I work in an emergency psych program that recently suffered the death of a patient (first death on site in over a decade....so it is a BIG deal).
In the aftermath I received a written warning citing me for not assigning rounds to the counselor (there is only one counselor who is fully aware that rounding is their job and customarily takes responsibility each and every night), not ensuring a bathroom door was locked (again a counselor duty), not monitoring a counselor's behavior who essentially dumped all her work on an orienting patient care tech, and not assisting a patient care tech in a patient search (again a function generally performed by a counselor). None of these incidents were related or contributed to the death of the patient (management explicitly admits this).
The whole scenario smacks of making someone "pay" rather than addressing the root cause and responsibility which in my opinion is....... you guessed it, staffing!
This environment is generally staffed (on nights....and remember this is an emergency environment) with two counselors, 1 RN and a LPN. Census may range from 5 patients to 30 with zero to 10 new intakes on any given night....and staffing is NEVER adjusted up regardless of acuity. As the RN I am asked to take responsibility for care of all triage/intakes and care for new intakes while supervising the counselor and LPN who care for those admitted for extended observation. We essentially run an Emergency department and an inpatient unit. Now at times I am asked to work without an LPN, which in my mind is downright UNSAFE!
On the flip side, some night i do jack squat. The manager likes to cite these kind of nights for the reason the staffing is as it is. Sure... the average hours of work each night might be 6 or so.... but that's an average, and you have to staff for those times when there are 12 hours of work to get done in 8 hours.
This particular night i was moderately busy. I proceeded no different than any other night nor different than any other nurse there would have.
My manager more or less minimizes the write up and it seems he needed to do this so that something was done....essentially someone had to "pay". However, I am concerned that I will be "witch hunted" in the future. For Pete's sake they couldn't even come up with something related to the death but had to review video tapes and come up with unrelated infractions.... done not by myself, but by subordinates.
I have accepted responsibility for poor performance of my subordinates. I am not convinced that I could have known about their lack of performance unless I had directly supervised their every move (obviously unrealistic). However, I am an old military man and you protect the troops.
Having been in a situation where I felt the need to keep documentation, and then unfortunately needed to use it I would vote for:
If you think you need to keep documentation, it is time to say goodbye.
Unfortunately, this is happening more and more frequently and not everybody can or will be able to jobhop so much. With CMS reimbursement regs coming into play this fall, I anticipate that things are going to get MUCH worse and more people will be writing books at home to CYA.
I am so sorry that this happened to you. While I have not worked acute care psych for 9 years now I do remember it well.Staffing often consisted of Rn, Lpn, psych tech and that was it on the night shift.
I can recall while doing q 15 min checks and regular nightly rounds one of the things we always checked was bathrooms, and outlets. Part of our policy was all bathroom at night were locked except for the ones in the lounge, all electrical recepticals were locked at all times unless in use for such things are doing an ekg. I do not know what your policies are, perhaps policies are what need to be looked into. Which make it more of system errors as opposed to staff error in and of itself. Sucks big time when you can not trust your co-workers to do their part in the expectations of what their duties are.
Am I naive in believing they don't want to "hang me out to dry"? I think they will if it comes down to it, but I don't think they will seek to do so if they can ultimately sweep the whole thing under the rug.
This is a Magnet facility....fairly decent to work for.... but very tight with money when it comes to psychiatry, thus staffing suffers. Their priorities are well meaning, but misguided. For example... you'll never get turned down for a time off request, but that may leave next to nobody left to work.
Fortunately I have maintained documentation of my repeated insistence that staffing is inadequate.
I'd hate to have to move on to another job..... I really like the environment and there is nothing like it for 60 miles. However, it might be nice to just go to school and not work at all (I started my Psych NP studies this week).
What I mean is that I am generally given an LPN to assist in nursing functions. Management has and plans to continue to staff me on occasion without the LPN and no replacement..... potentially increasing my workload beyond what is reasonable. Realize this is emergency psych..... patients walk in the front door all night long just like an ER often in such numbers that they cannot be triaged for hours (which in my mind is unacceptable). At the same time we are running an extended observation unit (pretty much an inpatient unit except there are not enough beds and people literally sleep on the floor). I can assign the LPN to work the extended obs unit and check in on her from time to time. When she is not there I literally must be in two places at once!
Wow... I make it sound really terrible..... perhaps it is and I've become denesitized.
AH. I thought you meant that because she was an LPN and not an RN it was unsafe. Sorry.
You are very naive to think that they won't hang you out to dry. Disabuse yourself immediately of any notion that mgmt is concerned about anything other than deflecting blame.
And make sure you pick up malpractice - http://www.nso.com. Insurance = 100 a year. Peace of mind = priceless.
Probably they'll try to sweep the whole thing under the rug. But if that's not possible they most likely will hang you out to dry. Never trust management!
You do make the job sound bad. You think staffing has repeatedly been unsafe, enough to document conditions, but don't want to change jobs. So how do you feel about changing careers if you lose your nursing license due to unsafe staffing?
I really suspect they are trying to build a case to show I somehow lack competence in order to implicate me in the patients death. They can't implicate me directly, but a civil court only needs to show that it is more likely than not (51%) that my action or lack of action contributed. The worse they make me look in the meantime... the better chance they have of making a case. It's a tough one... this patient was not expected to live into adolescence due to cardiac issues, yet lived well into her 30's (ultimately the cause of death was related to this cardiac condition). The facility insist nothing could have been done to save the patient.
They can't touch my license though.... like i said, they have nothing to implicate me at all.
Time to get out before something else happens and they CAN implicate me! I've allowed myself to be set up for failure too many times, and have been lucky nothing has happened.
During this transition period, please step back and try to seperate the emotional issues from the practical business issues.
Practical business issues being what is best for YOU.
Expect the unexpected. Upon resignation, they may just escort you out of the building. Also, upon resignation, you may find things so unteniable, that you escort yourself out of the building, i.e. just never come back.
Regardless, working your notice is minimal in importance compared to doing what is the safest thing for you professionally and legally. It may be safer for you to just disappear.
Unlike them, you are approaching the situation as a professional with ethics. Understand these things happen all the time and will NOT impede you getting your next GREAT job or continuing your career.
I've allowed myself to be set up for failure too many times, and have been lucky nothing has happened.
Unreasonable nurse/pt ratios have set us all up for failure. Those of us who make it through each year without incident are certainly lucky. I have seen several instances where short staffing directly led to poor pt outcomes. Our inability to unite and remedy this issue predisposes us to blame. As long as businessmen dictate the rules, you can bet that they will be exempt from accountability, and we will not. May all our luck continue.:)
RN1989
1,348 Posts
Unfortunately, this is happening more and more frequently and not everybody can or will be able to jobhop so much. With CMS reimbursement regs coming into play this fall, I anticipate that things are going to get MUCH worse and more people will be writing books at home to CYA.