Retaliation for voicing concern over unsafe pratices

Keysnurse2008 · Dec 12, 2005

tsunamikim,

were you as shocked as i...to find out how widespread this type of thing is?i mean...i have been contacted by tons of nurses who complained over patient safety issues ranging from ...unsafe staffing to incompetent pratictioners.the sad common factor in all of these situations is that.....the nurses suffered retaliatory acts/retaliatory discharge......and the other sad common factor is that patients were placed at risk.think about it...these patients are soooo sick now just to meet admit criteria......and then you introduce them into a environment where the nurses are complaining that the environment is not acceptable/unsafe.when you complain.....you are effectively silenced by management.there is just nothing about this whole situation thats ethically right, not to mention legally. i am shocked.i feel an obligation to become more invested in assisting the ana in any way possible.

on your situation....am i understanding you correctly?that they have accused you of making harassing phone calls simultaneously while you were physcially in the or as scrub?maybe.....you should ask if these messages(phone calls) they received were telepathic?...bc....otherwise you cant be doing both.thats an outrage.do they track the infection rates?since you were obviously touching the phone(fomite)?do they have reports from the surgeon complaining that you were placing his patient at risk by breaking sterility to go "scream" on the phone?.......i bet......they dont have jack from that surgeon...do they? i am just in awe.i feel like i have been so sheltered....bc....before this happened to me i never knew all these type of retaliatory acts occurred.want to know something sad? my facility lost so many experienced nurses ....that after i left they had no one to do charge one night. on this particular night...in one of the areas largest icus....a new grad nurse was left to be in charge of a very large level 1 icu.this new grad( nurse less than a year)...was the "most experienced" nurse on the unit that night.she...nor any of the other new grads were even acls certified. this nurse...is a great little nurse...who tries to do such a good job.but what would....that hospital have done to her and her nsg liscence if their had been a code that night...or if any negative event had happened?that was not fair to her....and i hate the fact that i now know what they would have done to her if they even heard a whisper that anything negative had occurred.she would have lost her nsg liscnece...they would have hung her out to dry.it makes me sick to think they placed her in a situation...bc...she is a good nurse...she is just trying to gain experience.lets play devils advocate....what do you think wouldve happened to her if she had refused to do charge?care to take any bets on it?

TsunamiKim · Dec 12, 2005

tnnurse,

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 trauma center 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 out 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).

unhcr is helping to legislate more humane working regulations in iraq than are afforded to us workers even in critical jobs like healthcare! the "labor act" is a un document, please visit this site: http://www.unhchr.ch/tbs/doc.nsf/(symbol)/e.1994.104.add.9.en?opendocument

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 absolutly 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. this is not transparency it is deceit. the real importance of opening my case is to expose the faulty dismissal process as it is used to silence patient advocates: that must stop. if i can keep going after five years and loosing everything then please tell me you will stick to your guns. the internet is a great equalizer, it may give us all recourse to justice. i hope you contacted the whistleblower hot line: don't give up,

fair winds & following seas, kim.

Haunted · Dec 12, 2005

After reviewing all your informative and thoughful posts on this thread I am overwhelmed with the multitude of abuse, physical, emotional and professional inflicted upon healthcare workers!!! I am astonsihed that we get buried, discredited, defamed, villified for our compassion and ethics.

True, I am a California agency nurse and am delighted that our nurse association, the CNA was able to effectively push for ratios but this was very costly and many nurses were unfairly painted with a broad brush by hospital administrators , the California Hospital Association, as lazy and unprofessional special interest groups.

Our media focused on horror stories like King/Drew Medical Center and attempted to panic the citizens with screaming headlines about the horrific "nursing shortage" in an effort to turn the public against us. I personally have been blackballed and branded by facilities and felt the sting of low self esteem and confidence shattered by being out gunned.

I have much to learn. My State BRN is working with a skeleton crew due to funding issues and laws and policies are being sheparded in the back door in the middle of the night, under the nurses radar and we are left to trust the facilities interpretation of these as gospel.

The fulcrum of justice will currently side with the big business and deep pockets of hospitals, ironic that they offer free legal representation as part of the attractive benefit incentives to newly hired MD's !!!

I submitted a thread about a year ago "I got canned" which was the first step on this journey towards truth , justice and patient advocacy and cannot see the light at the end of this tunnel. Just last month I was DNR'd from a facility that I had been going to for over a year and observed some of the most horrific acts and blatant disregard for patient safety, still have nightmares. I have submitted the documentation to every authority I could and have been ignored entirely.

I'm not going away but neither is this problem.

Arden2 · Dec 13, 2005

when i first read about your whistleblowing incident, i was angry with the administration - just as the other responders are. retaliation for whistleblowing is reprehensible. you are not alone - most whistleblowers experience personal stress and loss as a result of speaking out. you know all too well the personal pain involved in doing so.

this being the case, i hope you don't mind if i suggest another angle that may shed light on your supervisor's reaction (however unjustified it may be) and a consideration the members of the resolution committee may voice.

many nursing codes of conduct indicate that "nurses must strive to prevent and minimize adverse events in collaboration with colleagues on the health care team." collaboration entails working with the team in a congenial way to resolve the area of concern. in your situation, you quickly reported the unsafe practices to the risk management department because "you had no other choice." an alternative would have been to first speak with your supervisor about the incident in a congenial manner - implying a degree of uncertainty regarding the accusation. this tentativeness is a good strategy to get people to work alongside with you rather than being definite and forcing them to work in a competing role with you. remember the seriousness of your claim - you are declaring a team member incompetent without going through the normal channels. how would outsiders view your intentions? maybe malicious in which case they wouldn't want you on their team anymore due to the injury to morale etc.

if after speaking with your supervisor no positive change results, then, depending upon the circumstances, a report to the risk management department would be in order.

of course, if you truly believe that in the interim patients are being harmed, you may need to speed-up the whole process but how much time does it take to speak with a supervisor about your concern? she can act promptly to take corrective action.

your intentions are good. but can you effect a positive change without harming your own career and causing all this stress in your life?

Keysnurse2008 · Dec 13, 2005

haunted....i have been a nurse for many years...and am now realizing the magnitude of this problem.i know that readers digest did an article a few years back about the nsg shortage....but....people are not fully understanding "what"is going on here. it is like.....we are talking about a peice of equipment.....but we are not! these are people....with lives, emotions, thoughts, memories, personalities, children.these are human beings...and when a nurse is not praticing at a safe competent level .....and that facility allows that nurse to gain competency thru trial and error then the public should know. these are not mere peices of equipment we are talking about.we are talking about the most vulnerable in our society.we are talking about patients that are lying in icu beds relying on the icu nurses to have enough expereince and strong enough assessment skills to pick up on the small subtle differences in their assessment that can literally mean the difference between life and death for these patients. when tenured nurses are driven out of their jobs by a nm that is more concerned over her budget versus patient safety then it borders on criminal.at my hospital....i had a long flawless work history. in apx 4 years i went from a base salary of 18$ an hr to a base salary of over 30$ an hr +shift diff.i didnt get those kinda raises for the heck of it. i am an excellent clinical critical care nurse and am a strong verbal patient advocate. i was my nm's "prize child" until i complained about her best friends lack of competency.she sent me an email "thanking me for all my dedication " only hours before i complained about her best friends perfornmance issues. then ...."poof" i was gone .i didnt even know what hit me!!!!i am still in shock. the "alledged documentation error" i was accused of is ridiculous.that same facility....had another nurse in a level 1 icu that failed to document an assessment or vital signs on a critical care -icu patient for the entire shift...this nurses didnt document jack! would you like to know what happened to that employee?was she fired?no! was she written up...suspended?nope!she wasnt...and she has a hx of being on performance improvement.unlike myself...who has a spotless work record for this hospital...nothing but promotions and raises and email after email after email from mgmt stating "what a great leader you are".."excellent nurse"..."role model"..."leader in positive change"....then i tell them i am going to risk mgmt bc they arent doing jack with this nurse...and "poof".i am gone. ......i am gone.....but the problem is still there. that raises yet another concern.....these surgeons are left "wide open for liability" when nurses dont speak up and deal with nurses that are not functioning at a competent level.

you know.....eventually this nurse will have / has gained competency. but...she is being allowed to gain competency thru trial and error. these are people in those icu beds.they are some to "somebody".they are someones mother, father, brother, sister, child, spouse friend...neighbor. there is "someone" out there...that is hoping and praying that they will recover.and when a hospital allows a nurse to "gain competency" thru trial and error it is ethically , morally,...and legally wrong.it is also a violation of that physicians trust.how would youlike to be the family member of one of the ones she "learned from"...the one that she was allowed to say "oops...that didnt work"...gee maybe i will not do that again. it is an outrage. when my fellow nurses started complaining about this lady...i was determined to find out for myself how this nurse functioned. i was on vacation....on vacation now.....my vacation had been granted and i was suppost to be off the last night i worked......but i had seen enough "things" to make me worried.so i actually volunteered to come in.....on my day off........while i was on vacation to really just watch her.i was sick of all the complaints and i was going to see for myself what she was/was not doing. i got to see allright...and when i was had seen enough to validate their concerns...i ...as a tenure nurse....was determined to make sure risk mgmt knew what was going on. i followed the ana standards and informed this nurse i was going to risk mgmt bc of my concerns.do you want to know what following the ana standards got me?it got me fired.it got me fired. fired for doing the right thing. i have a family...kids that depend on my income.....and i feel so abandoned by my hospital. i followed their policies.i followed the nurse pratice act.i followed my hospitals nsg bylaws.i did the right thing...and for that both my family and i paid dearly. :nono: :nono:

Keysnurse2008 · Dec 13, 2005

arden 2i know you didnt just ask me if i couldnt effect a positive change with """causing"""" all this stree in my life. first of all....i didnt "cause " this. my nm's inactions caused this. you may have overlooked where i posted that i wasnt even in the top 10 of nurses who had went to this nm c/o this nurses poor performance.this was her best friend whom she refused to "allow" her to have to "be oriented" to a new job.her mind was closed. she had proven she was going to "do nada".and according to my facilities policies i am not obliged to consult with my nm when it is a patient safety issue.i am only obligated to notify risk mgmt...and tell the nurse about my plan and my concern over her pratices. but....i was professional.....i actually attempted to schedule a meeting with the nm to inform her ....and i was met with a date to come in for my termination. i was "upfront" with this nurse regarding my concerns...and followed the hospitals policy.i didnt "ask" for any of this.i didnt ask to be the victim of an illegal retaliatory discharge.offhand comments like that are "why" so many nurses feel pressured to remain silent.perhaps i read your text/post wrong and you didnt mean it...how i interpreted it.

Arden2 · Dec 13, 2005

tnnurse

i'm sorry that my response upset you. i meant to help. i really do believe your intentions were the very best and you may even have saved someone's life. i was just trying to present another approach to the problem to save you from this kind of retaliation in the future.

of course, you did do the right thing. you did the noble thing.

to read about your pain and your family's distress made me stop and think about the issues deeply. i was hoping my suggestion may present you with other approaches if the same situation ever occurs again in the future - and from the sounds of things, it sounds as though this type of incompetent nursing practice is occuring all over the place.

how are you going to respond if your next job presents you with the same dilemna?

i simply wanted you to consider how management looks at whistleblowing. in every code of conduct it states that employees must report the problem to their supervisor first, before going anywhere else with it. i sensed you empowered yourself to assume the responsibility of your supervisor when the codes recommend employees always go through the hierarchy.

one scholar, j. baker, indicates there are three conditions that must be met before blowing the whistle: (1) the harm or potential harm must be very serious (2) one must have reported up through the hierarchy by going to the supervisor first and if the supervisor does nothing then one must go above her head and (3) the employee must have good reason to believe that the act of whistleblowing will significantly increase the probability of the desired change.

why is whistle blowing viewed so negatively in organizations? because it indicates an undermining of trust, creates chaos and suspicion, breach of confidentiality, and a toxic working environment.

of course, we should blow the whistle when morally outraged and you did do the right thing. but we have to be aware of our codes of conduct because our actions impact the professional lives of those we work with too. in the end, we get hurt - we have to be more cunning than management to effect change without getting hurt ourselves. we have to understand how they see things.

that's all i was trying to say.

god bless you and your family. justice always prevails in the end. find peace for your own sake and the sake of your family.

panhandler · Dec 13, 2005

OMG OMG OMG

What I am seeing here is the tip of the iceberg.

Here's what we know:

1)The "nursing shortage" is a manufactured lie.

2)Experienced, innovative nurses are ground to a pulp by the system, ON PURPOSE.

3)There is WAGE-FIXING rampant in the healthcare industry for RN's.

4)The Nurses Associations have been de-clawed, de-fanged and de-balled. There is no effective representation for nurses.

5)Retaliation is broad throughout the health care industry when it comes to quality improvement initiatives, and any action designed to adjust patient ratios to reflect safe staffing.

6)There is no nation-wide pension plan specifically for nurses; there is no nation-wide health coverage for nurses; there simply is "no money": no money for nursing educators, nursing programs, nursing legal issues, and nursing rights. There isn't even any g/d representative of the profession for our funerals when we die.

Who's got the cujones to take on this outrageous problem?

TsunamiKim · Dec 13, 2005

Hi TNNURSE,

Arden2 has perhaps alerted you to a potential pitfall. At your Hearing, bearing in mind that we should be highly suspicious of such a "Hearing," the way I see it is that your intent is not as critical as your perceived intent. More to the point it is may not be permitted as much relevance as the way in which Management will almost certainly manipulate your perceived intent to their own advantage. They will try hard to demonstrate that your intent is purely a personal issue, a grudge against the incompetent Nurse and your NM, they will try and isolate you from all of your peers. It is too late and totally ineffective to get defensive when inevitably Management accuses you of trying to launch a personal vendetta against the incompetent Nurse and the Manager at your Hearing. It is almost 100% guaranteed they will take this position, so guard against such manipulations of the truth ahead of time by being well prepared.

Bear in mind your peers have now seen the ramifications of making a complaint known to Management: you get fired. If each of them has been approached individually by Management in a "divide and conquer fashion" you will be astounded how quickly amnesia has set in. They will undoubtedly feel threatened, their jobs are seriously threatened; they have seen the consequences of telling the truth. That is why in my OR, were two male employees had had a knock-down, drag-out, fight without calling Security, Management had me escorted out by two Guards. This is generally done to humiliate the exiting employee while intimidating and scaring the hell out of other workers. It bullies them into compliant silence and believe me it is remarkably effective. As an outspoken English person I was shocked at the speed with which most of my coworkers went to the dark side; my friends vanished and I was quickly ostracized. My whole persona was reinvented by Management and intimidated employee colluded in the cover up, defamed me and dutifully complied with the Hospitals wishes. While your exit might not have been so dramatic or publicly humiliating, the threat of job loss is very real and you are now the example of Management's abuse of power.

Here is what you might consider doing to combat this. Write a very carefully worded Petition that expresses your joint concerns regarding the incompetence of the Nurse and setting out realistic goals for correcting this problem that are your expectations of the Hospital Management. It should state your collective concerns for the safety of patients in this incompetent Nurse's care as the number one issue. It should state your concerns for the Nurse herself by highlighting her not having the proper orientation or support to adequately take on a very intense job assignment. Last but not least it should contain an honorable "excuse" for your Nurse Manager, do not discount the need for this last point. Elaborate on the pressures that might have clouded her judgment; her absorption in other important duties with less opportunity to directly observe this Nurse where the failings would have been more apparent to her. Be very, very diplomatic as this is your best chance for success. The expected outcome or request of your Petition should certainly include the missed orientation under the supervision of the most experienced person to tackle the task which might well be you. It might also suggest this Nurse's reassignment to a less critical area where her skills were a better match for the needs of the Hospital.

Now try and get as many of the Nurses who spoke to you about their concerns of incompetence to sign this Petition; enlist the support of Doctors too if possible. You might remind them all that the Hospital and their Risk Management dept will have to take this on board and they are obligated to keep it on file. This will protect all of you from "divide and conquer" retaliation. Persuade your former coworker that it is very important for you all to speak with one voice and in that way they cannot be individually targeted just as you were. Remind them that while they are still working alongside an incompetent Nurse there might be a serious medical error causing harm to a patient at any time and it will not reflect well on them or their licenses if they knew the danger and did nothing to prevent it. When faced with overwhelming evidence it will be extremely hard for Management to justify ignoring this request for a rational solution to a legitimate concern. Risk Management will also have to weigh the possibility that if this Nurse does cause harm in the future, there is documentation that they were warned by a consensus of the Nurses and they ignored that warning. Make copies of the signed Petition before handing anything in.

It is always important to separate your initial concern goal and good intentions, doing something about an incompetent Nurse, from your most immediate personal needs, your dismissal. The Management operates under the assumption that once fired, the distress caused will send you into self preservation mode and the patient safety issue you raised will be forgotten. This is a common tactic and a very successful one in most instances. Do not let this happen. Circulate the Petition quietly and obtain as many signatures as possibly before your Hearing. Try to keep a lid on knowledge about the Petition so that Management does not sabotage your plans. The Petition will become part of that essential paper trail that may not work at your Hearing, but will be established for future reference. Sometimes in these patient safety issues the most you can do is establish the paper trail and hope that action is taken before a patient is harmed. In the worst possible cases it is a medical error that brings your concern to light sometimes many years later. However, this usually happens when the trauma of personal sacrifice succeeds in silencing the witness.

At your Hearing resist the temptation to deal with your own situation first, they are expecting you to do this and if you fall into this trap the Hearing will be done and dusted before the patient safety issue is ever raised. Hand them the Petition and state how concerned all of the Nurses who signed this Petition are about this issue. They will try to personalize the complaint, you against the NM and this incompetent Nurse; you must be well prepared to vigorously defend your intentions. Reiterate how no matter how experienced you are as a Nurse you and your colleagues would never expect to be reassigned to a completely new practice area without the benefit of a period of orientation. State that doing this places unnecessary stresses and expectations on someone entering a new job and sets them up for failure especially in critical clinical areas like the one in which you work. Now you have provided a reasonable explanation for the incompetent Nurse's failings and it should be viewed as a genuinely compassionate consideration for her needs too. If done right they will be unable to accuse you of being vindictive or bearing a personal grudge.

Then describe how the meeting you wanted to schedule to discuss these serious collective concerns, being bought to you by your colleagues, with your NM was railroaded to fire you for some minor and totally inconsequential technicality. Present yourself as the elected spokesperson of this much larger group of concerned Nurses. I only hope the Management haven't already been busy working on whittling away at that supportive group of likeminded Nurses to dissuade them from signing your Petition in the first place. While you were shocked and deeply troubled by such an inappropriate and incomprehensible response "we" (the "Royal we" as we say in the UK, as it includes the Queen) cannot be sidetracked from addressing the real danger to patients in you clinical area. If they try to shuffle the Petition sideways then tell them you will have your Lawyer send Risk Management a copy by certified mail!

Tell them that all of the Nurses represented on the Petition will be expecting to see a written response from Risk Management and a plan for appropriate action to be taken. Then move on to your own defense against being unfairly removed for a technicality. Question the timing of your being fired and why your NM thought it was necessary to focus on such a triviality when you were coming forward to expose significant genuine danger to patients. Show the inconsistencies in discipline and again question why your unit bought a new Nurse onboard without orientation and how this is a deviation from policy besides letting both her and her patients down by putting them at risk.

Do not expect a rational response as it is most unlikely, but I think this might provide your best chance. I was fired for calling my Nurse Manager "unnecessarily inflexible" in a phone conversation about my schedule and the subjective feelings of office staff seeing me with my hands on my hips and my arms folded! At the same time it was OK to leave me in Surgery until I was almost comatose and consistently violate the Maryland Level One Trauma Center COMAR requirements for OR coverage. Not rational? Go figure! Our only possibility for protecting patients is to start the paper trail and then keep it up no matter what.

If your Hospital is equally irrational you have at least given them the possibility to take care of this issue internally first. You can tell them that due to the seriousness of this patient safety issue if you do not receive an appropriate response in a timely manor you will be forced to seek further action by notifying outside agencies. The documented presentation of a Petition calling for action signed by so many other Nurses at the time of your Hearing will help to give credibility to your external complaints. Management often does a preemptive strike at the first sign of potential trouble, firing you before the meeting with your Manager to discuss a patient safety concern, so that they can then discredit you latter. They count on being able to contend that your allegations are unfounded because you are just a "disgruntled former employee trying to cause trouble for the Hospital." A Petition with plenty of signatures, get Doctors to sign it too if at all possible, would severely compromise this tactic. Hope this suggestion is helpful and don't give up,

Fair Winds & Following Seas, Kim.

Keysnurse2008 · Dec 13, 2005

arden2..i appreciate your insight.to clarify things .....numerous nurses on my unit had previously gone to this nurse manager c/o this nurses"performance issues and lack of knowledge".not one thing was done.this nurse did not "feel she needed to be subjected to orientation"...and the manager agreed and wouldnt listen when good, experienced nurses c/o problems with this nurses performance. i dont think they could say i had any bad feelings towards this nurse....bc i didnt. i was actually the one who told some of the staff to "give her a chance".before this....when she was in an administrative position i honestly liked her.she functioned well in an administrative role.however,...when she "stepped down" to a icu staff nurse position she refused any orientation even though it had been "quite a looonnnnggg while since she had actually taken care of a patient...must less a critical patient".we had a good rapport established....but when problems arose...she wouldnt listen to me or the others.the nm wouldnt listen to the experienced nurses whom she interacted with...and she wasnt going to listen to me. she basically was giving the staff lipservice. my ultimate responsibility is to my patient....and myself.i did try to schedule a time to come in and discuss the problems with this nm....and i was met with a time to come in for my termination interview."poof"...i was gone.

on the unit i worked.....i was very much known for my experience, fairness,knowledge,support to my coworkers and my patient safety advocacy. when....even i....was saying there was a problem with this nurses performance.....then everyone knew there was a major problem.

in regards to the resolution meeting....i am just going to tell them what happened.thats all i can do.after that...the ball is in their court.i am not worried about it. they will do what they will do. their decisions will be the ones they have to deal with ethically, morally and legally.i have enough concrete proof to prove retaliatory discharge "if"...if i am forced into that position.i followed their policies, their bylaws etc etc...and look what it got me.

in regards to that nurses performane....like i said....eventually she will have or has gained competency by being allowed to " gain that competency thru trial and error" on her own.it doesnt make it right. the hospital was made aware of my and the other nurses concerns....and they are the ones left to cover her and this nm for the liablity of their actions/inactions.it doesnt make it ethically, morally or legally right to allow a nurse to gain competency thru trial and error.it is a violation of everyone's trust......the :coollook: other nsg staff...the patient...the patient's family....the physicians.but if a major hospital is willing to condone their actions and inactions and finicially cover them liability wise...then what can we as nurses do?what "law" is out there that will truly penalize them?

you are right...alot of the "teeth" has been taken out of the ana.i recently heard that what we now know as "physicians orders"...are soon going to be called "physicians requests"...so that if an order results in a sentinel event then the liability issue will return to the nurses...sine it will soon be just a request.i heard this at the orientation of my new job...and was shocked. :coollook:

Town & Country · Dec 14, 2005

I voiced my concerns over some incompetency acts performed by a coworker-nurse. These were acts that were not merely mistakes...they were acts that could have resulted in patient death. I tried to set a meeting with my nurse manager to discuss this nurses incompetent level of function...and I was met with a date to come in for a termination meeting...mine!

It sounds like you basically told the NM (in so many words) "it's either her or me."

Maybe in your opinion, this nurse was incompetent.

The NM apparently didn't think so.

Not to mention, most of the time we are only liable for what DID happen as opposed to "what could have happened" (thank goodness!!!)

It doesnt make it ethically, morally or legally right to allow a nurse to gain competency thru trial and error.It is a violation of everyone's trust......the other nsg staff...the patient...the patient's family....

Putting a new on the floor without enough orientation happens ALL THE TIME.

I got one day of orientation at the job I am doing.

It's not right but it happens everywhere all the time.

IMO you should move on with your life...

TsunamiKim · Dec 14, 2005

we are governed by our consciences. our level of concern or alarm is typically generated by knowledge and experience as this is the most reliable indicator of the potential for significant harm. when that little voice is telling you: "this could be a problem, someone could get hurt here" listen! on one frigid christmas night aboard a 42' sailing boat several hundred miles north of bermuda we were lying beam on to dangerous seas with the wheel tied. my little voice said: "we could get rolled over in this," but as the least experienced of three crew members on board i ignored that dire warning and said nothing. less than an hour latter, following a violent capsize, i was standing knee deep in icy water, a freezing north atlantic gale blowing through the gapping cracks in the deck, bailing for my life in a bucket chain with blood streaming down my face! i learned to listen to my little voice and therefore i am alive after sailing over 150,000 miles aboard yachts on offshore passages.

not nursing you may say, but the lesson is the same: ignore warnings at your peril. i bought the caution and attention to safety of over twenty years at sea, the responsibility that came with a uscg license, to the hospital setting where it has served me well. those who foolishly believe that nothing will ever happen to them or to their patient under dangerously negligent circumstances are risking patient's lives not to mention their licenses. instances where another nurse's inappropriate practice caring for their patients remind us that we must look out for one another too, by being supportive of that person who obviously needs more training to function safely. they say "ignorance is bliss." inexperienced staff take unacceptable risks because they don't identify the potential for harm; that is the very hallmark of their inexperience. it is the duty of experienced tenure nurses to recognize the deficiency and correct it by teaching them safe practices. they aren't my patients, i provide safer care, but another nurse's incompetence is not my business, shows a reckless disregard for human life and the core principals of medical practice.

those who, in good conscience, recognize that a situation exists where there is a significant potential for harm are duty bound to speak up. in tnnurs's case many of the icu nurses have recognized how the incompetence of this one nurse has created a potential for harm. obviously the potential for harm does exist or they would not all feel this way. this being the case, it would be neglectful to simply ignore it and just hope for the best; however it is vital that you all speak with one voice. i still believe that under the circumstances you are wisest to do this by getting a petition together that reflects this strong consensus of opinion. this will become a legally valid documentation of facts that will be very hard for the hospital to ignore. if you do not do this you will be extremely vulnerable to their fictitious accusations of vindictive intent. they will try to make this situation not just you against one incompetent nurse and your nurse manager; they will try to stack the odds until it looks like your word against the remaining icu staff and the hospital.

to best accomplish your goals of creating a safer environment where patients are no longer at risk, you must guard against their attempts to isolate you as the only nurse who is of this opinion because they will definitely do it to you. this is standard managerial defensive practice; to not recognize or prepare for it, is to walk blindly into a trap. i agree that you must take a stand; otherwise walking away from negligent practice will be on your conscience. if we always blithely waited for serious incidents to cause actual physical harm to a patient we would have a very reckless system. that would be playing russian roulette with our patients lives, "hey, there is only one bullet in the chamber," is no way to practice medicine!

there are numerous dangers accumulating at this time due to the deliberate agenda of understaffing to maximize hospital profits. profit driven toxic managerial policies are instituting multiple minor compromises under the guise of the "nursing shortage" which the management themselves created in unreasonable, unsafe staff cut backs. the dangerous compromises being forced upon nurses are insidiously trying to creep into the routine of what is we all consider "normal" and therefore perfectly acceptable practice. when this is justified, not by genuinely unavoidable circumstances, but by the relentless drive to cut experienced staff to the bone enabling major healthcare corporations to skim obscene profits, we must vigorously resist these dangerous changes. the most vigilant patient advocates among us recognize these subtle and sometimes not so subtle changes. it is our duty to our patients to remain vocal in our protests by taking responsibility and blowing the whistle on blatant negligence.

unacceptable practices include: minimizing orientation in a new clinical area, with that orientation led by new nurse grads who have barely even completed the inadequate orientation themselves. floating nurses to completely unfamiliar areas of the hospital and filling in all the gaps in coverage with agency nurses, some of whom are completely unfamiliar with the facility. forcing nurses to handle too many patients with too few experienced staff and no supportive help, thus making them feel the guilt of abandoning their patients when there is no one to cover for breaks. leaving nurses and techs scrubbed into surgery for 8, 10 and 12 hours continuously as there is often no one to break them out, as happened to me. mandated overtime and double shifts forcing nurses to continue working when they are dangerously fatigued. "occurrence policies" that compel staff to come to work caring for very seriously sick patients while they are themselves sick. excessive call commitments that disrupt family life and leave nurses overworked and overstressed. the drastically shrinking vacation time that there is never enough staff coverage to accommodate or that has to be taken at the convenience of the hospital as a brief get away.

by using toxic managerial policies like the ones listed above it's possible that some of the most conscientious and experienced tenure nurses will leave the hospital, but many are leaving nursing altogether. however, this is highly desirable for the profit driven hospital seeking more affordable staff. this clears the way for new nurse grads or cheaper assistive help who, in their naivety, are far more accepting of the dangerous understaffing compromises while earning a lot less money. these people should be filling out the ranks to provide better, safer coverage with a healthy mix of trainees and more experienced personnel. their positions should be part of a steady progression from entry level to higher grades of training through job commitment and length of service. instead trainees are outright replacing experienced nurses as if knowledge and experience were unnecessary. the trend now is to make nurses interchangeable with the minimally trained help thereby creating a generic pool of indistinguishable patient care staff.

discouraging assistive help and technicians from becoming better trained is another profit driven dangerous trend. at my former hospital, "the best in america," none of the or techs were required to maintain basic cpr skills. despite being expected to cover trauma cases as a level one trauma center cpr was either on your own time, at your own expense or if you felt like it and the or could accommodate being one tech down on your shift. i questioned whether this fulfilled the facility's basic training requirements under comar, but miemss thought it too unimportant to investigate. there was no real incentive for the techs to become certified either, as this lack of certification helped management to keep employees vulnerable to job loss and thereby more compliant. the widely accepted title of surgical technologist was disallowed in all official documents as the hospital felt that it gave the kind of undesirable impression of professionalism that they sought to discourage. while this appalling emphasis on dumbing down the job may now have changed i sincerely doubt it; this from a hospital winning accolades for excellence in patient safety!

those in assistive entry level roles should take every opportunity to gain as much experience and training as possible to be well prepared for an emergency, however they are not nurse replacements. nurses need to realize that their job is not the simple care giver role it once was. typically technicians have chosen a more practical role focused on only one specific area of practice. while nursing training provides a more generalized approach with a much wider field of basic training, their job is now far more complex, requiring a greater scope of experience. but it is unrealistic for them to be expected to excel in all of the areas they were originally trained in without refreshing their skills on entering a different practice area. it is ludicrous to buy into the hype that any nurse can be fudged into a demanding critical care role in an intensive clinical area without even a minimum of specialized orientation. management uses the perpetual short staffing guilt trip to induce arrogant overconfidence that can endanger patients. nurses: you are highly skilled specialists not interchangeable warm bodies, don't let management treat you as such! standard orientation, like continuing education, is in compliance with cautiously maintaining safe standards of practice: it should not be abandoned.

in an emergency we may be called upon to function above and beyond our standard duty assignment and this is acceptable. when this "crisis" situation is deliberately exploited as a consequence of unsafe staffing coverage to increase profits, there is no slack to deal with a genuine emergency and this is very dangerous. nurses have to stand up for what is right, so do not capitulate,

fair winds & following seas, kim.

ps: i have started a new thread and i hope you will review what i have written and comment on this other post.

re: blowing the whistle on deliberate understaffing & toxic managerial practices

it asks among other things: how long is too long for a member of the sterile team to remain continuously scrubbed into surgery?