they just don't care. at one point my manager changed my schedule so radically that i went from working over the weekend, at times when she was not there at all, in an or suite on the other side of the hospital, to working days alongside her in her or complex. she claimed that she felt threatened and harassed by me, but she deliberately chose closer, more frequent contact. it was the equivalent of inviting her stalker to dinner!
however, after the unwanted reassignment i wasn't provided with a locker, oriented to the new ors, given a mail slot or a hill rom beeper etc.: i was clearly slated for removal and i knew it. i put all these retaliatory measures in writing to the manager above my immediate manager, but it was all completely ignored: or management in general wanted me gone and they didn't care how blatantly corrupt the process of removal had to be. they ignored written appeals, lied and cheated all the way up to the director of surgical nursing who lied under oath at my arbitration. there is copious evidence to support my allegations of severe retaliation, but no one wants to touch it. if i could get a journalist to investigate that might help, but no one will challenge "america's besthospital. this hospital considers themselves 100% above the law and that is not healthy, but they always win. i am still fighting them after five years, broke, in debt; after being forced to abandon my baltimore home i have left the country where i resided for over twenty years and returned to the uk in disgust. i am thoroughly convinced that there is no justice system in america. the following post was placed by me on another thread regarding "retaliation for voicing concerns over patient safety." there is a lot of useful information on dealing with retaliation under this other thread that is well worth reading. this piece was written in response to taping calls:
good advice: you are right about informing the person you intend to tape; that is the law in maryland. you are able to tape if you inform the person you intend to tape. however, this really puts them on guard, because management rely on he said/she said where they will always claim more credibility than you. if you don't tape your next hearing you must at least bring witnesses, preferably one that will transcribe what is said would be very useful. i kept asking at my hearings why they had never informed me that calls between myself and my manager would need to be taped; this would have been a legitimate and logical course of action, if indeed i had been making dozens of threatening phone calls.
that was one of the major inconsistencies in their lies. who in their right mind would put up with dozens of harassing phone calls and take no action to stop the practice? at one point my manager blurted out that my calls tied up her phone for up to five hours a day! but no one thought that such a ridiculous claim was bogus or questioned her total inaction as suspect, after all they had to be in the right. an or nurse manager, who failed to document anything at the time, did not send written warning that the behavior must stop and who never bother consulting with the security department. but management at the most iconic institution in maryland couldn't possibly be suspected of lying under oath! that place was way beyond "goliath." i call this unjust phenomenon "iconic immunity" as it is a privilege that i am sure is shared by other iconic facilities.
the inconsistencies in my case were massive, but totally ignored. i will never have my day in court as i was cheated out of that when the union misinformed me regarding the arbitration being binding. i only found out much later when i tried to hire a lawyer. if there was any way i could testify under oath in a government hearing or to a us grand jury, on the need for whistleblower protections for healthcare workers, i would gladly return to the us in a heartbeat.
more than anything else i want to know that my sacrifices were worth it: that the necessary changes will be made and protections put in place. of course i would also like vindictive managers held accountable for wreaking my life. personal vindication and taking back my self respect are the biggest christmas presents i could receive right now. no one should have to face a life-sentence of shame for daring to speak out to protect patients from harm. getting my house back and paying off the debts i incurred trying to hang onto my home are beyond any hope of possibility, so i try not to even think about that dream anymore as it is unrealistic. this is the worst time of year for me as it is now the fifth anniversary of the day i was marched out of the or surrounded by security guards as a warning to my coworkers of the perils of rocking the boat. it is also the second anniversary of being forced to abandon my baltimore home and leave the us as a virtual refugee.
i did not even have the resources to file for bankruptcy before i left so the bad debts still hang round my neck like the proverbial albatross. i contacted all the companies and told them i had been cheated out of any possibility of compensation and there was nothing i could do. i have mail forwarded here and at least one has decided to sue me. i will certainly never have a home of my own again.
i will also have to forgo the security of a credit card just in case i need to fly myself back to the uk in an emergency from some volunteer assignment overseas. that is still my one greatest ambition, to continue the ngo medical volunteer work i began after the asian tsunami. this is my driving force in maintaining a strong sense of purpose it really gives me hope. i wish that all of you many disillusioned, well meaning, overworked nurses could find the special peace and sanctuary that i discovered living rough in my hammock/tent and working at meulaboh's only remaining very badly supplied hospital, cut nyak dhien.
perhaps in dealing honestly with the injustice that clouds my past i can regain the credibility i so desperately need, to obtain support for my ambitious program in aceh. if only i had the backing of my former prestigious hospital instead i must continue to battle their lies. they should be deeply ashamed of their actions, but i doubt they will ever face the truth let alone apologize. anyone who decides to blow the whistle on negligence and patient safety concerns needs to understand that the road ahead of them is a very tough challenge. we care so we take on the toughest of challenges, do not give up,
tsunami kim.....also these "audiotape" issues really vary from state to state.in my state as long as 1 of the 2 parties knows that a conversation is being recorded then it is ok.....i...was one of the two parties.so taping was legal and completly admissable in court...id it comes to that.
the sad sad reality is.....that unless i had audiotaped that nm ...it would have been her word against mine. now.....that hcf has to be willing to defend the nm who is on tape stating concrete lie after concrete lie.i mean the lady was so untruthful ....that she couldnt even "get her story straight" on what day an "alledged" event took place on.she is just ....aliar. but....do you think i would have been taken even remotely...the least bit seriously by anyone unless i had recorded that meeting? no....even with my perfect work hx at this hcf...and recent promotion......i would not not not have been believed.is that wrong? yes....yes it is.but thank god i did record it...and now...that hcf.....has to either stand behind their policies(pt safety policy, code of conduct policy, ethics policy, antiretaliation policy etc etc etc)...and do the correct ethical and "legal " thing...or be willing to stand up in court and say "well ...you see when this nm stated this "alledgedly"occurred on a friday she was lying then....but...judge please believe her now,.. bc she is actually now alledging this happened on a wednesday ...so ya really need to believe what she is saying "right now"....and lets "just not talk about" what day she said this "alledgedly" occurred on on that audiotape. i audiotaped it....and she is now caught in the tangled web of those lies. but......what if i hadnt recorded it? that nm could have said anything in the world she wanted and i would have been defenseless against it.is that scary?
i too advise everyone...audiotape, document times dates etc etc., look at all the events leading up to and after the event. make copies of your long distance phone records.utilize an atty.....and even though your trust has been damaged by that hcf.......give them a chance....as hard as it may be.give that hcf a chance to do the correct thing.in large hospitals...sometimes.....these unethical nm's are not uncovered for years.if that risk management dept and compliance office...and their legal team doesnt "know" about the problems then you cant expect them to correct it by removing them.they are kinda like a "big machine".....and sometimes they dont realize they have a small malfunctioning "part-nm" until we point it out.as hard as it is...when your trust has been violated...you have to give them the chance to correct it.i...am struggling with that...bc....it seems like all i get are more broken promises.i...loved my job....loved my coworkers...and put alot of myself into it. i lost my job....bc....i saw and reported that nm's best friend working ...praticing unsafely .does that scare you?well...it should.it should scare the h*** out of you.if they can take a highly skilled ccrn with a long hx at that hcf...with no write ups....in all the years i worked there....and terminate me for voicing my concerns over patient safety issues...then it can happen to you....your coworker.it should scare you so much...and wake you up enough to pay those monthly dues to your state nsg association....and make you get active in their legislative efforts. these laws like the patient safety act that president bush enacted a few months ago are begining to be expanded in all the states.stories are making it out to the public and more legal protection is being offered to the nurses like barry adams who have a strong ethical core to their pratice.
tsunamikim....have you thought about a different avenue?maybe since ...this is a "broken part-this nm"....maybe ...maybe there is someone at that hcf "the big machine"that is influential enough to actually listen to your concerns.it doesnt have to be in the compliance line. maybe someone...whose own life has been touched at some time by these patient safety issues. :idea: :typing
tnnurse and so many other dedicated patient advocates,
there are certain employees who are more likely to become the target of a campaign for removal: you are in one of those two groups: tenure nurses. the second group comprises innovative or outspoken employees in any job category; i am in the latter. the relentless drive to remove experienced tenure nurses is purely financially motivated. however, new grads are not only cheaper they are more compliant with breaches in patient care through lack of coverage. they are not yet secure in their job or bold enough to speak up. they may also fear not being taken seriously or being ridiculed for their inability to cope. sometime the more experience we gain the more we come to realize the potential for disaster; i have faced many disasters at sea and i became a very conscientious captain.
the toxic nurse manager is key to this process and very valuable to the hospital. don't be fooled your hospital will defend their toxic manager with a tenacity beyond belief. she is laterally worth her weight in gold with the money she saves; the dirty money of dangerous understaffing cut backs. the hospital can distance itself by pretending that the nurse exodus has nothing to do with them, but it was precipitated and supported by them. the toxic manager will help to transform her clinical area into a less desirable working environment and worse. as the situation deteriorates the tenure nurses are the first to leave as they do not have to put up with abuse they can find another job. policies that make the tenure nurses feel demeaned and undervalued are instituted and their benefits package meets a few budgetary constraints. as more nurses leave the working situation becomes more oppressive with mandated overtime and excessive call to cover the staff losses. you are left with the least experienced personnel trying to cope as they scramble to gain basic experience. this is happening all over the us so that we can maximize hospital profits. it is unsafe to the point of criminal negligence and we must expose this corruption to public scrutiny.
people like me are dangerous because we dare to rock the boat; i even broached the subject of the "nursing exodus." i am an ideas person and i was vocal right from the very start. as a new tech i considered myself still in training when after less than a year on the job i made my mark. a surgeon became frustrated during a case and humiliated me with a reckless tirade during surgery. i wrote a letter to him admitting that i was still learning, but making a point about how his conduct had intimidated those in the or and thereby endangered the patient when we could no longer function as a team. it was a long letter, very cathartic in the writing, but then i questioned giving it to the surgeon. an anesthesiologist friend read it and wanted to share it with her boss as she felt it really struck a cord. i removed all the names and it went from rooky tech to the new dean in one leap. the dean called a meeting of all the heads of surgery and made them read the lengthy two page letter; he said "this behavior has to stop and it has to stop now." i thought "the letter," as it was now called, might shake a few trees; it napalmed the forest!
i was really pleased with the hospital's swift response. they set up six separate multidisciplinary teams to look into various issues in the or and i was on one of them. we were all committed to the new goal: creating a "perfect day in the or." the frustrations that precipitated the outburst i experienced were finally going to be addressed and dealt with, i was impressed. due to the vintage of our prestigious institution's general or suite the challenge was tremendous, an antiquated facility had not kept pace with new technologies and the frustrations were numerous. these committees met once a week for almost six months. this culminated in an or retreat at the inner harbor, a grand event that took place on my birthday the 28th of march with over 200 or employees attending. the dean while never publicly acknowledging me as "the letter" writer wrote a letter of commendation that was placed in my file. the outgoing director of surgical nursing also wrote a letter, but more to the point we were making progress.
the new director of surgical nursing bought these efforts to a screeching halt. we didn't even see her in the or for the first 8 months that she was there. this is the same top level or manager who lied under oath at my arbitration hearing and she remains there to this day: enter toxic management all of the recommendations in the one inch thick book we had generated through the diligence of our committees was swept under the rug. we returned to our old fatalistic, "nothing changes" mindset, employees felt jaded and used. the "perfect day in the or" became an elaborate wall exhibit to fool jcaho during one of their perfectly choreographed scheduled visits where as usual the or was transformed to deliberately deceive them. filthy overflowing trash dumpsters were only kept in the hopper room during jcaho visits. if challenged in a future hearing the hospital will have to count on more than a hundred or employees all lying to cover up the sordid facts of this negligent practice and deliberate deception: i don't think so.
the entire or retreat project was abandoned in favor of toxic managerial policies to trim down the work force by getting tenure nurses to leave, and they left in droves. the pto (paid time off) that trimmed their paid leave benefit, the "occurrence policy" that discouraged use of sick time: calling in more than three times a year put you in the disciplinary process. then there was the final insult big fat bonuses paid to travelers for signing on for a few more weeks while regular staff shouldered the burden of excessive call. in my ignorance i, a non-nurse, tried to suggest strategies for nurse retention as i was deeply concerned about patient care. i had failed to grasp the deceitful concept of understaffing through toxic management policies. i also tried approaching the dean again to suggest a follow up that used a computerized system to channel ideas from ordinary employees to the management, but it was of course ignored. i now call that idea the "kaleidoscope of innovative momentum," but it was an outgrowth of the or retreat.
however, my hospital now had a far more important focus, they were right on track to sop up all those profits from understaffing. toxic management was the key and input from the staff was unwelcome. i was warned by many, "nothing ever changes around here, don't rock the boat." my evaluations were astoundingly mediocre while they did not reflect the duties i was entrusted to. i started reorganizing the instrument trays on the insistence of my nurse manager. however, after devoting hours of my personal time to this project when it was finished she stalled me with "there's a lot of change going on right now." i was selected as one of the techs who would work with our most difficult and demanding surgeon the other was a far more experienced older tech. at first i used to tremble in his cases; at the end of the first one he shook my hand and said: "you survived." it was working with this surgeon that made me so fanatical about the way i did my job in the or. i was fastidious to the point of being a tad neurotic and this did not endear me to all of the nurses, but i could live with that. i tried not to let surgeons "dump and grab" from my mayo stand with impunity and that annoyed a few. however, when management tried to delete their most effective skin stapler i alerted the doctors by circulating a petition and the decision was reversed to meet their needs.
although all of the staff were free to attend surgical grand rounds, no one ever did except me. perhaps i gained the respect of my surgeons through hard work and that dedication to further learning i demonstrated by attending their grand rounds every saturday without fail for three years. later i became one of the techs trained to work with the operative robot used in our living related donor nephrectomies. i joined the or education committee, submitting a quiz on ecmo. i was able to change my shift assignment to work several of the most challenging and severely understaffed weekend shifts which i continued to cover for nearly two years until my untimely departure. i did a lot of trauma and transplant cases; i had to be able to do literally any type of surgery that came to the or, even opening for the cardiac team until they arrived. this level of functioning wasn't the hallmark of an incompetent tech, but my evaluations remained alarmingly noncommittal as i was already identified as a risk to managers. knowing they would look downright negligent assigning an incompetent person to cover such demanding shifts the or managers chose to paint me as a "troublemaker," abusive, threatening and even mentally disturbed. the hard earned respect of surgeons was almost certainly destroyed when they saw me escorted out by security like a common criminal.
my hospital was a level one traumacenter and as such under comar we had to be able to man a trauma or in 15minutes or less. comar didn't say we could abandon another patient already in surgery just to man a trauma room. however on a saturday night after 11:00pm our coverage dropped to just one nurse and two techs with an assistant for room turnovers. if we started a case we were supposed to call in a call person to stand by for trauma because at that point we only had half an or team. however, if we didn't call in that call person it saved the department money. so if we had a lengthy case under way and a trauma came up to the or then the one nurse would split her services between two ors that were technically not even in the same building let alone next to one another. there was no spare person to even call the call team for backup if they came to the or stat. it seriously compromised the care of or patients, but it saved the department money and the toxic manager who condoned it would profit from that with a bigger, fatter bonus for doing her part in helping to make the unit unsafe. when the compliance line questioned managers about not calling in the call team they blamed it on the "nursing shortage." this was bs because we had people standing by on call and the obligation to cover that call had no bearing on the "nursing shortage" as it was always covered. we were just saving money by leaving our call people at home.
the night that i was left stranded for 12hours was one such occasion when they should have called in a call team person to stand by for trauma. the charge nurse on duty was the hospital's most notoriously abusive or nurse manager and after 11:00pm that night there was a fairly new nurse on duty instead of another tech. this nurse manager was so abusive that droves of nurses left her shift and she could barely get new nurses though orientation before there was no one there experienced enough to orient them, that's how toxic this manager was and how bad the situation got! new grads assigned to her had to learn very quickly as they were needed to train even more inexperienced new grads replacing the tenure nurses. working under this abusive nurse manager employees talked about dealing with the "s....factor" (her name); no one tolerated it for long. when i told upper management about this they appeared genuinely shocked, as if it was something they had absolutely no knowledge of. there is no possible way that they could not have noticed how many staff especially tenure nurses left her shift: it was a lie.
this rouge nurse manager was responsible for the decision to keep so few staff on duty on weekend nights, she could have stated that she needed more staff: negligent in itself.. she taught the trauma courses, but she was also responsible for teaching new grads that if they took charge on saturday night it was simply unnecessary to call in a call team to stand by for trauma. the hospital had confidence that these raw recruits barely out of orientation would cope ok if there was an emergency. they could just wing it covering two ors until a call person drove in from home after they got a chance to call them in. luckily there was no trauma on the night i was stranded for 12hours in that liver transplant because my patient was on bypass and that case was very challenging to say the least.
the abusive nurse manager entered the room once to relieve the circulating nurse who had come on duty at 11:00; she was told to "run to the bathroom quickly" as if some major emergency was pending. she returned in less than 10minutes, but i was really absorbed in a critical part of the case and had barely looked at miss abusive while she was in the room let alone spoken to her. this nurse manager did not believe techs were worthy of being given a break at all anyway, so she left and didn't return until the end of the case at 6:00am. because of her comment to my circulating nurse we refrained from calling the desk thinking some emergency was about to come to the or. i was convinced this was the case and since calling the desk would tie up one of the only people able to call out to bring in call people we refrained from doing this. it was becoming an increasingly more harrowing task to call in people with the staffing shortages. there were no overhead calls, but there was only one other person free in the or to hear it.
i think the abusive nurse manager spent the entire night surfing the internet in her office. when she came to my or i tried telling her i was about to pass out and she might have to take over from me so i could get something to eat. i had to repeat myself three times and when she finally heard me she gave me another task to complete before breaking scrub: "just suction out all the fluids before you leave." to avoid getting written up by miss abusive for disobedience i suctioned out all the saline, slush and ice despite feeling as if i was about to pass out. after 12hours without food, water or a pee it was little short of cruel and inhumane punishment. i was shocked to find out there had been no pending emergency, but she claimed she wasn't "just sitting around eating bonbons" that she was preparing instrument trays. this task would in no way preclude her from giving me a break. i was later expected to explain why i had not pestered the desk with calls requesting a break as i had to prove i had asked for a break. i feel that the nurse manager's single most important duty that night was to my patient; she should have ordered me to break scrub to protect his safety. however, not only did hr condone this abuse, the compliance line and several regulatory agencies i contacted all thought that leaving me stranded for 12hours straight was perfectly ok.
this is an interesting reprint from a document that those who work under similar unreasonable, torturous or downright inhumane circumstances in the us should take careful note of:
43.hours of work are interspersed with one or more eating and rest periods of not less than half an hour. continuous work may not exceed five hours. the rest period in jobs which span two meal times ranges between one and four hours (labour act in force, art. 58).
in my case the comar violation was a "smoking gun." which my complaint about the situations where i was left without relief had inadvertently uncovered. their dirty little secret was out: not calling in call people to stand by for trauma when another case was running was against their own policy, not to mention comar regulations, but it saved them money. all these little infractions, changes in policy, leaving toxic managers in place to help trim down the work force: it is all about the money. just one month after i left they started calling in their call people to stand by for trauma. for me there was no stronger indication that what i said was absolutely right. when i contacted miemss the maryland trauma agency i told them that quite possibly all of the baltimore level one trauma facilities were misinterpreting their comar policy on or coverage in exactly the same way and perhaps they should consider altering the wording to close this loophole. i was never thanked for this input, instead i was treated as a nuisance.
i made sworn statements to the meimss attorney about several violations of the comar regulations at my facility that i, in good faith, believed endangered trauma patients. another issue was not expecting or insisting that our or techs maintained any basic cpr certification. it was the hospital's way of discounting our role in the or as "idiot work" at the expense of demanding that we were better prepared for trauma. as you all know good cpr quickly becomes exhausting so in minimally staffed off-shifts it was doubly important for the or team to all be able to take turns maintaining cpr in an emergency. i was acls trained at my previous hospital and was adamant about at least keeping current with cpr. but it was if you feel like it, on your own time. they wouldn't even allow use of the title surgical technologist as it implied that we were trained. this is the big trend towards minimally trained staff. some hospitals have or techs doing the circulator role which is grossly inappropriate as it does not match the absence of documentation training that we receive as techs. and just provides a cheap scapegoat when things go wrong.
meimss did not bother to investigate, but informed me over the phone that the issues i had raised "did not specifically endanger trauma patients." obviously it was ok to endanger other or patients to drop everything to offer timely care to or trauma patients: presumably those "other" patients weren't in their remit! miemss never put anything in writing to me, as that would have acknowledged that there was indeed a problem and that i had reported it. i had tried to deal with this issue in-house by going up the chain of command, but after i was fired i was not prepared to let the matter go. then i contacted the compliance line to give my hospital another opportunity to handle things internally, but that too was ignored. only then did i contact outside agencies. unfortunately, those agencies were easily fooled by the "disgruntled former employee with an axe to grind" hype. added to which i was going up against the single largest employer in the state of maryland, the most prestigious well revered hospital in the nation; it was like squashing a gnat! this lack of oversight may still endanger patients in baltimore even five years on.
the important thing here is that it was documented and i did absolutely everything i could do to end the negligent practices; my conscience is clear. it may take a patient death to expose the issues i bought forward, but if and when that happens my documentation of the danger will surface at last. what continues to drive me five years on is that it is not necessary for anyone to die to correct these problems, so i feel compelled to continue speaking out even from exile on the other side of the atlantic. this is what you must keep in mind: document the danger and do not allow them to silence you, hopefully no one has to die from this negligence before the truth is revealed. it is easy to imagine that if there is no written reply from them it was not very important; be governed by your conscience human life is important. they think that by ignoring your letters of complaint and reports on negligence that the situation will go away and the big bucks from understaffing will keep rolling in. understaffing is a form of fraud and you are bearing testament to the truth. do not let their inaction persuade you to abandon this important paper trail of evidence; this is really vital. if something adverse happens in the future it will be hard for them to deny any knowledge of past reported negligence when there is a stack of ignored letters of warning from you documenting everything.
even as i parted with so many personal possessions when i was forced to abandon my baltimore home i got one file of paperwork out to be carefully preserved with a trusted friend in the us so it will always be ready to go to court. there were so many other treasured items i left behind, but it was my solemn duty to protect that one file. i hope that one day we may be called upon to testify before an inquiry. i live for that day. i will beg and borrow the money to return to the us to testify with all of my british family and american friends in full support of my stand for justice. that will perhaps be my last duty of us citizenship as i have been totally trashed and abandoned by the us in every possible way. please keep speaking out!
although i know that some things have changed for the better at my old hospital i am sure many have not. they rely on their iconic status to avoid scrutiny and bend a few rules to maximize profits. they have been caught a few times recently, but no one seems to recognize the pattern of "we are above the law;" they think regulation are made for lesser institutions and do not apply to them. meanwhile their spin doctors are busy building on this aura of squeaky clean respectability, honesty, integrity and transparency. have you been overwhelmed by the honesty, integrity and transparency of their actions in the accounts i have posted? my former hospital is still wining accolades for their innovative patient safety initiatives while refusing to explain why they have not bothered to investigate my allegations or the retaliation used to silence me. they should really take the prize for hypocrisy!
when my petition is posted on thepetitionsite.com you will know the name of this hospital; it will be there soon enough. i do not know how effective this tactic will be in demanding an investigation into my case. my petition appeal will only call for their compliance line to do a proper investigation; it appeals to that same dean who wrote a letter of commendation for me so long ago to insist on this being done. the compliance line say that they looked into things, but i just didn't like the outcome. they can hardly have looked into my case very thoroughly if they did not need to review anything from me or call me in for an interview. besides a legitimate investigation would result in a written conclusion sent to me, but there was nothing, just vague reassurances over the phone to fob me off. i was told: "there seems to be some truth to what you are saying, but we have decided to just keep an eye on things." this was not an investigation it was crude damage control, a cover-up, good pr spin; it was certainly more about deceit than "transparency."
the real importance of opening my case is to expose the faulty hr dismissal process as it is used to silence patient advocates: that must stop. it must also expose the fact that the hospital's compliance line does not comply it is just a sham. if i can still maintain my commitment after five years, loosing everything and abandoning my country of residence, then please if you are facing a similar situation stick to your guns and do not give up. the internet is a great equalizer, it may give us all recourse to justice. do not trust management, hr, a compliance line or outside agencies; unless their actions prove worthy of your trust remain cautiously skeptical at all times. keep generating the paper trail and hang on to every document you can get hold of. contact the whistleblower hot line, but don't ever give up.
if all i manage to do is leave a paper trail to demonstrate that all the warnings were there in black and white, then so be it. my most fervent hope for the future is that my petition will pressure the doctors who have created such impressive patient care initiatives at my former hospital to first clean up their own facility then work towards enacting sweeping changes industry wide. because of this prestigious hospital's influential position in the most prominent leadership role in us healthcare there is an excellent chance they may try to do this if for no other reason than to regain public trust and polish a tarnished reputation. this possibility is a good thing for all of us and well worth fighting "goliath" to achieve. i hope you will support my petition when i post it as they will need to end their denial, investigate my case and humbly admit wrongdoing first.
there are certain employees who are more likely to become the target of a campaign for removal: you are in one of those two groups: tenure nurses. the second group comprises innovative or outspoken employees in any job category; i am in the latter. the relentless drive to remove experienced tenure nurses is purely financially motivated. however, new grads are not only cheaper they are more compliant with breaches in patient care through lack of coverage. they are not yet secure in their job or bold enough to speak up. they may also fear not being taken seriously or being ridiculed for their inability to cope. sometime the more experience we gain the more we come to realize the potential for disaster; tsunamikim...you hit the nail on the head.these new grads..."want" to do such a good job.....and will become excellent nurses as they gain more experience.but...when you have a mass"exodus" of all the experienced nurses who are there to mentor them, to be a resource to, to pick up on the things they "cant see yet" before they turn into larger issues that results in a patient coding.....then how truly beneficial is it for them? how safe is it for patients to be in that position to where an icu is staffed 90%+ with nurses who have 1 year or less experience.on an average night you have 10 icu nurses working........9 out of 10 just graduated.on some nights you have a new grad (8 months) who is the most "experienced" nurse on that large icu and has to do "charge nurse" for the unit.is that fair to her? has she been a nurse long enough to realize the potential gravity of being placed in that situation?i dont like it.they would have hung that young nurse out to dry if a sentinel event had occurred.she....nor any of the others were acls certified.guess what? this is a large level 1 trauma center we are talking about here too. our nm turned a deaf ear to the experienced nurses as they complained about pt safety being compromised by the high# of new grad hires...and eventually they pretty much all (on my shift) left.now those new grads have fewer and fewer resources...and yes.....you are correct ....their huge fear is being perceived as "not being able to cope". it's not about "being able to cope"....it's about what is the best safest thing for the patient.and....that is not an icu staffed by 90%+ of new grads. these nurses....are excellent and want to do such a good job......but those kids are left high and dry with limited resources....and that huge fear of "if i complain...they will say i am weak , that i cant cope,..that i wasnt cut out for high acquity patients". and that tsunamikim.....is sad.it is ethically and morally wrong....just wrong to place those kids that have come there to learn....and that want to do a good job...it is wrong to place them in that situation....and wrong re: the pt safety aspect of it as well.nurses are going to have to get active.....go to those state nsg association meetings...participate....find out what can be done....what "they " can do.
Specializes in ub-Acute/LTC, Home Health, L&D, Peds.
Hey Kim, very thought provoking post, but why was it edited by Nurse Ratched as noted at the end? I am an RN and have extensive experience as a circ and understand the environment you describe. In reviewing many posters here it is evident that this cord of frustration and intimidation runs rampant within many environs of healthcare.
Those that speak out are effectively silenced and discredited as zealots who hold a grudge! How are things going for you now? I am still working registry but also venturing into Forensics since I also am passionate about the law and this job combines the 2 dynamics. How about a book about your insights and experiences? I predict a best seller!!! Keep up the good fight.
I was thinking the same thing. TsunamiKim you write so eloquently and I enjoy reading your posts. I was thinking you should have something published!!:yelclap:
:idea: :typing
steelcityrn, RN
964 Posts
There are many, many cost related gross understaffing issues going on in our hospitals and this is one of the worst. Could this lack of O.R. staffing during surgery also be causing the high incidence of staph related post-op infections? I think we all know the answer to that. The fact that this person said she is diabetic does not have any bearing on her position. Come on now, if you can't stand for 10 hours because of poor leg circulation or low back pain should you be tossed out of your job? Too bad nurses can't be like the coal miners.