ICU Nurse Fired For Refusing 3rd Patient

Nurse Julie Griffin was fired for standing up for what she thought was the right thing.

ICU Nurse Fired For Refusing 3rd Patient

At Westside Regional Medical Center in Plantation, Florida, ICU nurse Julie Griffin worked in the 12 bed cardiovascular ICU (CVICU.) Until she was fired for refusing to take a third patient.

Westside Regional Medical Center is part of HCA Healthcare. HCA Healthcare is the largest for-profit hospital chain in the U.S., owning over 150 hospitals, and earning over 47 billion in 2018.

Unmonitored Patients

One of Julie's concerns for patient safety was that the in-room monitors provided for a split screen display. This allows for an ICU nurse to be in one of her patient's rooms, set the monitor for a 2-view display, and be able to monitor her second patient. The problem? It does not allow for a 3-way display. If the ICU nurse has 3 patients, one of those patients will not be monitored.

In an interview with Hospital Watchdog, Julie Griffin explained that there is a standing order for all ICU patients to receive continuous monitoring, and nurses must electronically attest to the fact that the standard of care was met. HCA CVICU does not staff a qualified monitor tech at the nurses station where the central bank of patient monitors display. If all the nurses are away from the station providing patient care and an unmonitored patient goes into a lethal rhythm, there is no one to see it. An alarm would sound, but there are constant alarms in CVICU that compete for a nurse's attention. Alarms cannot be relied upon as a substitute for a nurse.

Hospital Watchdog reports that 2 such unmonitored patients have died. Allegedly, one of the patients was discovered dead and may have been dead for up to 30 minutes. A family member went out to the nurses station to report that something was wrong.

In the other case, allegedly the nurse was assigned 3 patients, was able to monitor only 2 of them, and the 3rd patient died of pulmonary problems, possible a pulmonary embolism (PE).

Hospital Watchdog qualifies the above cases saying they are not substantiated with medical records or other documentation, they are reported by nurse Julie Griffin in an interview.

Whistle-Blower

Julie says all of her colleagues shared her concern about patient safety and lack of monitoring, but they were afraid to speak up. They needed to keep their jobs in order to support their families. Julie, previously in the Navy, believed in following the chain-of-command. She reported unsafe patient conditions to her charge nurses and manager. She believed that if corporate only knew about the practice, they would want to do the right thing and rectify the situation.

Instead of rectifying the situation, nurses were frequently required to take 3, and sometimes 4, patients in the CVICU. Julie claims that untrained nurses were assigned ICU patients.

Julie trusted there would not be retaliation if she complained. There was. Julie claims her Director intimidated her and at one point frightened Julie by getting physically close. Julie's schedule was changed to working every weekend. She felt harassed.

Even the HR department at Westside acknowledged that the Director's actions were inappropriate. Even so, Julie was removed from duty within hours the day she refused to take a third patient.

On the day she was terminated, Julie had 2 patients. One patient had orders for transfer out to the floor. One of the patients was a post-op open heart surgery, and was on a diuretic. Julie knew that a patient on a diuretic often has to urinate urgently, and was concerned that she needed to respond right away to make sure he didn't fall.

Julie refused to accept the assignment of a 3rd patient. At 1700, The CVICU Director came to the unit and told Julie she had to take the 3rd patient. She again refused, was placed on investigative leave, and terminated 2 weeks later, in 2017. Julie had worked in HCA ICU since July 2016.

Julie later filed 2 Florida Whistle-Blower complaints in 2018, and has filed a suit against HCA for unlawful termination.

Julie's Director says that Julie was a disruptive staff member.

Julie says that the standard of care required by HCA called for continuous monitoring of her patients, and she was unwilling to violate that standard.

Right or Wrong?

Should Julie have gone with the status quo and quietly accepted a 3rd patient, knowing that at least 1 of her patients was lower acuity? Or did she do the right thing?

Is her reputation so damaged that she will have difficulty securing employment? Was she acting on principle or imminent patient endangerment?

Does she have any chance of prevailing against HCA?

Many of us have been in similar situations. What would you have done?

Nurse Beth,

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

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Nurse Beth

About Nurse Beth, MSN

Career Columnist / Author

Hi! Nice to meet you! I love helping new nurses in all my various roles. I work in a hospital in Staff Development, and am a blogger and author.

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Specializes in Medsurg.

This gonna be good

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Specializes in ER OR LTC Code Blue Trauma Dog.
7 minutes ago, Nurse Beth said:

Julie, previously in the Navy, believed in following the chain-of-command. She reported unsafe patient conditions to her charge nurses and manager. She believed that if corporate only knew about the practice, they would want to do the right thing and rectify the situation.

And here's another example of the difference between the Navy and a private, for profit corporation.

Whenever there's profits involved, there's clearly a financial incentive to engage in unsafe practices. You see it occuring everywhere.

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Two thoughts:

- On the surface of it, it seems that there are probably more compelling hills on which to risk dying with regard to the particular situation described.

- I DO think hospitals should have to answer for how they support their own policies. Whether it be hourly rounding or full assessments or cardiac monitoring or whatever, if your policy is such that X must be done, then it's time for hospitals to stop being able to get away with not staffing to actually provide what standards, regulations and their own policies say is required. Right now they are able to simply make a policy saying X must be done, and then leaving each single licensee figure out how to navigate the fact that there isn't time to do it all.

They get the best of both worlds: If the employee overdocuments/documents things not done as the charting would make it appear, obviously they are in the wrong (one should never do this). But if the employee accurately charts only those things which they have hustled around and honestly accomplished, then if that ends up not being enough to prevent whatever untoward thing might occur, they are also in the wrong because the policy is that they should have done X, which they didn't do. (And that's to say nothing of all the care that we do provide that there really isn't time to chart in play-by-play fashion all day long...it just looks like we didn't do it).

You can say whatever you want about the rights of corporations/employers and the duty and responsibilities of individual licensees (as well as their "right" to find a new job), but being able to get away with all of the aforementioned is just such a shameful loophole. It's when I start thinking about the word evil.

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I have yet to read anything positive about HCA. Were I in the acute care realm, I would never go to that entity for employment. Unfortunately, my life experience tells me that HCA is most likely not the only hospital with such unsafe policies.

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53 minutes ago, JKL33 said:

They get the best of both worlds: If the employee overdocuments/documents things not done as the charting would make it appear, obviously they are in the wrong (one should never do this). But if the employee accurately charts only those things which they have hustled around and honestly accomplished, then if that ends up not being enough to prevent whatever untoward thing might occur, they are also in the wrong because the policy is that they should have done X, which they didn't do.

Perhaps you did not intend this, but I read your use of the words: "If the employee overdocuments/documents things not done as the charting would make it appear, obviously they are in the wrong (one should never do this)." as euphemistic language when these actions are actually falsification of the medical record which is a criminal activity. I think that in our sympathy with overburdened nurses we should not downplay this fact. Falsification of the medical record affects patient safety and quality of care and can result in patient harm; all reasons that we were taught in nursing school to never falsify the patient's medical record. I think it is important to mention this.

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Specializes in Cardiology.
2 hours ago, Crash_Cart said:

And here's another example of the difference between the Navy and a private, for profit corporation.

Whenever there's profits involved, there's clearly a financial incentive to engage in unsafe practices. You see it occuring everywhere.

Eh, government hospitals are guilty of this too, as are "non-profit" hospitals. It all comes down to the same thing though....$$$.

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Specializes in ICU.

I understand where she was coming from, and I do understand the problem of not being able to monitor your third patient adequately. But one of her patients was a downgrade, so it really wasn't a true triple. This situation arises in my unit often. Typically what I will do is get a tele box from central monitoring for my PCU/tele downgrade patient so that they are monitored by someone else. Then I can devote most of my attention to my ICU patients. Of course I don't know if this was an option for her.

Until we have mandatory staffing ratios this issue will happen. I personally would not have chosen that moment to fight that battle.

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1 hour ago, Susie2310 said:

Perhaps you did not intend this, but I read your use of the words: "If the employee overdocuments/documents things not done as the charting would make it appear, obviously they are in the wrong (one should never do this)." as euphemistic language when these actions are actually falsification of the medical record which is a criminal activity.

I wrote exactly what I meant, and I even added a parenthetical clarification so that there would be no question that I was not suggesting that fraudulent documentation should be excused because of the circumstances/environment.

I mentioned that situation because it's either this or that, and very little in between.

I could have stated it this way: There is no way to get every required thing done. Either you document truthfully and accurately or you don't, but either way you are to blame and you have done wrong. The option of "well just get it done and document it properly" is no longer a reasonable suggestion because it is impossible. No sarcasm intended there either.

And Susie, you should know that I do not advocate doing wrong and that what I have consistently claimed here on AN is that there is no "good" option. Exactly as I said.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Julie obviously felt that the assignment is unsafe and I am not in a position to disagree with her not being in her shoes that day. I also don't know the liability in terms of a charge of patient abandonment for a nurse refusing an assignment in Florida and what the hospital's policy states regarding that.

What I would do is to plead my case to the charge nurse or the nursing supervisor and if they insist that I take the assignment, make sure that they are aware that I will sign a sworn statement that I am taking the assignment despite my objection because of the risk of harm to the patients under my care. If bad things were to happen, I want to make sure management is aware of my concerns yet they ignored it.

https://www.nationalnursesunited.org/sites/default/files/nnu/files/pdf/nursing-practice/advo-alerts/ado-explained.pdf

https://nurses.3cdn.net/92b610cbb72e06beba_ldm6ivxkn.pdf

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22 minutes ago, juan de la cruz said:

Julie obviously felt that the assignment is unsafe and I am not in a position to disagree with her not being in her shoes that day. I also don't know the liability in terms of a charge of patient abandonment for a nurse refusing an assignment in Florida and what the hospital's policy states regarding that.

What I would do is to plead my case to the charge nurse or the nursing supervisor and if they insist that I take the assignment, make sure that they are aware that I will sign a sworn statement that I am taking the assignment despite my objection because of the risk of harm to the patients under my care. If bad things were to happen, I want to make sure management is aware of my concerns yet they ignored it.

https://www.nationalnursesunited.org/sites/default/files/nnu/files/pdf/nursing-practice/advo-alerts/ado-explained.pdf

https://nurses.3cdn.net/92b610cbb72e06beba_ldm6ivxkn.pdf

Juan, Details can’t all be in an article due to brevity! Julie has months and months of emails she covered her behind with regarding going up the chain of command and they did nothing! I’m proud of her for speaking up!

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38 minutes ago, JKL33 said:

I wrote exactly what I meant, and I even added a parenthetical clarification so that there would be no question that I was not suggesting that fraudulent documentation should be excused because of the circumstances/environment.

I mentioned that situation because it's either this or that, and very little in between.

I could have stated it this way: There is no way to get every required thing done. Either you document truthfully and accurately or you don't, but either way you are to blame and you have done wrong. The option of "well just get it done and document it properly" is no longer a reasonable suggestion because it is impossible. No sarcasm intended there either.

And Susie, you should know that I do not advocate doing wrong and that what I have consistently claimed here on AN is that there is no "good" option. Exactly as I said.

It’s courageous that Julie finally said she wasn’t going to do it anymore. She has months and months of proof In writing that her leaders told her she had to document the attestation at the end of every shift or be fired which is what happened when she said she wasn’t going to do it anymore.

thank you Julie! For your courage!

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