Good Nursing Home Nurses Bad Nursing Home Administrators

Hey everybody, this is Tina again with Good Nurse Bad Nurse. Welcome back to another week of, well, true crime. This week it's gonna be a little different. We're doing a very interesting story, and I'm really excited for the conversation that we're gonna get to have about the, the, the bad, the quote, "bad nurse" story this week. I feel like it's probably gonna, um, ruffle a few feathers and that's okay. I'm totally fine with that, but it's also gonna lead us into.

when we get into the, the good nurse portion, because once we get there, we're gonna talk about some research and real world things that are going on that I believe affect what happened in this particular story. But before we get into our stories, I would like to introduce, or actually just welcome back an old friend of the show. I'm really happy to have you back on, Nurse Keith.

I actually, today, I just recorded episode 420, so the show's been around a while, and I do some writing, I speak at conferences, I do all sorts of things, and I love being on the microphone, talking about nursing and healthcare. So I'm super happy to be here to dig into this case with you.

And so the combination of the two, I think is what's given you the, the staying power that you have and the reason that people want to hear what you have to say. And you're so good at conferences and so. I'm just, I'm always thrilled to have you back and have you on, and I'm just thrilled to that I can call you a friend and to have you on.

Unbelievable. And Samuel Merritt University has been kind enough to continue to sponsor our podcast and they want us to let you know they're continuing to offer a $10,000 scholarship to anyone enrolled in their MSN DNP or family nurse practitioner programs. If you're interested in getting more information about these programs, you can visit them at smumsn.com. That's smumsn.com. And of course, we'll put that link on our website if you wanna just go to goodnursebadnurse.com.

I also wanted to remind you that if you're interested in travel nursing, to go to trustedhealth.com/goodnurse and fill out a profile so you can see what kind of jobs are out there, and you can also see what they pay, the stipend, the hourly rate, all of that. I'm a travel nurse now with Trusted Health and I absolutely love working for them. So go to trustedhealth.com, be sure and put forward slash "goodnurse" so that they'll know that we sent you there and fill had a profile today.

All right, well, I guess we can get started with this story. So, I told you guys, this is gonna be a little different and maybe ruffle a few feathers. I, I'm, I've never been afraid to do that. You know, you guys know me, you know me. I'll say whatever, and it gets me in trouble sometimes. It's all right. I'm all right with that. I've gotten myself in trouble more than once, and people have their opinions about my opinion, and I, I'm okay with that. I am totally fine. I accept it.

I'm a big girl. I can take it, take the heat, but I'm always very passionate and kind of firm in my beliefs, but I like to believe I'm open. But one of the things that I do believe, and I am, I was talking to Keith about this before, I am very passionate about the fact that I believe that nurse- nurses and other healthcare professionals should not be charged criminally for making a good-faith mistake while in the process of doing their job.

And I, I will say that I believe that that is the case if you're honest and open about it, and if it's something that you're, if you're trying to cover up and hide, obviously, that, that, that is unacceptable. And at the same time, I can understand in this day and age, because it seems like left and right people are getting arrested for really what's obviously mistakes that are happening while they're doing their jobs.

And it's, it's always arguable whether or not it's, whether, whether they were maybe being sloppy, whether their technique was not accurate or proper or they following actual protocol. You know, if you look up the Lippencott Manual Procedure, the way things are supposed to be done.

But what drives me crazy about that is so many times and facilities allow the, these things to be done this way because they know that these corners have to be cut in order for the nurses and and other healthcare staff to be able to do their job with the ratios that they're given so many times they're given impossible, um, standards, they're given impossible jobs to do.

They're, they're, they're given in a situation where maybe you're in an ICU, you should only have one to two patients and you're given three. And you not only should, you only have one to two patients, but you should have someone working in a desk answering the phone, maybe monitoring telemetry.

You should have someone, a tech to help you with turning your patient or bathing your patient or I, I don't know, just there should be more staff that's available and then you end up with this skeleton crew of, of staffing. And so what happens? Nurses and, and, and techs or whoever it is, they end up cutting corners. They, because they're just like, obviously I don't have time to do this. So they try to cut the corners to where it's the safest, still safe for the patient.

A lot of times I feel like sacrificing themselves, their own safety, their own health, many times, and I, I feel like that's the situation we get ourselves in. I think hospitals and facilities will look the other way a lot and have been looking the other way because they know that it's allowing them to keep these skeleton crews running these hospitals and that, like I said, I knew, I know it's gonna be controversial. I wanted to kind of get that out, out there and just say that upfront.

It is how it is, what I believe. I've been working in a hospital, right, you know, all the way through Covid in the ICU, I've, I've been travel nursing. I, I've just, I've seen too much. I've talked to too many people and this is, you know, how I feel. And then having said that, this, this case comes along that's very kind of hot off the presses. This just happened in, in January. It sort of all came, I guess, sort of to a close in January.

So having said all that, to kinda lead up to this, this is a story of a nurse, an LPN called Amanada Fafana. She was a, an LPN, licensed practical nurse in Ohio. She worked at Capri Gardens Nursing and Rehabilitation Center in Lewis Center, Ohio, just north of Columbus, and she was working night shift and she was approaching the end of her shift on May the 20th in 2021 when she attended to one of her patients, Paul Mallory. Now, Paul Mallory was 72 years old.

He had been a resident at this long-term care facility since 2019. Shortly after the facility opened its doors. His wife had cared for him for more than 20 years before transferring him to Capri Gardens. He had previously suffered multiple strokes and an aneurysm that had left him debilitated and without short-term memory, his condition, however, continued to decline and his family had made the decision to place him on hospice care in January of 2021. So that's kind of the situation.

That's sort of where, where we are when this particular incident happened. And before we kinda get into what happened, one thing that I will say is at 6:45 AM for me for, and I've, I think for probably most nurses, if you are that time period toward getting toward the end of your shift, my husband knows, he's heard me talk about this before, how hectic it can be. How- Because what are you doing?

You're trying to kind of, so you're, you're trying to scramble around and make sure everything is done. You want your patients to look good. You want them to be ready for the oncoming shift. You don't wanna leave them, you don't want them to walk into a mess. You want them to walk in and feel like, okay, I can get my day started, this looks great, everything looks good.

And I, I can get my shift started with things I do I need to do, as opposed to walking in to like a huge mess to have to try to clean up and then it's gonna put your day behind. So I feel like that's sort of where we were in this setting. It's the end of her shift and she's going in there to clean this- Paul Mallory had a trach.

And so he had a tracheostomy, a tracheostomy mask, which I'm assuming is sort of like one of those, almost like a blow by mask that sort of lays there right on top of the trach. But usually they're not like real secure, but they, they just sort of like have, I don't know. Have you ever taken care of somebody with a trach like this?

And so taking it away, a lot of times it's, and it, you know, it can get dried up and the, that can kind of c- cause it to sort of, sort of close off, you know, and so you really wanna keep that moisture going, but I'm sure he probably needed the oxygen as well. So in this particular case, she's going in there to clean that, that trach mask.

And I don't know if she maybe was doing trach care too, because in so many times in these, these, um, these stories, they're, a lot of the stories, like when you're doing research, you are a lot of times reading news stories and they aren't necessarily medical people. And so they don't, they may not understand exactly what's going on.

So she, who knows, she may have taken, you know, the, the inner cannula out and cleaned it and put it back, or if they're, or switched it out, you know, depending on what kind he had. The way, it's, the way it seems to be told is that, that she just cleaned the trach mask and then put it back on him. But then the blue connector, the blue, you know, bendy connector that goes over to the oxygen had gotten disconnected and was not put back on to the mask part, which is absolutely horrifying.

And I, I, I hate to, you know, the thought of what he went through, you know, over the next hour or so because about an hour later, the day shift nurse came in to his room and found the tracheostomy tubing disconnected on the floor, and then also found the patient to be asphyxiated. So I, you know, this is having worked in a hospital, I worked on a progressive care unit with, which dealt with trachs all the time. This is, they would be on ventilators a lot of times.

And so, when you're on a ventilator, you kind of know they're, they're gonna tattle if anything's going wrong, you know, because if, if, if there's some kind of disconnect, something disconnected or blocked, it's gonna alarm.

But in this particular case, with the oxygen hooked up that way, it's, there's nothing to let you know unless you have what an oh two probe, you know, if you have an actual oh two monitor that maybe is on his finger that is assessing his oxygen level, and I, they didn't have that. Part of the, the thing that I struggle with, with the story is that I think a lot of people will say, well, yeah, but he was on, he was on hospice.

So, you know, if you're on hospice, you wouldn't a lot of times have monitoring equipment. But if that's the case, if you don't have monitoring equipment because he is on hospice and you kind of are, you know, not, you're not wanting to disturb them. You want them to be, you're making them as comfortable as you can and you don't, you don't want 'em hooked up to lots of machines and that sort of thing. But then why I, I don't know.

I just, I feel like if, if you're going to look at it like, well, this patient had the potential to decline if his oxygen was removed, I mean, shouldn't he have been monitored some way? I don't know. That's just kind of what I was thinking about it, but I'm not sure. I don't know. What do you think about that?

So first of all, we just think about that and we think about the, the meds, the treatments, the equipment, the care that needed to be done and having that many patients, one is responsible for is, in my mind, egregious and we'll talk about that later. Yeah, and I, I assume she was probably not just cleaning the masks, she probably was cleaning the inner cannula.

She probably took the trach apart and put it back together and, granted, she made an error, you know, and she admitted the error and it was a fatal error. And yeah, I mean, in a perfect world, even a person on hospice is gonna be monitored if they're on oxygen or other, other treatments. But we know that that doesn't always happen. Right? Especially in a nursing home where you have so many patients and probably limited resources. So that's, it's, it's a very, very unfortunate situation.

I feel terrible for the wife. I feel terrible for the suffering of Mr. Mallory. And I feel terrible for the suffering of the nurse because, either by your inaction or your action causing someone else to suffer and or to experience, you know, to, to die prematurely is a horrible thing to live with. And I can only imagine what that feels like. You know, Tina?

We're kind of maxed out and that is a really horrifying and scary place to be when you're trying to give those patients medications like Ativan and morphine to try to calm their breathing down, to try to relax their airway, to help them feel more comfortable. It is, it's excruciating to watch someone in that situation and you're doing, you have things you're trying to do for them to help them be more comfortable. To think about what he went through when there was none of that.

There was nothing to, to try to comfort him or help him through. Oh my gosh. No, I can't, it's hard. I don't even wanna think about it really. It's just unimaginable.

I just, that's excruciating.

It, if he had had an O two monitor on this, could have been avoided because then you, at worst case scenario, you're gonna hear the alarm beep beep beeping, and you're gonna go in and check and see, oh, his oxygen is off and you're gonna put it back on. So maybe the discomfort would've been for a few minutes as opposed to who knows how long, you know, and, and what all happened. Um, but, but that's just, you know.

They wanna spend the least amount possible and bring in the most revenue possible in order to appease their shareholders, especially if they're a public, you know, publicly owned company. Right. So if it's a company with shareholders who they have to answer to, then they're going to potentially cut corners and not have certain safeguards in place because those safeguards are going to cut into profits. And that's, you know, that's one of the places I land when it comes to for-profit healthcare.

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They only offer very strong CBD greater than a thousand milligrams. If you're interested, you can go to cbdstat.care/goodnursebadnurse, that's cbdstat.care/goodnursebadnurse. Be sure and put the forward slash "goodnursebadnurse" in there so they'll know that we sent you there. So the Ohio Department of Health and the Center for Medicare Services conducted an investigation, of course, into the death of Paul Mallory, and this nurse Fofana fully cooperated with the whole investigation.

She explained to investigators that she had forgotten to reattach the mask and that, you know, she just had made a mistake. Her report differed from an earlier account of events by the nursing home director. So apparently the nursing home director were kind of some people were spec- some, I guess nursing advocates were speculating that it was an attempt to absolve the facility of blame and maybe to kind of throw the nurse under the bus or feed the, feed another nurse to the wolves, so to speak.

But their account, this nursing home director had advised the Ohio Department of Health that the patient quote "had the ability to displace the tubing." This statement, however, was heavily refuted by Mallory's wife, who informed local media outlets that her husband was incapable of moving his body apart from opening and closing his eyes. Fofana was fired from her position at the long-term care facility and stripped of her nursing license.

She faced charges of reckless homicide and involuntary manslaughter. She initially pleaded not guilty, but then she changed her plea to guilty to involuntary manslaughter in just this past January, 2023. The guilty plea came with a possible prison sentence of a minimum of nine months and up to three years along with a possible fine of $10,000. Very emotionally charged hearing. She, the nurse repeatedly apologized and asked for forgiveness. I watched the video of this. She was visibly distraught.

I, I know that in so many of these cases, what happens is, was known as second victim syndrome, where if a, a nurse or another healthcare professional is directly or indirectly responsible for the death of a patient because of a mistake that they made, they will punish themselves emotionally and mentally so much that they even, uh, uh, people have gone to the extreme of taking their own life because of, of just not being able to live with what they have done.

I've done those stories on this, on this podcast before. It's, it's horrible. It's so sad. They just can't quite move beyond because they can't get a, they can't get over the fact that they caused a death. Especially like for some, in some cases it was like, you know, children, babies, and then the nurses just can't, they can't let themselves go.

They can't let themselves move on from it because in their mind they're just like, how can I, how can I just go on with my life and, and as if this didn't happen? And, and then ultimately, you know, it, they succumb to that the, the, the pressure and the stress and the anxiety of, of all of the, the rumination and the, you know, just those thoughts that that go along with, with, with all of that.

So I, I can, you could see that in the video on her face, the turmoil, I'm sure how she has tortured herself and will continue, I am sure to torture herself over this. I saw the same thing in RaDonda Vaught throughout the years leading up to her trial. I, I saw that in her, the, how she tortured herself over what she had done. And it's just, it's sad because I think so many times people, people want to have somebody to blame for their loved one. You know, something like this happening.

They want to see someone pay and somehow it's like, if you have, sometimes there is no one, sometimes things just happen and horrible things happen and it, there is no one to blame. It's just the circumstances. But if there, if there is someone that can, that, that you can like put up, you know, put out there and say, this person actually made a mistake.

So it's like, it, it just feels good to be able to direct all of that, all those feelings, those feelings of grief and frustration at a person. And I just don't know what, what does that solve? What does that do? It, I don't, it's hard for me to imagine that it really makes those people feel better. And it does. It's not, certainly not gonna bring the, the victim back. It's not gonna bring them back. And is it gonna prevent this from happening again? I would say the opposite.

That, and that's, that's what I believe. I believe that it is very likely that the more we do this, the more we're handcuffing healthcare professionals and charging them criminally, you know, with n- negligent homicide. And, and, and these, you know, other charges that, where they're facing years of, of proceedings and possible jail time, I think, you know, completely ruining their lives aside from what happened.

I think the more we, we see that you're either gonna, you're gonna have a combination of two things. You're gonna have people that are gonna say, I don't wanna be in healthcare anymore. It's not worth it. I, I'm gonna do something where I'm not, I don't, I'm not involved in direct patient care because it's not worth it. It is not not worth it to me to lose my license that I work so hard for.

I will find another way to use my license where I don't have to, at least I don't have the risk of being arrested and charged and, you know, going through all of, all of that. And then I think you also are gonna have people who are working at the bedside who just- culture is just gone. It's out the window and they make a mistake and they're immediately gonna be thinking self-preservation. They're immediately gonna be thinking, oh, I, oh dear, what have I done?

I can't say anything because, oh, they may, I may be in trouble. I may get arrested for this. Oh, oh my gosh. You know, like, and all this stuff's going in their mind and they're, they're hesitating before they speak up. And say something and you, and that could result, I think, into not only not, you know, in a situation where you're not gonna be able to prevent things in the future, because that's what we're supposed to be able to debrief.

We're supposed to be able to, to say, how can we keep this from happening again, by looking back and kind of doing a recount of every of the, of the steps, what happened leading up to this? How can we prevent this from happening again? But not, not only will we not have that opportunity, but what if there's a mistake that has happened that you could potentially reverse?

What if you gave something that there's an antidote to that there's a reversal for, but there, the p- the nurse is sitting there going, oh gosh, I, what have I done? And they wait, they hesitate just long enough that it's too late. And then they just decide, oh, I, I can't say anything at this point, or I'm just gonna be in trouble. And before you, you know, then it's just too late and they never say anything and nobody ever knows what happened.

I mean, we, I, I believe that that is a really scary place to be for me as a person who could potentially be a patient in a hospital or my family could be. I don't, I don't believe that's a safe place. I believe in just culture. What do you think about that, Keith?

So if nurses and other healthcare professionals are afraid of criminal prosecution, and we mean, you know, not a civil case, but a criminal case where they're being charged with, like you said, manslaughter, et cetera, et cetera, and facing the potential of jail time, it has a chilling effect on those who are already in the professions, those who are caring for patients and increases the worry and stress over, you know, making errors.

And it also has a chilling effect on people who might be thinking of coming into the professions and, you know, staffing hospitals and clinics and doctors' offices, et cetera. So the chilling effect is, is potentially very powerful. And I, I believe I fall in the same place as you that, that this, this quick movement towards criminal prosecution isn't necessarily in anyone's favor. And like you said, it doesn't bring the person back.

And of course, the people who are the, the remaining family members. Right. The survivors of the person who died. Let's say someone died like Mr. Mallory, of course they want someone to pay. Right? And that's, that's sort of a natural human inclination. We want there to be someone to suffer consequences for what happened. And I completely understand that.

And the consequences of, let's say, losing one's license, not being able to practice as a nurse or whatever provi- type of provider you are, never being able to practice again. And also the mental and emotional and spiritual anguish that one would suffer after having caused something like this to a large extent, I feel like is, is a just punishment. The criminal prosecution, I think is where we get into a pretty slippery slope, don't you think?

I ab- a hundred percent believe that in, in a situation like in anywhere near like this where someone's made a mistake that's so, so costly that it should be evaluated. They're the board of whatever profession they are should be looking at this situation and dissecting it and interviewing the person and really trying to determine, you know, what is appropriate.

Whether it be continuing, you know, education, some sort of education to help, help improve their understanding of the, the way they should have been doing their job. Or maybe it is just so egregious that it's like, you know, it's, it's just unacceptable. We can't have you working in direct patient care anymore because, no matter what the circumstances, you should not ever be in a situation where you would not have some sort of self double check in place.

And I, this is what I've always said to nurses, whenever I precept new nurses, I'm always, you know, always talk about my always and my nevers. You know, you, you have, you, you should always, you should have every nurse, especially working at the bedside, indirect patient care should have their always and their nevers. You should have certain things like I, my my, some of my things that I, I know I always do is I always read aloud medications as I am about to open them. I read them aloud.

Even if the patient is intubated and unable to speak back to me or acknowledge what I'm doing, I just basically act as though they can, and I just say it out loud. It's a habit that I formed a long time ago and it, I feel like it helps me because I'm reading it off the, the computer screen, you know, off the mar. I'm saying it out loud and I'm make, you know, making sure that it matches, that it makes sense.

I even say, you know, this is, you know, pantoprazole, and it will help decrease the acid in your stomach. You know, like, whatever, whatever it is. That way- and, and, and I, I do that for all these meds, you know, this, the, whatever it is, and a very, very simplistic mechanism of action. And that's my habit. And if I don't that, because if I make a habit out of that, then I, if, if I get to a med that I can't, I don't know what it is, then I better stop.

I, I'm not gonna keep, don't keep going. Don't just be like, oh, I don't know what this one is. Keep open, open it up, keep, no, then you gotta stop and just be like, oh my gosh, okay, what is this one? I don't know what this is. Am I gonna give a medication to a patient that I don't know what it is? No. Don't ever, that, that is a never, that is one of my nevers. You never ever give a medication to a patient that you don't know what it is and what it does ever.

It's just that is a never, and, and so to me, if you don't have these always and nevers in place for yourself, there's just certain things like, don't ever ever let somebody talk to you when you're programming it, a pump. You're, if you are programming a pump, I don't care what you're programming, what you're doing, if it's just saline, don't let somebody talk to you. Oh, hold on just a minute. I'll, I'll, I'll talk to you in just a second.

Do not allow yourself to be distracted when you're programming a pump. Period. Because what can happen, you might be programming what you think is an antibiotic and it's like, yeah, I mean, just mindlessly programming merrem and it's over 30 minutes or whatever. One of my nurse managers one time told me about a case where she was supposed to, she had diltiazem hanging there and then some other kind of, of like an antibiotic, and they were both in the same bag.

So it must have been like a pre-mix kind of thing, because the diltiazem that I used didn't look at all like this, but apparently they, the antibiotic bag and the diltiazem looked exactly the same the way it was mixed in the pharmacy. So she ran the diltiazem over like 30 minutes because she programmed the diltiazem bag as if it were meropenem.

So the dil, the , the pump allowed her to do it because she looked, you know, she's, it's not gonna think it's odd to run meropenem over 30 minutes because it's appropriate. So, She had 'em both hanging there together. There's another, there's another never, you know, to do, don't ever have two meds hanging together. Do 'em one at a time.

You know, like, this is how, to me, you, you come up with these always and nevers and if you have these things that you establish from the beginning and establish as you go, as you're learning about yourself, as you're learning, stop and think about what could happen. What, what could happen if I made a mistake with this, what could happen if I'm cleaning someone's oxygen mask, if I'm readjusting their oxygen, if I'm do whatever, if I'm messing with their oxygen at all? What could happen?

It could come, you could unplug it from the wall. You could for, you know, it could, obviously in this particular case it could come unattached from the, the mask. So what's a, an always that you could create in this particular situation so that you know, this is not gonna happen or it's very unlikely that it would happen?

If you're messing with someone's oxygen before you walk out the room, you always double check to make sure the tubing goes from the patient all the way up to the wall, and that the oxygen is turned on the appropriate amount. That way, and you follow it, you follow it yourself, 'cause I've had that happen before where there's multiple oxygen tubings and one of the oxygen

tubing is hooked to the wall and one of 'em is hooked to the patient . So if you ever had that, I've seen, I've walked into rooms and seen that before. Why is the patient de setting? It looks like they're on like eight liters and that it's in their nose, but the one that's in their nose is hanging in the floor and the one that took to the oxygen the other end is, is like laying in the bed. Do you, you know what I'm saying?

By creating these always habits, you can make it to where it's almost, uh, really impossible for something like this to happen. But what you cannot do, I could not say that there isn't a mistake I could make that could take the, the life of a patient because I believe that no matter how mar- hard, I try, I'm a human being working in a very flawed system, very flawed system, and I am not perfect.

And I, as hard as I try and as much compassion as I I have for people and how much I love my job, I cannot, I know I'm gonna make mistakes and I, I just, I, I can't get over this. I can't get past it. I just can't. And it horrifies me. It's one thing to risk losing my license and losing, you know, what I work so hard for, and the job that I love.

I, I know that's a possibility if I make a mistake, but to risk losing my freedom, to be, to, to put my family through years of a trial like this and, and possibly have to go to prison, that's not acceptable, Keith, I'm sorry. It's just not for me personally.

But I do think this, this chilling effect of, of a potential prison sentence is really sending a message to those who work in healthcare and those who might wanna work in healthcare, that, that we're putting our lives on the line in, in such a intense way, in such a scary way that it could scare many of us away from serving in the first place.

And she could say after the trial, "I'm not ready to forgive her. I'm glad that she was convicted for causing my husband's death." It's just, to me that is just, it's hard for me to hear that as a healthcare professional who, because we, we do sacrifice so much of ourselves to take care of people and for people to be, I'm sorry, but really kind of selfish, you know, with that attitude that you're not allowed to make a mistake. You just don't, you are just not allowed to be human.

You, you want robots taking care of, of you in the hospital because it's probably gonna come to that at some point, but are robots gonna go in and turn you every two hours? Maybe. I don't know. Maybe that's what they're gonna do. Maybe they'll have robots going in and cleaning people's bottoms and assessing for lung sounds and heart sounds and, and for skin problems.

And I, I don't know, maybe they will have robots doing that and other machines that can take over and do that and nurses won't be able, you know, won't have to, to risk that, you know, we won't have to worry about being perfect. But if that's the case, who's, who's programming the robots? Somebody ultimately will be responsible for, there will be a human being involved at, at somewhere down the line. I mean, uh uh what, where do you draw the line? Where do you draw the line with this?

Where we just wanna criminalize everything and put people in jail, make someone pay, and we're just not allowed to make mistakes. I don't know.

And as long as you have human beings taking care of human beings, things are gonna happen. And it's highly, it's very unfortunate and tragic, you know, and how we as a society deal with these sorts of issues is definitely is very telling. Tells us a lot about who we are.

They teamed up with Littmann to make the stethoscopes to beat all stethoscopes, the 3M Littmann Core Digital Stethoscope, and this is the one that I use now. So she said, "Oh my gosh, I've been wanting to try one of those." So of course I let her use it and she just could not stop talking about it for the rest of the shift. It was so cute. She was like, "You know, I can't hear anything with my normal stethoscope because I have tinnitus."

And so she was so excited because she could actually hear what heart sounds were supposed to sound like. She said, "I'm gonna ask for one of these for graduation." And I was like, yeah, you definitely should. So just so you know, the Eko technology that makes the stethoscope so amazing, uh, you can enable it with a flip of a switch. You can turn it on and off.

It has active noise cancellation up to 40 times amplification, wireless oscultation using Bluetooth technology, it connects with Eko's free app and software so that you can visualize record, share, livestream, analyze heart sounds, lung sounds, and whatever body sounds you wanted to listen to. So you can go to ekohealth.com and use the promo code "gnbn" to get $50 off your order. And that's Eko is spelled E K O, by the way.

So it's ekohealth.com and use the "gnbn" promo code to get $50 off your order. Did you know that you don't have to go all across the country to be a travel nurse? You certainly can, but you don't have to. I literally took an assignment that's an hour and a half away from my house, and I love it. I can stay in a hotel room if I want, or I can drive back home. So it's the best of both worlds for me.

For my next assignment, we're gonna get a cabin in the mountains that's about two hours from our house, so it'll really be like a little getaway. Also, one of my really good friends is going with me so we can share expenses. You guys, even if you're just a little curious about travel nursing, go to trustedhealth.com/goodnurse and fill out a profile so you can see what kind of jobs are out there and what they pay. Go to trustedhealth.com/goodnurse and fill out a profile.

The prosecutor said, "Our office will never hesitate to fight those who victimized the most vulnerable in our population." What kind of a statement is that? It, for one thing, it sounds so out of touch with what actually happened because nobody victimized anyone. This was a mistake. Clearly was just, it was a mistake. It was horrible. Horrible. And I, I, I, I don't really, you know, like I said, I don't wanna think about how absolutely tragic it really was. It's just really unimaginable.

But at the same time, the, no one set out to victimize a vulnerable adult. This is not a case of elder abuse in the strictest sense of the word, where you have someone who is supposed to be taking care of someone who is vulnerable, elderly, and they are not giving them the food that they need, the, the, the medications that they need, or they're deliberately doing things to try to restrain them or abuse them in some way.

That is not what we're talking about here, and yet, this is what the, this is what's happening. These prosecutors all across the country are seeing this as an opportunity to win a case, because no one wants to think that no one wants to let anyone get away with abusing children or elderly people. No, it's unacceptable. No one wants, you know, no, most people are not gonna want that, and you're gonna be a hundred percent behind anyone who's gonna try to stand up for those people.

And you want people standing up for those people and representing them and advocating for them, but not in the case where it's, it's not really what's happening. That does nothing to further that cause to protect people in vulnerable situations. If anything, to me, who is responsible? Is it maybe the facility who's not req, who's not re- requiring adequate staffing, who's not putting systems in place to where something like this could be prevented?

Well, this nurse was sentenced to three years of basic level community control. Additionally, she has to complete any classes ordered by her probation officer. She has to do a hundred hours of community service, pay a $500 fine and maintain approved residence and employment. She has to also surrender her nursing license, and she's prohibited from working in any field of nursing or taking care of sick individuals, whether it be paid or volunteer.

So she's not allowed to say, oh, well I am a nurse so I can vol. You know, I have these skills. I can volunteer to help. You can't do that. She's also unable to leave the state without permission or have any future violations of the law in any manner. Failure to comply could result in a, in an extended two year community control sentence, or a judge could impose a prison sentence.

So there are a few pressing questions, obviously, that remain unanswered regarding the circumstances leading to his death. You know, were there the safeguards in place that should have been, could the, a central monitoring unit, a video surveillance maybe have been utilized to allow the staff to watch patients who are considered critical or require equipment to maintain their life?

And, as you said earlier, how many patients was that nurse caring for that night, and how many shifts had she taken prior to the accident? A lot of times that's the case too. People will work 12 hours and then be asked to work an additional, you know, four hours or so. And so they're working like 16 hour shifts. You know, this case is, has a lot of parallels to the case in Nashville with RaDonda Vaught and um. Her story was more about a medication error that led to a death.

But, you know, they, they were both transparent in their interactions with investigators. They admitted to making mistakes. Vaught was definitely scapegoated by her employer. Just like Fa- Fofana, she was charged and convicted, criminally and lost her ability to continue to work for, in her profession. The death of Paul Mal- Mallory will de- undoubtedly haunt this nurse in all aspects of her life, not just as she seeks new employment opportunities.

So the patient's wife also filed a wrongful death suit against Capri Gardens, the parent company of the long-term care facility. And that hearing is scheduled for March of 2023. I, you know, I, I told you guys we were gonna talk as we get into the good nurse portion, more about things that are, that go on, that really, I feel like affected this and, and we've already kind of alluded to it.

But the thing is that everybody, I think everybody, anybody listening to this podcast, whether you are in healthcare or not, probably is aware of what goes on in nursing homes. If you're not, you probably should be, because if you think that you couldn't possibly end up in a nursing home, think again. You do not know at, at what, at, at any time.

If you, you could be in a car accident, you could suffer a stroke, anything could happen that could cause you to be in a situation where you, your people, your family at home just literally physically cannot take care of you. And you could end up in a facility like this, whether it's a long-term care facility, skilled nursing facility, or, or you know, whatever you wanna call. You could end up in a facility like this.

And the numbers are really scary as far as what these facilities are allowed to get away with. There really are not a lot, there are not any really strict laws in place to protect the patients. And so these facilities are, what is their number one goal? Making money, keeping their, you know, keeping the bottom line in the black, right? So as we said earlier, if they can, if they can have 30, you know, 30 patients to one nurse instead of, you know, 15 to one, that's a whole salary.

Think about how much, you know, a nurse score at these long-term care facilities. A lot I know in Tennessee, they probably make somewhere in the neighborhood of, I don't know. 50,000 a year or something. 50 maybe. Maybe 55 to 60,000 a year. Something that, something, somewhere like $25 to $30 an hour, I would guess. A lot of these, the LPNs that work in these hospitals are in these facilities.

Some of them more, but they have the ratios so ridiculous that the nurses literally spend their whole time up and down the, the halls of these facilities passing meds. They're from one to another, to another, to another, to another. And then the CNAs are just like from one to another, to another, to another. Turning the patients and cleaning them up, turning the patients and cleaning them up. I don't know. Have you ever spent any time in any of these facilities, Keith?

I didn't wanna just be shoveling food down their gullet, you know? So I saw the inhumanity of the situation right then and there, and I decided to quit. I quit on the spot, you know, after just, I think one shift. And I've seen these facilities also as a nursing student when I was, you know, on my rotations, and they're, they're horrible places to a large extent, especially the ones that serve the Medicaid population.

You know, the lower down, the socioeconomic, louder you go, the worse the facilities are, the more they smell, the dirtier they are, the more crowded they are, it, the more it seems like people are warehoused sitting one next to the other, next to the other, next to the other in the hallway. Just kind of like waiting for time to go by. And when we look at ratios of 30 to 1, 50 to 1, 60 to 1, there's just ask any lay person on the street.

Just go up to someone and say, okay, so let's say you were a nurse working in a nursing home. How many patients do you feel like would be a reasonable number of people to take care of? Or let's say your father was in a nursing home. How many patients would you want your father's nurse to care for and during any given shift? And they would probably give you a fairly reasonable number.

I don't think any reasonable person would say, oh, the person taking care of my dad could handle maybe 60 patients at a time. You're not gonna hear that. So it just goes to show that there's something wrong with the system.

The system is broken and it's sick, and when we're asking nurses who have worked very hard to get their licenses, to get where they are, to care for patients who are putting trust in us and trust in the facility to care for them, if we're asking them to do something that is obviously superhuman, then we are, we are greatly, greatly, gravely misguided.

And then one designated RN to serve as their director of nursing on a full-time basis, who is allowed to double as the charge nurse if the average daily resident occupancy, reg, yeah, occupancy is below 60. So, and then also it says, "and otherwise sufficient nursing staff to meet residents' needs." So it's like, where does that, that's awfully vague and it is very vague. The Medicare website even states, "There is no current federal standard for the best nursing home staffing levels."

As long as these nursing homes meet the bare minimum. They're technically in the clear. There was a, a little in- unofficial poll done in a Facebook group that was taken by thousands of long-term care and skilled nursing facility nurses to determine, you know, basically like what kind of nurse to patient ratios that they're facing in their own workplaces.

And so the way that they, uh, divided these results were by state and in the state of Ohio, the average nurse to patient ratio in these facilities was 32 patients to one nurse and 16 patients to one CNA.

So when I think about there being one nurse and 32 patients and then 16, you know, so in that, obviously in this setting you've got two CNAs for this, for this floor and one nurse and you know, 30 patients and, and each one of these patients I'm sure is gonna have some kind of medication that is due. And if it's a skilled nursing facility, I would imagine they probably could have a pretty extensive list of things that they're doing. You know, they could have, obviously trach care has to be done.

They could have peg tubes, where the meds have has to be crushed. Who knows the extent, you know, that, that they could have to go through. So I can just imagine these nurses up and down the hall trying to get all of this done. And then you've got the CNAs, if you have one for every 16, you know, patients and you've got 32, so that's two CNAs.

Well, they're gonna have to go together in most cases to take care because you can't really, most of the time you can't take care of a patient by yourself. You, it takes two people to safely for both the safety of the, the healthcare worker and the patient, you needed two people helping you do it most of the time.

So by the time they get through all 30 people, trying to turn them, and you know, you're supposed to be turned a lot of times, every two hours, it's gonna be time to turn around and do it all over again. And, and, and I guarantee you, a, a lot of times, 'cause I did, I've worked in one of these facilities as well when I was in nursing school. A lot of times the second you get, you clean someone up and move on, they will, they, they soil themselves again.

But it's gonna be another two hour and a half to two hours before you're ever gonna be able to get back to that person because you can't just keep going back to the same people. You gotta keep moving on or you're never gonna get, you know, around to all the other people. So the, that 32 to one may sound crazy and ridiculous, and yet in the state of Tennessee it's 44 to one nurse, 44 patients to one nurse, 44 patients for every two CNAs. That's just ridiculous.

I'm sorry, but that it's, it's not doable. It just isn't. So people are,

So it's the only, if I kind of equate that floor and think, you know, if this, if they, if that was sort of like a nursing home and they weren't, they didn't necessarily have acutely ill things going on. Like you weren't trying to, you know, give them antibiotic, IV antibiotics and all of the things that go along with being in, in like an acutely care, acutely ill facility.

So I just try to imagine what would be reasonable and it, I feel like if you had two nurses for that 18 bed, like for eight, for eight, those 18 patients, if you had two, so like basically one to what, one to nine, one to eight, one to nine, something like that. If you had two nurses for the floor and then on that floor you had, it was a three to one ratio for, there was three nurses to, or three patients to one nurse. So we had six nurses for the 18 beds, and then we had three CNAs.

So each CNA would have. six patients, and it was totally doable. We took excellent care of those patients. They stayed turned, they stayed bathed. They were always cared for. The nurses just saw themselves as an extension of the CNAs and you know, we just did everyth- everybody, everybody pitched in and did everything. There were also three respiratory therapists for that floor. Now that I think about it, because there were also the trait vent, vents and all that.

So, but it's the only thing I have to kind of gauge it by. So I would say somewhere around like nine, between eight and 10 patients to one nurse and at least three CNAs. But I, and I think that that would definitely, you could take good care of people, you could keep an eye on their skin, you could feed them. A lot of these people have to be fed too.

And there's all, think of three meals a day and you know, you ha- you have to, if you're not, if you're just going in there and sitting their, their tray in front of them, they're not going to eat. They're not gonna be eating, you know, and it's, they, they're you- they're, I'm sorry. I just, this is so disgusting.

Unless if you had that, you know, higher number, like maybe you had 18 or 20 patients per nurse, then I would say you need somewhere in the vicinity of maybe six aids. And maybe that nurse also needs other assistance as well. But I, I think it all depends on what the other ancillary staff are available. But I, I definitely, I definitely land in that same place as you.

And thinking about Nebraska, thinking about one nurse with 60 patients, I don't know how anyone could even face going to work each day.

But now in schools you have kids who've been mainstreamed for good reason. I think it's, I think it's great to have kids mainstreamed, but you have kids with G tubes, you have kids with trachs and vents. You have kids who are, you know, have some pretty severe disabilities. And the job of the school nurse has shifted a great deal in the last, I'd say several decades. So what's happened in the nursing homes? Are you aware, Tina, of how the acuity has changed?

And here's the thing, this is not at all unheard of for, imagine this, you have this 60 to one ratio in Nebraska, you have a, a nurse who is 60 patients and they're going one patient, to the other to, you know, supposedly assessing these patients, keeping an eye on their skin somehow. Some, you know. And then one of them develops a pressure ulcer.

And someone comes along maybe, I don't know, at some point and says, oh my goodness, look, there is a stage three pressure ulcer on this patient's six. And oh my gosh, there's also one on their hip. This patient's not been turned. There's no way this patient has been turned. Nobody's been looking at their, no one has seen, wait, this nurse has charted that their, that they've been turned, or they, the nurse has charted that their skin was bla, you know, blanchable or had no, no issues.

And then they're gonna point at the nurse and say, you, it's your fault. You missed this. You did not look at this patient's skin. There's no way you could have, and now this, this ulcer has gotten into the bone, has caused osteomyelitis, has caused that infection to get into their blood. Now they're septic, now they're in the ICU. Now they are fighting for their life. Oh, I'm now they died. They're dead because of you.

Because you didn't turn that patient, you didn't assess their skin, you didn't catch that pressure, pressure ulcer when it was at a stage one or two. You, it, you just ignored it and just went right on with your day as if it didn't matter, taking care of your 60 patients and-

So they also have to be supervising other human beings, making sure they're doing a good job. So we put that on top of it. And during the course of that nurse's shift, they're not working in a vacuum. There are colleagues who are saying, "Hey, could you help me out for a second here? I need to turn this patient." speaking of turning. Or the doctor or nurse practitioner comes in on rounds. And then you have to, you have to stop.

Talk to the nurse practitioner or doctor, get their attention, talk to them about med changes. Tell them about your assessment of patient A, B, or C. And then you have family coming through, right? So you also have to deal with family, answer their questions, maybe do a little counseling on the side, talk to other visitors who are coming through. It's not simply just doing these tasks that you check off on your, your MAR and your other lists.

You also have to be dealing with a lot of other human beings and other tasks that aren't necessarily the quote unquote "clinical tasks" to take care of. So to put that on top of everything else that this nurse has to do, and it's an outrageous amount of work.

When treatments are heavy, there are, there needs to be a treatment nurse on the day and night shifts. This is a safety issue for the, for the staff and the patient and resident."

So within a typical eight hour shift, the nurses in these facilities are expected to quote "pass meds at least twice per shift, monitor blood sugars, give insulin, check vital signs, manage their CNAs or nurse techs, watch mealtimes, perform wound care, receive and transcribe physician orders, complete incident reports, complete documentation, arranged transportation, diagnostic testing, schedule appointments" on top of keeping in contact with their family members and physicians.

They're expected to do all these tasks alone for 30 to 60 plus residents. So, just what you just said, it is absolutely impossible to keep up with all of the things that are put on, you know, the responsibility that's placed on their shoulders. And not only is this stressful, but statistically residents living in an understaffed facility are more likely to experience bedsores or what, what we would call pressure ulcers, infections, falls, malnutrition, and weight loss.

Despite this, only 12 states in the US have a minimum staffing requirement. Fortunately, in February of '22, uh, President Biden announced a plan to improve the quality and safety of nursing home care. One issue that will be addressed is under staffing and a study will be held by the Center for Medicare- Centers for Medicare Medicaid Services to determine new staffing requirements by conducting site visits, observations, and interviews in spring of 2023.

CMS plans to issue a formal proposal for minimum staffing requirements. And we are right on the cusp of that and that's why we're doing this, this show. And that's, I'm super excited about it 'cause it's like all the, this negative stuff and then maybe a little light at the end of the tunnel. I don't know. I'm hoping

I'd like to know what's happening in Australia and Japan-

I don't personally think we do, but maybe in order for a governmental body to make recommendations, they need more studies. My only, my only statement around that would be, well hurry up and do the studies so that we can actually invest in change.

What are you guys working in the, I know you are, I know you're working in these facilities. I wanna hear from you. I think you're are definitely the unsung heroes. You, the people who are willing to really put their license on the line and their life on the line. It's, it is crazy to say, but you are, when you're working in these facilities, and I do appreciate you and what you're doing and I do wanna fight for you and advocate for you.

I would love to be able to do whatever I can to advocate for change. If there's any, any view that have anything, anything you, you want, you wanna share? You can send me an email at tina@goodnursebadnurse.com. I'd love to hear from you. You can also follow us on social media at @goodnursebadnurse. Keith, tell everybody where they can find you.