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  1. I received an email from the BON compliance officer about wanting me to participate in an investigation. When I spoke with them, they stated it was about a med error for suboxone many months prior that 15 other nurses at the facility made. They stated it was minor and wouldn't result in suspension or loss of license, just disciplinary action at the very most. I told them I was concerned and may seek legal counsel. They continued to state that it was minor and they just wanted to get my take on the situation regarding safe medication administration. They want to schedule a time to interview. Do I accept the interview or consult an attorney? Should I speak to my unit first? Nobody has written me up or informed me of any med error regarding this. I also have not heard of our entire unit being under investigation, either. I have only been a nurse for 3 years and have never had this happen. My state nursing board has a reputation for being notoriously aggressive. What's the best way to proceed?
  2. The facts are startling: - Nurse Neils Hogel was convicted of killing 85 people in his care. - He was sentenced to life in prison (the maximum sentence). - He killed patients in three different facilities. - He is the most prolific serial killer in peacetime Germany. - The judge called his crimes “incomprehensible.” - Fellow employees are also being charged with negligent homicide. Rumors Wherever Hogel worked, the rumors followed. His patients died after he injected them with a variety of drugs to provoke a heart attack. He said he intentionally brought about cardiac crises in some 90 patients in Delmenhorst because he “enjoyed the feeling of being able to resuscitate them.” Reportedly, he would administer life-threatening drugs and then come back to the bedside to heroically attempt to resuscitate his victims, tragically earning the name “Resuscitation Rambo” for his efforts and even proudly wearing a misguided necklace of empty IV tubes that was given him as a reward. Desire for Attention After being transferred to an anesthesiology unit, a doctor noticed the perpetrator’s attempts to push himself into the spotlight during resuscitation efforts and told him his services were no longer needed. Others noticed his involvement in a large number of cases where the patient arrested and/or died but did not follow up. Convicted & Sentenced Hogel was convicted in 2015 and currently serves a life sentence and the prosecution continues to pursue additional cases against him with new convictions this month. Susanna K., one of those who worked with him said, “In the beginning, you just think it’s fate. But at some point, you grow distrustful.” In the trial, she went on to say that she and her colleagues talked about the events and their suspicions but did not go forward with a more formal complaint. In a country that highly values privacy, they didn’t see it as their business. Failure to Report In addition to Hogel, investigations are in the process against six fellow employees in one of the hospitals where he worked. The defendants are accused of negligent manslaughter because, despite their suspicions, they failed to follow up and report what they saw. He went to several facilities and help a variety of positions until he was finally apprehended and stopped. Breaking the Silence In the end, it took a nurse to break the “Code of Silence” that made all these murders possible. Frank Lauxtermann, a former colleague of Mr. Högel’s, was the first nurse to break the silence. In Germany, privacy is highly valued and despite suspicions, many felt it was not their responsibility and that they might be reprimanded for reporting their suspicions without absolute proof. Frank Lauxtermann, nurse, and the first person to break the silence In the United States, being a whistle-blower is also a risky endeavor, one that takes great courage and often involves personal sacrifice. Many industry whistle-blowers end up losing their jobs and do not have their efforts rewarded in the workplace. “The study of 25 workers who revealed wrongdoing in their organizations such as banks and healthcare found that whistleblowers lost their job either by being pressured out of the organization or being dismissed. At this time, eight doctors or nurses face charges of perjury for their part in lying to cover up the lack of follow-through that made the mass murders possible. Families of the Victims Family members of the dead, continue to struggle and ask questions as the process of prosecution unfolds over a timeline of years. The murders started in the late 90’s. The first arrest was in 2006. Several trials have happened since then as the cases grow. Meanwhile, families suffer pain, grief, and loss. Christian Marbach, whose grandfather was a victim, asked: “If it is possible that in Germany more than 300 deaths over 15 years can be swept under the carpet, what else is possible?” What could possibly motivate someone to do such evil? Dr. Karl-Heinz Beine, a psychiatrist in Germany, examined the perpetrator and said he appeared to be “driven by narcissism and a need to fill a deep lack of self-worth.” In court, even during current proceedings, observers report a remarkable lack of empathy for the victims or their families. Beine went on to say that he hoped this trial would raise awareness of the need for healthcare professionals to report suspicious behavior and to follow-up. Now 40, Hogel is incarcerated but according to Arne Schmidt, the detective who leads the Oldenburg police investigation into the killings, “I personally am convinced that the defendant continues to live out his narcissism today.” What Can We Learn From This? What can we learn from the horrific events in Germany as they continue to unfold? Many questions remain, but we have to search out ways that we can avoid the same outcome. What happened in Germany can happen again here or elsewhere. It is our duty as professional nurses to protect our patients to be alert and willing to take prompt and measured action. If we see something, let’s say something.

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