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September 11, 2000

Safety first

This is in response to "Nurse, Interrupted." Being a nurse who made a medication error from which a patient died, I have very strong emotions about the "process" that nurses are put through.

I currently am on probation. This is only after paying an attorney $2,500 to defend myself in a case that I was up front about, and over $3,000 to the state of California for its investigational costs. All that seems immaterial, I’m sure, to some who say that a patient lost their life; I do not take that lightly and live with it daily.

The problem I have is the three years that it took California to file a claim against me and say that I am unfit to practice as a nurse. All of a sudden I received papers saying that they were going to revoke my license. It would seem that if they are so concerned about public safety, as they stated in your article, they should not wait three years. Should someone who is a true danger – enough to revoke their license – practice for this time?

I tried several times in those three years to find out about the case and was denied on the basis that the case was under investigation. In the meantime, my life went on. I married and was eight months pregnant when my probation started.

For those who do not know the probation setup, I am now required to drive to Sacramento every three months, which is two hours from my house, for 10 minutes of questions.

I also have to work so many hours a week for the evaluation process. My previous three years do not count. I am doing this for three more years.

I am a great nurse and I used to have a love and passion for nursing, but that is gone.

Sarah Collins, RN
Santa Rosa, Calif.

Legal affairs

I could not agree more with your excellent advice for a nurse facing a potential disciplinary action to seek the advice of an attorney ("Nurse, Interrupted.").

I am a law student late in life whose studies were interrupted by the questionable motives of my employer, but that is a whole different subject.

What strikes a chord in me after 40 years of being in the workforce is the "legal" aspect of being employed. I could not help but notice the "JD, RN" after some of the quoted persons’ names. How sad.

I am assuming that most of these people probably had the RN long before they became a Juris Doctor. And this is what I am seeing more of these days. People are getting their JD because of the "legal" aspects of employment which require JD knowledge. It seems to me that in order for a person to look after their own employment affairs, they practically have to become a lawyer to protect themselves from the unscrupulous actions of some employers (managers) let alone legitimate discipline. How sad.

My advice to young folks these days is to get the JD first. Everything else seems secondary unless you have so much money you can hire a staff of attorneys to look after your best interests. How sad.

Absent a JD, I feel your publication has a duty to bring forth these types of articles on a regular basis to keep health care providers informed as to the current climate of "legal affairs" in their profession.

Joe Brown
Walnut Grove, Calif.

Close to home

I read with interest the article "Nurse, Interrupted." I am an RN myself so this sort of thing is of interest to me, but it is especially significant because I have a very close friend who is being disciplined by the California Board of Registered Nursing.

The statement made in the article that the board would opt to put a nurse on probation if they felt they could be adequately monitored must be a false statement because I can see no reason at all why my friend could not be monitored adequately while working. Instead, the board has put him through a tremendous amount of pain and suffering, not to mention practically bankrupting him, and it is not over yet.

He has hired an attorney and had a hearing. The judge ruled in his favor, but the RN board refused to honor that decision. He now has to appeal the ruling, which of course is costing him thousands more dollars. In the meantime, he had to turn in his license.

His attorney is trying to obtain a stay so he can at least work until a decision is hopefully made in his favor. Even if he wins and is allowed to keep his license, he still loses because he will have to pay the RN board for its court costs. The whole thing seems a little unfair.

I know he is an excellent nurse and the profession would lose a valuable person if his license is revoked.

I feel that he is being made an example of, possibly because he is a male nurse and the nature of the infraction. I feel that the whole thing has been taken way overboard. California is crying for good nurses, yet they do something like this to someone who is an asset to the profession. Then they wonder why there is a shortage.

Helen Vogl, RN
Sanger, Calif.

More whine and cheese

I am writing in response to Linda Bousquet’s letter "Whine and cheese" (Readers Respond).

Everything she describes is what my nurse colleagues and I are experiencing at our place of employment, Sutter Lakeside Hospital.

The Sutter Health system is huge in California, and our small country facility is locked in a battle with a CEO who has thus far spent $1.5 million locking us out on two occasions and hiring U.S. Nursing to replace us. In fact, some of them continue on as contracted "travelers."

As far as I am aware, no actions have been taken against them for the poor nursing care our community experienced while they were here. It is a slap in the face to us that these RNs making large salaries are staff nurses and in positions of authority over us as supervisors.

Any remark deemed negative by a supervisor, traveler or not, is met with immediate warnings and discipline. It is akin to working in an armed camp and I for one no longer speak to anyone in management – with the exception of my immediate manager – for fear of reprisal. I have never worked in such a grim environment in my 20 years of licensure. I and many others have taken steps to obtain other part-time work so that we can experience a nonoppressive workplace again.

I understand that every hospital has its own set of problems with which the staff work. However, disrespect and iron-fisted discipline from management have never been among them in my experience.

I eagerly await the day when management abandons its apparent interest in trying to control the staff and allows a collaborative environment wherein we may return to our first objective: caring for the health of the people in our small community.

Susan Hunter, RN
Lakeport, Calif.

Still abuzz

In response to your article on the Africanized honeybees ("The Buzz"), it should be emphasized that most people can outrun a swarm of bees. They should seek shelter in a building or car as soon as possible.

The two most damaging components of bee venom are the peptide mellitin and the enzyme phospholipase A2. They cause hemolysis, increased capillary permeability, cellular damage and smooth muscle contraction. The mast cell degranulating peptide destroys the mast cells, causing release of histamine, serotonin and bradykinin. Hyaluronidase spreads and potentiates the action of the other toxins.

Complications of envenomization can include nausea, vomiting, diarrhea, hypotension, hemolysis, bronchospasms, pneumonia, acute pulmonary edema, myocardial infarction, disseminated intravascular coagulation, acute renal failure, rhabdomyolysis and myoglobinurea. The severity of the symptoms depends on the number of stings received as well as the body size and general health of the victim.

Treatment, which is based on symptoms, can include epinephrine, diphenhydramine, corticosteroids, endotracheal intubation, bronchodilators, fluid resuscitation to dilute the venom and increase blood pressure, peritoneal dialysis, plasmapheresis to remove the venom and circulating mediators, and alkalinization of the urine. Most treatment modalities omit psychological counseling, which is important following such a terrifying experience.

Yvonne Scannell, RN
Huntington Beach, Calif.

System overhaul

I read with much interest José Alaniz’s article "Great Expectations".

Although his description of the future nurse is a bit exaggerated, the need to overhaul our current basic nursing education is a reality. There has been so much debate on the topic of BSN vs. ADN. However, we have to realize that the needs of our patients are getting more complex as compared to about 10 years ago. How we deliver care has changed drastically in the past 10 to 15 years and will continue to change as new diseases develop, life expectancy improves, payment/reimbursement practices change and technology advances.

As we train new nurses, we need to equip them with the knowledge of basic nursing science, research utilization and development, and accounting/business administration. The latter may sound radical, but if we stop and think about it, we as nurses need to understand this other side of health care. Health care must be viewed as a business in order for hospitals and health care organizations to survive. We do not operate under the presumption that health care organizations get their money from a bottomless pit.

Our profession has traditionally been playing "catch up" and I think that we need to be more proactive. Let us all stop the fighting and bickering and sit down and listen to the needs of the nurses as they care for patients. This is a challenge and we’ve handled challenges in our lives.

Remember, "knowledge is power" and "the life you save may be your own." The time to change is now!

Chet J. Gujol, MSN, RN
Los Angeles

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