It took me back to the "Travel Nurse" stint I did in the mid 1990s after I had moved back to Canada from California. I was hired by a travel agency and was placed at a nationally very well-known and respected institution in Southern California.
Anyway. I get there and go through a 5 day orientation which was mostly testing and classroom work, which was ok with me. Most of my hospital orientations in Canada had consisted of jumping right in - so this orientation was similar to taking a very nice break while reviewing/testing stuff I already knew. I was used to both the American and Canadian system and was ok with whatever they could throw at me.
What I don't understand is how one particular nurse could have slipped through that rigorous testing process.......as you are about to read....
The Birthing Center was a brand new one, expensively appointed - but they were still working out the "newness" kinks. I could see that it was going to present quite a challenge. The birthing unit was supposed to be a swank one that would entice "celebrities" to come and give birth. Unfortunately, that wasn't the case. Most of the "customers" were middle to lower class types with work-supplied insurance or MediCal.
I come from a Canadian system ....everyone in each province carries the same insurance and are treated the same no matter who you are or how much you have donated to the hospital. I have looked after very many wealthy patients, 2 mayors, 2 prominent politicians and several well-known celebrities (2 musicians and one actress still on TV) known all over the world - it didn't matter. They were just like any other patient while in the hospital. There were no admin people falling all over themselves, trying to see if everything was being done to please those "special" clients...or watching their nurses' every move....
I had been acclimatized to the Canadian system of L&D after being specialty trained in an American Hospital, and it was painfully difficult to go back. First thing they did to these poor laboring moms was to confine them to the bed, strap them to the monitors and electronic BP cuff calibrated to read out every 5 - 15 minutes, flat on their back - no hope for mobilization. So much for being a Birthing Center.
I went into the Labor room and found a mom clearly in hard labor all by herself. Hispanic gal, primip, 6 cm and really working at it, slightly out of control. I stayed with her and coached her through the breathing and showed her how work with her body.
When it came time to push I stayed with her and quietly coached her through each contraction. One nurse peeked in the room to check and see what we were doing and to try and get me to come to the desk. "Just leave her...you can watch from the monitor at the desk just as easily".....she tried to convince me.
I believe nothing substitutes for hands on care in Labor. Statistics show that is the most important thing for a successful outcome during labor - a support person to be present with the mom.
When it came time for the woman to deliver....the scrub tech came in the room with the delivery table/instruments. The OB came in last minute and the scrub tech basically handed over every single piece of equipment - as if it were an operating room. Where I worked, MDs got their own instruments off the table.
The patient was all draped out. I had never seen such a "sterile" type delivery since my student nurse days in the 1970s.
Once the baby and placenta were out, the OB - who by the way had not even looked at the woman never mind saying one word to her - not even an initial greeting or a nod of acknowledgement - and, before even waiting to see if there was going to be any bleeding or not - proceeded to reach into her vagina almost up to his elbow to "check for and retrieve clots" - all the while the woman screaming in obvious discomfort, almost crawling up to the head of the bed, trying to get away. I stood with my mouth agape at this scenario.
WHO DOES THAT KIND OF THING????? Horrified didn't begin to describe how I felt. There was absolutely no need for that kind of torture.
It was explained to me later that the OB was upset because he wasn't getting as much for this delivery because she was "MediCal" insured - and besides, she was Hispanic...........as if any of that was a reason for the barbaric treatment of a human being. After I left that job, I wrote a letter to the celebrity whose name was connected with the hospital, hopefully to inform them of what they were associated with and perhaps urge some change. I don't think it did one bit of good.
I was to experience something else that would shock me - and cause me to cut my assignment short and make me high-tail it back to Canada asap.
It was a busy night. Another travel nurse was looking after a PIH mom with an epidural and a pit drip. I had an active patient and was also very busy. The night got slightly out of control as more and more patients came through the door.
There didn't seem to be anyone that was triaging these new patients. Someone had to do something with these women. The in charge had already had as many as she could manage and the rest of us had to take the overflow. We did the best we could to quickly assess and release - or admit - per protocol - while trying to manage our own patients.
In the midst of all this - the travel nurse looking after the woman with PIH/epidural had disappeared. Without telling anyone - not even the in charge - she had left to deal with a "family crisis". She had had a fight over the phone with her boyfriend and left the Hospital to deal with her kids.
Now, I can understand the need to attend to family emergencies as they happen, but at the very least - tell *someone* you are leaving first - would be a good idea - especially when your patient is hooked up to an epidural with oxytocin still running - AND YOU HAVE A LIVE BABY you are supposed to be monitoring.
No one had any idea that she had left....until the OB came around asking for the nurse taking care of his patient. Apparently the MD arrived on the scene to discover the pit running - he had given the order to stop it long before the RN departed. He was upset - rightfully so - and so were we.
What a nightmare. Unfortunately, as can happen anywhere, one of the moms that was discharged through the night developed some sort of complication and was brought back in the next day for a c/s. The hard strip was well documented and tagged correctly but an error at the admitting desk had filed the information on another patient that had been put in that same room before they had time to change the name over.
All of the RNs that worked that night - except for the disappearing RN - were hauled into the office a day later and questioned about the whole incident as if it were our fault.
The disappearing nurse was never hauled in or grilled - and never disciplined - never mind fired. I questioned the manager on this lapse in judgement, nicely and politely. Apparently, because the disappearing RN wasn't there when the other patient came in - she wasn't held accountable. The manager didn't see how the absence of that RN might have contributed to the fiasco.
The next few days I called in sick ( and I never call in sick unless I actually AM sick). The writing was on the wall. I wasn't going to jeopardize my license for a dangerous set up that obviously wasn't going to change.
I put in my resignation as soon as the travel company deposited my last paycheck owing. The rest I wrote off.
When the Travel Nurse company tried to tell me I broke my contract - and threatened how they were going to "come after me" for the expenses incurred - I explained to them that they had obligations also - never mind they had let slip highly confidential personal information about that disappearing travel nurse that just happened to also be under contract with the same company as myself.
Which brings me back to the article I mentioned in the first paragraph above.
Unfortunately the system in the USA seems to fail when a nurse is going between states.
I have a practicing license to work in WA state. I did have to submit to them any license information for any other states I had worked in.
Apparently California and 12 other states - or 40% of the 3.5 million RNs working in the USA- don't participate in the national data base that would alert them of any nurses that have been disciplined and licenses revoked elsewhere.
It got me to wondering about the bad apple that I had run into on my travels.
I happen to practice "Universal Precaution Nursing" at all times anyway.... taking precautions to protect my own license. In other words - I don't assume that someone else has checked what I am supposed check, or use a medication drawn by someone else or assume the hospital is going to protect me or MD is going to stand up for me in any given situation. I practice as if I am all on my own, legally speaking.
I paid a lot for, and made many sacrifices to earn my RN license and I will not jeopardize it in any way.
I am so close to retirement and I want to go out with a clean slate.
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| What would you consider to be an amount of money that would compensate for working in an unsafe environment? For me: Zero |
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