Reported Suspected Elder Abuse, now I'm terrified

southern_rn_brat · Jan 27, 2005

The DON or administrator should be the only ones reporting to the state.

When a med error is found, you should follow your facility policy and procedure.

All I can say is....WHAT were you thinking??????

southern_rn_brat · Jan 27, 2005

the patient got an order from the doc?? who took the order? the patient?

When you recieve allegations of abuse, your job is to interview the patient, remove any staff involved from care of the patient and notify your supervisor on call/DON. That's all. That is what policy and procedures are for. From there, they will investigate it and decide what needs to be done. That decision is not ours.

I would fully expect to lose my job had I done this.

spaniel · Jan 28, 2005

Anyone suspecting abuse should and must call and report the abuse, be it the janitor,LPN or DON. It is corrrect to call the hotline or the state directly. If the administration relatilates, call the dept of Labor. It is not infrequent for the administration to retaliate. The state and DOH is well aware of that as are the various Attorney Generals. Do not resign. You absolutely did the right thing from a legal and moral perspective.

spaniel · Jan 28, 2005

Hi again-One cannot just "let it up to the management to decide" if there is abuse/neglect,etc. This is why we have licenses. The law is quite clear. In fact to NOT report abuse is defined as abuse.

CHATSDALE · Jan 28, 2005

please clarify part of post in which you said that the patient called md for drug order?

did the md then call and give nurse an order? how was it written and how did the over-dose occur..did you call the adon when you could not reach don and report it when you made discovery? a lot of unanswered questions here...

talking with don/adon would have given them a chance to report it to state themselves after they had inverstigated...usually on weekends there is a window to the next business day for reports such as this...did the pharmacy respond

was lab for possible liver damage done??

you weren't wrong but maybe you need to get some idea of what the facility procedures are in cases...one problem here is that you may have endangered another nurses license and brought the facility under investigation for something that may have been handled in house...

i would never advise you not to put the patients welfare first and foremost .. you have your own license to protect and if you felt like this was the proper way to proceed then it was your ultimate decision .. if things don't get better look around for something else...

CrunchRN, ADN, RN · Jan 28, 2005

You did what you are supposed to do. Unfortunately not all management decisions are made to comply with the law. Elder abuse is very serious and must be reported. I think I would resign as I would not want them to have a chance to trump up any kind of retalitory evidence. I would give proper notice, but if they (hopefully) ask you to leave right away, I would make them document that it was their request that you not work the 2 weeks. These things are covered up all the time, and that is one of the reasons some LTC's get away with some really nasty conduct. I know some LTC's that are wonderful, but many that are not. I would look for an RN,JD as they would know how to protect you and understand the system much better than an attorney who is not a nurse. I know there is a website that helps nurses in this way - does anybody know the name?

I am very sorry for what you are going through and wish you all the best.

PMHNP10 · Jan 28, 2005

The DON or administrator should be the only ones reporting to the state.
When a med error is found, you should follow your facility policy and procedure.
All I can say is....WHAT were you thinking??????

The nurse told the pt. to call the MD for pain meds herself and as a result a medication error occurred with the total dosage of tylenol. While the story doesn't make much sense to me, telling the pt. to call the MD herself is abuse, plain and simple. Did I understand correct that the nurse charted that she actually said this? Talk about hanging yourself. As for the med error--again, from reading this story I feel there are details missing, but I get the sense that the OP did follow policy and procedure by notifying the family and MD; or at least it seems reasonable.

I guess the issue I'm having with your post is that I don't quite understand why you believe the OP was wrong for not reporting to the NHA and DON first. I'd agree in this case it might have been better to report it to them first, but to post the question "WHATwere you thinking??????" I sense you believe it was a horrible thing for her to do; as though it were an unethical, or illegal action. I just don't see where she did anything so wrong, but I don't work LTC, and never have, so maybe laws for reporting abuse are different from the acute care setting.

southern_rn_brat · Jan 28, 2005

Hi again-One cannot just "let it up to the management to decide" if there is abuse/neglect,etc. This is why we have licenses. The law is quite clear. In fact to NOT report abuse is defined as abuse.

I don't agree.

That is what policy and procedures are in place for. She didn't follow them. I believe you should follow your p&p first. Had she done that and then they STILL didn't report it...now thats another story. In that case, yes she SHOULD report it. But she never even gave her administration a chance to do an investigation, which should be the first thing done internally. That is what I was referring to. Any of us can lose our job at any time for not properly following policy and procedure. Had she done that and then still felt the need to call the state in instead of calling the state BEFORE she even reported it to her supervisor, then I think she would have a case. As I see it now, she didnt follow her p&p at all.

Following this protocol is NOT not reporting abuse. Of couse we have to report abuse! But we need to do it properly.

That's all I am saying.

southern_rn_brat · Jan 28, 2005

The nurse told the pt. to call the MD for pain meds herself and as a result a medication error occurred with the total dosage of tylenol. While the story doesn't make much sense to me, telling the pt. to call the MD herself is abuse, plain and simple. Did I understand correct that the nurse charted that she actually said this? Talk about hanging yourself. As for the med error--again, from reading this story I feel there are details missing, but I get the sense that the OP did follow policy and procedure by notifying the family and MD; or at least it seems reasonable.
I guess the issue I'm having with your post is that I don't quite understand why you believe the OP was wrong for not reporting to the NHA and DON first. I'd agree in this case it might have been better to report it to them first, but to post the question "WHATwere you thinking??????" I sense you believe it was a horrible thing for her to do; as though it were an unethical, or illegal action. I just don't see where she did anything so wrong, but I don't work LTC, and never have, so maybe laws for reporting abuse are different from the acute care setting.

My "what were you thinking comment" was at the entire post. I don't think she did anything illegal. I haven't read the charting so I can't comment on the unethical part.

From the OP, I just got the feeling that she didn't think through the whole situation to the end.

Since when do we take it upon ourselves to report med errors to the state on a weekend?

I believe in the chain of command and following policy & procedure. They are in place for a reason. Once that is properly followed, THEN if I feel it was "covered" up, I would feel justified to report it to the state myself.

At NO time do I feel resident abuse is acceptable!! But there are mistakes and then there are reportable mistakes. P&P helps management determine the difference. I don't feel from the OP that she thought thru the situation.

If I did something like that on my shift, I would fully expect to be reprimanded for not following facility protocol and would probably lose my job.

As the nursing supervisor, it is my job to do that. That is all I am saying.

danvet · Feb 16, 2005

Thank you all for the comments you have posted, positive and negative. I'd like to clarify some of the questions you had:

1. The patient stated that the nurse told her to call for herself. There was an entry from a nurse that said they had received a call from a doctor in response to a patient calling for herself. So yes, the nurse received the order from the doctor that the patient called in response to the nurse's comment.

2. I just want you all to know that OF COURSE, I called and notified my superiors. Unfortunately, I got told to begin the investigation which is when I happened upon the forms that were required. Unfortunately, the DON was out on leave and unavailable period. The administrator wasn't any help. I absolutely followed the policy and procedures within our Hospital which they have tried to dispute with me. I actually copied the p&p and gave a copy to the management team. The reason it said to do what I did was because to say anything else would be unlawful and against regs.

3. The state required form when you are doing an investigation is VERY clear and simple to understand. It is in fact an individual responsibility and don't you all think for a minute it is not. Perhaps if given more help or support from management, this would have all been avoided. It was a very difficult position to be in.

I still work there and have no intention of leaving. I filed a complaint with the CEO and quickly thereafter, all harassment has since quit. The management has even been "nice", overly nice to me. Wierd kind of nice. My legal counsel says that they likely have been informed by their own attorneys that what they have done is wrong and are now trying to avoid a lawsuit because no other explanation could be ascertained.

After having been pulled into many meetings with key top level management, after being harrassed and made to feel stupid, the only thing they could come up with was an issue on rating the pain level which I hold to be the responsibility of the nurse assigned.

Amazingly, the nurses I work with were AWESOME support. Nobody has pulled away, though I don't feel it's something that I have to drudge up at work anyway. I had an ex-employee (since all of this occured) come up and say that I had earned the respect of the nurses.

My intention was never to cause a problem with the facility, but to do what was required of me from the standpoint of the patient and for my license. I can't imagine that anyone would think I thought half-heartedly about something like this. I actually called the state first to find out if this was even considered a reportable event and have spoken with an obudsman as well. I am very meager and never want to draw attention to myself nor make waves. The LAST thing on this earth I would want is for the state to come in. I didn't think it was that big of a deal after hearing from the state and from the ombudsman that I was REQUIRED to do so. The reason for mandatory reporting being an individual responsibility is to protect patients from having problems of questionable abuse hidden and either partially or if at all corrected.

I do believe that these issues can be handled internally, however, even if handled internally, the facility must still report the entire case to the state as well and their findings. The state doesn't do a knee-jerk response either. They allow the facility time to complete their investigation and submit it as well. Apparently, most facilities have issues that are reported and all should be aware and not be so critical. It's part of being in this business. If any of you have a chance, please look at the state required form. The front page is crystal clear on your responsibilities as an individual and as a facility.

The bottom line is: Administration/management has a responsibility to be sure that they have adequate resources for the supervisor to consult with. A NON-RN is not appropriate. While the non-RN may be aware of the state regs, they are not aware of the ramifications to the RN license. I would rather defend myself on the actions I took rather than sitting in defense of my license. In my opinon, the facility should have give MUCH more training in regard to this issue if they are going to treat their staff like this. All staff should know what is required, what is expected, and what the ramifications are. No human being should have to be put through this much huimiliation or stress for doing what is required. The facility can take their own course in investigating and disciplining, but it's imperative that employees know that your responsibility is not the same as the facilities responsibility. Each has a responsibility and the punishment can be harsh for failure to report. I fully believe that the reporting party should be cooperative with administration, and I surely was! I had not grudge or issues against this employer. I know for a fact that the reason that I have my job today is because I did in fact follow procedure, and I followed the law. What I know is that I would still report, but it would be handled altogether different and I don't think I would be inclined to give the facility a "heads up." Just for fear of this type of stress. I still know that they did get the "best" of me. My spirit is truly broken and my self confidence is gone. I'm mostly upset that I had to be placed in this position to beging with.

This facility has accomplished one thing for sure. Not only would I NEVER tell them I was going to or did report something, the employees that have witnessed this have told management that they would not because of what they saw happen with me. They all say they would do the same thing but not write it down and call from home anonymously. I ask you: Would you rather your employees do it without telling you they did or just be hit with it when the state walks through the door?

I feel that this has really taken me down, almost enogh to want to leave the profession altogether. I have since been asked by non-nursing employees considering a career in nursing if I would recommend it.

Hard as it is, not only did I say I would despite my experience, I actually said that the employer was really a good employer with a few misguided individuals making it difficult at times. And I do firmly believe that we give the best care possible and I am proud of my work there. I know all the staff works hard and I do to. I refuse to run because they don't like to follow their own policy and procedure.

Please let me know if you have further questions. I'll keep you updated, though I think that aside from filing a complaint with the EEOC, I intend to let it go. I mean, I don't want to go to court and get lots of money. What I want is a: staff to feel that they can report what is reportable if doing so in good faith without fear of retaliation and B: To change their practice on punishing employees because they did their legally mandated obligation.

I can't help but wonder what the CEO was thinking about all of this. Time wil tell though. For me, this is a total loss of respect for management in regards to fairness, ethics, and the law. I respect them as professionals in their areas, but I wouldn't trust them as a manager any farther than I could throw them. I feel that's what has been crushed. I held the utmost respect for them prior to their retaliatory actions. I'm sure over time, and the process has begun, I will mend, but it will take time. At least when I lay my head on my pillow at night, I can rest knowing what I did was right, ethical, and fundamentally correct. I wonder how they sleep at night.

Oh, by the way, the nurse that was involved in this case and myself are very sociable and talk, laugh together a lot. I truly didn't think that it was that big of a deal, and neither did the nurse involved. We've discussed it and she agreed that she would've done the same. And, of course, knowing her, I know that this was not her intent. I'm willing to bet she had a day from hell on that particular day and no maltreatment was intended. She's a very sweet nurse and I do respect her.

Thanks!

DutchgirlRN, ASN, RN · Feb 16, 2005

YOU GO GIRL !!! I personally would never call the state until I was able to get a hold of the DON or whoever was on call. If they didn't do anything after you told them then that's a different story. You did follow the p&p's, you took the appropriate actions to protect yourself, you stood up for yourself. The main thing is that the patient was not harmed. YOU ROCK !!!