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Moral Injury for vascular access nurses--what else can we do?

Hello, I am just reading through this forum  as I attempted to  step back from the stress of the ridiculous, unethical, non-caring position that admisintrators have put nurses in, so they can have their BOTTOM LINE as they want it REGARDLESS of the poor pt outcome. This is truly what I would call "MORAL INJURY" (Zubin Damania MD) to the nurses who want to do what they went in to the profession to do---help patients. 

I had wondered if there have been any updates for the hospitals to have to report CRBSI's soon.   I know i am probably beating a dead horse when I question the future........ The HUGE need for CMS/CDC to update the definitions cannot come soon enough so that hospitals can no longer do more harm to pt's by tring to avoid a CLABSI report. 

I am seeing and hearing from totally  burned out  vascular access nurses from all over,  who want to do what is right for the pt but are being bullied by administration into doing what is clearly professionally and ethically wrong.  I cannot imagine that CMS/CDC officials do NOT know what is happening and will allow it to keep occurring.  If they do, shame on them.  Putting a VA nurse at risk for literally  having to cause harm to a pt or lose their job is not going to solve anything.   

I am seeing a trends in many hospitals in the area to:

 ------Pull the CL/PICC within a couple of days and place a PIV or ML even if there are still vesicants still ordered.          This is leading to more extravasations, episodes of thrombosis, pain for the pt and the need to look for new sites for a VAD.  This is assuming the pt doesn't have an occlusive DVT that could be infectious.      Then comes the order to put a PIV/ML in the other arm with the same meds, same outcome.  Now both  extremeties are compromised and the pt is more at risk. 

-----Wait till the last day before DC then place a PICC for long term ABX so the CL days are lowered.  In the meantime, the pt has multiple PIV attempts and increased risk for thrombosis and infection......I know, beating a dead horse.  

-----Cut VA teams hours/staffing so less surveillance can be done and leaving the floor nurses to deal with VA issues on their own.  

-----Have adminstrators make vendor decisions, write policies, etc. and NOT include weigh in from the highly skilled and educated suggestions of the frontline nurses that are actually placing the lines and see the outcomes first hand. 

-----Not allowing VA teams to advance their practices so the VA nurses can gain ownership of all VAD's and give the pt their best possible outcome.  

       I both place lines and take care of lines in the home after the pt has discharged.  I see first hand what happens when the inappropriate line is placed due to this administrative DEMAND.  I always place the line I feel is appropriate by following the AVA and INS guidelines.  I look at the whole pt, hx, labs, meds. dexterity, home life, support system etc, to determine VAD. Thank the lord I work for hospitals that respect our decisions and stand by them. They are willing to discuss any issues that may come up and will listen to possible solutions.  They don't just say it's THIS WAY OR THE HIGHWAY.  

       If  pt's really knew what was going on at the corporate level just to increase profits they could have a reallly great case for a lawyer.....and unfortunately the nurse will be the one caught in the middle.  

I really do try to keep up on what is new with EBP but there is  so much out their I applaud those who have the guts and the time to really do what is right for your pt and allow you to sleep soundly at night.  There is so much more I would like to say but would really like to hear from other nurses who have been able to do their jobs and had great outcomes as I have had the best opportunity to have.  


Geez.....I hate being right

Geez...In the words of Jeff Goldblum from Jurrasic Park ....... I hate being right all the time

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