windcatcher
New Member
-----continued----
The state cannot be easily sued..... but with the deterioration of work ethnic, during and after my leaving...... I had knowledge of people not doing rounds and close obs but charting like they were done..... and of nurses being told by the doctors' nurse practioner to alter an order to reflect a standard of care which she had failed to provide, (fortunately it did not become critical). If the administration for which I worked, had been sued due to some act or negligence, it might not be enough that I was not involved in the incident: Merely knowledge of facility policies and awareness that policies were not always followed, nor were they always backed by supervisors or administration (which policies are in place to both deliver a level of care plus protect the facility from liability), might be enough to make me a credible though reluctant and 'hostile' witness supporting a plantiff..... if called.
With in a couple of weeks of my leaving ...... a patient on close observation committed suicide. Another walked out the door on a unit which was supposed to be secure: And another was picked up by a visitor and taken 'on pass' for the whole day without being charted out..... and all rounds in the building reported her as eating, dayroom or attending class (the class instructors did not have record of her attendance either). I do not hold that I had any power over these occurrances, even if I had remained.... but, I do know some staff respected my self critical observance that 15 minute checks were done and recorded as done... and that annomalies occurring out of character, standards, or charting, were immediately reported to my supervisors...... and, in the event it was an 'agency' nurse who might not pass on the information.... I went to the next shift supervisor, if it was potentially essential to their knowledge. Feedback came to me through the grapevine of a few that morale dropped significantly after my termination and most especially among the few co-workers with whom I worked.
I'd like to think I'm wrong, but government liability is more difficult to enforce than the private area and therefore leads to a lot of wasted time and poorer care. Its a slothful animal which prefers to perpetuate its own interest ahead of the attention, care, and service it renders to others: Not all people in government have this attitude 'of just doing the (minimal) job' but it only takes a few to get in and establish themselves, and to push out those who take their responsibilities more seriously and could pose a considerable contrast of quality should anyone ever attempt to scrutinize. A hard worker who does his job has little time to complain or report to others, much less to document: One who sees the importance of their work and who judges the absence of others by the golden rule or the law of love..... as written in Corinthians...... will often assume, as I did so often...... that when another is absent from their post of work or in their duties, then it is for a 'good cause' and therefore make every effort to cover until such time as they are present again. (But there are some who perceive this as weakness and will advantage themselves of another 'covering' their job.......and, if it happens much, it is a reflection on supervisors and their complacence.)
With this poor lady in this 'emergency room' of a state mental health ward..... she should have been on close observations. It is not unusual for other patients to ignore..... or have a delay in registering a problem in their environment. Staff, on the other hand... should be watchful and attentive and alert. Even if a patient has an established behavior of acting out like falling to the floor, and it is decided that this is a behavior for staff to 'ignore'...... the 'ignore' part should exist only so far as to not show the patient attention or alarm, but to still take seriously the observation for life signs, the rise and fall of chest or back indicating breathing. (I could always find 'excuses' to presence myself close to a patient to observe....i.e. a cleaning task, or straightening task, or the floor needed sweeping, or rearranging the furnishings.)
I am surprised that the room itself is designed with a petition into part so as to present a secluded area outside the full view of cameras and staff. In our secure unit, cameras focused on all areas of hall and cul-de-sacs, not directly in the visual line of unit staff when in the office: All work inside the office done by unit staff were infront of the monitors so that quick glances gave immediate feedback to changes in conditions. Two rooms of the 13 bed ward were also available to use as secure rooms with one functioning for four point restraints. Bedrooms were private but walking rounds were done on schedule, 2 bathrooms with just toilet and sink were accessible from hall, and showers had doors locked at night and only opened during shower time or time of special need. All laundry was done by staff on the unit. Intensified observation is required during the process of time to determine the need for treatment and the compentency of the patient, and the need for medication and the evaluation of side effects during their stabilization. Close observations, which may rise to the level of eye-contact continual observation are done on an as needed basis after the initial 24 hour observation period.
It is wrong that she was ignored and left in that condition on the floor for a significant period of time with no evaluation, but it is particularly condemning that she was charted on as being 'observed' when clearly she was not. Beyond that, i don't know what to say critical of the staff when I consider that our facility was regularly 'inspected' for and received 'accreditation' on standards which included 'patient-staff' ratios, but was an 'average' and not consistantly reflective of the standard. Where I worked, at night, we might have a census of 60-70 patients, 2 techs, 1RN and 2 LPN's. The closed unit might have a 'full-house' of 11 or 12 patients... 1 RN, and 2 techs. Any problem on one unit requiring staff for a code.... left other units short with only 1 staff present....exception was the secure unit. If a fire alarm went off.... on the two 'open units' the staff of each unit were required.....even at night...... to evacuate all rooms and do a census, plus check for fire, and meet the fire department and let them in for a check and reset of the alarm. It could get harried at times, lol..... but I enjoyed my work with a very special group of people who often find few who understand and accept their challenges and meet them with respect for their private tormoils and care.
The state cannot be easily sued..... but with the deterioration of work ethnic, during and after my leaving...... I had knowledge of people not doing rounds and close obs but charting like they were done..... and of nurses being told by the doctors' nurse practioner to alter an order to reflect a standard of care which she had failed to provide, (fortunately it did not become critical). If the administration for which I worked, had been sued due to some act or negligence, it might not be enough that I was not involved in the incident: Merely knowledge of facility policies and awareness that policies were not always followed, nor were they always backed by supervisors or administration (which policies are in place to both deliver a level of care plus protect the facility from liability), might be enough to make me a credible though reluctant and 'hostile' witness supporting a plantiff..... if called.
With in a couple of weeks of my leaving ...... a patient on close observation committed suicide. Another walked out the door on a unit which was supposed to be secure: And another was picked up by a visitor and taken 'on pass' for the whole day without being charted out..... and all rounds in the building reported her as eating, dayroom or attending class (the class instructors did not have record of her attendance either). I do not hold that I had any power over these occurrances, even if I had remained.... but, I do know some staff respected my self critical observance that 15 minute checks were done and recorded as done... and that annomalies occurring out of character, standards, or charting, were immediately reported to my supervisors...... and, in the event it was an 'agency' nurse who might not pass on the information.... I went to the next shift supervisor, if it was potentially essential to their knowledge. Feedback came to me through the grapevine of a few that morale dropped significantly after my termination and most especially among the few co-workers with whom I worked.
I'd like to think I'm wrong, but government liability is more difficult to enforce than the private area and therefore leads to a lot of wasted time and poorer care. Its a slothful animal which prefers to perpetuate its own interest ahead of the attention, care, and service it renders to others: Not all people in government have this attitude 'of just doing the (minimal) job' but it only takes a few to get in and establish themselves, and to push out those who take their responsibilities more seriously and could pose a considerable contrast of quality should anyone ever attempt to scrutinize. A hard worker who does his job has little time to complain or report to others, much less to document: One who sees the importance of their work and who judges the absence of others by the golden rule or the law of love..... as written in Corinthians...... will often assume, as I did so often...... that when another is absent from their post of work or in their duties, then it is for a 'good cause' and therefore make every effort to cover until such time as they are present again. (But there are some who perceive this as weakness and will advantage themselves of another 'covering' their job.......and, if it happens much, it is a reflection on supervisors and their complacence.)
With this poor lady in this 'emergency room' of a state mental health ward..... she should have been on close observations. It is not unusual for other patients to ignore..... or have a delay in registering a problem in their environment. Staff, on the other hand... should be watchful and attentive and alert. Even if a patient has an established behavior of acting out like falling to the floor, and it is decided that this is a behavior for staff to 'ignore'...... the 'ignore' part should exist only so far as to not show the patient attention or alarm, but to still take seriously the observation for life signs, the rise and fall of chest or back indicating breathing. (I could always find 'excuses' to presence myself close to a patient to observe....i.e. a cleaning task, or straightening task, or the floor needed sweeping, or rearranging the furnishings.)
I am surprised that the room itself is designed with a petition into part so as to present a secluded area outside the full view of cameras and staff. In our secure unit, cameras focused on all areas of hall and cul-de-sacs, not directly in the visual line of unit staff when in the office: All work inside the office done by unit staff were infront of the monitors so that quick glances gave immediate feedback to changes in conditions. Two rooms of the 13 bed ward were also available to use as secure rooms with one functioning for four point restraints. Bedrooms were private but walking rounds were done on schedule, 2 bathrooms with just toilet and sink were accessible from hall, and showers had doors locked at night and only opened during shower time or time of special need. All laundry was done by staff on the unit. Intensified observation is required during the process of time to determine the need for treatment and the compentency of the patient, and the need for medication and the evaluation of side effects during their stabilization. Close observations, which may rise to the level of eye-contact continual observation are done on an as needed basis after the initial 24 hour observation period.
It is wrong that she was ignored and left in that condition on the floor for a significant period of time with no evaluation, but it is particularly condemning that she was charted on as being 'observed' when clearly she was not. Beyond that, i don't know what to say critical of the staff when I consider that our facility was regularly 'inspected' for and received 'accreditation' on standards which included 'patient-staff' ratios, but was an 'average' and not consistantly reflective of the standard. Where I worked, at night, we might have a census of 60-70 patients, 2 techs, 1RN and 2 LPN's. The closed unit might have a 'full-house' of 11 or 12 patients... 1 RN, and 2 techs. Any problem on one unit requiring staff for a code.... left other units short with only 1 staff present....exception was the secure unit. If a fire alarm went off.... on the two 'open units' the staff of each unit were required.....even at night...... to evacuate all rooms and do a census, plus check for fire, and meet the fire department and let them in for a check and reset of the alarm. It could get harried at times, lol..... but I enjoyed my work with a very special group of people who often find few who understand and accept their challenges and meet them with respect for their private tormoils and care.
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