Is it appropriate for Risk Management to discipline? - page 3

by iiwdn 4,680 Views | 25 Comments

Please survey my situation and give me your reaction. My 19yo son came to visit me at my hospital. While he was diatribing to me about how sick he was and receiving my wrath for not taking care of himself-- he passed out at my... Read More


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    The Board did not find that she acted outside her scope of practice. I am not familar with the opinions of the Washington Board fo Nursing, but the California Board of nursing has clearly defined the scope of practice for nursing and it is much broader than most people think. Take a look at their statements in section #2 regarding "common practice" and "standard procedures"

    Scope of practice in California:
    http://www.rn.ca.gov/policies/pdf/npr-b-03.pdf

    I think that this Risk Manager thought that this nurse acted outside her scope of practice and was so adamant about it that she took it upon herself to discipline this nurse and report her to the Board. She obviously was wrong and now needs to admit that she was incorrect in her assessment of the situation.

    At this point "iiwdn" can either let this go, which I think is going to be very difficult. Or she can go though as many internal channels as possible to resolve the issue. Speak to someone in Human Resources. Speak to a doctor that you trust, who can voice your concerns at a higher level. Do they discipline the doctors in this same manner?

    Call a local nursing union and start organizing!
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    Interestingly, I just spoke to a nurse who filed a grievance with her employer at a unionized site for having another shift Supervisor, not her own immediate Supervisor, discipline her for calling in sick. She is having the disciplinary action withdrawn.

    I asked her what she thought about a Risk Manager disciplining staff? She said that would probably be considered harrassment in her facility and would definitely result in a union grievance being filed against the employer.
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    Originally posted by iiwdn
    Please survey my situation and give me your reaction. My 19yo son came to visit me at my hospital. While he was diatribing to me about how sick he was and receiving my wrath for not taking care of himself-- he passed out at my feet. I immediately dragged him onto a gurney, assessed him, got IV access with fluids, vitals and while he aroused and inquired I told him what had happened and that he was now an ED patient.
    At this point he informed me he couldn't afford an ED visit, had no insurance and would not agree to be admitted to the ED. I negotiated with him and told him the only way to avoid this was to agree to and get a "now" appointment at the local clinic (4 blocks away). His wife procured the "now" appontment, I squeezed in the last of the IV, documented the assessment and event and sent it to the Dr. with the patient.
    The Risk Manager, later, with no complaint from Dr. or patient and with the consent of my manager decided to suspend me without pay for 3 days, report me to the board of nursing for practicing outside the scope of my RN license and leave a wide open termination clause in case anything "like this" was to happen again.
    The nursing board generated no further investigation and said no disciplinary action was needed.
    I find it difficult to function with this open ended and undefined threat to my employment and do not trust a risk management office that thinks this was appropriate treatment.
    You were absolutely in the right in everything you did. The only licenses in jeopardy were the nurses who would have been standing around doing nothing while telling you that youíre in the wrong. Itís called implied consent and makes no difference that his SO was there. The implied consent comes from the pt. In the emergency department of our larger ERís we have protocols and standing orders. You see when you have 25-50 beds you canít always wait for the Dr. Secondly, she simply hung NS not a quote medication. I donít know about the other hospitals, but my NS comes from central supply not pharmacy. Thirdly, if it were my kid $%#^ straight Iíd be working on them I wouldnít trust anybody especially most of you giving negative comments. Your all welcome to help out, but apparently some of you are to busy standing around wondering what to do. I apologize for these so called professions chastising you, iiwdn, I guess they never worked in a real ER. When you all want to come play with the big boys you know where were to find us, but Iíd prefer if you stayed on your units. Risk management was out of line!
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    This makes me angry. Are you supposed to give less care if it is a relative? It seems reasonable to me to start an IV. I am an EP nurse and people who pass out may have a serious arrythmia and need drugs. The next step might be pulseless and IV start would be difficult. Would I err on the side of safety especially for my SON??? Absolutely!
    Personally I think someone in RM is powerhungry! I would consider filing a defamation suit. And if youdon't have a union and are in a right-to-work state be prepared to be fired. You have no legal recourse to being fired irregardless of whether you did the right thing or not. You have the wake up call now look into it!
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    This, so far, has already been a long and difficult task. It has now lasted just shy of one and a half years! Every month I hoped to be able to add a happy update, but....
    Presently, I have jumped through every hoop the hospital has asked-- the last being to allow an independent "employee resolution committee" to meet and review the issues and the process that was used. It has been quite instructive to hear the nurses who sat on this committee and compare what they said to the final report from the employee advocate (which has at this point accompanied me to a 90 min meeting with the administrator of the hospital). Two or three ships passing in the night explains that whole communication process.
    Bottom lines:
    @ the facility still can't agree on the exact accusation. The range has included starting an IV without an order, starting treatment in a non-lifethreatening event, initiating treatment on my son, using a bag of IV fluid from a community funded hospital that was not properly charged, letting him refuse treatment and leave before being seen by a provider, not putting an entry into the ED log, sending the only documentation with him to the clinic, acting outside the scope of a nurse licesure, an EMTALA violation, etc. Many of theses have quietly gone by the wayside after hours of confrontational meetings, letters, threat of legal proceedings and pounding on a desk or two.
    @ denying me the oppportunity to enter a "late entry" in the log was wrong-- as was the rest of the handling the disciplinary process by Risk Manager.
    @ much of the preceedings were blamed on a Dr. who has used the hospital to pursue a retaliatory action against me which they could not stop. (blah)
    @ should have entailed some form of defining the issues, instructive analysis, appropriate discipline etc. and not been purely punitive
    @ the admin said that if this would have been Joe Blow and not my son it wouldn't have been as severe a disciplinary process and at least the "appearance" of wrong doing would have been avoided.
    @ the administrator has agreed to my minimal request to avoid legal actions that an unlimited and non-specific termination threat in an employee file was "not fair" and will be removed.
    @ a nurse in the facility that was working toward organizing (no union in house) has been bought off with a 10-15% raise and an invitation to be part of the administration. (he was already on e of the highest paid and most senior nurses on staff)
    @ the rest of the staff is furious and afraid so is continuing the organizing attempt for which I have received the honorary and unenviable position of "poster child".
    I would have been satisfied with many options of discipline eg. verbal and/or written warning, late entry in the ED log, pay outright for the bag of IV fluid so as to avoid appearance of wrong doing, etc. It is interesting that the administration has been satisfied to let their Risk Manager create liability for the hospital with this kind of employee treatment rather than to try to improve the situation. Mabe I have been to nice and expect too much??-- I hope not.
    There will be more to the story.
    And thank very much for your support. I have been contacted by nurses, risk managers, nurse attorneys, labor law union negotiators, attorneys, and nurse managers. All those angles of view have been very helpful.
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    You know, I can't see where they have a leg to stand on, except possibly for nit picky paperwork details. Even after knowing what a snit fit the hospital made I can't see responding in any other way to a patient who passes out in front of you. Wish I was a lawyer or a politician and I would have a word or two to say about this as your advocate. (If you want a lowly RN, I am available)


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