Is it appropriate for Risk Management to discipline? - page 2

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... Read More

  1. by   passing thru
    Personally, I would look for other employment...tell the new place you're looking for new challenges.

    No open -ended termination threats hanging over me, ever !

    Too much risk here.
  2. by   passing thru
    P.S. Too much liscence risk....
    they jumped to the BON too fast...

    Next time the BON will be involved....
    and, there will be a "next time".....
    for SOMETHING...
    these people are not your friends,

    or interested in furthering your reputation or career.
  3. by   Erin RN
    Originally posted by BarbPick
    not just out of her scope, off the wall. Who "operates" on her own kid without involving the staff around her?
    It sounded like she started IV fluids without the pt (son) even being assessed and basically not ending up ever being assessed by an MD wouldn' t that be out of a nurses scope..initiating IV fluids without an MD order (before or after the fact?)...Like I said I can see starting the line but hooking up fluids?? Aren't fluids considered something close to medication?? What do you think Barb..guess it would be good to look at the nurse practice act for whichever state it occurred in... Erin
  4. by   canoehead
    The NURSE assessed the patient and judged it to be an emergent situation and started a line. In our hospital that would absolutely acceptable, and in fact, if she had stopped to get another nurse or the doc (if they weren't immediately available she would be going against standards.

    If I was you I would find out if you are allowed to start ACLS protocols at that hospital without an order and then argue that this situation fell under that protocol.
  5. by   rstewart
    Was it appropriate for Risk Management to discipline this nurse? I would think not. The role of Risk Management is to manage risks, not employees. Nursing/Hospital administration is responsible for managing employees. Any attempt by your manager, director to deflect or minimize their role in the process should be recognized for the BS that it is. Risk management may have made a determination that you did something wrong, but if management wanted to forgo discipline or choose a lesser punishment they surely could have. Likewise, it was nursing administration's decision to report you to the Board. So my advice is don't lose sight of who your "enemy" is here.

    That is not to say I wouldn't suggest some modification as to how the ER event itslf was handled. The Board obviously considered the actions which the nurse took were within the scope of that nurse's practice; that is, she was found to have necessary "authority" to do what she did both in terms of protocals/standing orders/emergency care guidelines and her ability to safely perform the tasks. (I think we all know how anal Boards are in general---if there was ANYTHING to hang the nurse on they would have done so in the vast majority of cases.)

    So that leaves employer/employee issues as the basis for the Hospital's punitive response. Specifically, the nurse violated hospital policy and procedure when handling the event . So without my speculating further...what specifically did the hospital say regarding the reason for imposing discipline? That you shouldn't have started fluids? That you did not attempt to obtain medical assessment/assistance as soon as possible? That you did not obtain or attempt to obtain an AMA signature with documentation that the patient was aware of all potential risks of leaving once you established a relationship with the patient?
  6. by   fiestynurse
    Anytime a nurse is disciplined in a unionized facility, the union is involved. Rules are in place as to who can do the discipline. And if the employee considers the discipline to be too harsh, a grievance can be filed and the issue can be fought all the way to arbitration. Many times a suspension is reduced to a written warning.

    I think that this disciplinary action was too harsh and should have come from her immediate Supervisor. If I were "iiwdn," I would write a response to the discipline and ask that it be put in my personnel file.
  7. by   TNnursejane
    I work in Risk Management and it sounds like the Risk Manager went WAY out his/her job description. The RM manages risk! They don't make determinations of discipline! That would be the Nursing Administration's job.

    As an ACLS provider you would be OK doing exactly what you did.
    Someone mentioned the "250" EMTALA law. As a hospital we are required to care for and treat anyone within that 250 feet. We even have policies in place for that.

    Is this Risk Manager in Administration??? It seems that his/her job is to make recommendations on the possible liabilities of a situation.

    What you did sounds perfectly logical to me. We have a form that is filled out whenever there is a 250 called. If the patient is treated and refuses further treatment in the ED, then we at least have documentation if someone does come back on it.

    Just my 2cents
  8. by   fiestynurse
    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:

    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!
  9. by   fiestynurse
    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.
  10. by   Speculating
    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 you're in the wrong. It's 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 ER's we have protocols and standing orders. You see when you have 25-50 beds you can't always wait for the Dr. Secondly, she simply hung NS not a quote medication. I don't know about the other hospitals, but my NS comes from central supply not pharmacy. Thirdly, if it were my kid $%#^ straight I'd be working on them I wouldn't 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 I'd prefer if you stayed on your units. Risk management was out of line!
  11. by   efy2178
    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!
  12. by   iiwdn
    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.
  13. by   canoehead
    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)