Svn disciplinary?!

RE: Svn disciplinary?!

Wendy Sneddon — Tue, 05 Sep 2017 22:55:57 GMT

Hi Generally a final written warning is given after a verbal warning, and then a written, depends on your disciplinary policy, however in the case of gross misconduct - you can be given a final written warning or be dismissed. Check your practice disciplinary policy and see if where what you have been disciplined for fits. Have you been disciplined for the near miss or for your conduct in response to the incident? If you believe you have been treated unfairly then appeal against their decision. Write a letter explaining what you take responsibility for and why you feel the outcome is unfair. They might reconsider and reduce it to a written warning. If their decision is upheld it will be on your record for 6 months (they must state how long it will be there for). You are still learning - a critical case review and revised training plan for you would probably have sufficient. Take this as a learning experience. We all make mistakes. It's allowed. Good luck!

RE: Svn disciplinary?!

Mark Hedberg — Tue, 29 Aug 2017 12:30:48 GMT

[quote user="Arlo Guthrie"]

[quote user="Ben Ogden"]the same way disco has no place in the music scene [/quote]

hahahaha .. priceless. Thank you, that put a smile on my face to start the day with!

[/quote]

oi, you'll pull my disco playlists out of my cold, dead hands...do the hustle!

RE: Svn disciplinary?!

Alison Clare Hickman — Tue, 29 Aug 2017 10:12:46 GMT

[quote user="Ben Ogden"]the same way disco has no place in the music scene[/quote]

..or the fashion, Ben... Stayin' Aliiiiiiiiive!!

RE: Svn disciplinary?!

Arlo Guthrie — Tue, 29 Aug 2017 09:26:24 GMT

[quote user="Ben Ogden"]the same way disco has no place in the music scene [/quote]

hahahaha .. priceless. Thank you, that put a smile on my face to start the day with!

RE: Svn disciplinary?!

Ben Ogden — Tue, 29 Aug 2017 09:02:20 GMT

Completely agree. The fear and blame culture some practices continue to cultivate has no place in modern practice the same way disco has no place in the music scene ;P

RE: Svn disciplinary?!

Sal the 1st — Mon, 28 Aug 2017 11:24:52 GMT

[quote user="Arlo Guthrie"]

Rather than jumping to apportion blame, as seems to have happened here, everyone should have sat down and had an open discussion about what happened, without fear of recrimination, and then decided what should be done to stop it happening again.

[/quote]

RE: Svn disciplinary?!

Arlo Guthrie — Mon, 28 Aug 2017 10:02:50 GMT

I suppose I should preface what I am about to say by highlighting that I am not a nurse or a VS and have never worked in practice. So what do I know?

BUT, reading through this thread, a few things strike me:

the OP is an SVN. My understanding is that SVNs always work under the supervision of RVNs and VSs, so if a mistake is made by an SVN, then responsibility in all cases rests with those further up the chain.
There seem to be some assumptions being made here about talchis behaviour towards her colleagues being perhaps rude after the incident. I think that even if that is true, it's not relevant to the underlying mistake.
I think the same about the fact that she quoted the RCVS Code of Conduct. True to say that the COPC has no bearing on an internal disciplinary (except that you might expect an internal disciplinary to be based on similar principles). Also true to say that it may not have been the most diplomatic thing to wave the COPC in front of colleagues. But again, it's not relevant to the underlying mistake.
This SEEMS to me to be a real case of scapegoating, and this story seems (to me) representative of the 'fear and blame' culture that exists in some places.
Rather than jumping to apportion blame, as seems to have happened here, everyone should have sat down and had an open discussion about what happened, without fear of recrimination, and then decided what should be done to stop it happening again.

RE: Svn disciplinary?!

Alison Clare Hickman — Sun, 27 Aug 2017 10:20:38 GMT

Yes, Sal the 1st, I too found it deeply unsettling that T has declared she was signed off as competent in anaesthetic monitoring; when it now seems, from what she reveals, she had either not been comprehensively trained or, if trained, not checked sufficiently as being competent in all aspects. Oh my.

There is an investigation required, surely, into the adequacy of the checks made to assess her competence before she was signed off? With remedial action required.

I can also now understand the level of trust in her abilities by her colleagues; clearly it would have seemed to them unnecessary for their *direct supervision* as she was assumed to be fully capable.

To be brutal, I would be querying the assessor’s competence? Were their tutoring skills and/or checks in the SVN's competence adequate? The answer is *No* (if I am to trust what she reports as her reason for not understanding the importance of the flow meter and pre/intra anaesthetic checks).

Need further training? *Yes, definitely*. For her confident competence and, vitally, patient safety.

As for the incident itself, as I said originally, I feel this was not the culpability of one person alone, rather it was that of the whole team involved on the day; with the fault lines of 1. a failure in education and 2. a failure in anaesthetic equipment set- up checks. These were the break-points of a disaster waiting to happen. It appears to have been a catalogue of failed stop-checks leading ‘domino-fall' procession to the end disaster.

Do mistakes occur in practice? Hell yes - here's one as prime example of the 'domino effect' of a primary mistake and then the failed checks and balances...

-A new patient, a brown-tabby cat, recorded in client records but without gender and with a gender-neutral name. Let's say it was called 'Cat'.

- Cat had been booked in by a vet that morning, as a result of an on the spur of the moment decision by the client that morning. The usual calm and orderly patient record checks, against the consent form, on the previous day had not been conducted (no chance to).

- Cat was admitted at the end of the consulting morning and hurriedly place in Prep with the consent form on top of the basket with the term 'spay' as the procedure (client had signed the consent form).

- Cat's details were recorded on the Ops board and as the procedure was 'spay' the gender was assumed as female (and recorded on the board as such).

So far so rushed...

-One Prep VS and one theatre VS.

- Prep VS asked who had admitted Cat and was advised 'X' VS. Did not give Cat another comprehensive health and anatomical check as (assumed correctly) that Cat had just had one from the consulting and admitting VS. "What's this cat in for?"... "Spay", answered an RVN reading from the Ops board and consent form.

- Prep-VS was itching to get on with a dental procedure so went straight into Cat's induction without anatomical checks.

- Cat was inducted by VS and then prepped by RVN for a spay procedure.

- Prep-VS went off to start inducting the dental patient.

- Cat was taken into theatre.

- Theatre VS starts the spay procedure but gets increasing frustrated at not being able to find the uterus - was this an anatomical anomaly? Kept digging around - considered doing a mid-line incision etc etc... Now then , (I bet you've guessed already) - here comes the rub...

- A light bulb went off in the anaesthetic nurse's head, (she had had no involvement in admit or prep). She quietly looked under the drape at the cat's rear end and felt around... 2 testicles. Oh dear me.

So - a catalogue of 'failed checks' , misdirection and poor communication led to poor Cat having a procedure HE did not need. Luckily not life-threatening.

So - what do I think needs to happen in T's practice?

1. Training for SVN (and others)

2. A revision of all practice SOP equipment checks

I wish you well and hope you will get through this ordeal without permanent personal damage.

I know you have now learnt much to improve both your nursing skills and (I trust) your communication skills with your professional colleagues, through reading the instruction and advice given in this forum.

I do implore you to now research and read as much as you can on the subject of anaesthesia, monitoring anaesthesia and how to manage and monitor all the equipment used.

Also, I suggest you might want to create your own SOP's so that, whatever environment you are in, YOUR standards are GOLD standard.

Strive to be the best of the best for your patients and yourself.

Peace and love.

Ali h

RE: Svn disciplinary?!

Sal the 1st — Sat, 26 Aug 2017 23:01:38 GMT

[quote user="r-more"]

I don't know the other staff involved, but I would be surprised if the RVN and/or VS hadn't ever made a serious mistake or come close but for the action of someone else.

[/quote]

I suspect the same, but I am concerned that some of what has been said by way of defence may have in fact 'goaded' management into taking this course of action ie saying 'Anyway i was suspended for being rude(pointing out the qualifieds didnt notice it)', it would really depend on how this was done. Fair enough pointing it out in a calm way that you aren't the only one but then to add ''i cannot be held liable for a disciplinary as i am a student,and under the direction of the vs,and told me to remind her if the rcvs code of conduct,delegation to veterinary nurses.'' I can see that is going to really pee somebody off. Its like sticking two fingers up and saying - can't touch me.

I don't know anything of the interaction between student and management - apart from what has been written here- but the statements on here are littered with clues ''i have had two clinical coaches over the last year(currently going into second year of nursing at college),due to the EXTREMELY high turn over of staff.'' Why the emphasis - may well be perfectly innocent but it comes across as attitude.

''I know i am responsible for monitoring,but i feel myboss has taken this too far with the disciplinary action,especially as the bvna have adv that she is legally responsible....they have said it is not a disciplinary matter for me as i am a student.by all means i can be "toldoff etc"but not have a formal disciplinary.she seems to think however that i am liable for a final written warning,despite this being my first"offense".''

I do feel for the OP - maybe all of this could have been handled much better and I do think they need to get some good advice quickly because inadvertently they are digging themselves into a very deep pit and I really don't want them to do that - ie you can't possibly use the following statement as a defence ''Also,i have been at my practice since 2012,my clinical coach has apologised that they hadnt shown me how to monitor the flow rates properly.'' if you then go on to say '' i have always felt completely confident in my anaesthetic monitoring prior to this,and have been signed off on mynpl on monitoring and preparing for anaesthesia'' (and does anybody else find this just a bit concerning?)

We all make mistakes, nobody is perfect and most of us learn to not make the same mistake twice, some lessons are very hard learnt. I know I have had to learn a few in my time.

RE: Svn disciplinary?!

talchi — Sat, 26 Aug 2017 17:03:20 GMT

[quote user="r-more"]Despite it's name, for a final written warning to be issued, there doesn't have to have been prior warnings of any kind. A final warning can be issued if the event is deemed serious enough that no further "chances" are being given. Of course the employers disciplinary procedure will apply. [/quote]

Thanks for clearing that up for me r-more!im finding it all very confusing!

RE: Svn disciplinary?!

talchi — Sat, 26 Aug 2017 17:00:20 GMT

[quote user="VetNurse Anon a/c"]OK so I have to say I feel like your being treated extremely unfairly, if your the only one being disciplined and not the RVN who was with you at the time that is not right at all, and you definitely shouldn't be getting a written warning. You are a student, under the responsibility of the RVN, so why are you being given all the blame? Do you think its possible your practice wants you to go? I really feel for you, especially as a similar thing happened to me in my last practice, also during an anaesthetic that I was monitoring ( and I'm only a VNA ) and I got the blame even though I was on my own with the vet and I hadn't even received full training. Its always the lowest ranking member of staff who is the scapegoat and its not right or fair but as a SVN I don't know if there's much you can really do about it :( [/quote]

Hey,its annoying isnt it!!ive spoken to a lotof nurses that i know locally in relation to this,and our head receptionist was a head vn for 40years and they all say that a formal disciplinary is over the top,and perhaps a bit of extra training in that area would be a good start,instead of a formal punishement...

RE: Svn disciplinary?!

talchi — Sat, 26 Aug 2017 16:54:01 GMT

[quote user="Sal the 1st"]I would strongly suggest you get in touch with CAB they will probably be able to give you some sound advice on this[/quote]

Thankyou for the advice re the CAB.i have never had a written or verbal warning before.i uave never even had "a slapped wrist" at work before,however i have had an occassion where the vet said i jad done something wrong,and asked not me not to do it again(i sent clinical history to another practice without checking with her first).my employer is stating this occurance as"serious misconduct",and our employee handbook states that for serious misconduct on the first occassion is a final written warning.she is saying that i "failed to follow the rules and procedures"...but in the employee handbook that comes under unsatisfactory conduct and misconduct.in the first occasion,unsatisfactory conduct is a formal verbal warning, and misconduct is a written warning,again for the first "offense".

RE: Svn disciplinary?!

r-more — Sat, 26 Aug 2017 16:49:29 GMT

[quote user="talchi"]...final written warning,despite never been formally disciplined before.[/quote]Despite it's name, for a final written warning to be issued, there doesn't have to have been prior warnings of any kind. A final warning can be issued if the event is deemed serious enough that no further "chances" are being given. Of course the employers disciplinary procedure will apply.

From what has been written only, there does seem to be something of a finger pointing exercise going on here. I don't know the other staff involved, but I would be surprised if the RVN and/or VS hadn't ever made a serious mistake or come close but for the action of someone else.

RE: Svn disciplinary?!

talchi — Sat, 26 Aug 2017 16:39:40 GMT

Hi,as far as i was aware,ihad received the appropriate training.when i started monitoring GAs,the rvn told me to write the amount of o2 and the iso on the monitoring form,and then record it when it was changed to a higher/lower level by the vet.i have always felt completely confident in my anaesthetic monitoring prior to this,and have been signed off on mynpl on monitoring and preparing for anaesthesia

:-/

RE: Svn disciplinary?!

Alison Clare Hickman — Sat, 26 Aug 2017 14:04:09 GMT

in case you're not sure what Sal means by CAB... Citizens Advice Bureau. Free advice.

https://www.citizensadvice.org.uk/

RE: Svn disciplinary?!

Sal the 1st — Sat, 26 Aug 2017 13:13:32 GMT

''.i am being told that i am likely to get a final written warning,despite never been formally disciplined before.''

ok well lets see what we can work with - presumably you have a contract? If you do it should be able to give you an idea as to how many verbal warnings or written warnings are given before a final written warning? I am not quite clear on what you mean by 'never formally disciplined before'? does this mean you have had verbal warnings prior to this? The fact that it is called a final written warning would suggest that there should have been warnings given prior to this? If you are given a final written warning you should also be given some indication as to how long this is to remain on your file.

For now I think you need to put your annoyance to one side, I know its not easy, but that feeling of annoyance can lead up to you doing and saying things without really thinking and then lead to actions against you that you may regret dearly. You need a level head, not one driven by anger. I am not saying roll over and play the victim I am saying just be a bit careful

I would strongly suggest you get in touch with CAB they will probably be able to give you some sound advice on this

RE: Svn disciplinary?!

Katie Mack — Sat, 26 Aug 2017 12:58:02 GMT

As an SVN/ANA if you are asked to undertake jobs which you feel you haven't had correct and complete training in making you competent, you should be refusing to undertake them. Now, this would bring about its own set of issues (why are ANA's running GA's, how employers would cope with you refusing to do things etc etc) but it is your professional and personal responsibility to speak up for yourself (and the animal!!) if you don't feel you are capable or haven't received suitable training. Simply turning around after an event and saying 'i haven't been taught properly' is not an excuse I'm afraid. As a head nurse in a practice with a number of SVN's, I would expect them to speak up if they feel unsure of their own competence.

RE: Svn disciplinary?!

VetNurse Anon a/c — Sat, 26 Aug 2017 11:09:02 GMT

Hi Talchi ( great name, do you practice tai chi by any chance? :) )

OK so I have to say I feel like your being treated extremely unfairly, if your the only one being disciplined and not the RVN who was with you at the time that is not right at all, and you definitely shouldn't be getting a written warning. You are a student, under the responsibility of the RVN, so why are you being given all the blame? Do you think its possible your practice wants you to go? I really feel for you, especially as a similar thing happened to me in my last practice, also during an anaesthetic that I was monitoring ( and I'm only a VNA ) and I got the blame even though I was on my own with the vet and I hadn't even received full training. Its always the lowest ranking member of staff who is the scapegoat and its not right or fair but as a SVN I don't know if there's much you can really do about it :(

RE: Svn disciplinary?!

talchi — Sat, 26 Aug 2017 10:34:14 GMT

I feel physically sick to know this happened.i love my job and what the profession stands for,but this is making me not want to do it anymore.

RE: Svn disciplinary?!

talchi — Sat, 26 Aug 2017 10:29:54 GMT

Hi thanks for the advice.i do realise the dog could have died,and i feel awful for it.i am really upset about the whole situation,but as you have said i am also VERY annoyed about the situation.i do feel that the full responsibilty has been placed on my shoulders,and whilst i understand i was monitoring the anaesthesia,if they had trained me the correct way,then i would have been more aware of what to look out for.my points of annoyance are that the vs noticed the mms were blue...and despite checking the dog ,didnt notice anything amiss.my secind point of annoyance is that the one qualified nurse in the practice who was at the mouth end also failed to notice the mm colour,despite her doing the dental procedure...but these two points are being swept under the carpet by the practice.

The dog is and was,thankfully,absolutely fine.within ten minutes of this incident,he was up and about in his kennel.from my point of view,i feel that the vs should have explained to the owners what had happened,so that they could keep an eyeon the patient for any signs/symptoms after this,but it has not been mentioned to the owners at all.if it was my dog i would want to know.

I have had meetings with work,and i am the only person they are holding responsible.i am being told that i am likely to get a final written warning,despite never been formally disciplined before.

RE: Svn disciplinary?!

Sal the 1st — Fri, 25 Aug 2017 21:16:59 GMT

ok - for what its worth

1 how is the dog?

2 ,''but ten mins in she asked the rvn to take over so she could leave the room.she then came over and mentioned themms were blue/grey,and asked me what resps /hr was..i told her(24 and 100) and said they were steady.she then left the room.i cont to monitor the patient ecery 5mins or so,hr and resps cont to be at the same rates,and steady.the reservoir bag was inflated and i could see it moving due to the resps.another ten minspasses,the vs comes into prep and states the o2bobbin was at 0!!!!''.

Very worrying - so even after it has been pointed out that something is amiss with this dog it takes another 10 mins before VS, RVN, SVN Uncle Tom Cobley and who ever else was involved to carry out any investigation of what could be amiss and do something about it

''she then gets arsey with me for not noticing,i say im sorry but also point out that the rvn is sat next to the machine,and she didnt notice,neither did the vs or other svn.''

I bet - and had it been me you would probably be peeling me off the ceiling now because it sounds like everybody is passing the buck. The dog could have died -its not just a case of damage to professional reputations - the dog could have died!

4''they have suggested i cannot be held liable for a disciplinary as i am a student,and under the direction of the vs''

Wrong even if you can't be held accountable by the RCVS the practice as an employer can still discipline an employee - which is what they are doing

5 ''told me to remind her if the rcvs code of conduct,delegation to veterinary nurses.she is having none of it!''

Nope - bet the boss was absolutely thrilled to bits to be hearing that, I can see where that would have improved their mood greatly.

Yes its true we all make mistakes. Just seeing this from both sides of the fence yes I can see why you are annoyed (and I will use annoyed rather than upset because if you are upset it isn't the way you are coming across) it may just look to you that you are being made an example of but how do you know if others haven't been reprimanded too? I can also see this from the practice point of view where from what you have written here you are coming across as somebody who hasn't really taken in how serious this is (and I acknowledge that we don't always give a true picture of ourselves when it comes to writing it down, you may well be somebody who has been greatly affected by what happened).

I don't think you should be held totally responsible for what happened - it was a group effort by the sounds of it with nobody wanting to carry the can but some of what is down on here if said or suggested to your employer wouldn't really have helped your case.

This was a very near miss by the sounds of it.

I think you need to be very very careful and will echo what Alison has said - be careful what you write on here you don't know who might be reading it.

My feelings are that you will learn a lot from this experience and it will make you into one very careful nurse in the future - don't let it get you down.

Perhaps I'm not posting what you would like to hear but this is somebody who nearly died when they were desperately trying to breathe against a ventilator and for what seemed like an age nobody noticed - so I guess I just get a teensy bit wound up about these things

RE: Svn disciplinary?!

talchi — Fri, 25 Aug 2017 12:31:08 GMT

Ok thankyou.i am new to the whole social media/forum world!thanks for the advice!

RE: Svn disciplinary?!

Alison Clare Hickman — Fri, 25 Aug 2017 12:12:56 GMT

Hey fellow RVN's (especially Clinical Coaches!) does anybody have cheat sheet or similar for required checks re set up for anaesthetic and equipment checks, intra-anaesthetic checks and/or guidance notes they have or especially created for their SVN's? If you do can you say so on here and perhaps get a copy to talchi please?!?

Thanks

Ali h

RE: Svn disciplinary?!

Alison Clare Hickman — Fri, 25 Aug 2017 12:01:25 GMT

Please do be careful what you say on here as it can be read by anyone...

I would speak with your college as a next step.

Let me know (PM me) how you get on.

Ali h

RE: Svn disciplinary?!

talchi — Fri, 25 Aug 2017 11:31:58 GMT

Hi thanks for your advice!as you have pointed out,i DEFINATELY will not be allowing this mistake to happen again!i have already learnt from this to check the o2 generator is on at the wall.its no excuses but it is difficult at my practice,the generator is in theatre,and the dental was taking place in the prep room,so i will definately be going into theatre to check!!the patient had been moved from xray,where it hadbeen on o2 via cylinders,then moved by 2 others to the prep room where i connected it to the anaesthesia machine.my practice is not a "normal" practice....we have a daily list of jobs for the prep room,and checking circuits/bags are working is done weekly(sometimes even furthur between!),and the checking of iso etc,soda lime colour changes etc are done AFTER the shut down of the prep room.i have had two clinical coaches over the last year(currently going into second year of nursing at college),due to the EXTREMELY high turn over of staff.on our op sheets we have space to monitor the o2/iso ,but the way ive been taught is to put the initial levels on(for example 3 o2,4 iso) etc,then when doing resp rates etc just to put the same o2 rates as before,UNLESS the vs/rvn turn the dial down.towards the end of anaesthesia,the vs will say to turn the patient down,or turn off the gases to wake the patient up,and then we will do so.

The initial morning checks of the machine happen on setting up-the appropriate circuit is put on the machine for the patient,and the scaveging attached.thats it!if we are using the canister o2 machine,we will check the level of o2 in the canister at this stage also...but again,this was only shown to me a few weeks ago,after i set the machine up in the xray room,a patient was connected...and the canister was empty!despite me picking up a canister thatwas marked "full"!the rvn just explained i should have checked,and showed me so i knew for next time.she said she thought i knew.

Also,i have been at my practice since 2012,my clinical coach has apologised that they hadnt shown me how to monitor the flow rates properly.i have suggested tomy vs/boss that it would be. A good idea to refresh protocols,but also to make sure that there are actually copies availabke,and that i should have a refresher training session.however she has said if i go back to work,then i will notbe allowed to monitor anaesthsia for the forseeable future!

I accept that i shouldhavenoticed,but its difficult to notice things that havent been told.the o2 generator sometimes gets turned off as soon as a patient wakes up,between other patients being anaesthetised,but others its left on all day.

I know i am responsible for monitoring,but i feel myboss has taken this too far with the disciplinary action,especially as the bvna have adv that she is legally responsible....they have said it is not a disciplinary matter for me as i am a student.by all means i can be "toldoff etc"but not have a formal disciplinary.she seems to think however that i am liable for a final written warning,despite this being my first"offense".

Sorry for the loooooong reply!i am very confused and also concerned that this is going to be on my record for the rest of my career.