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!
JKL33
7,038 Posts
And don't think for a minute that in some places everyone is not very well aware that those orders are not to be entered until the bed is ready and the patient is ready to roll out.
ETA: Expected to not be entered, I should say.