All of us have times of the day where we are operating on “autopilot.”  We hop out of bed, go to the bathroom, brush our teeth, and groom ourselves for the day.  Breakfast is usually the same every morning.

Even when we are driving, while listening to a song or news or just thinking about something, our brain can go on autopilot.  Think of the times you’ve driven past your exit because you were thinking about something else.  It can’t be just me!

Many times, we find ourselves on autopilot when it comes to tasks that we have been doing so long or which are repetitive.  If we did not go on autopilot, we would be like our automatic nervous system and we would have to tell our heart when to beat and our lungs when to breath.  However, when it comes to assessments, we tend to be keyed-in and are present and not on auto pilot because of the importance.

At Methodist Hospital in Indianapolis in 2006, NICU nurses caring for premature babies would retrieve heparin to administer to the babies when it was ordered.  Tragically, the pharmacy technician had mistakenly stocked the medicine locker with dosages that were 1,000 times greater than what was required for the infants.

The treating nurses did not notice that the vial, labeled heparin instead of hep-lock, was a dark blue color rather than the baby blue of heparin.  I can envision that they possibly may have been on autopilot and saw the first 3 letters, H-E-P, without realizing it was the adult dose of heparin rather than baby dose of heparin.

The mistake resulted in the deaths of 3 infants.

This is the same scenario with RaDonda Vaught at Vanderbilt Hospital of whom I have often written in the past.  She mistakenly administered the strong paralytic vecuronium instead of the ordered Versed, resulting in the patient’s death.  She was charged, tried, convicted, and sentenced for negligent homicide and abuse of a dependent adult.  You can find more about this by reading previous articles archived in this blog.

As with the Methodist NICU nurses, Ms. Vaught may have been on autopilot, noticing the first few letters for both pharmaceutical (V-E) and tragically selected the incorrect one required for her patient.

Additionally, even speaking the names of some medicines that sound alike while on autopilot can also lead to a selection error.

When vials look so similar, have names that look and sound similar, it is easy to get them mixed up and possibly result in injury or, as in the Vaught matter, even death!

I do not need to emphasize that it is imperative for pharmaceutical companies to do what they can to differentiate the various medications by their labels, their packaging or even by their names [examples].  It goes without saying that the better the medicines are differentiated, the less likely a mishap will happen.

And, most important, since you are the last line of defense against a medical error, consciously shut off that autopilot and focus, focus, focus on what you are doing!

For more than three years, I have been providing you with updates on RaDonda Vaught, a Nashville nurse, who made a medical mistake and ended up not only losing her nursing license but having to face trial for criminal charges and was found guilty.  Here is the latest in her troubled journey.

Last Friday, May 13, 2022, Ms. Vaught was sentenced for a fatal medication error in which she erroneously administered Vecuronium instead of Versed to a patient suffering from claustrophobia and about to undergo a CAT scan.  She was found guilty by a jury of criminally negligent homicide and abuse of an impaired adult.

I felt the Judge was very deferential in her treatment.  In a sentencing hearing, one hears testimony from both sides as to aggravating and mitigating factors.  Even the victim’s family testified that they did not want Ms. Vaught to serve time in prison.

It seemed that everything was on her side except for the prosecutors who felt her sentence should be exacerbated because of her conduct.

The Judge did not agree but was able to impose what is called diversion in which she gave Ms. Vaught three years of supervised probation, no prison time.  If she successfully completes her probation, then her sentence will be dismissed or possibly even expunged from all records, just as if this conviction never happened at all.

This is a great result, but I think that everything Ms. Vaught endured to get to this point has been horrendous for her.  She will have to always live with the fact that her Registered Nurse license was revoked and, more personally, that her care and treatment resulted in the death of a patient.

Elsewhere, 2 other criminal cases recently came to light.  The first is Dr. William Husel of Columbus, Ohio who confessed to giving 10 times the legal dose of fentanyl to 14 critically ill patients, all who died as a result.  Dr. Husel was acquitted on all counts.

In the second, Christann Gainey, LPN, was taking care of Herbert R. McMaster, Sr., who struck his head in a nursing home and subsequently died hours later due to a subdural hematoma.  Ms. Gainey was required by hospital policy to perform neurochecks and vital signs on Mr. McMaster after the fall.  She documented that she did the checks, but camera footage showed that she never entered the patient’s room.

Ms. Gainey pled guilty to this offense which was an intentional act because she did falsify the medical records.

I believe this case was different than Ms. Vaught who made an unintentional medication error.  Albeit serious, it is still my position that Ms. Vaught should not have been charged criminally.  Unfortunately, prosecutors have discretion, and, in my opinion, the prosecutor just wanted to make a name for himself.

It was sad that Ms. Vaught, who inadvertently made a medication error, was convicted of a crime while in the matters of Dr. Husel and Ms. Gainey, their actions were intentional and not errors.

Today, everyone expects the “Amazon treatment” meaning they want health care immediately!

The delivery of health care is no longer the general practitioner in your community who has been there for years caring for patients ranging in age from birth through their geriatric years.

There are same day clinics and pharmacies that see patients, there are walk-in clinics at hospitals and urgent care centers literally every mile or 2.  You can even get a same day telehealth appointment with a provider.

Unfortunately, with this quicker, faster health care system things do not get accurately diagnosed and treatment is based on symptoms rather than diagnostic determination to find the correct cause of the ailment.  More mistakes are possible.

Now, would you think this makes for good patient care?

I think this “McDonald’s” way of medical care with patients not being properly diagnosed in a timely manner will lead to more medical malpractice claims against health care providers.

We have an “Amazon” type practice of medicine because almost every health care provider is required to see a certain number of patients each hour.  To get to a specialist or a proper worked up for a problem, it can take some time to see a specialist, even take a test and get the correct diagnosis and prescribed the requisite remedy treatment.

And, obviously, the more rushed the diagnosis and treatment, the greater the chance for error with the patient paying the price.  This impacts nursing as well as patients want things now.  We will see what the future holds and if this model of healthcare will continue.

Imagine being one of those who graduated from nursing school in the middle of the global pandemic?  It’s like going into a M*A*S*H* unit during the Korean War without having any training or experience.

Each generation of nurses has its own needs and, right now, the Millennials and Gen Z- Zoomers, those born between 1981 and 2012, are the hardest hit.

The number of patients being treated in hospitals has hit the roof.  Those who used to be ICU patients are now on general floors and some are literally being kept alive on life support in ICUs with every imaginable kind of drip.

Graduating at this difficult time is hard enough but actually practicing in the profession is even tougher.

A study by the American Nurses Foundation and Joslin Insight showed 10 needs of Millennials and Gen Z- Zoomers.

1. On-The-Job Training and Support. Keep in mind these nurses graduated from nursing school amid a huge nursing shortage that was complicated by a worldwide pandemic.  Yet, these graduates didn’t have the experience and training to perform at a high level of proficiency.  Remember how long it took you to get your nursing “legs”?
2. Mental Health Support. Approximately 60% of today’s nurses are ready to quit the profession.  They often encounter extremely grave medical situations and even death daily.  Many of the more experienced nurses are retiring, leaving the bedside, or just down right quitting, these new nurses are left to fend for themselves.
3. Financial Support. The salaries for nurses have not kept pace with the current cost of living and as inflation continues unabated, they are falling behind in that race.  One nurse can barely afford her $2,000 monthly rent.  Others are having great difficulty in making the proverbial “ends meet.”  Nurses deserve to enjoy the quality of life that they want meaning the basics of being able to pay their bills.
4. Respect and Recognition. It’s sad to say that nurses are often taken for granted and are not being shown the value and respect that they deserve.  That is why I urge you to never say, “I am just a nurse.”  This devalues you as well as the profession.
5. Improved Working Conditions. Nurses want to create and enjoy an environment where they can succeed.  However, employers are sticking with antiquated models, seemingly hesitant to flex to meet the needs of nurses and to move ahead with the times.
6. Long Term Workforce Solutions. There are no such answers that can make sure we have an adequate number of nurses to meet the needs of an aging world population.  This was highlighted in a report by the Institute of Medicine.
7. Patience. As I say be patient with your patients and fellow coworkers.  Every nurse knows of the saying that goes, “Nurses eat their young.”  This is neither a time nor place to eat to the young.  We need every nurse to provide the best care to make a difference in their patients’ lives as well as for other medical team members.
8. More Flexible Working Hours. Most hospitals schedule on 12-hour shifts.  Aside from picking up an entire shift, there are no other choices.  I would like to see flexibility with hours.  Yes, it will mean use of creativity in staffing by reducing shift hours to 4, 6, 8 time blocks.  If the nurse can pick the number of hours that meets her needs and ability, the value in use of that time is greatly enhanced.
9. To Be Fulfilled. I believe nursing in is your DNA and it is a calling.  But being a calling does not mean medical facilities can take advantage of nurses.  I know nurses would rather be fulfilled in knowing that they’re doing a great job while getting the support and appreciation that they need and desire rather than money.
10. Continuing Education Support. Years ago, there was a trend toward having a Bachelor of Science in Nursing for an entry level requirement.  But many cannot afford to pay for the 4-year education.  Many today who already have that bachelor’s degree or 2-year Associate degree, are still paying pay student loans.  There should be options, including but not limited to grants, to encourage those going into nursing to reach their goal.  There once was a time when education for a master’s degree was given free.

The way nursing is practiced in hospitals is outdated and needs to change with the times.  Hopefully, our Millennials Gen Z- Zoomers will be the leaders to make that happen.