Archive for the ‘ Nursing ’ Category
As a RN with decades of experience at various nursing disciplines; I find myself conflicted as I watch my fellow health professionals, in particular nurses, protesting outside their respective hospitals. I fully support nurses who advocate for the patients and for themselves. It’s enshrined in our Nurse Practice Act – we, the nurse, are the patient’s advocate and we can’t cede that responsibility to another “agency”.
During this healthcare crisis our nurses claim to find that they’re lacking the appropriate protection to safeguard their patients, their families, and most importantly themselves. In order to bring light on these issues nurses have taken to the streets to protest with their state goal being to bring pressure to bear on hospital administrators to provide the appropriate safety materials, such as N95 masks, face shields, and other PPE. In turn, many of these same hospital administrators have claimed that these materials have been made available – so why the disconnect?
My experience has taught me that all too often when nurses claim that their concerns are being ignored that it happens for two reasons. The first, administration is either not listening to the nurses or ignoring the nurses’ concerns. The second, the nurses are failing to use their chain of command and thus there’s an appearance that administration isn’t being responsive to the nurses’ concerns. The first garners a great deal of press on behalf of the “beleaguered” nurse, and the second just reinforces the failure of the nursing staff to appropriately use their chain of command – which leads to the same sad result – a feeling that administration isn’t listening. One of my favorite things to do whenever I go to a hospital either to work as a nurse, consultant, or patient is to ask the nurses around me to tell me the name of their Chief Nursing Officer (CNO) and you’d be surprised how many can’t tell me that individual’s name.
COVID-19 has shown us the many weak points in our healthcare network. It’s also shown us that our healthcare community is willing to answer the call to serve in many cases putting aside their own needs. However, I’d like to recommend that the next time nurses chose to protest the failure of their hospital administration to provide appropriate PPE that those same nurses aren’t photographed failing to practice social distancing or not wearing face masks while outside – this somewhat undercuts their claim that requests for safety protocols are being ignored when they can’t practice basic safety protocols during their protest.
(169 countries/regions — 318,209 confirmed cases — 13,664 deaths – 94,700 recovered as of 03/22/2020 at 09:13:18 AM)
Not so long ago the NLRB ruled that Nurses Allysha Shin (Almada) and Vicki Lin were wrongly terminated and determined in their decision that Huntington Memorial Hospital (HMH) was required to rehire and repay back wages. In the same decision the NLRB also allowed HMH to in essence “black ball” the same two nurses from ever working at any HMH facility.
The issue I had with the NLRB’s decision was that the NLRB appeared to be making a decision on whether or not HMH had the right to terminate a registered nurse for violating the nurse practice act and/hospital policy and protocols. It was the failure of the HMH RN’s to follow both our state’s nurse practice act and hospital policy and protocols that were the grounds that HMH argued that they fired the two RNs and not because of these two RN’s involvement in unionizing activities (The CNA was trying to unionize HMH; a fight that the CNA lost with 539 nurses voting no compared to 445 nurses voting yes with pretty much every single eligible nurse casting a ballot). The NLRB, which we all know are experts on how nurses should perform their duties, decided in favor of the two HMH RNs.
However, on March 2018 our California Board of Registered Nursing placed a Public Reproval on both Nurse Shin (Almada) and Lin’s licenses, which will remain in affect for three years. In both nurses’ document they agree as follows: “Respondent admits the truth of each and every charge and allegation in Accusation Respondent agrees that her Registered Nurse License is subject to discipline and she agrees to be bound by the Disciplinary Order below… ” (Allysha Almada-Final Vicki Lin – Final).
What I concluded from the outcome is simple: the NLRB had no place in deciding the original case since it applied to nursing practice. The NLRB has no expertise in judging whether a nurse has acted within his/her scope of practice or followed hospital policy and protocols. Perhaps in the future when confronted with such an issue where a nurse is terminated due to an alleged failure to conduct themselves within their scope of practice and said nurse has been reported to their licensing board for such behavior the NLRB should wait for said licensing board to conclude their investigation. If the licensing board finds that the nurse acted within their scope of practice and didn’t violate hospital policy or protocols – then the NLRB can step in and render their decision.
In the future the NLRB should stick to adjudicating labor issues and stay out of the business of licensing boards, such as the Board of Registered Nursing, whose mission is to decide whether or not a nurse has failed to adhere to his/her nurse practice act.
You may recall that in May I reported that two former Huntington Memorial Hospital (HMH) RNs were being investigated by our state Board of Registered Nursing (BRN). The two nurses in question are: Allysha Rae (Almada) Shin and Vicki Lin. They were terminated by HMH for violating hospital policies, they and the California Nurses Association (CNA) argued that they were fired for their unionizing activity at the hospital. Long story short the nurses with the help of the CNA filed a complaint with the National Labor Relations Board (NLRB). The NLRB concluded that HMH inappropriately terminated the RNs and ruled that they were owed back pay and so forth, but HMH got the NLRB to agree that neither (Almada) Shin or Lin were eligible to work at HMH in the future.
Meanwhile the BRN began to investigate (Almada) Shin and Lin, I learned this from nurses that had been interviewed by BRN investigators regarding the incident. It would appear that the BRN investigator found the complaint to be substantiated and thus an “accusation” has been formally submitted. The accusations can be found by searching the license of both Allysha Almada and Vicki Lin.
Nurse (Almada) Shin is being cited for two causes for discipline from the BRN. They are:
- FIRST CAUSE FOR DISCIPLINE – (Unprofessional Conduct- Incompetence)
Respondent is subject to disciplinary action under section 2761, subdivision (a)(1), as defined in California Code of Regulations, title 16, sections 1443 and 1443.5(2), on the grounds of incompetence in that Respondent breached the Confidentiality Agreement, aided and abetted in the falsification of a medical record, and failed to comply with the double-check process for administering insulin. Complainant refers to and incorporates all the facts and allegations contained in Paragraphs 11 through 20, as though set forth fully.
- SECOND CAUSE FOR DISCIPLINE – (Unprofessional Conduct- Violation of Nursing Practice Act)
Respondent is subject to disciplinary action under· section 2761, subdivisions (a) and (d), as defined in California Code of Regulations, title 16, sections 1443 and 1443.5(2), for general unprofessional conduct and/or violating or attempting to violate, any provision or term of the Nursing Practice Act. Complainant refers to and incorporates all the facts and allegations contained in Paragraphs 11 through 20, as though set forth fully.
Nurse Vicki Lin is being cited for two causes for discipline from the BRN. They are:
- FIRST CAUSE FOR DISCIPLINE – (Unprofessional Conduct- Incompetence)
Respondent is subject to disciplinary action under section 2761, subdivision (a)(l), as defined in California Code of Regulations, title 16, sections 1443 and 1443.5(2), on the grounds of incompetence in that Respondent breached the Confidentiality Agreement, violated hospital policy by falsifying medical documentation and failing to comply with the double-check process for administering insulin. Complainant refers to and incorporates all the facts and allegations contained in Paragraphs 10 through 17, as though set forth fully.
- SECOND CAUSE FOR DISCIPLINE – (Unprofessional Conduct- Violations of Nursing Practice Act)
Respondent is subject to disciplinary action under section 2761, subdivisions (a) and (d), as defined in California Code of Regulations, title 16, sections 1443 and 1443.5(2), for general unprofessional conduct and/or violating or attempting to violate, any provision or term of the Nursing Practice Act. Complainant refers to and incorporates all the facts and allegations contained in Paragraphs 10 through 17, as though set forth fully.
There may be some who think, and the NLRB is one, that what (Almada) Shin and Lin did isn’t worthy of an investigation by the BRN. However we are talking about the standard of care as it applies to “double-checking specific medication” and insulin is one of these. I’ve worked NICU/PICU almost my entire career, and I can never recall a time when any nurse I worked with was “too busy” to come and go through this very basic nursing practice – perhaps that’s because I prefer not to place my patients at risk because of a calculation error in how much insulin needs to be titrated.
I also found their comments as it relates to how they handle their passwords rather cavalier, especially in today’s environment where hospitals are being locked out of their systems due to ransomware, the over 1 million Equifax customers who’s personal information that may be at risk due to a security breech and so forth. So not leaving your passwords written down and left out willy-nilly where anyone can pick it up is actually quite significant and important to maintaining security, confidentiality, and patient privacy.
What I find interesting is the following scenario, what happens if the BRN prevails and one or both (Almada) Shin or Lin is found “guilty” as per the accusations. Does this then vindicate the HMH management for their original decision to terminate these two nurses? Does this mean that perhaps the NLRB made a rush to judgment about the facts of the case? Perhaps in the future the NLRB shouldn’t attempt to dictate nursing practice and leave it to the BRN, whose mission is to do just that!
For the past several years the California Nurses Association (CNA) have launched what can only be described as a smear campaign against Huntington Memorial Hospital (HMH), its management, and ironically against many of the very nurses they purported they wanted to protect. The CNA held rallies and protests outside the hospital and of course many politicians, such as Congresswoman Chu and numerous members of the Pasadena City Council calling for HMH to “just let the nurses vote”.
So when time came for the HMH RNs to vote on the matter the RNs turnout in unprecedented numbers something that rarely happens. The outcome, which was no surprise to this RN, was that the CNA lost. The unofficial tally of the NLRB-led and supervised April 15th – 16th election was as follows – 539 No to 445 Yes with 176 challenged votes. Did the CNA honor the will of the HMH RNs, of course not? Instead they cried foul, filed complaints and demanded an opportunity to have a brand new election. The NLRB, which is not known for being all that fair and heavily favoring “unions” no matter how egregious their actions are – don’t believe me just ask the RNs from Cedar-Sinai that had to endure threats of violence against their children and pets if they opposed the CNA coming into Cedars. Threats which at first the local NLRB folks stated were no big deal, but at least the DC office disagreed and made the final decision that CNA employees have indeed made threats in order to chill the NO-vote.
The NLRB decided that HMH had made errors and that the CNA deserved another bite at the apple, and so another vote was scheduled. As the new date approached the CNA filed additional complaints further delaying the vote. Then about two months ago an interesting rumor began to spread through many of the HMH nursing units. The rumor was that the CNA had abandoned their efforts to unionize the HMH RNs, but no official announcement was made until April 26th when I received word from several of my sources that the CNA had withdrawn their petition – effectively ending the fight to unionize the HMH RNs.
So after all the wringing of hands and gnashing of teeth and stories from the so-called down-trodden RNs that the CNA were going to save from the “evil” machinations of the hospital administration – the CNA quietly pulled up stakes and left.
Why? You may ask did the CNA give up the battle for the hearts and souls and most importantly the dues of the HMH RNs because apparently in the end they did their math and figured that they would lose this election as well. And of course they could risk a news story about them losing an election, they only want news stories about their triumphs. So kudos to the IStandWithHuntington nurses and their supporters for being the voice of the opposition and it was due in large part to this opposition that HMH RNs got the opportunity to stand up to the CNA.
I do wonder where are all those community leaders, religious leaders and politicians, like Chu, Tornek, Gordo and others now? They rallied with the CNA endorsing the CNA line but failed to rally to show their support when the HMH RNs won the day. The silence is deafening!
Congratulations HMH RNs for making your choice known, now its time to rebuild many of the bridges and bonds with your co-workers that the CNA had no trouble breaking. It’s time to reunite once again for the good of your nursing team, the hospital, the community and most importantly for the very patients you have committed to serve.
A while back I published several articles on pain and opioid use. I wrote these article to shed light on the other side of the pain and opioid use debate that seemed to me to be very one-sided. And while opioid abuse has undoubtedly destroyed many lives, what concerned me most was the focus on opioid abuse without equal time being given to the estimate 25.3 million Americans suffering from chronic pain (8/11/15 NIH press release).
That said you can find my articles on the issue here
Nov. 2011 – Working Nurse Magazine – Chronic Pain: What nurses don’t know about pain management WNM Chronic Pain1 copy
Sept. 2012 – Working Nurse Magazine – The Great Opioid Debate: Balancing the need for pain management with the potential for abuse — WNM The Great Opioid Debate1 copy
May – Apr. 2014 – Working Nurse Magazine — The Opioid “Epidemic”: Why we need to dial back the sensationalism and find common-sense solutions — WNM Opioid Epidemic1 copy
Since April of last year there has been the constant drone from the California Nurses’ Association (CNA) and their supporters of “just let the Huntington Memorial Hospital (HMH) nurses vote”. Elected officials such as Congresswoman Judy Chu, Pasadena City Councilpersons, Gordo and Tornek, former Pasadena City Councilperson Robinson, various “community leaders” and others have picketed the hospital, held rallies, written letters to the editor and what not echoing this simple plea. However, when the vote which was held in April 2015 showed that a majority of HMH nurses voted no to having union representation these same individuals who claimed they were only interested in the HMH nurses getting to vote suddenly had a change of heart and cried foul, demanding that the vote be stricken and a new vote taken even though well over 90% of eligible HMH RNs came out to cast their vote.
As expected both the CNA and HMH leadership filed charges with the National Labor Relations Board (NLRB), each claiming that the other side had made one type of violation or another. The NLRB rendered numerous decisions, some in upholding the CNA claims and dismissing others. In the meantime the campaign to disparage the care at HMH continued unabated. Even after the CNA and HMH agreed to set aside the vote and hold a new election there were those CNA supporters who seemed unable to control themselves and continued their attempts to vilify HMH and its leadership.
One such person is an individual named John Grula, PhD who writes a column for the Pasadena Weekly. He’s most recent diatribe against HMH can be found here – http://www.pasadenaweekly.com/cms/story/detail/outbreak_of_truth/16130/.
He makes many claims in his article, which on their face sound absolutely outrageous. Claims such as CNA-affiliated RNs provide the best patient care in our state. To bolster this claim he brings up the Olympus scope and how the failure to properly clean them lead to bad consequences for many patients. He goes into great detail about these incidents that occurred at HMH, but failed to mention that there were at least two other LA-area hospitals that had similar outbreaks and breeches in reporting such outbreaks. One such hospital was UCLA Ronald Reagan Medical Center, which ironically he cites as having CNA-affiliated RNs that provide the best care in our state.
At the beginning of Grula’s article he cites a June 1, 2016 LA Times article which if you don’t read beyond the first paragraph paints a dim picture about how HMH handled the drug-resistant Pseudomonas aeruginosa. However, if you read the full article, which you can find here — http://www.latimes.com/business/la-fi-huntington-hospital-scopes-20160601-snap-story.html, a slightly different picture emerges. The article lays out the problem was not just at HMH, but at hospitals across our nation, it also lays out the steps HMH took to correct the matter.
His article goes on to mention the firing of two HMH nurses, which the CNA and their supporters claimed was in response to the nurses’ pro-union stance and unionizing activities. He then writes that the NLRB agreement rescinded their termination, removing any mention of termination from their employment record, that they received back pay and that one nurse had returned to HMH. While some of his statement is correct, he fails to mention that while any mention of their termination was removed from their employment files notating instead that they had voluntarily resigned. Grula goes on to claim that one of these nurses chose to return, but my research shows that the nurse he claims returned to work at HMH, hasn’t. The reason for this appears to be related to the NLRB agreement, which bars both nurses from ever working at or having any business with HMH now or in the future. Not to mention that I know that at least one complaint has been filed with the California Board of Registered Nursing (BRN) about the nurses and the possible violation of our nurse practice act. Several weeks ago, I learned that several HMH nurses have admitted to being questioned by the BRN. Now whether this goes anywhere remains to be seen.
In the end, I find it ironic that the CNA and their supporters continue to rant and rave about giving the HMH RNs a voice, but seem to ignore that their “victory” at having the HMH vote overturn effectively gaged the voice of the 539 HMH RNs that voted no to union representation. Throughout this entire contested voting period the CNA and their supporters seem to only advocate for the 445 HMH RNs that voted for union representation and minimize the fact that a majority voted not to unionize.
Where are the CNA and their supporters speaking out in support of these nurses? Nowhere I guess, because it would appear to me that the CNA and many of their supporters appear ethically and morally challenged to acknowledging that these RNs might actually feel that they don’t need a nursing union to speak for them.
Update – California Board of Registered Nursing Investigating Two Huntington Memorial Hospital NursesAuthor: raconte
You may recall that back in September of last year I blogged about at least one complaint being filed against Nurse Allysha Almada and Vicki Lin with our Board of Nursing (BRN). It’s come to my attention that BRN investigators have interviewed several Huntington Memorial Hospital (HMH) nurses regarding the Almada/Lin affair.
At this point I have no idea what these nurses told the BRN investigators or what questions that the BRN investigators had for the nurses. However, as I learn more I’ll be sure to share the information on The Nurse Unchained. Of course the BRN investigators may conclude that there wasn’t a violation of our nurse practice act in which case the allegation can be closed with or without merit. However if its decided that the allegation is substantiated then the allegation can be refer to the Attorney General for formal disciplinary action or refer to cite and fine. This is call an accusation and if a nurse has an accusation filed against him/her it will show up on a license search.
You can learn more about the complaint process by pointing your browser here
Also point you browser here for my article on the California BRN WNM California BRN1
Here we go again, at the begin of June, just 4 days shy of the scheduled NLRB hearing regarding Huntington Memorial Hospital (HMH) and the California Nurses Association (CNA); the news broke that HMH and the CNA had come to an agreement. The papers spun it as if it was a victory for the CNA and the two nurses that had been fired, over the “evil” HMH and its management. HMH reportedly terminated Alysha Almada and Vicki Lin for violating hospital policy, however Almada, Lin, their supporters and the CNA argued that they had instead been fired for their activity in trying to unionize the HMH registered nurses. An attempt that failed with 539 HMH nurses voting NO to 445 HMH nurses voting YES (with 171 additional votes being challenged by one side or the other).
Our local media herald the “rehiring” of Almada and Lin, even going so far as quoting Almada that she had “decided to decline returning to work at HMH because for the past six months I’ve been working at Keck USC, a hospital where RNs enjoy a CNA contract”. However I received an email (which you can find attached at the end of this post) that tells a slightly different tale. Yes, Almada and Lin’s termination was rescinded, but this termination was replaced with voluntary resignations. However what struck me as odd was that part of the agreement assured that neither Almada nor Lin would never be permitted to obtain employment or have any other business relationship with HMH; a caveat that I found very interesting.
Still unresolved through all this is what is happening with the complaint (at least one that I know for a fact was filed, and another that has been filed which I cannot confirm) about Almada and Lin’s action that were filed with the California Board of Nursing (BRN). I’m not sure if the BRN is moving forward with the complaint, but if they do and if the BRN does decide that their action was indeed a violation of our nurse practice act then an accusation will in all likelihood follow. I wonder if that indeed happens will our media report on this or just ignore it? Only time will tell.
Meanwhile, various newpapers, including the Pasadena Star News, Pasadena Weekly and Pasadena Independent spun the agreement as some sort of victory for the HMH nurses, but never once interviewing a single one of the 539 nurses who voted no to CNA representation. Not a single reporter asked them what they thought about their votes being thrown out at the request of, ironically enough, the very nurses union that Almada and Lin argued were all about giving nurses a voice. I guess the only nurses deserving a voice in their opinion are those that favor a nurses’ union and the rest be damned.
As promised below is a copy of the email that nurses forwarded to me, and though I have confirmed that it wasn’t a confidential internal memo, I’ve redacted private and contact information to protect my sources.