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Medical Errors: When Nurses Do Not Support Nurses
In one of the more recent medical error cases, people on various versions of social media are accusing nurses of being racist for not supporting Christiann Gainey or Angela Martinez. They have indicated that had these nurses been white like Radonda Vaught, nurses everywhere would be screaming their support from the rooftops.
Unfortunately, it isn’t as simple as the color of one’s skin. It’s as simple as falsifying medical documentation.
Radonda Vaught always admitted to her error and for it, she was convicted of a crime.
Gainey and Martinez both falsified medical documentation, lied to police officers and under oath, and additionally have had their hospitals circle the wagons to protect them from liability. Martinez’s error was particularly egregious as it was a wrong route error that was covered up at the time, delayed in reporting to the coroner, and was obfuscated from the family. Even worse, the Knoxville hospital is using the auspices of Covid-19 in order to use immunity clauses for a death unrelated to Covid.
Nurses on social media are torn. Some are accusing nurses of racism, while others are accusing others of blind allegiance to a profession, rather than to the correct care of patients.
Even in the hallowed pages of Ricochet, it has been intimated that nurses simply support nurses regardless of error. While this couldn’t be further from the truth, it has been said. Nurses are a profession, not a mafia. However, it is interesting how the hospitals are behaving like them.
Cover ups. Lies.
More should be done to penalize the hospitals for their lies, rather than just making one person liable. Perhaps if we made individual administrators personally and criminally liable, we would have fewer situations like these.
I salute the nurses who, like me, do not support nurses who make grave mistakes and then attempt to cover their tracks. I salute the nurses who admit to their errors.
I stand with Radonda Vaught.
I condemn these other nurses completely.
Published in General
Hear hear.
The CEO of the hospital should be held to account for the cover up criminally. The management and nurse supervisors and everybody else in the position of power who helped to the cover up should go to prison.
Really. There’s more to say from a policy standpoint regarding these different events (that, of course, are making the news now that it’s all the rage). But I feel like that’s a larger discussion for another time and another post.
Like…I dunno….mandatory staffing ratios? Maybe we’re going to be ready for that sometime soon after seeing all of the stupidity that occurs when there’s 1 RN to 40 patients? Maybe we’ll be ready for that once people start understanding that this is a real, ongoing, systemic problem that will not be solved by the hospitals themselves and out of the goodness of their hearts.
All of these people and facilities need to be sued into oblivion.
Yes on all counts
I was recently in the hospital. I spent about 6 days in ICU and 2 days in the regular part of the hospital. I asked my nurse in the regular part of the hospital why the ICU nurses were so attentive, and she said they had 4 patients while she had 8.
A terrific post. Kneejerk responses aren’t needed; discernment is.
Actually 4 patients to an ICU nurse is about double what the load should be. 2 to 1 used to be the norm.
I agree that Vaught should not have been charged with a crime if she immediately admitted her mistake.
But damn. What she did was so egregiously incompetent I can’t wrap my head around it.
The order was for Versed, midazolam, an anxiolytic. She gave Vecuronium a paralytic which shuts down all voluntary muscle activity making the patients stop breathing. The Vecuronium comes in a bottle with a big red label that says Paralytic. The top of the vial is red and says “Warning Paralyzing Agent”.
She was clearly not familiar with either drug. Versed does not need to be reconstituted. You draw it straight from the vial. Vecuronium must be reconstituted, you add water or saline to a dry powder. Apparently, she administered the medication, did not document it, and the patient was left unattended and unmonitored. Anyone getting Versed IV should be monitored as it can cause respiratory depression as well.
This entire sequence of events is just unfathomable to me.
I didn’t notice any lack of care.
You may not have, but asking an ICU nurse to take care of 4 critical patients is a killing load. There’s a lot going on you don’t see as a patient.
Minimum ratios should not be the target. The ratio for staff to clients in inpatient mental health is 1:8 techs and nurses. I would not run a unit like that.
The problem with them is that money grubbing monsters that control healthcare see the minimum as the rate needed, not a cushion for those rare times you fall out of compliance. Without a set ratio, they will pair back staff past the breaking point, then blame management when things go south.
I agree with Kozak on all counts. BTW, the hospital where I work has a 1:2 ICU nurse:patient policy. I know this because we are so understaffed that they have been asking people from other parts of the hospital to help wherever they can. As a researcher, I haven’t laid hands on a patient in at least a couple of decades. As a former Air Force medic, I turned out to be very helpful to the Trauma and Surgical ICU and loved working there. Most of the times I worked there, at least several of the nurses had 3 patients–that’s why I was there. I can’t imagine 4 patients/nurse. As far as I know, that ratio held in all of the ICUs (medical, cardio-thoracic, neurological). Most regular units have, IIRC, about a 6 patient/nurse ratio. Under normal conditions, there are also 2-3 CNAs (Certified Nurse’s Aide) and a secretary.
TRN has, unfairly I think, accused me of being unsympathetic to Vaught; I, more or less, accused TRN of defending the indefensible. In reality, I don’t think we’re really that far apart. As I said, I agree with Kozak: the error was huge and, yes, unfathomable. I also don’t think she should have been criminally prosecuted. Those who deliberately falsified records– whether they be nurses, supervisors, or hospital administrators–when a patient death occurred, aught to be criminally charged. There are errors and there’s gross malfeasance. When death or great harm occurs, the error may be understandable (I can imagine many circumstances where errors can happen and not be anyone’s particular fault) or various levels of negligent. If the latter, some legal action may be warranted, whether it be suspension or loss of privileges associated with licensing or a civil malpractice suit (for nurses or docs). Deliberate falsification of records is premeditated, fraud, probably some form of conspiracy, way beyond negligence or error, and should be prosecuted as such.
I was not familiar with the Martinez case, but Yikes! that’s quite an error. In some ways, it was comparable to Vaught’s in that was an incredibly boneheaded error that directly resulted in a patient’s death. The bigger problem, especially compared to Vaught’s, is that she delayed reporting the patient’s death and tried to cover up what happened. It’s unclear from the article (imagine that–bad writing in a newspaper) what the hospital did in the cover up, though the claim that the Covid emergency shields them from liability seems to be coming from the hospital. In the Vaught case, the hospital very much tried to cover up what happened, while she didn’t, which makes her criminal prosecution all the more outrageous. Gainey does appear to have been both criminally charged and pled guilty. In that case, it looks quite reasonable. It also sounds like she was working in untenable circumstances if she was in fact caring for dozens of patients by herself. I guess the question there is what she was doing when she wasn’t checking on the patient. On night shift, even short staffed, she might not be busy even with that patient load.
I’m not quite sure why I was in the ICU. I certainly wasn’t critically ill. It might have been because only they or the cardiac unit were the ones authorized to give me one of the drugs, and the cardiac unit was full.
It seems like I might have been in an ICU room while waiting for my gallbladder surgery, but I think it was just because they didn’t have other space available. It was just me, and there wasn’t a full-time nurse present as there probably would have been if it was being used for other ICU cases.
One of the things that drove me nuts during my 30 years in the ED was we would have critical patients in the ED, and be forced to hold them because the ICU didn’t have any more staff and were at 2 to 1 patients to nurse. Meanwhile we would have nurses forced to cover the ICU patients and cover a number of other ED patients, all the time subject to getting more critical patients at any time via a walk in or EMS.
And frequently it was because the hospital did not want to call in a nurse due to budget.
That’s pretty awful. What I saw here was a full ICU with not enough nurses to staff and it was a hospital-wide problem (I worked one day with the nurse manager working as charge). There were patients backed up in the ED waiting for beds and there just weren’t any. We’re always on the tight side–empty beds don’t pay the bills–but during the omicron surge we were at something like 135%. The nurse shortage is nationwide and I don’t know what’s going to be done about it. Nurses (and docs) are retiring, taking temp travel jobs at high pay, taking desk jobs, staying home with kids. The premium pay brought some of the retired and desk nurses back, but that ended last week. The census is down, but staffing is still a big problem.
Yeah, oh, I went over that at great length in my other post. There were a series of errors. The difference is that she admitted all of her errors (many of which were process errors commonly done in the hospital) immediately and without retraction.
I can’t say that I recall doing so, certainly not in this post. But I wouldn’t put it past me. I think a number of people have been unsympathetic to Vaught because they have done their duties in much better controlled situations. I think you could be one of them.
Usually, in situations like that, it is less a criminal matter and more a matter of civil court. It is also a matter of duty, licensing, and hospital policy. All three may be impacted or only a few. When there’s outright fraud that isn’t just an attempt to cover up a crime, but is, in itself, a crime (documenting neuro checks, for one) legal action is more warranted.
Similar in some ways, very different in others. Most people don’t use the same syringe for orals as they do for G-tube feedings. Most G-tubes don’t even have a way to screw a luer lock on, for safety’s sake and vice versa. It’s not an uncommon error, sadly, but it happens much less frequently now that there are better IV tubings to prevent connection of a non-luer lock syringe.
Many facilities that are LTC or SNF have ratios like that and in her case, she was also a contract LVN.
[continued]
There are other details, but I cannot find original sources. Apparently, they didn’t even attempt CPR because he was that dead. The patient had died at least at 7am. When he originally was found down after an unwitnessed fall, he had already bled from his head on the floor and was found in a pool of blood.
All of this, of course, I can’t find sources for.
But this is what is said.
I can’t find the original 141 page report, but the details sound fairly credible and not out of the rage of what I have seen from the SNFs and LTCs.
They will often have a larger ratio of patients, but this is because they do not require 1:1 neurological assessment. The patient never should have been kept at the facility (among other things). 1:1 assessment is probably not appropriate for an outpatient setting like that.
While there may be more LVNs under one RN and multiple aides on a floor with 40 patients, I still find the ratios concerning. Regardless, it does not account for the gross neglect, lack of judgement, lack of compassion, and absolutely egregious (and I’ll keep calling it that) fraud that occurred in the Gainey case.
Sometimes if you’re post-operative, you’ll be in an ICU for monitoring for x amount of time. It just depends on policy. Might be one reason?
Yep.
One good thing about the staffing laws. It does help with that whole thing.
I admit this is going to sound awfully wishy-washy, and our site is devoted to incisive, decisive, morally based, irrevocable victories. But just about everyone here, on every side of the discussion, seems to be remarkably intelligent and professional. I’ve learned a lot reading it.
I hope you won’t hate me for saying it. ;-)
It’s the same across the US. ICU, med/surg, step-down. My unit is the largest in the hospital. Our ED was on diversion until the state put the kibosh on that because everyone was full. Even in CA (the mecca of nurses everywhere), it has not been easy. Nurses are leaving, doctors are leaving. CNAs are leaving. Travel jobs are just re-shuffling. Same nurses going back and forth between places. Desk jobs will still need nurses, too. Someone has to stay home with the kids.
There is more to it than just graduating other nurses and filling up staff. Locally, we have new grads up the wazoo. Nurse jobs were getting snapped up faster than we could post them. Many still are. But CA isn’t that attractive. Wow, great pay! Except that you’re making $90K and can’t make rent without a roommate. I filled my tank for $94 today. Food is more expensive.
Why even stay here? Many people, nurses especially, are finally asking themselves that. The patients are abusive. The families are abusive. Administration won’t support you. Why even stay?
And until these core things change, I don’t know what will happen.
I was getting dialysis. Maybe that was the reason.
It may be that in your hospital thats the only place they can do dialysis. In itself dialysis doesn’t require ICU as most of it is done on an outpatient basis.
Yeah, but if he’s post op or new dialysis with a dialysis catheter, they might’ve kept him there for obs.
I know some hospitals, the ICU nurses are the only ones who do dialysis. So you may be right.
Here’s a great take on this topic by Z DoggMD
They had a separate technician who came, set up the machine, plugged into the ports, and sat with me through the whole treatment. I had two different technicians; I think they were both RN’s.
That’s something I’ve found myself saying frequently in the past couple of years. The voice of uncommon sense. He’s spot on here, too.
He really, generally is. I so appreciate his radical moderate views.