Holy shit. As a healthcare provider. This 1 scares the hell out of me. 2 makes me rethink how I document. And 3 it makes me think watching a deposition should be a curriculum requirement for healthcare providers.
I am so tired of doctors who make staff do all the assessments and then pop their heads in the door, makes a diagnosis without ever touching the patient, and sends them home without proper treatment. Then the nurses get the blame if anything goes wrong. I recently took an 83 year old woman to the er with a broken back. No doctor ever touched her and they sent her home with a brace she couldn’t put on. She is Legally blind, lives alone and has no family. The doctor wouldn’t see her for 6 weeks. She finally went to another who was appalled by her treatment. She had emergency surgery to avoid paralysis because the break had worsened,
Oh noooo!!!! My heart breaks for her ♡ I wish her the speediest recovery possible and as much comfort as possible in the circumstances. This short comment just took my breath away... not in a good way.
My mother was in and out of nursing homes for awhile. The documentation in nursing homes is abysmally poor. One time they changed my mom's oxygen - no documentation for the change, no testing for the change, and no date of change. I flat out lost it. Be lazy on someone else's time.
@UCDQZHQFAzGlHYpDEsCZNosQ I did a stint in a nursing home, for evenings, I cared for 5 ventilator patients as well as 15 other patients. I was left alone in that unit for 5 days. On the 6th day I had 4 ventilators stop working. I had to send all four patients to the hospital. I only charted on those four patients that night. I called for help, but there was none. I was overtime 2 and a half hours as it was. You can't chart while bagging a patient. I quit that job the next day.
Exactly. Assessment is NOT diagnosis. That is for the MD or PA. It seems the big shots let the RN's run the place while they keep a low profile. It's up to the MD/PA to dig deeper.
@@candyorange266 And that's ok. What's important is to know what you don't know and where to find that information. If she claimed to know all policies I would be very suspicious, and concerned.
@@candyorange266 I agree. I also suspect that the plaintiff's attorney was deliberately acting just a little stupid to deliberately annoy her. By this means he provoked her into going deeper and deeper into detail, when it was already clear, that regardless of good intentions, she was acting far beyond the scope of nursing practice. He gave her a LOT of rope, and she took it. In the deposition of the ER physician, the same attorney dispensed with the facade, and demonstrated a profound depth of anatomy, physiology, and pathophysiology, to a point where he was going in circles around the physician.
@@kalik5665 EXACTLY!!!! I’m a psychiatric nurse, we don’t even have our last name displayed on our IDs for safety reasons. I wonder if they asked the MD to broadcast his address
Don't use a computer in which another person is still logged in. I also log out while I'm treating patients or performing other duties. I don't want someone else charting under my name.
@@donnabelitz3105 yes, I am. I've worked pediatrics, Internal Medicine, Dermatology and Cosmetics, and Obstetrics and Gynecology. Even in my humble position, I know the importance of charting so a veteran RN BSN definitely knows.
Yes, but they rather go after the nurse than the Dr. So, they’ll ask the nurse why they allowed the Dr ir PA to discharge him in that condition. Nurses are the scapegoats.
That’s true, but he was doomed from triage. He got fast tracked as a minor leg injury and conformation bias set in and everyone after that treated him as such. Also, there’s huge pressure not to bounce people back to the main ER from the fast track. I’m surprised the paramedics weren’t called to give testimony. They never alerted the triage nurse about his mechanism of injury. They knew he was hung up and twisted around by the knee. I believe they had to free him. This really could have been called a trauma from the field. Once it got pigeon holed as minor by first the paramedics, then triage and the PA and other nurses it was a done deal and the fact that the patient never gave the full story was at least half the problem. It’s sad all the way around.
These dispositions for medical professionals is so hard we see hundreds of patients and to remember one patient years later what happened to that patient. As a professional you feel totally thrown under the bus. I was deposed for a death in labor and delivery years after the fact and even given the death should be something you would remember you sometimes just don’t remember unfortunately. It is not lack of compassion it is the enormous number of patients we see daily.
I’m starting RN nursing school in the fall and so glad I saw this! I’ve done simple nursing classes and they always said to do this but to see the actual consequences is frightening 😳
@@lindaservantez6877 you are a true hero and leader! Thank you for the comment- it really helps hearing that it is possible to do in real life. All too often I hear nurses say things like “there’s too many patients to chart everything” or “if you forget vitals just put a little above or below normal range”. I appreciate your comment and thank you for your service as a nurse 🙏🏻 you’ve touched the lives of so many
This is why every malpractice attorney needs a Legal Nurse Consultant on their team. To help prepare the attorneys for depositions with medical professionals.
I totally agree. A legal nurse understands both sides and can help with either. Generally, I looked at charts for attorneys to see if anything was done outside the scope of care.
@@suseyq4559 Thank you for your reply! A nurse paralegal does legal research, ie searching for jury verdicts and legal precedents to support the plantiffs suit, and legwork for her attorneys, but a RN’s professional opinion is very valuable. That RN needs to be still practicing nursing , or not too far away from active clinical practice to “ stand up “ to a challenge by defense attorneys. However there are published Nursing Practice Standards and the hospital’s policy and procedure manual to cite. A nursing mistake is outside the hospital’s policies, obviously. That’s how hospitals avoid “going to bat” for an employee. Every Nurse needs to carry her own malpractice insurance, and if she owns a house, needs to buy the highest $$ amount of homewners liability available, because lawyers will come after all assets. The legal research includes property values of the defendant. For example, a kid, playing sports @ school, iwas injured by another kid in the game. The injured kid’s parents did not buy the insurance policy offered by the school to cover injuries@ school. The same parents had no recourse to get the school district to pay medical bills for their child. Therefore they sued the parents of the other kid and won. Their homeowner’s policy paid the medical bill. It does not seem fair, and ordinary people don’t think about stuff coming at them like that, but it is legal and it happens. Nurses and Dictirs can be held responsible for mistakes made by non professionals that are delegated a task and make a mistake. A famois case in point was an Eye diocror who never saw the patient but was successfully sued. A child, playing, got a splinter of wood stuck in his eye. The parents did not go to the ER but looked in the phone book and called an eye doctor. The receptionist at the office said the doctor was too busy on that friday and booked an appt for the following monday. . The parents thought the person on the phone was a nurse or someone qualified to determine the injury was not serious. The injury was in fact very serious and the child lost the eye. The Doctor was held responsible for his employee. Of course this was a tragic mis-communication. The receptionist should have directed the parents to the ER. Nowdays, every caller to every medical facility gets a message “ If this is an emergency, hang up and dial 911” Be safe out there, Stay well.
Janet, I agree. She was professional and when he kept asking the same questions, trying to see if she'd ever say anything different than she had before, she never did. I believe she knows exactly what she always does. In no way was she at fault. Obviously, the patient did not provide critical information to her.
He kept asking her the same the same question because she never actually answered them. If a mechanic never tightened a tire on your car and it flew off injuring yourself and others would you accept this answer. Well in my practice I always tighten the tire. No I don't think so.
The nurse will always be accused and sued first before a doctor or the facility!! Asking her to give out her address is dangerous cuz anyone can try n hurt her and/or her family.
@@jeanneeber there is a very big difference between someone going to pull public records and getting copies of depositions if those are even available publicly, and posting video of someone and doxxing them on the internet.
@@klocke9904 It is legitimate to give her personal details in the deposition, obviously. It is not legitimate to broadcast those details on youtube. Most channels of this type bleep such details as addresses and phone numbers.
She did hold her own, but she squirmed when asked about ordering tests and medications. She was out of her scope of practice, and probably knew it. The plaintiffs attorney pleasantly eviscerated her on this point. I've been in her shoes many times, but she is working above her nursing license. It's a no-win situation.
@@jeffreymcneal1920 I see your point. I think the problem of charting by exception leaves nurses wide open. He kept asking if she checked his pulses and she said it was part of the assessment and at discharge but he was trying to nail her for that. I personally think something went bad after he left. One of those assessing him would surely have noticed. Don’t you think? This case was lost but the one with the boy with headaches due to an aneurysm not having a CT Ann’s dying was lost. Go figure.
@@laurelmakula2835 I understand a few, yes. That was almost all of them and if you are always stalling the questions, it allows the individual to start fabricating or missing crucial details.
An injury to the popliteal artery should always be ruled out in any knee injury, especially if there has been a posterior dislocation. Also - all distal pulses should be examined post application of an immobilizing splint/cast and MUST be documented! This should be done together with visual colour (of the extremity) and capillary refill, and these MUST also be documented!
Patient sued hospital and was awarded 5 .1 million Discharged with a sprain. Sloppy assessment,sloppy communication. CS not mentioned in suit just ER physician and physician’ s assistant. Returned to ER 48 hours later. Ruptured artery in back of knee and Damage to muscles and ligaments. Leading to above knee amputation. Damages later reduced to I.2 million. Lots via Google.
So was this patient an idiot? Doesnt he bear SOME responsibility for his care? Its stupid! Maybe he was stable at discharge! He most likely was given discharge instructions! This was HIS fault, he should not get paid a settlement from the hospital, not one cent. Its stuff like this that proliferates the lawsuits, driving malpractice costs up, and costing US more money. This patient is an idiot!
@@debbiecalton5534 The Physician's Assistant and the Physician were responsible for the sloppy assessments. As one of the expert witnesses pointed out. Triage means to SORT. Charting only by exception may save time but obviously leads to problems. I felt that neither the PA nor the physician realized the serious nature of a deposition and really responded in a way that made me doubt their judgement. Regarding the patient,If I remember rightly, there was a history of psychiatric problems and Alcoholism,. He could not recite the alphabet nor read three letter words (reported by another expert witness). He was given discharge instructions but given his age and problems mentioned above he probably didn't understand them. I trained as an RN in the UK in the 1960's. Huge respect between physicians and nurses for each other and the people under their care.He would have been kept in overnight for observations. I totally agree about the inclusion of personal details poorly
@Lily Hyatt there are many practitioners of medicine who have the authority to order tests these days. Nurse Practioners, Physician Assistants, Nurse Midwives. Also, many MDs have standing orders for patients who present with certain conditions - especially in smaller community hospitals. Our healthcare delivery model has changed from the simple MD/Nurse model.
OMG his repetitive questions. I'm a Nurse and it's simple if there's no change from triage she's not documenting it. She only documents changes from the triage. She as any Nurse knows does a full assessment then passes any abnormal findings to the Doctor. Each facility has different policies. I document everything (stay late always to finish my notes from my page from the day). I was always taught in nursing school if it wasn't written it wasn't done. But his repeating repeating repeating is CRAZY!!!! Poor healthcare workers, we get heck (especially nurses) who work so hard we don't even have time to pee or eat!!!!
When my mom was hospitalized it was like pulling teeth to get a nurse to come in and help her. And this was before Covid, so no excuses. After ringing the call bell and waiting 20 minutes or more for someone to come I'd finally have to go in search of a nurse, only to find a group of 3 in deep conversation about their dinner the previous night, and 2 more sitting on their phones scrolling through Facebook, ignoring the call bells. No one does their damn job any more. Everyone just wants to play around or sit on their phones.
I worked in a hospital for 5yrs. I was passing out menues. When walking past a room I noticed a patient having a seizure, told the RN, and L PN at the desk. There where 3 of them, they where just talking about their personal lives. I continued passing out menues.20 min. Went by and still no one went in to check on him. By this time the bed was going across the room, it was almost to opposite wall. Once again I told nurses. They hAve me the evil eye and finally got off their butts and checked on him.I was really disgusted at their lackadaisical attitude towards patient's.
@@deekay1747 wow how rude! I have Epilepsy and know my seizures have gone unnoticed, if this lady had not persisted in telling the nurses no one would have gone in
@@deekay1747 I’ve been an RN for 40+ yrs and if I was charting at the desk and a menu passer, housekeeper or anyone else said they saw a pt seizing or in any kind of distress you better believe I would go check on them right damn now and thank the person who told me.
As an RN, (that has retired prematurely due to witnessing horrid practices and bad management and lack of support for nurses in our hospital systems after 20 years of practice! ) I want to support my fellow practitioners. However, it is obvious that basic documentation was not carried out and other discrepancies were noticed, the ER being slammed and lack of adequate staff needs to be looked at for the profession as a whole as well. Training and education has to be reviewed. Also, if it’s not documented it wasn’t done rule. Making a big X on a document for the chart is unacceptable in my opinion and in my training. Pardon my jumbled comment. This was frustrating to watch!
I stopped renewing my license over 30 years ago. I wanted so badly to take good care of people but those who paid me only cared about making more money. Do you know that about 4% of the population are psychopaths & that those people tend to rise to management? Even non-psychopaths can easily make decisions that harm others when they don't have to directly witness the pain. I'm grateful for my education & knowledge but it was a terrible job for a sensitive soul.
@@katiekane5247 This.. Im struggling as a disabled nurse teaching but part of me knows I cant ethically be in nursing with how shady everything is. Teaching is no better.. :(
Who knows what else was going on with her patient load that day? We can't judge, we've all been there! We are all guilty of poor or inadequate charting, its a flaw in the system that needs attention. One person can't do 50 things at once, so you take care of the urgent, bleeding or coding patient and chart when you can! Things get left out of your charting, even though you did them, and ya, if you don't chart it, it wasn't done is bull. We all try to provide excellent care, and given the choice, I would rather help my patient, and chart later, even with the hospital breathing down your neck not to have overtime! Dang, if we actually charted all the things wedo,we do, would not have any time to be nurses, as we would be charting all the time!
Wow. Ask the same question 18 times and see how badly you can piss off the witness. Nurses perform assessments. Doctors perform physical examinations. Nurses don’t typically test the stability of knees. She looks like a good nurse who had a bad outcome. SMH.
In nursing, you are expected to be perfect, and a super human being both during work and on your down time. I worked up to 24 hour shifts as a nurse in an emergency staffing situation. I worked back to back 16 hour shifts. I worked many 12 hour shifts. I would clock out at one job I did because the facility I worked out refused to pay overtime. I would spend 2 hours after my shift for free to document my work. It was a catch 22 situation. Damned if I do, damned if I did not. Until nurses are not expected to be super human, they will error from lack of support. I ask the powrrs that be, "how do you expect someone to be exact without sleep, food, or even having time to micturate. It is a set up for disaster.
Candace Sturtevant working a 24 hour shift puts patients at risk. If a nurse accepts that assignment, she is accepting the responsibility. It’s not safe. I wouldn’t want to be a patient of a nurse on her 23rd hour.
I was a phlebotomist in a hospital. I worked the same crazy hours. We were always short staffed. Sadly, I had to quit as I couldn't keep that schedule anymore.
I’m a nurse of 30 years. Just saw this now. She did great. Depositions are hard. The lawyers don’t know anything about how hospitals and medicine/surgery work, so their questions are stupid. Again, she did great.
AHHH! Of course there are protocols for Doppler use… I’m an RN. I was hospitalized several times over 12 months for a chronic condition. I generally don’t tell the nurses that I am a nurse. During one admission, I had a nurse who didn’t enter my room from 7am to 7pm. I know she falsified documentation. Not a single assessment was done. When the next shift nurse came in, she confirmed all my charting was done. Unbelievable
I had a ruptured appendix some years ago. I was on 7 antibiotics with a Tagamet in between to try to avoid a second surgery and more bowel lost. The nurse let my IV dry up because she wasn't paying attention. This caused the IV to fail. She pulled me across the room by the tubing and made me sit in a chair while she attempted frantically to flush it out. Not only did she not give me the meds on time, but she caused me to lose a hard won IV site (I was extremely dehydrated on admission and it was really hard to get it started). The IV therapist was pissed. It took a long time to find a new site. At shift change she stood outside my door to give report and said the IV was not working properly throughout the shift and she had worked hard to keep it going, but it still failed. When the next nurse came in and mentioned that it was a shame it had failed I told her what happened. I never thought she believed me. I should have called a complaint but I was drugged and very ill.
A few hrs after my daughter was born she turned blue. She had to be suctioned out and observed for awhile before brought back to our room. We had to stay a couple days for observation and the nurses were supposed to come in and do vitals every 4 hrs. On the 2nd day i never saw a nurse the entire day. Then the next shift my nurse came in and said based on her vitals over the last shift she would most likely be heading to the NICU. I was pissed! I immediately called the charge nurse and told her that nirse hadnt been in 1x to do vitals in her 12hr shift. So she called her at home and she admitted to making them up for her charting. Pretty sure i got her fired🤷
This nurse is under great pressure. I believe she is doing good under the situation. She is an ER nurse. She is not the doctor. She follows orders. Stop picking her apart!! The job in ER is high presssue and a lot of work. In the ER the nurse is there to do the medical work, take care of the patient, Not be their friend. The doctor is the final authority, not the nurse.
Not true at all . For instance if a Doctor prescribes medication the patient cannot tolerate or conflicts with another, the pharmacist dispenses it and misses the problem and the RN administers it to said patient and Patient has negative effects or expires , the RN will absolutely be considered negligent. RN’s are the patients last line of defense and advocate. When you study to become a Nurse there is a huge section of course study relating to this topic. It’s actually pretty ridiculous but as an RN you must question the doctor when they make a mistake
@@Arykperry Precisely. And one of the scenarios that happen where nurse gets thrown under bus is when nurse reports change in condition or response to treatment to dr and doctor fails to act or assess patient and negative outcome ensues. If nurse fails to chart her actions adequately then dr can wriggle out claiming ignorance. The environment in some institutions rather frowns upon nurses who question doctors. Doctors bring in the benjamins and nursing administration will not back up nurses. I worked only in teaching hospitals for that reason. Even then I got called out for refusing to carry out dr order that would put my license on the line and told him you can do it and i will chart that you did it but i wont. Dr. ran and complained to supervisor who jumped my behind. I stood my ground. Too much I'm the doctor you are the nurse do as I say or you will regret it mentality.
@@OrangeCopperTop Since your pronoun lacked an antecedent and doesn't seem to fit the discussion here, I am going to assume that you are referring to the plaintiff in this case. There was a lapse of time from when pt left ER and when he started having vascular decompensation. He could have been fine when left ER but the discharge instructions for every pt include what to watch for or if symptoms worsen before follow up to return to ER. In the time from when he was discharged he could have gone home and disregarded the discharge teaching took off the knee splint re injured the leg got drunk and been non compliant with treatment plan. I've seen it happen and have analyzed records of cases and it is not altogether uncommon. Even if he did everything was told, a problem might not appear immediately after injury but develop after discharge. It appears that the care he received immediately post injury was not departing from standard of care. Sometimes you get a bad outcome even if the staff did nothing wrong. If he delayed returning to ER despite worsening symptoms and when he did the damage was done. I wish I had a dollar for every leg amputation I did during my 7 year stint in OR where a person had a injury or infection in their toe who delayed treatment then went to ER and there was nothing to do but an emergency above knee amputation. Bad outcomes do not necessarily mean negligence on staff. Just saying.
ER/Trauma RN for more than a decade - she should have documented her assessment findings to support her actions. Describes she did it but didn't document it. Poor nursing practice on her part. Mechanism of injury is critical to for all injuries and provides pertinent clues to underlying injuries. Twisting, shearing or impact injuries will yield different findings, treatments or expected injuries.
I always thought it would be more accurate to verbally record my findings when I am doing assessments and can do 2 things at once.They would have to be transcribed which leaves room for error but when you have someone basically dying on you you tend not to think of charting so much. What I hated about that writing is it is time I am not giving direct care to the pt. I think if we were able to voice record charting with a watch or something we could get more done. BUT then if it is not transcribed correctly THAT is a problem, too.
@@lessisbest3286 no one want to identify lack of time being an issue.. Let the staff bend to the issues amd pay off problems and cover them up. Thats cheaper than investing with staff unfortunately..
I cant believe you are shaming her! You, of all people should understand how it is, she could have been dealing with a coding patient, or a traumatic injury bleeding all over the place or both at the same time as this guy. It is not right to throw her under the bus. She did her job, within her scope of practice. The PA decided to discharge the patient, not her. She did the teaching, the patient signed the paper. Is there NO responsibility on the part of the patient for his care? I mean if the injury got worse, became swollen, numb, painful, GO BACK and have it looked at! This guy is making big bank here, not only from the hospital, but his job is surely feeling the pain as well. These stupid lawsuits will never stop unless this stuff stops! The nurse wasn't out to hurt this guy, I mean she was doing her job, taking care of him. Things happen sometimes. This guy was given instructions to return if things changed, he didn't, and he is not responsible?? Charting has become more important than patient care, why is this OK? Nurse goes into a room and barely makes eye contact with her patient, because she has to chart those meds, or chart that IV, or morning assessment, all the while the call light is going off incessantly. I have been an RN for 35 years, I have seen things get worse, little by little, OH, its just one more patient, or one more form, or one more certification I cant count the number of days I have gone home in tears due to work. I have gone for 14 hours without peeing, or eating! Its a ridiculous mess, made worse by stuff like this. I retired early, I had had it, I became a nurse to take care of people, and I am barely able to talk to my 8 patients! I was floated from a newborn unit, to a postpartum unit and given 8 patients to take care of! how is this safe? it isn't, but mark my words, if anything went wrong, it would be on me
@@debbiecalton5534 being overburdened doesn’t excuse us in deviating from standard of care. This is the problem in our profession. If we all stand up and refuse to practice in unsafe substandard conditions, maybe it would change. As a nurse 35 years, you should know “I did my best” or “it was too busy” doesn’t stand up in a court of law. If we don’t meet standard of care, we are liable. Under no circumstances is it acceptable to deviate from best practice. When that becomes acceptable, we won’t need trained providers, nurses or doctors. There’s a culture in nursing of catering to the millionaires profiting on our willingness to keep costs down by taking on a workload that exceeds human capacity. The system is corrupt and broken and burnout is at an all time high. Patients and frontline staff suffer while the CEO’s are vacationing on their yachts. As professionals, we have a duty to maintain standard of care and if it isn’t possible, the hospital should be put on blast and shut down. Period.
This is a classic case of “if it wasn’t documented, it wasn’t done”. Opposing counsel clearly has no idea what the scope of practice for a registered nurse is. An RN CAN NOT: diagnose patients, interpret any imaging, order or perform any invasive procedure except as ordered by a physician or provider. What happened in my opinion is the nurse did an initial assessment and found that the patient was complaining of pain and numbness. Therefore as per her unit policy and or standing orders of the ER (orders used for every patient that meets criteria) the nurse obtained an x ray. Said X Ray is interpreted by a radiologist who writes a report and that is put in the patients chart. The nurse communicated those findings to the provider who then ordered the knee cast to immobilize the knee to prevent further injury and pain medications to relieve pain. Where the nurse is in the wrong is not assessing the patients leg and pain after the knee was casted or medications administered and documenting those findings. Nurses are taught to reassess patients after any nursing intervention is performed according to the nursing process. Maybe the nurse did assess the leg and forgot to document it. The ER is a crazy place and odds are this nurse had other more critically ill patients that required her attention. The patient was discharged and suffered complications. The patient could have always followed up with his PCP or went to the ER again for any further issues that arised after discharge.
She had more critically ill patients. Really. He had he freaking leg cut off two days later. Its better to be safe then sorry better for them to over do treatment then not do enough
@@melissadunkling7010 We don't know what other patients she may have had, but a sucking chest wound trumps a knee injury every time. You seem to imply that there could not possibly have been anything more urgent than this case, which is simply wrong. We just don't know.
Isn’t the duty of an emergency room to basically stabilize a patient until they see a regular doctor for their problem? Is it at all possible they could have prevented his additional issues?
@@notimeforfoolishnessreally5986 i agree people deserve better - unfortunately most hospitals are run by financially driven buisness people who have the bottom line in mind , not the well-being of the patients or the staff- so i hate to tell you that most hospitals are understaffed. Nurse to patient ratios has been a long-standing issue in hospitals. Nursing groups have tried to push laws to require sufficient ratios. Hospitals with nursing unions generally have better nurse to patient ratios, if not it can be scary. At some point you have more patients than are safe , you cant eat pee or sit down for 12 hrs, but are expected to document every detail of your care for each patient in a bug riddled electronic record . This sets the stage for poor patient care and lawsuits … and alot of the time these lawsuits in my opinion should be brought against the hospital rather than the overworked staff.
Another thing…ER Nurse’s are known to be very judgmental when it comes to patients complaining about being in Pain/or asking for pain control! They think everyone is “drug seeking”! Sooo wrong! So cruel!
I've been a nurse for 30 years. Have a lot of time with addictions recovery. My lasting impression is that people that get addicted to opiods are people that want to get high. People in severe pain, whether it is a toothache, trauma, or bone cancer deserve better than to be treated with Tylenol. Lying on a stretcher in a trauma bay, after being run over by a truck, the pain, absent initially, became unimaginable. When the doctor only wanted to give me IV Tylenol, I pulled myself off the stretcher, cervical collar and lower lip hanging from a strip of tissue, bruised and bleeding butt hanging in the breeze, I told the doctor to get me AMA papers, and that I would seek treatment where my trauma could be handled appropriately. It worked. Patients in pain need to be treated for pain with opiod analgesia.
Cant make such big generalizations..... do you know how many people come who are actually looking for drugs? There are good nurses and bad nurses and in between...don't judge us until you've been in our shoes.
Pain is considered “the 5th vital sign which in fact that their pain doesn’t matter. They ask about pain just to satisfy the beast (paperwork) Physicians don’t wanna prescribe any narcotics.U could have an amputation and told to take Tylenol!
@@jeffreymcneal1920 We experienced this first hand. We entered the ER with extreme calf pain and were told it couldn't be a DVT because of no other symptoms than pain. My husband is very healthy and NEVER goes to the doc. They finally agreed to ultrasound and that missed the DVT...unfortunately. Back in ER 2 days later (surgeon sent us...again) with chest pain, right rib pain and he could hardly breath. He was triaged and sent back to waiting room...for 2 HOURS. Finally got into a room and waited another 45 prior to any meds given. They hooked him up to EKG and O2, etc. His 02 was around 79-88 the entire time (usually he's at 98/99. Blood pressure was 191/118 (usually 116/65 ish). After being hooked up we were left in the room another 45 minutes before someone came in to administer morphine. Didn't touch the pain...administered another morphine and then, at my request, gave a muscle relaxer. I asked for CT to check for PE since he had all the symptoms and his surgeon said he's sure that's what he had...hence, sending us to the ER...was told they would do a D-Dimer first. D-Dimer came back VERY HIGH. Finally...5 hours after presenting to ER he was given a CT scan which showed multiple, bilateral pulmonary embolisms. The NP said..."gosh, I really didn't think he had PEs or that he was in that much pain!". and then she laughed!!!!!!! Even though when they asked about the pain scale he told them he was at a 20 and he kept saying.."please help me, I cannot breathe!" He was never given oxygen and they discharged him with nothing but a prescription for a blood thinner. I begged them to keep him but hospitalist said no he was low risk. Went home in once again in excruciating pain and 02 levels 74-82 all night. I was worried sick and stayed up all night watching him struggling to breathe feeling helpless and powerless. I taped it all and took pictures of his vitals throughout the visit to document. He has permanent damage because his body was oxygen starved, according to the pulmonologist.
I was accused of drug seeking when I went to the ER years ago with extreme stomach pain. I had an appointment with a gastroenterologist the next day but with the pain i was in, there was no way I was going to make it until then. They ended up giving me some pain medicine but the nurses treated me like I was subhuman. Turns out after my doctor ordered texts, I had 4 bleeding ulcers in my stomach.
The rn did an excellent job on the patient and during the deposition. Professional and looking at the times recorded the patient did not have to suffer for a lack of pain medication. Well done
@@dana102083 They really are. Good people that are kind and decent sometimes regularly give awful care. We can only speak to the care in this case so we can't speak to other care these health care providers have given. But what we do know is that a lot of great people provide awful care (and a lot of awful people provide great care, too).
@@Millerandzois thanks for the comment! Im an RN and teach Health Care Aides, and sometimes I fewl I discuss the bad things othera do more than highlignt whats right! ..but no one wakes up wanting to hurt someone at work ..but sometimes we do. Sometimes we do and dont know..and sometimes we have opportunity for growth and acceptance, but always chart like your life depended on it, to show how amazing you are!. 🖖
When you become an ER nurse then you can come and talk to me. One of the hardest, and smartest nurses are found in the ER. One is multitasking with not only 7 plus patients with high acuity levels but we are helping other colleagues as well when a lifesaving decision is being made. Personally, I think she could of documented focusing on the injury but I wasn’t there with her that day.
Attorneys don’t ask questions of the opposing side’s witnesses without already knowing the answers to each of those questions. That’s probably law school 101. It’s how they impeach lying witnesses.
@@truthhurts9843 That may be true during trial but one of the purposes of a depo is to gather more detailed information and facts about the case. And to verify the facts they may already have. Also they use depos to see how a witness does in the "hot seat".....how they will present to a jury. If the witness will be believable, sympathetic, boring, unlikeable, etc. If they can hold up under intense questioning or cross exam.
@@impalamama7302 I was talking specifically about medical malpractice claims and why lawyers don’t take those cases. They are not at all like other civil matters, especially those involving medical issues, and you would know this if you have ever worked as a paralegal in multiple civil law matters. Speak to your experience, not what you think you know.
That is a common thing that happens in a deposition all the time. The attorney will put an objection on the record just in case, as their wasn't a judge presiding over the depo. It is like a CYA move. Because it might come down later down the line. The purpose of a depo as part of "Discovery" phase is to elicit and gather admissible evidence. If later something a depo witness says leads to discover evidence that helps or hurts the attorneys case, if the attorney during depo had objected to the question then they have something to have that evidence included or thrown out. If the objection wasn't made during deposition, then if it comes up later, then there is no grounds to object later. Sometimes depositions will be stopped because the attorney deposing witness gets off the hook and the other attorney will stop it and file a motion for a judge to rule. Sometimes a judge may be available to rule in real time but usually not.
@@lolasmom5816 Im not a nurse, but i was a CNA and took 1yr of nursing school and they constantly told us that if the Dr. gives you a bad order, or a med you know can interact with another and you sont speak up, you are legally just as responsible for any bad outcome. In reality though, a nurse 2nd guessing a dr can be extremely intimidating. Some Drs dont use their nurse as another diagnostic tool bc theyre arrogant.
Movement is part of the assessment. If nurses in ER were to document everything said and done, it might be best to record everything-it's unfortunate but it's also reality that as much as we were told to CYA and document EVERYTHING (& I ALWAYS overdocumented) but in a busy ER there's likely no time to do this and would not be very likely to stay in the ER sadly. There's a shortage of nurses as it is and hospitals are cutting staff regularly and it seems to fall on the nurses (& pts) sadly. It's unfair. In ER the staff are running nonstop, they are hard working and bear the brunt of alot of nonsense. Sometimes these lawyers are looking to trip up the staff (this one for example) to make them look somewhat incompetent when they were not. They ask the same questions over and over and tire the individual out so that they may end up questioning themselves later on regarding some of their replies. This video would be good to show all nursing students and to prepare them that the can and will likely be put thru the wringer by malpractice lawyers. Would like to see/hear the physicians' testimony in this case also.
As a nurse this frightens me. We are taught to chart as if it will one day be read back to us in court years later. An attorney will try to rip apart your documentation. We are overwhelmed and short staffed, and doing the best we can
Yes! Charts are legal documents. It’s so crazy. I go over board on my charting now bc of these types of videos but I don’t care I’m going to be thorough!
I’m an RN, never been deposed or sued. I did serve as an expert witness a couple of random times. All settled out of court. The primary reason there was any settlement was because they were on the hook for shotty documentation. ER RNs (and staff) have a very hi stress, hi pressure role. This girl is probably a great ER RN who can save your life from a bloody GSW, MVA, MI, CVA, etc. Bring in the non life threatened pt and she’s probably a bit bored. HOWEVER, as much as I respect the RNs in the ER, it doesn’t surprise me much that her charting is sorely lacking. I feel bad watching her getting backed into the corner and getting nervous. I hope she will step away from this, reflect, and realize any pt in her ER can potentially become a disaster even when things look mild or vague initially. Also, hospitals nowadays using e-charting w a bunch of ‘check the box’ and do not encourage narrative documentation. Yes, seconds count, but as over worked and underpaid as they are, they do need to spend more time on complete and thorough documentation. I hate she had to take or spend her day off getting raked over the coals by an atty who’s goal is to make her look bad. I wish her the best. (i know this case is probably over but i just saw this today)
@@lindaf114 I don't know if she's a witness or what. However, I'm just a lowly paramedic. I would much rather run an arrest, do a needle decompression, or yeet some atropine, one person at a time, than deal with 30 patients for 16 hours straight. I will say, nursing at an ER probably sucks ass, and things can be easily overwhelming/overlooked.
She should know how long it took for pain meds to work. Standard of care is you assess pain and medicate according to hcp orders, and if pain medication is IV you reasses pain again in 15 minutes to determine efficacy of the intervention, if given po ( orally ) you reasses in 30 minutes to determine efficacy of intervention. So if she followed the standard of care she would have had to document after giving medication for pain how well it worked. Since they are using the antiquated method of charting by exception ( a lawsuit waiting to happen and whoever came up with this form of charting should never work anywhere again) pain is outside of normal so if pain document pain type level where on body time given what type given. Then as above reasses and document findings.
Pain is very subjective. All assements are mainly what patient states what his pain is, describes pain and rates pain. Nurses observe signs and symptoms of pain including vitals. A REGISTERED NURSE also speaks and gets a good pain complaint history per patient and his medication reconciliation. Nurse also should be aware patient can be narcotic drug seeking opiate drug seeker. Just part of good assessment.
For what it’s worth: I had been an RN for decades when I had to undergo a hysterectomy (with complications), so I was hospitalized two days. The first night I was experiencing quite a bit of pain, so summoned and asked my nurse if anything was ordered. She returned with a syringe and slowly pushed into the port in my line. All done correctly (come on, nurses, admit it: as patients, we’re gonna watch every little thing but not let the nurse know we’re doing that)! Well, a half-hour later, no reduction in pain. An hour later, same thing. She never returned, nor did I mention it to her. (After all, wouldn’t that be construed as drug-seeking behavior?) So I suffered bigly through the night. Incidentally, I didn’t see her again. Well, now. Six months later, whose booking photo did I see on the front page of our local paper? That’s right. My nurse, busted for stealing narcotics from the hospital. I was sick from head to toe reading this; a black eye to our profession, one we didn’t need. And I felt for her personally. But I also was a little mad; she let me lay there in pain! But my anger didn’t last long. She very well could have been far along enough in her addiction that she had no other choice (or so she thought at the time). Then I was mad at myself, for not calling her back that night to delve further into why I got no relief. There was an outside chance I might have nipped this baby in the bud. But likely not. I brought this story up because it used to be a problem; I learned that there were quite a few dependent healthcare professionals with access to drugs. A couple of years prior to my situation, we had a bright, intelligent Cardiologist with a shining future commit suicide because of a drug problem few knew he had. I’ve been retired for 15 years; hope this situation has improved. If any dependent nurses are reading this, please get help before you throw your career away. It goes without saying that withholding relief from a patient in pain is an act of cruelty; my State’s Board of Nursing has a great peer assistance program that has helped nurses while salvaging their careers. It’s my understanding some of the graduates go on to teach and counsel those on the brink of losing everything.
Her whole deposition seemed based on "i must've done it because it's what I would usually do in practice" or "i would've done it because its protocol" that doesnt mean she did it in this case. She can't remember the patient so if it wasn't noted down her statements like "i checked his pulse" carry no weight. The pulse was an important factor, as was the movement so it's no surprise her lawyer was all over these points like a rash with objections.
I am an RN and because of this I never chart by exception! As an RN you are only as good as your note. “ If it is not charted you did not do it.” You need to write in detail the injury because it may affect the care! I feel this is a crushing injury which he could get compartmental syndrome which could cause amputation by hindering the vessels and nerves
Thank God for my nursing instructors' driving us crazy daily, with these words over and over IF IT'S NOT DOCUMENTED IT'S NOT DONE. I graduated in 1998 for my RN . Never ever did I hear except when you chart by exclusion. You soon learn, in the real world of Health Care, to CYA bc if you don't you will be the scape goat.
I’m missing something here. If the facility policy is to chart by exception, what did this nurse do wrong? Everyone saying to “chart everything” is being unrealistic (and completely defeats the whole purpose of charting bu exception). I’m honestly wondering what she did “wrong” to implicate liability for this patient’s claim?
Im only 75% through, but at this point it sounds like she wasnt thourough in her assessments, and if she was thorough she didnt document them accordingly. Not documented, not done. Its the completeness of it.
It’s seems she is being held liable for charting by exception. That’s what’s confusing for me. If nothing deviated from the original assessment, and her facility policy is to only chart when there’s a deviation, what did she do wrong? Looks like they use paper charting too- which is other way less descriptive. This is an urgent care facility- not like their doing full assessments by each nurse. I feel like the problem is that those involved in the judgment/decision making have no understanding of healthcare or medical charting.
@@Vegan4them around the 49:00 mark is a good example at how her charting was incomplete. She is unable to positively state whether or not that patient was unable to move his foot at the time of discharge because she didn't thoroughly document it. An x on the form tells her nothing definite. If she had charted properly she'd be able to say his discharge condition confidently because it's documented. Instead she can only assume or guess. This is why you should document everything. It protects not only the patient, but the nurses too. If it's not documented, it legally didn't happen. So document, document, document. If she had charted properly she most likely wouldn't be answering simple questions with "possibly" or I "assume.". Eta: At 1:01:35 is another example of poor documenting. She should be able to confidently say she took his pulse at discharge and what it was. She didn't do that so she doesn't remember what his pulse was and only can assume she took it.
asking a person on the stand their home address is a No No..any1 sane or insane in the courtroom will knw where they live..I believe that should be change n kept to the cour workers involved.
@@xxtinabobina if your address was given out and you or your loved ones were murdered.. Doesnt matter hmm? Lots of people want to take justice into their own hands..people go missing, are eternally shut up or blackmailed..forget harassment and stalking. Thats the world we live in.
As an ER and OR nurse I have to say her documentation is just incomplete! If something is not documented, there is no proof if you did something or not, therefore it would theoretically mean it wasn't done!
@@shelleyj1780 charting by exception means only charting abnormal findings. It means anything that wasn't documented means it was within normal limits or expectations of current patient condition. It's supposed to save time and is shorthand. But, this is what happens when you chart by exception.
Witch hunt! There are "levels" of assessment! She did her job! The doctor/NP/PA makes the diagnosis and prescribes treatment. I applauded the nurse for her professionalism! I am a retired NP.
I assessed the patient's leg for pulses, color and warmth to confirm blood flow with a full knee brace. Yeah, sounds like she did her job real well, his leg was amputated.
One night shift in an ICU many moons ago, I was chatting with an experienced RN who had generally let it be known she was a Born Again Christian. I asked her if her faith was a motivation for her nursing career. She replied that it was absolutely not, that it was a job that put bread on the table. While startled by her candor, I believe her point was that it is unwise to romanticize any profession. There are many types of nursing, and it is wise to gravitate towards where one feels most comfortable. For years I strove to be an ICU nurse because the complexity and fast changing nature of the work was fascinating, as was ER work. However, as a male in nursing, it became clear to me that I was a persona non grata, or a black man at a KKK rally. A lot of women resented men intruding in what they considered their domain. Not all, maybe not even a third, but that third conspired to make my life in ICU intolerable, and I tried a number of a different hospitals in different parts of the country. It's not paid slavery if you are engaged in the work, but don't expect many pats on the back, either.
@@jeffreymcneal1920 except when they need help with doing something that requires physical strength. I am sure they don't resent male nurses in that instance.
That is untrue. Nursing is a rewarding profession with many different areas of care to choose. If that's how you feel about the profession then nursing isn't in your heart and you don't belong there.
You can tell when a nurse has first worked as an LPN or CNA and gone back to school to obtain his/her RN. They are 10x the nurse than those that come out of school directly as an RN. Those RN's have no experience, have an attitude as if they are above LPN's even though they have no experience and often refuse to do any hands on dirty work. They are given supervisor positions and half the time have no idea what they are doing.The RN's that have worked thier way up remember how they were treated and the knowledge they have you can't get from a book.
I think the "us vs. them" is unhelpful. Your confirmation bias is very strong. I've known lots of RNs that have never been CNAs, MAs, etc. that are excellent nurses.
RN's assess, they do not diagnose. Palpation and the other things she did fall under assessment. It sounds like she did what she was supposed to and practiced within her scope of practice. The provider ultimely made a diagnose and he allowed the patient to be discharged and "walk out".
Documentation, Documentation, documentation just like in real-estate location location location. If it's not document then it wasn't done,, and document like a lawyer was asking you a question , these we were told in by nursing instructor over and over. Ok nurses here let's hear your comments. I didn't hear any documentation of knee if was swollen, red, warm , if able to move leg or numbness and tingling, pain scale to site and visible injury like any bruising. Yes she could have assessed these but you still have to document even if no findings. From the deposition it sounds like he came, we saw him, gave him something for his pain and did x ray, then the doctor came and saw him.
@Miss M oh my goodness please have checked ASAP, I had something similar too, leg edema with heaviness when walking , extreme fatigue and vomiting and was having anxiety with heart palpitations, I actually thought I was having some kind of heart issues as you know nurses like to diagnose themselves but it was from iron being very low that I had get blood transfusion. Almost fainted at work. Be proactive when it comes to your care and your loved ones, ask questions, when you go back tell them you are leaving till someone does assessment of your legs. What if you have deep vein thrombosis [DVT) and gets missed. No one saw your leg and I won't be surprised if it was documented somewhere that they did coz they still need that documentation of patient's care for their billing. Good luck.
Nurse for 30 yrs, I was thinking the same thing, he ended up with a ‘knee sprain’, no skin assessment of the calf, knee and femur, there must have been some color changes, also knee ROM, a lot missing on assessment
@@cortney3798 Not everyone worldwide can access those Court records with ease. That's the difference between publicly available Court records, and publicly published videos. It was grossly irresponsible of this channel to publish her personal details.
This attorney is very good. He is hitting every topic he should be hitting. His manner is soft and non-threatening. He could be a little stronger on the set up foundational questions but that is secondary. The witness appears to me to have a negative very defensive attitude and does not come across in a sympathetic manner. On a side note - there is a total change of the witnesses demeanor when she is questioned by the second attorney who undoubtedly is a defense attorney for the physician or hospital. The change is striking and probably goes far into the reasons for a 5 million dollar verdict.
God bless them for the work they do, but I’ve personally experienced nurses and doctors taking their stress out on me, mistreating me, and even forgetting me in the er bed for 7 hours until i had to get up and walk on my injured leg to the front desk to ask to be discharged. There is no excuse for Hospitals to allow this type of treatment to patients, and kudos to you guys for continuing to hold them to account for this nonsense.
If we wrote everything the PT said we would never get away from the chart. Give us credit for being a nurse. Lawyers are assholes. Does he document all that in his records? I would never choose nursing now and I just retired after 44 years. MD,s do medical assessment. They are two different things.
Amen! Agree 1000% This is crazy & why I always trained students to know what they can/cannot do, responsibility, what meds are for… etc! Basically told them they were not prepping to care for a gold fish & always needed to understand the enormity of their job & that they could kill someone! So sad
I hear ya Ellen. Remember SOAP Charting at the later part of our shifts. I had technical abilities hardly used by the end. I was turned into a medical secretary taking up 90% of my time by the late 80s.
My nursing started in 1982, our nursing instructor always instructed us to chart everything!!! I retired in 2006. Charting has completely changed! just from listening to this nurse, there are no longer detailed charting available, if there was and she documented everything, there would be hardly any questions or doubt of what was expressed in assessment and what this nurse did for this pt, I always treated a chart as a legal document! ie.. pt states, details of assessment, stated what and when drs or NP present... ECT..follow up completed...I would never go back to nursing because they are overworked and understaffed.
Subjective, Objective, Assessment and Plan (SOAP) and most importantly intervention and evaluation. Always report emergent pertinence to your provider. CYA (cover your axx) bottom line!!
"I don't remember" .... that is WHY the forms need to be completed thoroughly!!!!! Again if you checked pulse you SHOULD have noted the rate in chart!!! NOT just assume .... that you did.
What pulse are you referring to? Pulse pedal by palpation or automated? If automated usually charted automatically and immediately charted digitally. If not charted by exception otherwise, did not happen.
The nurses documented subjective data and failed to do basic nursing assessments for 'objective' data. The doctor needs both sets of data to make informed medical decisions in the best interest of their patients. This ER staff is in the meat market business.
"If it wasnt charted it wasnt done". You might have done it but if you dont chart it there is no proof. One thing she did leave out was comparision to other side.
Many places want charting by exception which means if it’s normal you don’t chart anything. And you don’t chart pedal pulse rates anyway. If you do chart you state weak, moderate, strong, positive, or +
@@Superduper666 Exactly. But one thing that should be done especially with pedal pulses is to check other side to compare. A person could still have a decent pedal pulse on injured side, but if compared to other side, could be diminished, which would be something to note. Likewise some could have rather weak pedal pulse on injured side, but if compared to other side could be the same if person had poor circulation and baseline for that individual. Still needs to be noted, of course. But in first scenario, would indicate a problem but in second it would not.
Maryland must have better compensation laws in Arizona. I was having a minor surgery and my surgeon slipped and cut my left brachial artery and I was told I was not able to sue even though I died on the table and was brought back and ended up with a large keloid scar the length from the middle of my forearm to Mid bicep. Even worse as surgery was in the evening no one kept my husband informed of what was happening, for 5 hours they refused to inform my husband of the truth. My husband kept asking the guy in the waiting room what was happening, they just kept saying her surgery is taking longer than anticipated. For the cherry on top the surgeon tried to sneak past my husband, you could see the elevators from the surgery waiting room. After a week in the ICU, blood transfusions and 3 days in telemetry I finally was able to go home from my 20-30min I&D inflamed cyst surgery turned 5hr life or death battle. For the final surprise the surgeon billed me for my artery repair, I&D, additional time in surgery & post op follow ups. I was not charged by the hospital,any other doctor or person just the surgeon.
No one would probably take your case if you didn’t have any permanent damage as a result of the incident. Medical malpractice cases are extremely difficult to prove and it takes a lot of money advanced by the law firm to foot the bills for medical records, experts, court reporters, witness and expert depos, investigators, processing agent fees, and court fees, so they don’t take a case unless they know they can prove malpractice. It doesn’t matter that you “almost” died, but if you had, your relatives may have had a claim that attorneys would have taken. Lots of people think they are owed because something went wrong medically, but it has more to do with what permanent damages were actually sustained.
@@truthhurts9843 I’m not about getting millions I do have circulation and nerve damage. I’m just about them not billing me for his error that’s all I want I just want his office to remove my debt & get the negative marks off my credit. Honestly the hospital, anesthesiologist and the follow up doctors no one charged me only the surgeon’s office who caused the damage, his office actually billed me for repairing my artery. I am grateful that I am alive so many people have it worse.
@@cobramom3 Med mal cases have very short statutes, so if you wait too long, you are barred from making any claims. Let the doctor sue you, and then counter sue him back. Or file chapter 7 bankruptcy to force the write-off of his bill. Either way, you end up with bad credit, so may as well screw him if he’s wrecking your credit anyway.
How would a case work? If I have an inflamed ulcer that they knew was there. And knew that it would rupture and cause a 4 inch hole in my stomach. Because they figured it would heal with taking stomach acid reducer. The ulcer rupture and I had to have surgery where I lose 7 pints of blood and they had to pump my heart by hand because my heart was failing from the synthetic blood they used. Instead of using real O- negative blood. Now I have a scar right down the middle of my stomach. It starts right below the middle of my rib cage to my belly button. Another doctor told me, they didn't need to open me up like that. 😒. And this was done at well known hospital with a supposed top surgery!!!
So I was sent home with mrsa and then readmitted 2 days later almost dead....I was told if there's not long term issues and a strict deviation from standard and appropriate medical practices there's no case and I live in Maryland
I am a nurse and I would DEFINITELY write down the chief complaint of the patient in the chart. I was surprised and appalled by her lack of concern that she didn't and that it is not her habit to do so.
She wrote down the chief complaint as "injury at work" but she did not get into the details of the injury. I would write "pt c/o door falling on his right leg at his job. FINDINGS--:" I probably wouldn't get into how it happened which is what the prosecutor was trying to get her to say-- how the accident happened. However if a door falls on someone's leg to the extent that he cannot move his foot, then the injury is significant- it is ultimately the doctor's responsibility to perform a thorough assessment of the injury, the nurse just do a cursory assessment consistent with her scope of practice. And the application of the splint... the applicator ought to have checked all the pulses in the extremity!
In my assessment of this court proceedings. I believe some lawyers need to learn medical lingo before accusing someone of medical malpractice. Workmans comp not paying for patient injury so they go after the nurses/doctors/hospital staff. Wowzer
Honestly, unless you are a nurse and unless you have that real life experience of having to multi task so much and be under so much pressure, you simply don’t understand. Things sometimes get overlooked on documentation when you have so many alarms beeping, phones ringing, having to stop your documentation and your train your thought so many times to run from patient to patient, family members showing up at the station, etc. There’s a lot of distractions. I know my assessment is always thorough once I’m in front of my patients and I always give my all to make sure they are safe, but I am not so sure if 100% of my notes in the past 10 years have been 100% accurate. I’m sure I might have missed something at some point. We all have. She seems like a very good and experienced nurse IMO. I think ultimately the MD was at fault.
It seemed to me, in a later deposition of the same case, this time with an ED doctor, that he was markedly well informed about the various ligaments of the knee. I am wondering if he was playing "Colombo" a bit, to draw the nurse deeper and deeper into the trap of over-explaining herself to demonstrate that she was out of her scope of practice. Yes, documentation really broke down on this case, I believe I heard the nurse saying that her assessment was manifested because she (not the doctor) ordered an x-ray. No, that's not even in the ball park. Color, sensation, movement are what needs to be documented. In thirty years, some of it in the ER, trying to document is like trying to drink from a fire hydrant. True, the last computer system I used had a lot of "click the button" responses, to facilitate the process, but it is so hard to do when the charge nurse is demanding you to get the patient out of the bay for the next one. A nurse's day is running from one fire to another, with a leaky bucket. If it's not a patient demanding ice water, it's another in DT's pulling out his IV, or better yet, an A-line, or the senile little old lady wobbling her way to the bathroom with her Foley still hooked on the bed. Meanwhile, the Safety Officer is having you called into the office because you haven't been initialing off your hourly round sheets and two more admissions are getting bounced in and you have two pending discharges. It is just a minefield out there. Now I do pediatric home health. One patient, one doctor, one family. Good luck to the rest of you, you'll need it, in spades.
Indeed! My one nursing instructor told me every nurse should be prepared to go to court once in their life, so chart as though it will be read by people that want to make you look guilty!
Documentation is EVERYTHING! My documentation saved me in a case I was involved in. I had written everything- including who was present in the patient's room during my encounter. The attorney was so impressed at the succinct yet thoroughly written documentation of the event. I was cleared from the case because my documentation showed the facts, and clearly illustrated everything.
I agree, and many, many are the times I would have to stay up to four hours after my shift trying to remember as much detail as I could to get it into the record. A nurse's day is one series of interruptions and demands ranging from admissions, discharges, emergencies, and getting ice water. That is just the tip of it. Sorry the guy lost his foot, that rots. But diagnosing a ruptured popliteal artery isn't in her scope.
I ALWAYS overdocumented and when chart audits came around, I never had a worry. In fact, I was asked to help perform these audits but wasn't what I wanted to do (8 hr shifts) at the time. (It's a tough choice because eventually auditors have to work on the floors with these people later on.)
I understand the patient and the need for the lawsuit. With that being said, let's not go down this road blindly. Medicine is not a perfect science, much less Emergency Medicine. Going into it with the idea that doctors will always have the right diagnosis, and treatment is wrong. You find great professionals, but in general is just a bandaid. The quicker they get you out, the better. All the time underdiagnose, saving insurance companies and the hospital money. They will treat the symptoms, as simply as possible, not the diseases. BE AWARE, you are the one in need, listen to your body, ask for treatment for what is bothering you. Get a second, third opinion, and by no means sit on injuries, and medical issues for days, without seeking help.
Upon initial evaluation and assessment by a nurse, they are required to document findings and quote the patient’s responses to those questions. Failure to do so implies that it was not done. Documentation is everything. If it was not written, it was not done in the eyes of the law.
Exactly!!! We are tough that pretty much day one of nursing school. Always cover your butt just in case you run into situations like this. If its not documented, its not done 🤷🏽♀️
Yes it is. It means she doesn't know but that would be a possibility. He can't reasonably expect her to remember everything. Also a doctor would've examined and diagnosed him. That's not the nurses job.
It really sucks watching a ER nurse being sued. They bust their ass working in some of the craziest shit you can imagine. I am a paramedic, and I would really like to see one of those big shot lawyers to their job.
Are you asserting that every single person in the medical field should be above the law and exempt to any critical review under any circumstances AND that everyone in medicine is in those professions because of the best intentions? Just because you may be a decent person who tries their best to care for people medically and is competent to do so- that does not mean every single other person in medicine is...that is extremely naive, black and white thinking and pack mentality, as opposed to critical thinking
The JOB of all ER staff is to work in "the craziest shit you can imagine", so if one can't perform in a chaotic ER setting, one should not seek to work or try to do the work required in an ER. It is sad that at times an ER is crazy and chaotic, but it is.
Lawyers in description: "Health care practitioners are often prepped for trial with the defence of charting by exception" Lawyer in court an hour forty into testimony: "what is charting by exception? I don't know what that means"
A 34 years old patient goes to ER complaining of chest pain, all tests negative in ER, was discharged in 24 hours he gets huge heart attack. Hospital ER is liable.
"Instability in/to a knee" is a diagnosis to be made by a doctor . Nurses cannot document that, nor can they assess for it. All they can do is observe- observations, reportage, and notifying a patient's/ward medical officer of the results of those observations. He's trying to wrangle a medical diagnosis on the day out of her.
@@LillysConner Not for knee instability! If pt knee buckles when he tries to stand or walk yes that is an observation to note. Swelling numbness deformity pain as well. But to check for knee instability usually an orthopedic surgeon would be one to do that! Rarely does even a ER doctor do that unless he has undergone proper training! Some ER doctors may have had that and some may have not.
@@cynthiatucker2147 Yes. Attorneys especially plaintiff attorneys who work off percentage of award they get are notoriously cheap and balk at paying an LNC the money their services command. Had I been hired by plaintiff attorney I would have prepped him with questions that would have truly been relevant to what may have been missed by the documentation. I can think of at least a dozen or more questions he would have been better off asking than ones he did ask. Smart attorneys are beginning to realize in these days of tort reform that a competent LNC is money well spent. But far too many just don't realize the bang for their buck. I had one attorney client who could have had an entire malpractice suit thrown out because the actual failure to diagnose and treat and gross negligence which culminated in a horrible outcome started 6 weeks prior and again 3 weeks prior. I suggested that they might want to file an amended complaint. I have worked for defendant and plaintiff attorneys....because what I do is rather objectively giving them the strengths and weaknesses of their case, where and what to look for, and help them with their strategy.
August 24, 2021: RN here. As I watched this depo, I thought this would be a great nursing school video for students to watch. Take notes of what you "catch" and class/instructor could discuss. Trust me, those RN students would NEVER forget watching this nervous ER Nurse. Her eyes shifting back and forth cracked me up. I was screaming on my laptop, "Nooooooo, not a good answer." I precepted thru an ER in San Diego. I don't care what Triage has "documented," I'm documenting my care, what pt said to me, etc. And I always documented pretending an attorney was going to read it. CYA at all times, and protect that License. Yeah, yeah, yeah and care for your patient as if they are your own relative.
I have been a Nurse in the operating theatre for 30 years and have probably forgotten 80% of all my patients. I do know that at the end of every case after all instruments swabs and sharp checks have been completed. I do another verbal and visual check of the swabs and sharps before I discard anything. I do this for every single case. I can honestly and truthfully account for my actions for every single case. In nursing. If it’s not written down, it didn’t happen.
Wait…. What? Since when does a nurse order diagnostic testing? I’ve been one 26 years & that is outside the scope of a nurse… we DO NOT prescribe procedures or medications UNLESS you are a NP. You inform doctor of findings to determine that!
@@user-el1rx4is7f I get that … but that is NOT how she presented information… plus I have never seen standing orders allowing a nurse to indiscriminately decide this…
It is the responsibility of the attorney to ask specific questions. The nurse's answers are specific to her job at the hospital on that date in question and not in general to the profession unless they are an expert witness. He could have phrased a follow-up question: “Is the ability to order X-rays part of a standard protocol at St. Agnes?” He later clarified that it was standing order at the hospital in another deposition from an expert witness. When I was an RN, I remember having similar protocols for arm/hand/leg/ankle traumas, in addition to standing orders for chest and abdominal pain and anaphylaxis.
Ummm welcome to the new world of health care! got nurses aides drawing blood for lab test . No unit secretaries helping with lab results and documenting orders...nurses aide drew my blood had blood everywhere! Jesus fix it! and these PA's, four years of college! Doctor please!!!!!!
@@notimeforfoolishnessreally5986 and why many old school nurses try to fix ourselves…. You want real nightmares? Nursing students are basically dumped off at nursing homes & hospitals without their instructors around… & the nurses in these places always want to toss keys to the poor kids & walk away. 🤦♀️ Yeah… not when I was on floor… wouldn’t let them give Tylenol without explaining what it was, why it was being given, possible side effects… etc. & told students they weren’t caring for a gold fish & they needed to realize the importance of their job… they could kill someone.
I went to an ER in montana with a broken neck they diagnosed as a sprain. I went through a lot before I got fixed 6 months later. I sued. I got 300,000.00 because montana has a cap on how much ppl can be rewarded in malpractice. After costs and such, I ended up with about half that. It didn't last long, but here I am still disabled. Thanks to George Bush. I did buy a property with a mobile hone on it. Then my husband died. Etc. I just want to say that mistakes they make affect people's lives. I don't agree with just suing for frivolous things, but like this man, he lost his leg. The rest of his life is adversely affected.
Robin, I'm sorry to hear what happened to you and the loss of your husband. Some damages in this case were similarly subject to a cap on pain and suffering damages. I would not blame George Bush for any damages caps. The reality is caps on damages can cut across party lines. California, for example, is a very liberal state that has malpractice caps that are almost as draconian as what you have in Montana.
Documentation is extremely important. Should have been CMST documented by these nurses. Charting by exception does not excuse not having a CMST assessment.
it is called a fracture/trauma screen: observe, ask them to move it (range of motion), palpate, assess vascular/neurological. She is checking if they need advanced imaging. (xray, mri, ct)
My question would be who went over the discharge instructions and what was included in the info on when to return to the ER. Also was there a family member at bedside to convey discharge info.
I wish someone would’ve taken our case for my mom. The pandemic happened right as my 2 year window was expiring so I couldn’t get an appointment with the few medical malpractice lawyers here. Now it’s been 3.5 years since her first stroke and we can’t do anything about it. I begged and begged for them to do an MRI and both my mom and I told the paramedics, the PA, the nurses and everyone we could speak to that she was having a stroke. My mom was an RN for 40 years and understood what was happening to her. She was not believed despite her suddenly losing her sight and ability to walk. They waited over 24 hours and until she fell unconscious to finally do the MRI that showed she was having a massive Right Cerebellar Stroke. She had to be rushed to emergency brain surgery to save her life. She survived and was doing well. She was in the ICU for 33 days. They finally extubated her after 31 days and on the 33rd day, they chose to discharge her to a Long Term Care Facility (not even a different floor in the hospital-completely OUT of the hospital). As we were waiting for the ambulance to transport her to the low maintenance facility, I started noticing the same signs from her first stroke (nonsense speech, disorientation) and I alerted the ICU nurse to do an MRI. I explained to her that the CT did not catch the first stroke so they had to do specifically an MRI. She said, “oh no. Your mom had a CT ten days ago. She’s just having ICU Delirium.” TEN DAYS AGO doesn’t matter. I told the nurse this. No one listened once again. Within 15 minutes of arriving at the LTCF, she fell unconscious yet again and this time had a left side stroke. But this time it was too late. She’s now brain damaged and paralyzed for life. She’s paralyzed in 3 limbs, cannot speak normally (she talks like a baby and can’t form words), she has severe nerve pain, mood swings, confusion, etc. My mother was climbing a mountain the day before her first stroke and was a highly intelligent professional. Now she’s a prisoner of her own body and mind. We get ZERO assistance cuz we don’t qualify. I am now 36 and I alone take care of her, having to work multiple jobs from home just so I can afford her diapers, meds, etc. Both of our lives are ruined because they treated us like we were just stupid women who didn’t know what we were talking about. They ignored our pleas. They grossly neglected my mother and now she’s forever screwed. It’s NOT right!!!
1st… it is not “her practice” as she is neither a medical doctor nor a NP 2nd… “I assume” blah blah blah… doesn’t mean squat. There is a saying in medicine…. “If it’s not documented? It did not happen.” That’s why documentation is so important
That is why I always hated some charting systems of ‘charting by exception’. I love narrative charting. You get a much more visual account so even a lay-person could understand. yay for EMR’s- NOT. Had there been a more comprehensive system in place, not just checkboxes, this nurse could recall this pt with greater accuracy.
@@rondafarmer341 I always charted my notes for that very reason. If you had to go to court a month later (more or less 4 years) … how would you remember?
@@rondafarmer341 This! Yes our patients are reduced to check boxes now and I think it gives us less time with them and more time on a computer. Give me a pen and paper and I will paint you a picture of this patient with quotes included and I would probably remember them too because I make the note unique for them.
People don’t seem to understand nurses aren’t allowed to diagnose so we can’t chart certain things that imply diagnoses. Only doctors can “diagnose”. And her facility’s charting is flawed because it lacks the details required for his lawyer. She doesn’t remember the patient. Nurses see tons of patients. So she can’t recall and the charting is vague. It’s a no win situation. Also, nurses are taught that charting too much is a problem and not charting enough is a problem 🤦♀️
It puzzles me why Hospital seem to only do Xrays and not MRI's on the same day. If I'm correct, a xray only detect Bone injury and not soft-tissue injury.
I know that’s what caused my son to have a hip replacement at 14.. He had a football injury I took him to the emergency room they only did an x-ray and they said it was just a sprain turned out he had a vascular necrosis of the hip he was continuing to walk- run still trying to play sports while his hip was deteriorating .. I feel as if they did A CT scan or MRI to begin with we could of possibly saved his hip..
Holy shit. As a healthcare provider. This 1 scares the hell out of me. 2 makes me rethink how I document. And 3 it makes me think watching a deposition should be a curriculum requirement for healthcare providers.
Word.
Yes
I'm in an RN program and watching this own my own time after the recent verdict in the radonda vaught case 😓
@@kl-jn4kh Me too. Another RN student that heard the verdict and found myself here...
@k same here.
I am so tired of doctors who make staff do all the assessments and then pop their heads in the door, makes a diagnosis without ever touching the patient, and sends them home without proper treatment. Then the nurses get the blame if anything goes wrong. I recently took an 83 year old woman to the er with a broken back. No doctor ever touched her and they sent her home with a brace she couldn’t put on. She is Legally blind, lives alone and has no family. The doctor wouldn’t see her for 6 weeks. She finally went to another who was appalled by her treatment. She had emergency surgery to avoid paralysis because the break had worsened,
That poor lady. So sad.
oh my God
THIS is real, sad but true sometimes.
Oh noooo!!!! My heart breaks for her ♡ I wish her the speediest recovery possible and as much comfort as possible in the circumstances.
This short comment just took my breath away... not in a good way.
Yep and they are the worst violators of washing hands before touching another patient!!!!
If it’s not documented, it wasn’t done. Period. That’s taught from the first day of nursing school.
Yes, that’s very true. Nursing motto
My mother was in and out of nursing homes for awhile. The documentation in nursing homes is abysmally poor. One time they changed my mom's oxygen - no documentation for the change, no testing for the change, and no date of change. I flat out lost it. Be lazy on someone else's time.
@UCDQZHQFAzGlHYpDEsCZNosQ I did a stint in a nursing home, for evenings, I cared for 5 ventilator patients as well as 15 other patients. I was left alone in that unit for 5 days. On the 6th day I had 4 ventilators stop working. I had to send all four patients to the hospital. I only charted on those four patients that night. I called for help, but there was none. I was overtime 2 and a half hours as it was. You can't chart while bagging a patient. I quit that job the next day.
That is correct charting is what is done not charged not done
@@zencat55 stop dogging nurses
What she needed to say was, I make assessments, I do not diagnose injuries.
Exactly. Assessment is NOT diagnosis. That is for the MD or PA. It seems the big shots let the RN's run the place while they keep a low profile. It's up to the MD/PA to dig deeper.
@@candyorange266 And that's ok. What's important is to know what you don't know and where to find that information. If she claimed to know all policies I would be very suspicious, and concerned.
@@candyorange266 I agree. I also suspect that the plaintiff's attorney was deliberately acting just a little stupid to deliberately annoy her. By this means he provoked her into going deeper and deeper into detail, when it was already clear, that regardless of good intentions, she was acting far beyond the scope of nursing practice. He gave her a LOT of rope, and she took it. In the deposition of the ER physician, the same attorney dispensed with the facade, and demonstrated a profound depth of anatomy, physiology, and pathophysiology, to a point where he was going in circles around the physician.
@Zetylin YES! That's what I kept saying to myself!! Why doesn't she say I do assessments not diagnose..thats the MDs job!!
Could we have at least edited out her home address before posting to the masses?
That was my question also. I’m dumbfounded as to why this sensitive information was not edited. A law firm should know better.
No kidding
I couldn’t even believe they left that in there.
@@kalik5665 EXACTLY!!!! I’m a psychiatric nurse, we don’t even have our last name displayed on our IDs for safety reasons. I wonder if they asked the MD to broadcast his address
It's in the official court document which is public knowledge. Perhaps that's the reason since anyone can access that info now
Maybe it’s a good idea to take out peoples home addresses. It seems unfair that anyone can now know her home addres
i agree, however it's all public information. the difference is someone would have to know to look it up the court records to know it.
@@PRINCESSDREAMYLYN there’s a difference between being public information and having it displayed on youtube
@@dianecheney4141 And you don't say what the difference is. Public information is just that.
I agree.
Especially in these times !
Don't use a computer in which another person is still logged in. I also log out while I'm treating patients or performing other duties. I don't want someone else charting under my name.
Absolutely right!!!
@@donnabelitz3105 at whom is your comment directed? Are you a medical professional?
@@donnabelitz3105 yes, I am. I've worked pediatrics, Internal Medicine, Dermatology and Cosmetics, and Obstetrics and Gynecology. Even in my humble position, I know the importance of charting so a veteran RN BSN definitely knows.
where I come from, a nurse that walks away from a computer without logging off can be fired... this is very important and not a simple mistake..
Which is why electronic records is bad.
The PA and/or the Dr. Diagnosed AND discharged this man, not the nurse.
Yes, but they rather go after the nurse than the Dr. So, they’ll ask the nurse why they allowed the Dr ir PA to discharge him in that condition. Nurses are the scapegoats.
That’s true, but he was doomed from triage. He got fast tracked as a minor leg injury and conformation bias set in and everyone after that treated him as such. Also, there’s huge pressure not to bounce people back to the main ER from the fast track. I’m surprised the paramedics weren’t called to give testimony. They never alerted the triage nurse about his mechanism of injury. They knew he was hung up and twisted around by the knee. I believe they had to free him. This really could have been called a trauma from the field. Once it got pigeon holed as minor by first the paramedics, then triage and the PA and other nurses it was a done deal and the fact that the patient never gave the full story was at least half the problem. It’s sad all the way around.
These dispositions for medical professionals is so hard we see hundreds of patients and to remember one patient years later what happened to that patient. As a professional you feel totally thrown under the bus. I was deposed for a death in labor and delivery years after the fact and even given the death should be something you would remember you sometimes just don’t remember unfortunately. It is not lack of compassion it is the enormous number of patients we see daily.
That makes perfect sense.
Take time to chart
I definitely don’t hold her not remembering against her. The ER would have to be crazy busy.
@@traviscountryliving7833 sounds like you’ve never worked in healthcare….
This is a fair point.
This is why they drill us to document EVERYTHING, if it wasn’t documented it wasn’t done 🤷🏿
Truth!!
Could shoulda woulda
I’m starting RN nursing school in the fall and so glad I saw this! I’ve done simple nursing classes and they always said to do this but to see the actual consequences is frightening 😳
@@lindaservantez6877 you are a true hero and leader! Thank you for the comment- it really helps hearing that it is possible to do in real life. All too often I hear nurses say things like “there’s too many patients to chart everything” or “if you forget vitals just put a little above or below normal range”. I appreciate your comment and thank you for your service as a nurse 🙏🏻 you’ve touched the lives of so many
Yep. One of the most important parts of our jobs after advocating for our patients.
This nurse is a believable witness. I congratulate her honesty and composure. Her attorney seems competent and attuned and familiar with this case.
If that's all she do when she come in the room she makes a lot of money hell I can do that I can look and see if it's swole if you have a temperature
@@barbaragibson6756 swole?!
@@tixie1895 I thought the same thing too . 😂🤣😂😂💀💀
@@barbaragibson6756yep you definitely seem like someone who could take care of someone in the ED
Yes.😅
This is why every malpractice attorney needs a Legal Nurse Consultant on their team. To help prepare the attorneys for depositions with medical professionals.
🎯
Exactimundo!
I totally agree. A legal nurse understands both sides and can help with either. Generally, I looked at charts for attorneys to see if anything was done outside the scope of care.
@@suseyq4559 Thank you for your reply! A nurse paralegal does legal research, ie searching for jury verdicts and legal precedents to support the plantiffs suit, and legwork for her attorneys, but a RN’s professional opinion is very valuable. That RN needs to be still practicing nursing , or not too far away from active clinical practice to “ stand up “ to a challenge by defense attorneys. However there are published Nursing Practice Standards and the hospital’s policy and procedure manual to cite. A nursing mistake is outside the hospital’s policies, obviously. That’s how hospitals avoid “going to bat” for an employee. Every Nurse needs to carry her own malpractice insurance, and if she owns a house, needs to buy the highest $$ amount of homewners liability available, because lawyers will come after all assets. The legal research includes property values of the defendant. For example, a kid, playing sports @ school, iwas injured by another kid in the game. The injured kid’s parents did not buy the insurance policy offered by the school to cover injuries@ school. The same parents had no recourse to get the school district to pay medical bills for their child. Therefore they sued the parents of the other kid and won. Their homeowner’s policy paid the medical bill. It does not seem fair, and ordinary people don’t think about stuff coming at them like that, but it is legal and it happens. Nurses and Dictirs can be held responsible for mistakes made by non professionals that are delegated a task and make a mistake. A famois case in point was an Eye diocror who never saw the patient but was successfully sued. A child, playing, got a splinter of wood stuck in his eye. The parents did not go to the ER but looked in the phone book and called an eye doctor. The receptionist at the office said the doctor was too busy on that friday and booked an appt for the following monday. . The parents thought the person on the phone was a nurse or someone qualified to determine the injury was not serious. The injury was in fact very serious and the child lost the eye. The Doctor was held responsible for his employee. Of course this was a tragic mis-communication. The receptionist should have directed the parents to the ER. Nowdays, every caller to every medical facility gets a message “ If this is an emergency, hang up and dial 911” Be safe out there, Stay well.
She's doing a great job. She's correcting his confusion and clarifying.
If by great job you mean dodging guestions and back peddling yeah she's doing great.
Janet, I agree. She was professional and when he kept asking the same questions, trying to see if she'd ever say anything different than she had before, she never did. I believe she knows exactly what she always does. In no way was she at fault. Obviously, the patient did not provide critical information to her.
@@rosefurlong1575 she didn't dodge anything. In fact, everytime she was told she didn't have to answer she always did.
She never actually answered his questions just dodged around them, well played she was very well coached.
He kept asking her the same the same question because she never actually answered them. If a mechanic never tightened a tire on your car and it flew off injuring yourself and others would you accept this answer. Well in my practice I always tighten the tire. No I don't think so.
The nurse will always be accused and sued first before a doctor or the facility!!
Asking her to give out her address is dangerous cuz anyone can try n hurt her and/or her family.
Agreed. Her identifying information should have been bleeped out.
Not how that works. 🤷♂️
It's ALL a matter of Public Record anyway! Anyone can look it up whenever they like!
@@jeanneeber there is a very big difference between someone going to pull public records and getting copies of depositions if those are even available publicly, and posting video of someone and doxxing them on the internet.
@@klocke9904 It is legitimate to give her personal details in the deposition, obviously. It is not legitimate to broadcast those details on youtube. Most channels of this type bleep such details as addresses and phone numbers.
She’s very good at answering questions and seems very experienced. Very well spoken.
She did hold her own, but she squirmed when asked about ordering tests and medications. She was out of her scope of practice, and probably knew it. The plaintiffs attorney pleasantly eviscerated her on this point. I've been in her shoes many times, but she is working above her nursing license. It's a no-win situation.
@@jeffreymcneal1920 I see your point. I think the problem of charting by exception leaves nurses wide open. He kept asking if she checked his pulses and she said it was part of the assessment and at discharge but he was trying to nail her for that. I personally think something went bad after he left. One of those assessing him would surely have noticed. Don’t you think?
This case was lost but the one with the boy with headaches due to an aneurysm not having a CT Ann’s dying was lost. Go figure.
After each one was repeated.
@@dupasraja9885 I’ve done depositions and feeling nervous I can understand asking to repeat questions.
@@laurelmakula2835 I understand a few, yes. That was almost all of them and if you are always stalling the questions, it allows the individual to start fabricating or missing crucial details.
An injury to the popliteal artery should always be ruled out in any knee injury, especially if there has been a posterior dislocation.
Also - all distal pulses should be examined post application of an immobilizing splint/cast and MUST be documented!
This should be done together with visual colour (of the extremity) and capillary refill, and these MUST also be documented!
So correct. Good nurse
Agreed!
Patient sued hospital and was awarded 5 .1 million Discharged with a sprain. Sloppy assessment,sloppy communication. CS not mentioned in suit just ER physician and physician’ s assistant. Returned to ER 48 hours later. Ruptured artery in back of knee and Damage to muscles and ligaments. Leading to above knee amputation. Damages later reduced to I.2 million. Lots via Google.
So was this patient an idiot? Doesnt he bear SOME responsibility for his care? Its stupid! Maybe he was stable at discharge! He most likely was given discharge instructions! This was HIS fault, he should not get paid a settlement from the hospital, not one cent. Its stuff like this that proliferates the lawsuits, driving malpractice costs up, and costing US more money.
This patient is an idiot!
@@debbiecalton5534 The Physician's Assistant and the Physician were responsible for the sloppy assessments. As one of the expert witnesses pointed out. Triage means to SORT. Charting only by exception may save time but obviously leads to problems. I felt that neither the PA nor the physician realized the serious nature of a deposition and really responded in a way that made me doubt their judgement. Regarding the patient,If I remember rightly, there was a history of psychiatric problems and Alcoholism,. He could not recite the alphabet nor read three letter words (reported by another expert witness). He was given discharge instructions but given his age and problems mentioned above he probably didn't understand them. I trained as an RN in the UK in the 1960's. Huge respect between physicians and nurses for each other and the people under their care.He would have been kept in overnight for observations.
I totally agree about the inclusion of personal details
poorly
Thanks. Saved me some time listening to entirety of video.👌🏼
Asking this nurse if she has the ability to order an MRI or other diagnostic procedures is not the same as asking if she has the authority to do so.
Only a Doctor has the Authority to order diagnostic tests. This hospital is operating outside of public GOoD in partnerSHIP with roMAN DOCtrines$
@Lily Hyatt there are many practitioners of medicine who have the authority to order tests these days. Nurse Practioners, Physician Assistants, Nurse Midwives. Also, many MDs have standing orders for patients who present with certain conditions - especially in smaller community hospitals. Our healthcare delivery model has changed from the simple MD/Nurse model.
@@nmanon4960 standing orders are common but are ordered by a MD, DO, NP, PA, etc. Not nurses.
@@AlphaMom55 yes I know. I was responding to a comment that said only MDs can order tests. That is not the case.
@Lily Hyatt 43:57 he asks if she has the authority to order X-rays and she says yes.
OMG his repetitive questions. I'm a Nurse and it's simple if there's no change from triage she's not documenting it. She only documents changes from the triage. She as any Nurse knows does a full assessment then passes any abnormal findings to the Doctor. Each facility has different policies. I document everything (stay late always to finish my notes from my page from the day). I was always taught in nursing school if it wasn't written it wasn't done. But his repeating repeating repeating is CRAZY!!!! Poor healthcare workers, we get heck (especially nurses) who work so hard we don't even have time to pee or eat!!!!
the lawyer is a dolt. i would have spoken slower....and quieter....
So true
When my mom was hospitalized it was like pulling teeth to get a nurse to come in and help her. And this was before Covid, so no excuses. After ringing the call bell and waiting 20 minutes or more for someone to come I'd finally have to go in search of a nurse, only to find a group of 3 in deep conversation about their dinner the previous night, and 2 more sitting on their phones scrolling through Facebook, ignoring the call bells. No one does their damn job any more. Everyone just wants to play around or sit on their phones.
Nope. Everyone wants to get their paycheck.
I worked in a hospital for 5yrs. I was passing out menues. When walking past a room I noticed a patient having a seizure, told the RN, and L PN at the desk. There where 3 of them, they where just talking about their personal lives. I continued passing out menues.20 min. Went by and still no one went in to check on him. By this time the bed was going across the room, it was almost to opposite wall. Once again I told nurses. They hAve me the evil eye and finally got off their butts and checked on him.I was really disgusted at their lackadaisical attitude towards patient's.
Sad but this is what the rePUBLIC gets for following Men who wear black women's Dresses and claim they are worKING for public GOoD.
@@deekay1747 You are absolutely incorrect. I know plenty of nurses who Barely passed nursing school and would be completely lost without the internet.
@@deekay1747 wow how rude! I have Epilepsy and know my seizures have gone unnoticed, if this lady had not persisted in telling the nurses no one would have gone in
@@deekay1747 I’ve been an RN for 40+ yrs and if I was charting at the desk and a menu passer, housekeeper or anyone else said they saw a pt seizing or in any kind of distress you better believe I would go check on them right damn now and thank the person who told me.
@@capricioushorse 👏👏👏👏👏👏👏
As an RN, (that has retired prematurely due to witnessing horrid practices and bad management and lack of support for nurses in our hospital systems after 20 years of practice! ) I want to support my fellow practitioners. However, it is obvious that basic documentation was not carried out and other discrepancies were noticed, the ER being slammed and lack of adequate staff needs to be looked at for the profession as a whole as well. Training and education has to be reviewed. Also, if it’s not documented it wasn’t done rule. Making a big X on a document for the chart is unacceptable in my opinion and in my training. Pardon my jumbled comment. This was frustrating to watch!
I stopped renewing my license over 30 years ago. I wanted so badly to take good care of people but those who paid me only cared about making more money. Do you know that about 4% of the population are psychopaths & that those people tend to rise to management? Even non-psychopaths can easily make decisions that harm others when they don't have to directly witness the pain. I'm grateful for my education & knowledge but it was a terrible job for a sensitive soul.
@@katiekane5247 This.. Im struggling as a disabled nurse teaching but part of me knows I cant ethically be in nursing with how shady everything is. Teaching is no better.. :(
Who knows what else was going on with her patient load that day? We can't judge, we've all been there!
We are all guilty of poor or inadequate charting, its a flaw in the system that needs attention. One person can't do 50 things at once, so you take care of the urgent, bleeding or coding patient and chart when you can! Things get left out of your charting, even though you did them, and ya, if you don't chart it, it wasn't done is bull. We all try to provide excellent care, and given the choice, I would rather help my patient, and chart later, even with the hospital breathing down your neck not to have overtime! Dang, if we actually charted all the things wedo,we do, would not have any time to be nurses, as we would be charting all the time!
@@katiekane5247 and that is what nurses are, caring and sensitive.
@@dana102083 its always about the money, isn't it?
Wow. Ask the same question 18 times and see how badly you can piss off the witness. Nurses perform assessments. Doctors perform physical examinations. Nurses don’t typically test the stability of knees. She looks like a good nurse who had a bad outcome. SMH.
I feel bad for her
Right. I hate she going through that
In nursing, you are expected to be perfect, and a super human being both during work and on your down time. I worked up to 24 hour shifts as a nurse in an emergency staffing situation. I worked back to back 16 hour shifts. I worked many 12 hour shifts. I would clock out at one job I did because the facility I worked out refused to pay overtime. I would spend 2 hours after my shift for free to document my work. It was a catch 22 situation. Damned if I do, damned if I did not. Until nurses are not expected to be super human, they will error from lack of support. I ask the powrrs that be, "how do you expect someone to be exact without sleep, food, or even having time to micturate. It is a set up for disaster.
Candace Sturtevant working a 24 hour shift puts patients at risk. If a nurse accepts that assignment, she is accepting the responsibility. It’s not safe. I wouldn’t want to be a patient of a nurse on her 23rd hour.
@@wishingyoupeace by law, where I am from, you can’t work over 16 hours.
I was a phlebotomist in a hospital. I worked the same crazy hours. We were always short staffed. Sadly, I had to quit as I couldn't keep that schedule anymore.
Nobody care
Yep and no time to chart and not allowed to stay overtime to complete your charting
I’m a nurse of 30 years. Just saw this now. She did great. Depositions are hard. The lawyers don’t know anything about how hospitals and medicine/surgery work, so their questions are stupid.
Again, she did great.
AHHH! Of course there are protocols for Doppler use… I’m an RN. I was hospitalized several times over 12 months for a chronic condition. I generally don’t tell the nurses that I am a nurse. During one admission, I had a nurse who didn’t enter my room from 7am to 7pm. I know she falsified documentation. Not a single assessment was done. When the next shift nurse came in, she confirmed all my charting was done. Unbelievable
I had a ruptured appendix some years ago. I was on 7 antibiotics with a Tagamet in between to try to avoid a second surgery and more bowel lost. The nurse let my IV dry up because she wasn't paying attention. This caused the IV to fail. She pulled me across the room by the tubing and made me sit in a chair while she attempted frantically to flush it out. Not only did she not give me the meds on time, but she caused me to lose a hard won IV site (I was extremely dehydrated on admission and it was really hard to get it started). The IV therapist was pissed. It took a long time to find a new site. At shift change she stood outside my door to give report and said the IV was not working properly throughout the shift and she had worked hard to keep it going, but it still failed. When the next nurse came in and mentioned that it was a shame it had failed I told her what happened. I never thought she believed me. I should have called a complaint but I was drugged and very ill.
A few hrs after my daughter was born she turned blue. She had to be suctioned out and observed for awhile before brought back to our room. We had to stay a couple days for observation and the nurses were supposed to come in and do vitals every 4 hrs. On the 2nd day i never saw a nurse the entire day. Then the next shift my nurse came in and said based on her vitals over the last shift she would most likely be heading to the NICU. I was pissed! I immediately called the charge nurse and told her that nirse hadnt been in 1x to do vitals in her 12hr shift. So she called her at home and she admitted to making them up for her charting. Pretty sure i got her fired🤷
@@berryknobberry2465 GOOD! Wow, these stories are unspeakable.
@@berryknobberry2465 I wonder if she lost her nursing license, if not she should have.I hope and your baby are doing well.
I don’t tell others either. I just watch to make sure they are doing what’s right.
This nurse is under great pressure. I believe she is doing good under the situation. She is an ER nurse. She is not the doctor. She follows orders. Stop picking her apart!! The job in ER is high presssue and a lot of work. In the ER the nurse is there to do the medical work, take care of the patient, Not be their friend. The doctor is the final authority, not the nurse.
@@cindymcintosh9949 also protecting your license
Not true at all . For instance if a Doctor prescribes medication the patient cannot tolerate or conflicts with another, the pharmacist dispenses it and misses the problem and the RN administers it to said patient and Patient has negative effects or expires , the RN will absolutely be considered negligent. RN’s are the patients last line of defense and advocate. When you study to become a Nurse there is a huge section of course study relating to this topic. It’s actually pretty ridiculous but as an RN you must question the doctor when they make a mistake
@@Arykperry Precisely. And one of the scenarios that happen where nurse gets thrown under bus is when nurse reports change in condition or response to treatment to dr and doctor fails to act or assess patient and negative outcome ensues. If nurse fails to chart her actions adequately then dr can wriggle out claiming ignorance.
The environment in some institutions rather frowns upon nurses who question doctors. Doctors bring in the benjamins and nursing administration will not back up nurses.
I worked only in teaching hospitals for that reason. Even then I got called out for refusing to carry out dr order that would put my license on the line and told him you can do it and i will chart that you did it but i wont. Dr. ran and complained to supervisor who jumped my behind. I stood my ground.
Too much I'm the doctor you are the nurse do as I say or you will regret it mentality.
It's ok, no stress. He'll grow another one.
@@OrangeCopperTop Since your pronoun lacked an antecedent and doesn't seem to fit the discussion here, I am going to assume that you are referring to the plaintiff in this case.
There was a lapse of time from when pt left ER and when he started having vascular decompensation. He could have been fine when left ER but the discharge instructions for every pt include what to watch for or if symptoms worsen before follow up to return to ER. In the time from when he was discharged he could have gone home and disregarded the discharge teaching took off the knee splint re injured the leg got drunk and been non compliant with treatment plan.
I've seen it happen and have analyzed records of cases and it is not altogether uncommon. Even if he did everything was told, a problem might not appear immediately after injury but develop after discharge. It appears that the care he received immediately post injury was not departing from standard of care. Sometimes you get a bad outcome even if the staff did nothing wrong. If he delayed returning to ER despite worsening symptoms and when he did the damage was done.
I wish I had a dollar for every leg amputation I did during my 7 year stint in OR where a person had a injury or infection in their toe who delayed treatment then went to ER and there was nothing to do but an emergency above knee amputation.
Bad outcomes do not necessarily mean negligence on staff. Just saying.
ER/Trauma RN for more than a decade - she should have documented her assessment findings to support her actions. Describes she did it but didn't document it. Poor nursing practice on her part. Mechanism of injury is critical to for all injuries and provides pertinent clues to underlying injuries. Twisting, shearing or impact injuries will yield different findings, treatments or expected injuries.
I always thought it would be more accurate to verbally record my findings when I am doing assessments and can do 2 things at once.They would have to be transcribed which leaves room for error but when you have someone basically dying on you you tend not to think of charting so much. What I hated about that writing is it is time I am not giving direct care to the pt. I think if we were able to voice record charting with a watch or something we could get more done. BUT then if it is not transcribed correctly THAT is a problem, too.
@@lessisbest3286 no one want to identify lack of time being an issue.. Let the staff bend to the issues amd pay off problems and cover them up. Thats cheaper than investing with staff unfortunately..
I cant believe you are shaming her! You, of all people should understand how it is, she could have been dealing with a coding patient, or a traumatic injury bleeding all over the place or both at the same time as this guy. It is not right to throw her under the bus. She did her job, within her scope of practice. The PA decided to discharge the patient, not her. She did the teaching, the patient signed the paper. Is there NO responsibility on the part of the patient for his care? I mean if the injury got worse, became swollen, numb, painful, GO BACK and have it looked at! This guy is making big bank here, not only from the hospital, but his job is surely feeling the pain as well.
These stupid lawsuits will never stop unless this stuff stops! The nurse wasn't out to hurt this guy, I mean she was doing her job, taking care of him. Things happen sometimes. This guy was given instructions to return if things changed, he didn't, and he is not responsible?? Charting has become more important than patient care, why is this OK? Nurse goes into a room and barely makes eye contact with her patient, because she has to chart those meds, or chart that IV, or morning assessment, all the while the call light is going off incessantly. I have been an RN for 35 years, I have seen things get worse, little by little, OH, its just one more patient, or one more form, or one more certification I cant count the number of days I have gone home in tears due to work. I have gone for 14 hours without peeing, or eating! Its a ridiculous mess, made worse by stuff like this. I retired early, I had had it, I became a nurse to take care of people, and I am barely able to talk to my 8 patients! I was floated from a newborn unit, to a postpartum unit and given 8 patients to take care of! how is this safe? it isn't, but mark my words, if anything went wrong, it would be on me
@@debbiecalton5534 The patient did come back, he came back the very next day.
@@debbiecalton5534 being overburdened doesn’t excuse us in deviating from standard of care. This is the problem in our profession. If we all stand up and refuse to practice in unsafe substandard conditions, maybe it would change. As a nurse 35 years, you should know “I did my best” or “it was too busy” doesn’t stand up in a court of law. If we don’t meet standard of care, we are liable. Under no circumstances is it acceptable to deviate from best practice. When that becomes acceptable, we won’t need trained providers, nurses or doctors.
There’s a culture in nursing of catering to the millionaires profiting on our willingness to keep costs down by taking on a workload that exceeds human capacity. The system is corrupt and broken and burnout is at an all time high. Patients and frontline staff suffer while the CEO’s are vacationing on their yachts. As professionals, we have a duty to maintain standard of care and if it isn’t possible, the hospital should be put on blast and shut down. Period.
This is a classic case of “if it wasn’t documented, it wasn’t done”.
Opposing counsel clearly has no idea what the scope of practice for a registered nurse is. An RN CAN NOT: diagnose patients, interpret any imaging, order or perform any invasive procedure except as ordered by a physician or provider. What happened in my opinion is the nurse did an initial assessment and found that the patient was complaining of pain and numbness. Therefore as per her unit policy and or standing orders of the ER (orders used for every patient that meets criteria) the nurse obtained an x ray. Said X Ray is interpreted by a radiologist who writes a report and that is put in the patients chart. The nurse communicated those findings to the provider who then ordered the knee cast to immobilize the knee to prevent further injury and pain medications to relieve pain. Where the nurse is in the wrong is not assessing the patients leg and pain after the knee was casted or medications administered and documenting those findings. Nurses are taught to reassess patients after any nursing intervention is performed according to the nursing process. Maybe the nurse did assess the leg and forgot to document it. The ER is a crazy place and odds are this nurse had other more critically ill patients that required her attention. The patient was discharged and suffered complications. The patient could have always followed up with his PCP or went to the ER again for any further issues that arised after discharge.
She had more critically ill patients. Really. He had he freaking leg cut off two days later. Its better to be safe then sorry better for them to over do treatment then not do enough
@@melissadunkling7010 We don't know what other patients she may have had, but a sucking chest wound trumps a knee injury every time. You seem to imply that there could not possibly have been anything more urgent than this case, which is simply wrong. We just don't know.
Isn’t the duty of an emergency room to basically stabilize a patient until they see a regular doctor for their problem? Is it at all possible they could have prevented his additional issues?
Pt should not have several bills to pay.. If hospital is understaffed shut it the hell down. These are ppl not live stock.
@@notimeforfoolishnessreally5986 i agree people deserve better - unfortunately most hospitals are run by financially driven buisness people who have the bottom line in mind , not the well-being of the patients or the staff- so i hate to tell you that most hospitals are understaffed. Nurse to patient ratios has been a long-standing issue in hospitals. Nursing groups have tried to push laws to require sufficient ratios. Hospitals with nursing unions generally have better nurse to patient ratios, if not it can be scary. At some point you have more patients than are safe , you cant eat pee or sit down for 12 hrs, but are expected to document every detail of your care for each patient in a bug riddled electronic record . This sets the stage for poor patient care and lawsuits … and alot of the time these lawsuits in my opinion should be brought against the hospital rather than the overworked staff.
Another thing…ER Nurse’s are known to be very judgmental when it comes to patients complaining about being in Pain/or asking for pain control! They think everyone is “drug seeking”! Sooo wrong! So cruel!
I've been a nurse for 30 years. Have a lot of time with addictions recovery. My lasting impression is that people that get addicted to opiods are people that want to get high. People in severe pain, whether it is a toothache, trauma, or bone cancer deserve better than to be treated with Tylenol. Lying on a stretcher in a trauma bay, after being run over by a truck, the pain, absent initially, became unimaginable. When the doctor only wanted to give me IV Tylenol, I pulled myself off the stretcher, cervical collar and lower lip hanging from a strip of tissue, bruised and bleeding butt hanging in the breeze, I told the doctor to get me AMA papers, and that I would seek treatment where my trauma could be handled appropriately. It worked. Patients in pain need to be treated for pain with opiod analgesia.
Cant make such big generalizations..... do you know how many people come who are actually looking for drugs? There are good nurses and bad nurses and in between...don't judge us until you've been in our shoes.
Pain is considered “the 5th vital sign which in fact that their pain doesn’t matter. They ask about pain just to satisfy the beast (paperwork) Physicians don’t wanna prescribe any narcotics.U could have an amputation and told to take Tylenol!
@@jeffreymcneal1920 We experienced this first hand. We entered the ER with extreme calf pain and were told it couldn't be a DVT because of no other symptoms than pain. My husband is very healthy and NEVER goes to the doc. They finally agreed to ultrasound and that missed the DVT...unfortunately. Back in ER 2 days later (surgeon sent us...again) with chest pain, right rib pain and he could hardly breath. He was triaged and sent back to waiting room...for 2 HOURS. Finally got into a room and waited another 45 prior to any meds given. They hooked him up to EKG and O2, etc. His 02 was around 79-88 the entire time (usually he's at 98/99. Blood pressure was 191/118 (usually 116/65 ish). After being hooked up we were left in the room another 45 minutes before someone came in to administer morphine. Didn't touch the pain...administered another morphine and then, at my request, gave a muscle relaxer. I asked for CT to check for PE since he had all the symptoms and his surgeon said he's sure that's what he had...hence, sending us to the ER...was told they would do a D-Dimer first. D-Dimer came back VERY HIGH. Finally...5 hours after presenting to ER he was given a CT scan which showed multiple, bilateral pulmonary embolisms. The NP said..."gosh, I really didn't think he had PEs or that he was in that much pain!". and then she laughed!!!!!!! Even though when they asked about the pain scale he told them he was at a 20 and he kept saying.."please help me, I cannot breathe!" He was never given oxygen and they discharged him with nothing but a prescription for a blood thinner. I begged them to keep him but hospitalist said no he was low risk. Went home in once again in excruciating pain and 02 levels 74-82 all night. I was worried sick and stayed up all night watching him struggling to breathe feeling helpless and powerless. I taped it all and took pictures of his vitals throughout the visit to document. He has permanent damage because his body was oxygen starved, according to the pulmonologist.
I was accused of drug seeking when I went to the ER years ago with extreme stomach pain. I had an appointment with a gastroenterologist the next day but with the pain i was in, there was no way I was going to make it until then. They ended up giving me some pain medicine but the nurses treated me like I was subhuman. Turns out after my doctor ordered texts, I had 4 bleeding ulcers in my stomach.
The rn did an excellent job on the patient and during the deposition. Professional and looking at the times recorded the patient did not have to suffer for a lack of pain medication. Well done
If ever you want to really annoy th out of someone, have them deposed. By this guy.
Hurricane
He seems pretty calm compared to some I've seen! Some lawyers are intimidating before even asking a question!!
My last company had their attorneys train us to handle depositions
I'm pretty sure it's his first medical malpractice based on his lack of knowledge of nursing ranks. Or even what a BSN is. Come on, man.
This woman is handling herself beautifully.
Apparently the jury didn’t think so…
@@mercury_rising handling herself in court and appropriately doing her job are two different things.
She is, you can tell she is a great nurse, very by the book.
@@dana102083 They really are. Good people that are kind and decent sometimes regularly give awful care. We can only speak to the care in this case so we can't speak to other care these health care providers have given. But what we do know is that a lot of great people provide awful care (and a lot of awful people provide great care, too).
@@Millerandzois thanks for the comment! Im an RN and teach Health Care Aides, and sometimes I fewl I discuss the bad things othera do more than highlignt whats right! ..but no one wakes up wanting to hurt someone at work ..but sometimes we do. Sometimes we do and dont know..and sometimes we have opportunity for growth and acceptance, but always chart like your life depended on it, to show how amazing you are!. 🖖
When you become an ER nurse then you can come and talk to me. One of the hardest, and smartest nurses are found in the ER. One is multitasking with not only 7 plus patients with high acuity levels but we are helping other colleagues as well when a lifesaving decision is being made. Personally, I think she could of documented focusing on the injury but I wasn’t there with her that day.
CORRECT
Someone tell that lawyer that shes not a doctor. He obviously doesn't know.
Attorneys do that to rattle the witness. It is a common ploy. Just like police when interrogating a suspect or witness to try to trip them up.
5 million dollars says he is right and you are wrong lmao
Attorneys don’t ask questions of the opposing side’s witnesses without already knowing the answers to each of those questions. That’s probably law school 101. It’s how they impeach lying witnesses.
@@truthhurts9843 That may be true during trial but one of the purposes of a depo is to gather more detailed information and facts about the case. And to verify the facts they may already have.
Also they use depos to see how a witness does in the "hot seat".....how they will present to a jury. If the witness will be believable, sympathetic, boring, unlikeable, etc. If they can hold up under intense questioning or cross exam.
@@impalamama7302 I was talking specifically about medical malpractice claims and why lawyers don’t take those cases. They are not at all like other civil matters, especially those involving medical issues, and you would know this if you have ever worked as a paralegal in multiple civil law matters. Speak to your experience, not what you think you know.
If my lawyer said objection, I am not talking lol.
That is a common thing that happens in a deposition all the time. The attorney will put an objection on the record just in case, as their wasn't a judge presiding over the depo.
It is like a CYA move. Because it might come down later down the line. The purpose of a depo as part of "Discovery" phase is to elicit and gather admissible evidence. If later something a depo witness says leads to discover evidence that helps or hurts the attorneys case, if the attorney during depo had objected to the question then they have something to have that evidence included or thrown out. If the objection wasn't made during deposition, then if it comes up later, then there is no grounds to object later.
Sometimes depositions will be stopped because the attorney deposing witness gets off the hook and the other attorney will stop it and file a motion for a judge to rule. Sometimes a judge may be available to rule in real time but usually not.
You have to in a deposition the objections are to ask the judge to exclude that later on
Report to YT: A personal address shouldn’t be uploaded to a public platform like this!
An assessment should include circulation of the limb esp. if there was an injury. And she should know if the patient could move his foot or not.
She did but it's not her job to diagnose. The dr would've done all of that, diagnosed, decided treatment, and his release. None of that is on a nurse
@@lolasmom5816 Im not a nurse, but i was a CNA and took 1yr of nursing school and they constantly told us that if the Dr. gives you a bad order, or a med you know can interact with another and you sont speak up, you are legally just as responsible for any bad outcome. In reality though, a nurse 2nd guessing a dr can be extremely intimidating. Some Drs dont use their nurse as another diagnostic tool bc theyre arrogant.
Oh so that is why the hospital had me do this. All this time, I remember doing this at one particular hospital and never knew why I was doing it!
It was not charted and she does not remember the patient. Emergencies are so busy sometimes nurses are on auto-pilot.
Movement is part of the assessment. If nurses in ER were to document everything said and done, it might be best to record everything-it's unfortunate but it's also reality that as much as we were told to CYA and document EVERYTHING (& I ALWAYS overdocumented) but in a busy ER there's likely no time to do this and would not be very likely to stay in the ER sadly. There's a shortage of nurses as it is and hospitals are cutting staff regularly and it seems to fall on the nurses (& pts) sadly. It's unfair. In ER the staff are running nonstop, they are hard working and bear the brunt of alot of nonsense.
Sometimes these lawyers are looking to trip up the staff (this one for example) to make them look somewhat incompetent when they were not. They ask the same questions over and over and tire the individual out so that they may end up questioning themselves later on regarding some of their replies.
This video would be good to show all nursing students and to prepare them that the can and will likely be put thru the wringer by malpractice lawyers. Would like to see/hear the physicians' testimony in this case also.
As a nurse this frightens me. We are taught to chart as if it will one day be read back to us in court years later. An attorney will try to rip apart your documentation. We are overwhelmed and short staffed, and doing the best we can
Same. I'm definitely going to dedicate more time to charting from today forward even if I have to stay after or not take a full lunch break
@@NoNakersAllowed I have been since I watched these depositions. It’s really opened my eyes
Yes! Charts are legal documents. It’s so crazy. I go over board on my charting now bc of these types of videos but I don’t care I’m going to be thorough!
@@glowbaby1794thank you so much God bless your extra effort will be rewarded in helping someone greatly solve their problem
I’m an RN, never been deposed or sued. I did serve as an expert witness a couple of random times. All settled out of court. The primary reason there was any settlement was because they were on the hook for shotty documentation. ER RNs (and staff) have a very hi stress, hi pressure role. This girl is probably a great ER RN who can save your life from a bloody GSW, MVA, MI, CVA, etc. Bring in the non life threatened pt and she’s probably a bit bored. HOWEVER, as much as I respect the RNs in the ER, it doesn’t surprise me much that her charting is sorely lacking. I feel bad watching her getting backed into the corner and getting nervous. I hope she will step away from this, reflect, and realize any pt in her ER can potentially become a disaster even when things look mild or vague initially. Also, hospitals nowadays using e-charting w a bunch of ‘check the box’ and do not encourage narrative documentation. Yes, seconds count, but as over worked and underpaid as they are, they do need to spend more time on complete and thorough documentation. I hate she had to take or spend her day off getting raked over the coals by an atty who’s goal is to make her look bad. I wish her the best. (i know this case is probably over but i just saw this today)
She had to take a day off. The plaintiff lost his leg for life. ⚖️
Yeah when you miss the crush syndrome, DVT, or whatever, maybe it's time you go to court
@@dylanfitch2997 she's NOT the doctor.
@@lindaf114 I don't know if she's a witness or what. However, I'm just a lowly paramedic. I would much rather run an arrest, do a needle decompression, or yeet some atropine, one person at a time, than deal with 30 patients for 16 hours straight. I will say, nursing at an ER probably sucks ass, and things can be easily overwhelming/overlooked.
She should know how long it took for pain meds to work. Standard of care is you assess pain and medicate according to hcp orders, and if pain medication is IV you reasses pain again in 15 minutes to determine efficacy of the intervention, if given po ( orally ) you reasses in 30 minutes to determine efficacy of intervention. So if she followed the standard of care she would have had to document after giving medication for pain how well it worked. Since they are using the antiquated method of charting by exception ( a lawsuit waiting to happen and whoever came up with this form of charting should never work anywhere again) pain is outside of normal so if pain document pain type level where on body time given what type given. Then as above reasses and document findings.
Good explanation, thank you.
Pain is very subjective. All assements are mainly what patient states what his pain is, describes pain and rates pain. Nurses observe signs and symptoms of pain including vitals. A REGISTERED NURSE also speaks and gets a good pain complaint history per patient and his medication reconciliation. Nurse also should be aware patient can be narcotic drug seeking opiate drug seeker. Just part of good assessment.
Your objection to called antiquated "charting by exception" is totally subjective and not determined legal precedent.
What's taught and practiced are two different things. RN's are usually understaffed so they may not be able to check on the patient as frequently.
For what it’s worth: I had been an RN for decades when I had to undergo a hysterectomy (with complications), so I was hospitalized two days. The first night I was experiencing quite a bit of pain, so summoned and asked my nurse if anything was ordered. She returned with a syringe and slowly pushed into the port in my line. All done correctly (come on, nurses, admit it: as patients, we’re gonna watch every little thing but not let the nurse know we’re doing that)! Well, a half-hour later, no reduction in pain. An hour later, same thing. She never returned, nor did I mention it to her. (After all, wouldn’t that be construed as drug-seeking behavior?) So I suffered bigly through the night. Incidentally, I didn’t see her again.
Well, now. Six months later, whose booking photo did I see on the front page of our local paper? That’s right. My nurse, busted for stealing narcotics from the hospital. I was sick from head to toe reading this; a black eye to our profession, one we didn’t need. And I felt for her personally. But I also was a little mad; she let me lay there in pain! But my anger didn’t last long. She very well could have been far along enough in her addiction that she had no other choice (or so she thought at the time). Then I was mad at myself, for not calling her back that night to delve further into why I got no relief. There was an outside chance I might have nipped this baby in the bud. But likely not.
I brought this story up because it used to be a problem; I learned that there were quite a few dependent healthcare professionals with access to drugs. A couple of years prior to my situation, we had a bright, intelligent Cardiologist with a shining future commit suicide because of a drug problem few knew he had.
I’ve been retired for 15 years; hope this situation has improved. If any dependent nurses are reading this, please get help before you throw your career away. It goes without saying that withholding relief from a patient in pain is an act of cruelty; my State’s Board of Nursing has a great peer assistance program that has helped nurses while salvaging their careers. It’s my understanding some of the graduates go on to teach and counsel those on the brink of losing everything.
Her whole deposition seemed based on "i must've done it because it's what I would usually do in practice" or "i would've done it because its protocol" that doesnt mean she did it in this case. She can't remember the patient so if it wasn't noted down her statements like "i checked his pulse" carry no weight. The pulse was an important factor, as was the movement so it's no surprise her lawyer was all over these points like a rash with objections.
I am an RN and because of this I never chart by exception! As an RN you are only as good as your note. “ If it is not charted you did not do it.” You need to write in detail the injury because it may affect the care! I feel this is a crushing injury which he could get compartmental syndrome which could cause amputation by hindering the vessels and nerves
Thank you very much for you comment Joyce
Thank God for my nursing instructors' driving us crazy daily, with these words over and over
IF IT'S NOT DOCUMENTED IT'S NOT DONE.
I graduated in 1998 for my RN .
Never ever did I hear except when you chart by exclusion.
You soon learn, in the real world of Health Care, to CYA bc if you don't you will be the scape goat.
Where I work we chart by exception.
@@tassymccormick Make sure you cover your self. Nurse now are being used as the scape goat. Good Luck
This is such BS. How does a medical diagnosis fall onto a nurse? The is 100% the providers failure.
According to the doctor she also checked all the pulses and everything she needed to do.
Yes, and the doc was found liable so he won his case
Again, she was not a defendant at trial.
I’m missing something here. If the facility policy is to chart by exception, what did this nurse do wrong? Everyone saying to “chart everything” is being unrealistic (and completely defeats the whole purpose of charting bu exception). I’m honestly wondering what she did “wrong” to implicate liability for this patient’s claim?
Im only 75% through, but at this point it sounds like she wasnt thourough in her assessments, and if she was thorough she didnt document them accordingly. Not documented, not done. Its the completeness of it.
It’s seems she is being held liable for charting by exception. That’s what’s confusing for me. If nothing deviated from the original assessment, and her facility policy is to only chart when there’s a deviation, what did she do wrong? Looks like they use paper charting too- which is other way less descriptive. This is an urgent care facility- not like their doing full assessments by each nurse. I feel like the problem is that those involved in the judgment/decision making have no understanding of healthcare or medical charting.
@@Vegan4them around the 49:00 mark is a good example at how her charting was incomplete. She is unable to positively state whether or not that patient was unable to move his foot at the time of discharge because she didn't thoroughly document it. An x on the form tells her nothing definite. If she had charted properly she'd be able to say his discharge condition confidently because it's documented. Instead she can only assume or guess.
This is why you should document everything. It protects not only the patient, but the nurses too. If it's not documented, it legally didn't happen. So document, document, document.
If she had charted properly she most likely wouldn't be answering simple questions with "possibly" or I "assume.".
Eta: At 1:01:35 is another example of poor documenting. She should be able to confidently say she took his pulse at discharge and what it was. She didn't do that so she doesn't remember what his pulse was and only can assume she took it.
asking a person on the stand their home address is a No No..any1 sane or insane in the courtroom will knw where they live..I believe that should be change n kept to the cour workers involved.
whoever uploaded this shoud lhave redacted it, unprofessional
It’s public record. Who cares.
@@xxtinabobina if your address was given out and you or your loved ones were murdered.. Doesnt matter hmm? Lots of people want to take justice into their own hands..people go missing, are eternally shut up or blackmailed..forget harassment and stalking. Thats the world we live in.
Why give home address that was really stupid on so many levels
As an ER and OR nurse I have to say her documentation is just incomplete! If something is not documented, there is no proof if you did something or not, therefore it would theoretically mean it wasn't done!
Does charting by exception mean you don’t have to chart at all? This is confusing to me.
@@shelleyj1780 charting by exception means only charting abnormal findings. It means anything that wasn't documented means it was within normal limits or expectations of current patient condition. It's supposed to save time and is shorthand. But, this is what happens when you chart by exception.
OR you
Witch hunt! There are "levels" of assessment! She did her job! The doctor/NP/PA makes the diagnosis and prescribes treatment. I applauded the nurse for her professionalism! I am a retired NP.
ewwww, if doing her job lost someone their leg then they do not need to be applauded. they need to be held accountable. frightening coming from a np
all ur old patient cases outta be reviewed for malpractice
I assessed the patient's leg for pulses, color and warmth to confirm blood flow with a full knee brace. Yeah, sounds like she did her job real well, his leg was amputated.
This solidifies my decision now to become a nurse. They're basically underpaid hospital slaves.
Not really.. it’s a great job. You can work anywhere in the country and you don’t have to work in a hospital. Many areas to work in.
One night shift in an ICU many moons ago, I was chatting with an experienced RN who had generally let it be known she was a Born Again Christian. I asked her if her faith was a motivation for her nursing career. She replied that it was absolutely not, that it was a job that put bread on the table. While startled by her candor, I believe her point was that it is unwise to romanticize any profession. There are many types of nursing, and it is wise to gravitate towards where one feels most comfortable. For years I strove to be an ICU nurse because the complexity and fast changing nature of the work was fascinating, as was ER work. However, as a male in nursing, it became clear to me that I was a persona non grata, or a black man at a KKK rally. A lot of women resented men intruding in what they considered their domain. Not all, maybe not even a third, but that third conspired to make my life in ICU intolerable, and I tried a number of a different hospitals in different parts of the country. It's not paid slavery if you are engaged in the work, but don't expect many pats on the back, either.
@@jeffreymcneal1920 except when they need help with doing something that requires physical strength. I am sure they don't resent male nurses in that instance.
That is untrue. Nursing is a rewarding profession with many different areas of care to choose. If that's how you feel about the profession then nursing isn't in your heart and you don't belong there.
Nah registered nurses are treated like cream of the crop at hospitals.
You can tell when a nurse has first worked as an LPN or CNA and gone back to school to obtain his/her RN. They are 10x the nurse than those that come out of school directly as an RN. Those RN's have no experience, have an attitude as if they are above LPN's even though they have no experience and often refuse to do any hands on dirty work. They are given supervisor positions and half the time have no idea what they are doing.The RN's that have worked thier way up remember how they were treated and the knowledge they have you can't get from a book.
Agreed ! ( from a retired Hospice RN of over 30 yrs).
You sound like an LPN with a grudge. ha ha
@@catherinewyatt1675 Thanks you for your service as a hospice nurse from a working night shift hospice nurse.
I beg to differ… I’ve met many nurses who were never LPNs or CNAs and are fantastic nurses, including myself. You just sound bitter…
I think the "us vs. them" is unhelpful. Your confirmation bias is very strong. I've known lots of RNs that have never been CNAs, MAs, etc. that are excellent nurses.
RN's assess, they do not diagnose. Palpation and the other things she did fall under assessment. It sounds like she did what she was supposed to and practiced within her scope of practice. The provider ultimely made a diagnose and he allowed the patient to be discharged and "walk out".
You got some sense, thank you❤️
Absolutely!!
Nope
Documentation, Documentation, documentation just like in real-estate location location location. If it's not document then it wasn't done,, and document like a lawyer was asking you a question , these we were told in by nursing instructor over and over. Ok nurses here let's hear your comments. I didn't hear any documentation of knee if was swollen, red, warm , if able to move leg or numbness and tingling, pain scale to site and visible injury like any bruising. Yes she could have assessed these but you still have to document even if no findings. From the deposition it sounds like he came, we saw him, gave him something for his pain and did x ray, then the doctor came and saw him.
@Miss M oh my goodness please have checked ASAP, I had something similar too, leg edema with heaviness when walking , extreme fatigue and vomiting and was having anxiety with heart palpitations, I actually thought I was having some kind of heart issues as you know nurses like to diagnose themselves but it was from iron being very low that I had get blood transfusion. Almost fainted at work. Be proactive when it comes to your care and your loved ones, ask questions, when you go back tell them you are leaving till someone does assessment of your legs. What if you have deep vein thrombosis [DVT) and gets missed. No one saw your leg and I won't be surprised if it was documented somewhere that they did coz they still need that documentation of patient's care for their billing. Good luck.
Nurse for 30 yrs, I was thinking the same thing, he ended up with a ‘knee sprain’, no skin assessment of the calf, knee and femur, there must have been some color changes, also knee ROM, a lot missing on assessment
The nurse did the correct charting and assessment. The MD or NP should be held liable if the client had a DVT.
She did an excellent job answering questions.
Why didn't they bleep her Address out that's *ucked up! Some crazy can get it and hurt her wow
Yep exactly...hope she sues them for this.
@@sweetpea4967 Yes. They deserve it. It's grossly irresponsible to put her address out there for the world.
It’s public record so pretty sure she can’t sue them
Transparency is a principle of the court system. It’s public record.
@@cortney3798 Not everyone worldwide can access those Court records with ease. That's the difference between publicly available Court records, and publicly published videos. It was grossly irresponsible of this channel to publish her personal details.
The first attorney is purposely trying to act incompetent and unintelligent in order to trip her up.
I really feel he is too!!! 😳 her cell phone number just went off, lol
That's what lawyers do!
This attorney is very good. He is hitting every topic he should be hitting. His manner is soft and non-threatening. He could be a little stronger on the set up foundational questions but that is secondary. The witness appears to me to have a negative very defensive attitude and does not come across in a sympathetic manner.
On a side note - there is a total change of the witnesses demeanor when she is questioned by the second attorney who undoubtedly is a defense attorney for the physician or hospital. The change is striking and probably goes far into the reasons for a 5 million dollar verdict.
He said at one point this is kind of a trick question lol
Which makes him a great attorney
Why would you not redact personal information before posting this?
Much appreciated description of the case in the preamble.
God bless them for the work they do, but I’ve personally experienced nurses and doctors taking their stress out on me, mistreating me, and even forgetting me in the er bed for 7 hours until i had to get up and walk on my injured leg to the front desk to ask to be discharged. There is no excuse for Hospitals to allow this type of treatment to patients, and kudos to you guys for continuing to hold them to account for this nonsense.
If we wrote everything the PT said we would never get away from the chart. Give us credit for being a nurse. Lawyers are assholes. Does he document all that in his records? I would never choose nursing now and I just retired after 44 years. MD,s do medical assessment. They are two different things.
Attorney is stupid to ask is she was a licensed nurses when she is clearly a registered nurse.
RN's do head to toe assessments or should for each shift as MD's don't today.
Amen! Agree 1000% This is crazy & why I always trained students to know what they can/cannot do, responsibility, what meds are for… etc! Basically told them they were not prepping to care for a gold fish & always needed to understand the enormity of their job & that they could kill someone! So sad
I hear ya Ellen. Remember SOAP Charting at the later part of our shifts. I had technical abilities hardly used by the end. I was turned into a medical secretary taking up 90% of my time by the late 80s.
Yeah wright everything down... It's your job
She is wrong. We are taught to document " Patient states..." and go from there.
That was in 2003, they probably do that in 2021 since the lawsuits
My nursing started in 1982, our nursing instructor always instructed us to chart everything!!! I retired in 2006. Charting has completely changed! just from listening to this nurse, there are no longer detailed charting available, if there was and she documented everything, there would be hardly any questions or doubt of what was expressed in assessment and what this nurse did for this pt, I always treated a chart as a legal document! ie.. pt states, details of assessment, stated what and when drs or NP present... ECT..follow up completed...I would never go back to nursing because they are overworked and understaffed.
I’ve been a nurse since 1981. If you don’t document it then it wasn’t done has ALWAYS been part of nursing.
Subjective, Objective, Assessment and Plan (SOAP) and most importantly intervention and evaluation. Always report emergent pertinence to your provider. CYA (cover your axx) bottom line!!
"I don't remember" .... that is WHY the forms need to be completed thoroughly!!!!! Again if you checked pulse you SHOULD have noted the rate in chart!!! NOT just assume .... that you did.
What pulse are you referring to? Pulse pedal by palpation or automated? If automated usually charted automatically and immediately charted digitally. If not charted by exception otherwise, did not happen.
The nurses documented subjective data and failed to do basic nursing assessments for 'objective' data. The doctor needs both sets of data to make informed medical decisions in the best interest of their patients. This ER staff is in the meat market business.
"If it wasnt charted it wasnt done". You might have done it but if you dont chart it there is no proof. One thing she did leave out was comparision to other side.
Many places want charting by exception which means if it’s normal you don’t chart anything. And you don’t chart pedal pulse rates anyway. If you do chart you state weak, moderate, strong, positive, or +
@@Superduper666 Exactly. But one thing that should be done especially with pedal pulses is to check other side to compare.
A person could still have a decent pedal pulse on injured side, but if compared to other side, could be diminished, which would be something to note. Likewise some could have rather weak pedal pulse on injured side, but if compared to other side could be the same if person had poor circulation and baseline for that individual. Still needs to be noted, of course. But in first scenario, would indicate a problem but in second it would not.
Maryland must have better compensation laws in Arizona. I was having a minor surgery and my surgeon slipped and cut my left brachial artery and I was told I was not able to sue even though I died on the table and was brought back and ended up with a large keloid scar the length from the middle of my forearm to Mid bicep. Even worse as surgery was in the evening no one kept my husband informed of what was happening, for 5 hours they refused to inform my husband of the truth. My husband kept asking the guy in the waiting room what was happening, they just kept saying her surgery is taking longer than anticipated. For the cherry on top the surgeon tried to sneak past my husband, you could see the elevators from the surgery waiting room. After a week in the ICU, blood transfusions and 3 days in telemetry I finally was able to go home from my 20-30min I&D inflamed cyst surgery turned 5hr life or death battle. For the final surprise the surgeon billed me for my artery repair, I&D, additional time in surgery & post op follow ups. I was not charged by the hospital,any other doctor or person just the surgeon.
No one would probably take your case if you didn’t have any permanent damage as a result of the incident. Medical malpractice cases are extremely difficult to prove and it takes a lot of money advanced by the law firm to foot the bills for medical records, experts, court reporters, witness and expert depos, investigators, processing agent fees, and court fees, so they don’t take a case unless they know they can prove malpractice. It doesn’t matter that you “almost” died, but if you had, your relatives may have had a claim that attorneys would have taken. Lots of people think they are owed because something went wrong medically, but it has more to do with what permanent damages were actually sustained.
@@truthhurts9843 I’m not about getting millions I do have circulation and nerve damage. I’m just about them not billing me for his error that’s all I want I just want his office to remove my debt & get the negative marks off my credit. Honestly the hospital, anesthesiologist and the follow up doctors no one charged me only the surgeon’s office who caused the damage, his office actually billed me for repairing my artery. I am grateful that I am alive so many people have it worse.
@@cobramom3 Med mal cases have very short statutes, so if you wait too long, you are barred from making any claims. Let the doctor sue you, and then counter sue him back. Or file chapter 7 bankruptcy to force the write-off of his bill. Either way, you end up with bad credit, so may as well screw him if he’s wrecking your credit anyway.
How would a case work? If I have an inflamed ulcer that they knew was there. And knew that it would rupture and cause a 4 inch hole in my stomach. Because they figured it would heal with taking stomach acid reducer. The ulcer rupture and I had to have surgery where I lose 7 pints of blood and they had to pump my heart by hand because my heart was failing from the synthetic blood they used. Instead of using real O- negative blood. Now I have a scar right down the middle of my stomach. It starts right below the middle of my rib cage to my belly button. Another doctor told me, they didn't need to open me up like that. 😒. And this was done at well known hospital with a supposed top surgery!!!
So I was sent home with mrsa and then readmitted 2 days later almost dead....I was told if there's not long term issues and a strict deviation from standard and appropriate medical practices there's no case and I live in Maryland
I am a nurse and I would DEFINITELY write down the chief complaint of the patient in the chart. I was surprised and appalled by her lack of concern that she didn't and that it is not her habit to do so.
She wrote down the chief complaint as "injury at work" but she did not get into the details of the injury. I would write "pt c/o door falling on his right leg at his job. FINDINGS--:" I probably wouldn't get into how it happened which is what the prosecutor was trying to get her to say-- how the accident happened. However if a door falls on someone's leg to the extent that he cannot move his foot, then the injury is significant- it is ultimately the doctor's responsibility to perform a thorough assessment of the injury, the nurse just do a cursory assessment consistent with her scope of practice. And the application of the splint... the applicator ought to have checked all the pulses in the extremity!
Wouldn’t that already be in chart in the triage note as well as the ER provider’s documentation?
I’m only about 25 minutes into this. She’s doing a good job. I’m so nervous for her, but she’s doing great.
In my assessment of this court proceedings. I believe some lawyers need to learn medical lingo before accusing someone of medical malpractice. Workmans comp not paying for patient injury so they go after the nurses/doctors/hospital staff. Wowzer
Honestly, unless you are a nurse and unless you have that real life experience of having to multi task so much and be under so much pressure, you simply don’t understand.
Things sometimes get overlooked on documentation when you have so many alarms beeping, phones ringing, having to stop your documentation and your train your thought so many times to run from patient to patient, family members showing up at the station, etc. There’s a lot of distractions.
I know my assessment is always thorough once I’m in front of my patients and I always give my all to make sure they are safe, but I am not so sure if 100% of my notes in the past 10 years have been 100% accurate. I’m sure I might have missed something at some point. We all have.
She seems like a very good and experienced nurse IMO.
I think ultimately the MD was at fault.
Agreed
I truly agree
Listening to an attorney try to act like he knows what medical records mean is pretty annoying and hilarious.
I’m a court reporter. They do it all the time. Sometimes the pronunciations are so butchered, you have no idea what they’re actually talking about.
It seemed to me, in a later deposition of the same case, this time with an ED doctor, that he was markedly well informed about the various ligaments of the knee. I am wondering if he was playing "Colombo" a bit, to draw the nurse deeper and deeper into the trap of over-explaining herself to demonstrate that she was out of her scope of practice.
Yes, documentation really broke down on this case, I believe I heard the nurse saying that her assessment was manifested because she (not the doctor) ordered an x-ray. No, that's not even in the ball park. Color, sensation, movement are what needs to be documented.
In thirty years, some of it in the ER, trying to document is like trying to drink from a fire hydrant. True, the last computer system I used had a lot of "click the button" responses, to facilitate the process, but it is so hard to do when the charge nurse is demanding you to get the patient out of the bay for the next one. A nurse's day is running from one fire to another, with a leaky bucket. If it's not a patient demanding ice water, it's another in DT's pulling out his IV, or better yet, an A-line, or the senile little old lady wobbling her way to the bathroom with her Foley still hooked on the bed. Meanwhile, the Safety Officer is having you called into the office because you haven't been initialing off your hourly round sheets and two more admissions are getting bounced in and you have two pending discharges.
It is just a minefield out there. Now I do pediatric home health. One patient, one doctor, one family. Good luck to the rest of you, you'll need it, in spades.
I know two attorneys that are also MDs
I was told in nursing school if it isn’t documented it isn’t done. We were also told that you were always writing for a judge.
Spot on!
Indeed! My one nursing instructor told me every nurse should be prepared to go to court once in their life, so chart as though it will be read by people that want to make you look guilty!
Documentation is EVERYTHING! My documentation saved me in a case I was involved in. I had written everything- including who was present in the patient's room during my encounter. The attorney was so impressed at the succinct yet thoroughly written documentation of the event. I was cleared from the case because my documentation showed the facts, and clearly illustrated everything.
I agree, and many, many are the times I would have to stay up to four hours after my shift trying to remember as much detail as I could to get it into the record. A nurse's day is one series of interruptions and demands ranging from admissions, discharges, emergencies, and getting ice water. That is just the tip of it. Sorry the guy lost his foot, that rots. But diagnosing a ruptured popliteal artery isn't in her scope.
I ALWAYS overdocumented and when chart audits came around, I never had a worry. In fact, I was asked to help perform these audits but wasn't what I wanted to do (8 hr shifts) at the time. (It's a tough choice because eventually auditors have to work on the floors with these people later on.)
I understand the patient and the need for the lawsuit. With that being said, let's not go down this road blindly. Medicine is not a perfect science, much less Emergency Medicine. Going into it with the idea that doctors will always have the right diagnosis, and treatment is wrong. You find great professionals, but in general is just a bandaid. The quicker they get you out, the better. All the time underdiagnose, saving insurance companies and the hospital money. They will treat the symptoms, as simply as possible, not the diseases. BE AWARE, you are the one in need, listen to your body, ask for treatment for what is bothering you. Get a second, third opinion, and by no means sit on injuries, and medical issues for days, without seeking help.
There is a standard: If you didn’t chart it, it didn’t happen!
She is so professional. I wanted to put a pencil in his eye.
Upon initial evaluation and assessment by a nurse, they are required to document findings and quote the patient’s responses to those questions. Failure to do so implies that it was not done. Documentation is everything. If it was not written, it was not done in the eyes of the law.
To me she sounds like a good nurse. Why not bother the doc who makes all the big calls.
Nursing 101….DOCUMENT DOCUMENT DOCUMENT EVERYTHING. Every time you speak, touch or observe to and or with a patient you document it.
Exactly!!! We are tough that pretty much day one of nursing school. Always cover your butt just in case you run into situations like this. If its not documented, its not done 🤷🏽♀️
LOVE this (plaintiff's) lawyer. Very thorough & nothing slips pass him with this nurse. 'Possibly' really isn't a an answer!!!
Yes it is. It means she doesn't know but that would be a possibility. He can't reasonably expect her to remember everything. Also a doctor would've examined and diagnosed him. That's not the nurses job.
@@lolasmom5816 Correct
It really sucks watching a ER nurse being sued. They bust their ass working in some of the craziest shit you can imagine. I am a paramedic, and I would really like to see one of those big shot lawyers to their job.
Are you asserting that every single person in the medical field should be above the law and exempt to any critical review under any circumstances AND that everyone in medicine is in those professions because of the best intentions?
Just because you may be a decent person who tries their best to care for people medically and is competent to do so- that does not mean every single other person in medicine is...that is extremely naive, black and white thinking and pack mentality, as opposed to critical thinking
The hospital gets sued
The JOB of all ER staff is to work in "the craziest shit you can imagine", so if one can't perform in a chaotic ER setting, one should not seek to work or try to do the work required in an ER.
It is sad that at times an ER is crazy and chaotic, but it is.
@Highly Offensive Thank you
So someone who may or may not be a reliable medical worker shouldn't be held accountable? That's utter nonsense.
Lawyers in description: "Health care practitioners are often prepped for trial with the defence of charting by exception"
Lawyer in court an hour forty into testimony: "what is charting by exception? I don't know what that means"
A 34 years old patient goes to ER complaining of chest pain, all tests negative in ER, was discharged in 24 hours he gets huge heart attack. Hospital ER is liable.
He was awarded $5.2 million.
What happened to his knee or were there other medical injuries.
@@walliegoolsby5389 above knee amputation. Also damages were lowered to a bit over 1 million
"Instability in/to a knee" is a diagnosis to be made by a doctor .
Nurses cannot document that, nor can they assess for it. All they can do is observe- observations, reportage, and notifying a patient's/ward medical officer of the results of those observations.
He's trying to wrangle a medical diagnosis on the day out of her.
Wait what nurses can assess the knee and document and can give a nursing diagnosis but not a medical diagnosis ,
@@LillysConner Not for knee instability! If pt knee buckles when he tries to stand or walk yes that is an observation to note. Swelling numbness deformity pain as well. But to check for knee instability usually an orthopedic surgeon would be one to do that! Rarely does even a ER doctor do that unless he has undergone proper training! Some ER doctors may have had that and some may have not.
I do find this lawyer obviously has a TH-cam learning of proceedings, procedures in the medical field.
@@cynthiatucker2147 Yes. Attorneys especially plaintiff attorneys who work off percentage of award they get are notoriously cheap and balk at paying an LNC the money their services command.
Had I been hired by plaintiff attorney I would have prepped him with questions that would have truly been relevant to what may have been missed by the documentation. I can think of at least a dozen or more questions he would have been better off asking than ones he did ask.
Smart attorneys are beginning to realize in these days of tort reform that a competent LNC is money well spent.
But far too many just don't realize the bang for their buck. I had one attorney client who could have had an entire malpractice suit thrown out because the actual failure to diagnose and treat and gross negligence which culminated in a horrible outcome started 6 weeks prior and again 3 weeks prior. I suggested that they might want to file an amended complaint.
I have worked for defendant and plaintiff attorneys....because what I do is rather objectively giving them the strengths and weaknesses of their case, where and what to look for, and help them with their strategy.
@@impalamama7302 Plaintiff’s counsel in this case retained 7 experts, but I’m sure you would’ve gotten them more than $5.2 million.
Thia was grueling questioning but I think the nurse did a good job of answering.
August 24, 2021: RN here. As I watched this depo, I thought this would be a great nursing school video for students to watch. Take notes of what you "catch" and class/instructor could discuss. Trust me, those RN students would NEVER forget watching this nervous ER Nurse. Her eyes shifting back and forth cracked me up. I was screaming on my laptop, "Nooooooo, not a good answer." I precepted thru an ER in San Diego. I don't care what Triage has "documented," I'm documenting my care, what pt said to me, etc. And I always documented pretending an attorney was going to read it. CYA at all times, and protect that License. Yeah, yeah, yeah and care for your patient as if they are your own relative.
There is a actually a risk manager at a hospital in Patterson New Jersey that shows this video to her nursing staff as part of one of her seminars
I have been a Nurse in the operating theatre for 30 years and have probably forgotten 80% of all my patients. I do know that at the end of every case after all instruments swabs and sharp checks have been completed. I do another verbal and visual check of the swabs and sharps before I discard anything. I do this for every single case. I can honestly and truthfully account for my actions for every single case. In nursing. If it’s not written down, it didn’t happen.
Have these people any idea how busy these departments are?
Wait…. What? Since when does a nurse order diagnostic testing? I’ve been one 26 years & that is outside the scope of a nurse… we DO NOT prescribe procedures or medications UNLESS you are a NP. You inform doctor of findings to determine that!
Standing orders
@@user-el1rx4is7f I get that … but that is NOT how she presented information… plus I have never seen standing orders allowing a nurse to indiscriminately decide this…
It is the responsibility of the attorney to ask specific questions. The nurse's answers are specific to her job at the hospital on that date in question and not in general to the profession unless they are an expert witness. He could have phrased a follow-up question: “Is the ability to order X-rays part of a standard protocol at St. Agnes?” He later clarified that it was standing order at the hospital in another deposition from an expert witness. When I was an RN, I remember having similar protocols for arm/hand/leg/ankle traumas, in addition to standing orders for chest and abdominal pain and anaphylaxis.
Ummm welcome to the new world of health care! got nurses aides drawing blood for lab test . No unit secretaries helping with lab results and documenting orders...nurses aide drew my blood had blood everywhere! Jesus fix it! and these PA's, four years of college! Doctor please!!!!!!
@@notimeforfoolishnessreally5986 and why many old school nurses try to fix ourselves…. You want real nightmares? Nursing students are basically dumped off at nursing homes & hospitals without their instructors around… & the nurses in these places always want to toss keys to the poor kids & walk away. 🤦♀️ Yeah… not when I was on floor… wouldn’t let them give Tylenol without explaining what it was, why it was being given, possible side effects… etc. & told students they weren’t caring for a gold fish & they needed to realize the importance of their job… they could kill someone.
Those are the calmest ASMR objections I ever heard
🤣🤣🤣🤣🤣🤣🤣🤣
Nurses don’t test stability this only done by advanced practice NP, PA or physician. Stability test are not to be done by nurses.
Good video! Remember, if it isn't documented you cannot prove it was done!! Love Nurse Angela East TN
Lucky you in East TN. We used to live there: it's not Heaven, but you can SEE it from there!
As a veterinary technician, we documented everything that happened to the animal before the dr comes in.
I went to an ER in montana with a broken neck they diagnosed as a sprain. I went through a lot before I got fixed 6 months later. I sued. I got 300,000.00 because montana has a cap on how much ppl can be rewarded in malpractice. After costs and such, I ended up with about half that. It didn't last long, but here I am still disabled. Thanks to George Bush. I did buy a property with a mobile hone on it. Then my husband died. Etc. I just want to say that mistakes they make affect people's lives. I don't agree with just suing for frivolous things, but like this man, he lost his leg. The rest of his life is adversely affected.
Oh wow! I'm sorry that happened to you! May your husband RIP 🙏
Robin, I'm sorry to hear what happened to you and the loss of your husband.
Some damages in this case were similarly subject to a cap on pain and suffering damages.
I would not blame George Bush for any damages caps. The reality is caps on damages can cut across party lines. California, for example, is a very liberal state that has malpractice caps that are almost as draconian as what you have in Montana.
She said that she does not document details....wow just wow!!
Documentation is extremely important. Should have been CMST documented by these nurses. Charting by exception does not excuse not having a CMST assessment.
it is called a fracture/trauma screen: observe, ask them to move it (range of motion), palpate, assess vascular/neurological. She is checking if they need advanced imaging. (xray, mri, ct)
My question would be who went over the discharge instructions and what was included in the info on when to return to the ER. Also was there a family member at bedside to convey discharge info.
True, mentation becomes misaligned with narcotics.
@@mabelkane8240 True! But they should have DC paperwork to refer to.
I wish someone would’ve taken our case for my mom. The pandemic happened right as my 2 year window was expiring so I couldn’t get an appointment with the few medical malpractice lawyers here. Now it’s been 3.5 years since her first stroke and we can’t do anything about it. I begged and begged for them to do an MRI and both my mom and I told the paramedics, the PA, the nurses and everyone we could speak to that she was having a stroke. My mom was an RN for 40 years and understood what was happening to her. She was not believed despite her suddenly losing her sight and ability to walk. They waited over 24 hours and until she fell unconscious to finally do the MRI that showed she was having a massive Right Cerebellar Stroke. She had to be rushed to emergency brain surgery to save her life. She survived and was doing well. She was in the ICU for 33 days. They finally extubated her after 31 days and on the 33rd day, they chose to discharge her to a Long Term Care Facility (not even a different floor in the hospital-completely OUT of the hospital). As we were waiting for the ambulance to transport her to the low maintenance facility, I started noticing the same signs from her first stroke (nonsense speech, disorientation) and I alerted the ICU nurse to do an MRI. I explained to her that the CT did not catch the first stroke so they had to do specifically an MRI. She said, “oh no. Your mom had a CT ten days ago. She’s just having ICU Delirium.” TEN DAYS AGO doesn’t matter. I told the nurse this. No one listened once again. Within 15 minutes of arriving at the LTCF, she fell unconscious yet again and this time had a left side stroke. But this time it was too late. She’s now brain damaged and paralyzed for life. She’s paralyzed in 3 limbs, cannot speak normally (she talks like a baby and can’t form words), she has severe nerve pain, mood swings, confusion, etc. My mother was climbing a mountain the day before her first stroke and was a highly intelligent professional. Now she’s a prisoner of her own body and mind. We get ZERO assistance cuz we don’t qualify. I am now 36 and I alone take care of her, having to work multiple jobs from home just so I can afford her diapers, meds, etc. Both of our lives are ruined because they treated us like we were just stupid women who didn’t know what we were talking about. They ignored our pleas. They grossly neglected my mother and now she’s forever screwed. It’s NOT right!!!
I'm sorry for what your mom (and you) have been through.
1st… it is not “her practice” as she is neither a medical doctor nor a NP
2nd… “I assume” blah blah blah… doesn’t mean squat. There is a saying in medicine…. “If it’s not documented? It did not happen.” That’s why documentation is so important
That is why I always hated some charting systems of ‘charting by exception’. I love narrative charting. You get a much more visual account so even a lay-person could understand. yay for EMR’s- NOT. Had there been a more comprehensive system in place, not just checkboxes, this nurse could recall this pt with greater accuracy.
and re “ her practice”, the nurse is correct.
@@rondafarmer341 I always charted my notes for that very reason. If you had to go to court a month later (more or less 4 years) … how would you remember?
@@rondafarmer341 This! Yes our patients are reduced to check boxes now and I think it gives us less time with them and more time on a computer. Give me a pen and paper and I will paint you a picture of this patient with quotes included and I would probably remember them too because I make the note unique for them.
People don’t seem to understand nurses aren’t allowed to diagnose so we can’t chart certain things that imply diagnoses. Only doctors can “diagnose”. And her facility’s charting is flawed because it lacks the details required for his lawyer. She doesn’t remember the patient. Nurses see tons of patients. So she can’t recall and the charting is vague. It’s a no win situation. Also, nurses are taught that charting too much is a problem and not charting enough is a problem 🤦♀️
It puzzles me why Hospital seem to only do Xrays and not MRI's on the same day. If I'm correct, a xray only detect Bone injury and not soft-tissue injury.
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@@BoringTroublemaker Yes I know. I just didn't want to change the conversation and tone of the comments. But it is money!
And we aren't even doctors and know this
Exactly !! Waste of money to do x-rays for nothing .. when we know they won't show soft tissue damage ect.. ask the insurance companies why$$$$
I know that’s what caused my son to have a hip replacement at 14.. He had a football injury I took him to the emergency room they only did an x-ray and they said it was just a sprain turned out he had a vascular necrosis of the hip he was continuing to walk- run still trying to play sports while his hip was deteriorating .. I feel as if they did A CT scan or MRI to begin with we could of possibly saved his hip..