The hospital I work for requires a VAT nurse to be on call every night until 1 AM. I would be interested in hearing from everyone as to the requirements of their institutions?
Many hospitals have VAT nurses on call for all after hours. Hope others will add to this. Just wanted to point out that the same standard of care must be available to all patients 24 hours a day, 7 days a week. So how can you provide that same standards unless there is a VAT nurse available 24/7/365? I have seen this be an issue in at least one legal case. Lynn
Hi Lynne, Now I'm assuming this legal case would be against the hospital, not the nursing staff. We don't determine staffing patterns . Our hospital will not allow a paid on-call schedule , so we come in early ( 3-11 nurse will come in early depending on how many PICCs ) OR a nurse will come in ON HER DAY OFF to do PICCs. We will even do them on the weekends and holidays ,which IR VERY RARELY will agree to.We recently lost one of our staff nurses to an Infusion Services company, so there are only four of us. NOBODY is full time, only 24 hours each. Again , not our decision, we wanted more hours and staff when we ramped up our PICC program. It has been denied. We have been putiing PICCs in for years and even did out-patients, but only in October of 2013 did we start using U/S and MST (after years of begging to be up to standard ). So in 2013 we placed 56 PICCs. In 2014 we are on target to place 270 !!! So we have a great deal of satisfaction in what we have accomplished, but when I hear about expectations, it makes me sad/nervous? If a patient needs emergent central access, a surgical consult could be initiated; so that patient is not being denied care . We do not do outpatients at this time, no appropriate location currently. Though we certainly go to ICU and CCU to place lines, the vast majority of our PICCs are for patients with poor access or who are going home on antibiotics. How is scheduling a PICC not providing the same level of care ( if they have PIV access and are receiving their medications as ordered )? We are allowed to use some overtime for placing PICCs but 4 of us cannot possibly cover the hospital ( also doing our regular PIV starts/restarts, dressing changes ,etc. ) 24/ 7/365. Just wondering your thoughts. iveern
The lawsuit would name the facility AND all healthcare professionals involved. Some may be excused from the case as it progresses though. RE meeting the standard of care at all hours of the day, here is one scenario that could cause patient harm and the accusation that the staff did not meet the SOC - Appropirate vascular access means assessing each patient's needs for VAD very early in the hospital stay and continuing to assess those needs as they change. This easily could mean changing from reliance on PIVs to insertion of a PICC. If the patient's peripheral veins are difficult to manage, and the hospital did not provide staff with the required skills, regardless of the hour or day of the week, obtaining reliable vascular access (by another PIV, PICC, other CVAD, whatever) could be delayed. This means critical medications could be missed and the patient's condition could worsen because of this delay. To avoid this situation and reduce the need for any CVAD insertion during the nighttime hours or weekends and holidays, there must be someone assessing the needs for vascular access and then inserting the most appropriate device when that need is identified.
Another situation could involve an unrecognized and untreated catheter or infusion related complication because available staff did not have the needed knowledge and skill. This could be anything from a serious extravasation injury leading to necrotic ulcer. Or infiltration leading to compartment syndrome and amputation. Or a CRBSI leading to multple organ failure and increased length of stay and costs. Or a drug adverse event leading to death! In cases involving these situations, it could easily be only the nurses named in a lawsuit and not the hospital. This may not seem fair but it is the reality. Lynn
Just some thoughts.... if an organization makes staffing decisions that affect the patient outcome regarding IV access - I think nurses could mount a strong defense why a related outcome is not on them.
Attorneys cast a wide net in identifying and naming defendants... it is a process to do their diligence to represent their client. There is a line - a plaintiff would have to show why nurses should be held responsible for things the organization controls.
Yes if you know the standard is x but x is not an option, how you manage the situation is the key. There are always exceptions to a situation.
Making sure one acts responsibly as another reasonable, similarly trained nurse in a similar situation should be how nurses approach a situation. If you find yourself in an ethical dilemma, you need to decide if you can work under those conditions. Talk to peers - show management the evidence to support your concerns...
Before all the VAS teams, the burden was on the medical staff to insert the line... Are you reporting to the attending and seeing what the options are...? It is not all nursing responsibility..
Don't harbor all the worry yourself... open a discussion.. talk to risk managers, ID any one who may help... Even EAP...
We are all CRNIs who love what we do and try to provide the optimal level of care IN THE TIME ALLOTED to us . As I said , we even come in on our days off . We begged for an U/S because we knew that was the Standard of Care. Having taken a Legal and Ethical Issues in Nursing course , I remember the term "cast a wide net" and acting as another reasonable and prudent nurse would . I
don't possibly see how individual nurses could personally be held responsible for a situation they have no control over. Administration is NOT willing to increase staffing or hours. If we complain to Risk Management what if they eliminate us completely ? Then where would the patients be then ? I look on other nursing blogs , currently there is one asking the question "Is your PICC team 24/7/365"? Many are not ! What about hospitals that don't have PICC or IV Teams ? I think we would easily be able to show we exceed the standard of care for provision of IV services in our geographic area.
Many hospitals have VAT nurses on call for all after hours. Hope others will add to this. Just wanted to point out that the same standard of care must be available to all patients 24 hours a day, 7 days a week. So how can you provide that same standards unless there is a VAT nurse available 24/7/365? I have seen this be an issue in at least one legal case. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi Lynne, Now I'm assuming this legal case would be against the hospital, not the nursing staff. We don't determine staffing patterns . Our hospital will not allow a paid on-call schedule , so we come in early ( 3-11 nurse will come in early depending on how many PICCs ) OR a nurse will come in ON HER DAY OFF to do PICCs. We will even do them on the weekends and holidays ,which IR VERY RARELY will agree to.We recently lost one of our staff nurses to an Infusion Services company, so there are only four of us. NOBODY is full time, only 24 hours each. Again , not our decision, we wanted more hours and staff when we ramped up our PICC program. It has been denied. We have been putiing PICCs in for years and even did out-patients, but only in October of 2013 did we start using U/S and MST (after years of begging to be up to standard ). So in 2013 we placed 56 PICCs. In 2014 we are on target to place 270 !!! So we have a great deal of satisfaction in what we have accomplished, but when I hear about expectations, it makes me sad/nervous? If a patient needs emergent central access, a surgical consult could be initiated; so that patient is not being denied care . We do not do outpatients at this time, no appropriate location currently. Though we certainly go to ICU and CCU to place lines, the vast majority of our PICCs are for patients with poor access or who are going home on antibiotics. How is scheduling a PICC not providing the same level of care ( if they have PIV access and are receiving their medications as ordered )? We are allowed to use some overtime for placing PICCs but 4 of us cannot possibly cover the hospital ( also doing our regular PIV starts/restarts, dressing changes ,etc. ) 24/ 7/365. Just wondering your thoughts. iveern
The lawsuit would name the facility AND all healthcare professionals involved. Some may be excused from the case as it progresses though. RE meeting the standard of care at all hours of the day, here is one scenario that could cause patient harm and the accusation that the staff did not meet the SOC - Appropirate vascular access means assessing each patient's needs for VAD very early in the hospital stay and continuing to assess those needs as they change. This easily could mean changing from reliance on PIVs to insertion of a PICC. If the patient's peripheral veins are difficult to manage, and the hospital did not provide staff with the required skills, regardless of the hour or day of the week, obtaining reliable vascular access (by another PIV, PICC, other CVAD, whatever) could be delayed. This means critical medications could be missed and the patient's condition could worsen because of this delay. To avoid this situation and reduce the need for any CVAD insertion during the nighttime hours or weekends and holidays, there must be someone assessing the needs for vascular access and then inserting the most appropriate device when that need is identified.
Another situation could involve an unrecognized and untreated catheter or infusion related complication because available staff did not have the needed knowledge and skill. This could be anything from a serious extravasation injury leading to necrotic ulcer. Or infiltration leading to compartment syndrome and amputation. Or a CRBSI leading to multple organ failure and increased length of stay and costs. Or a drug adverse event leading to death! In cases involving these situations, it could easily be only the nurses named in a lawsuit and not the hospital. This may not seem fair but it is the reality. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Just some thoughts.... if an organization makes staffing decisions that affect the patient outcome regarding IV access - I think nurses could mount a strong defense why a related outcome is not on them.
Attorneys cast a wide net in identifying and naming defendants... it is a process to do their diligence to represent their client. There is a line - a plaintiff would have to show why nurses should be held responsible for things the organization controls.
Yes if you know the standard is x but x is not an option, how you manage the situation is the key. There are always exceptions to a situation.
Making sure one acts responsibly as another reasonable, similarly trained nurse in a similar situation should be how nurses approach a situation. If you find yourself in an ethical dilemma, you need to decide if you can work under those conditions. Talk to peers - show management the evidence to support your concerns...
Before all the VAS teams, the burden was on the medical staff to insert the line... Are you reporting to the attending and seeing what the options are...? It is not all nursing responsibility..
Don't harbor all the worry yourself... open a discussion.. talk to risk managers, ID any one who may help... Even EAP...
Ann Zonderman, BSN, JD, CRNI
We are all CRNIs who love what we do and try to provide the optimal level of care IN THE TIME ALLOTED to us . As I said , we even come in on our days off . We begged for an U/S because we knew that was the Standard of Care. Having taken a Legal and Ethical Issues in Nursing course , I remember the term "cast a wide net" and acting as another reasonable and prudent nurse would . I
don't possibly see how individual nurses could personally be held responsible for a situation they have no control over. Administration is NOT willing to increase staffing or hours. If we complain to Risk Management what if they eliminate us completely ? Then where would the patients be then ? I look on other nursing blogs , currently there is one asking the question "Is your PICC team 24/7/365"? Many are not ! What about hospitals that don't have PICC or IV Teams ? I think we would easily be able to show we exceed the standard of care for provision of IV services in our geographic area.