Nurse files lawsuit over firing

gcupid · Aug 17, 2014

With only the info from the article to off of I think the firing was justified. The is no way she should have been stripping wires to rig a pacer! She could have very easily killed the pt. He was being externally paced and if he needed more interventions cardio should have been at bedside.

I guess it depends on how unstable were the vital signs and was the patient symptomatic. There is no doubt in my mind that cardio was not paged or a doctor was not consulted but it takes time to get a response. I think that 98% of nurses would not have gone to that limit but after nursing for 30 years she felt comfortable trying anything because the likely hood is that the patient probably would have died had an intervention not been done ASAP.

Hopefully she documented her ass off as far as notifying the docs and receiving orders. She got fired because had the patient died, the hospital could have gotten sued for millions.

elkpark · Aug 17, 2014

As is so often the case on this site and in these kind of newspaper articles, we only have one side of the story, and we don't know what other information may be relevant. This may be another of those "final straw" kind of situations' in which the hospital had other concerns or issues with this nurse,a nd were looking for an opportunity to get rid of her. We just5 don't know.

Also, scope of practice is scope of practice, and I've never heard of a situation in which a nurse exceeded her\his scope of practice and successfully argued thathaving acted to save someone's life made it okay.

icuRNmaggie, BSN, RN · Aug 17, 2014

If the pt was a transfer from a community hospital, why did they even stop in the ER, he should have had a bed number and been admitted directly to CCU, otherwise, no bed or accepting doctor makes this a huge EMTALA violation.

SionainnRN · Aug 17, 2014

If the pt was a transfer from a community hospital, why did they even stop in the ER, he should have had a bed number and been admitted directly to CCU, otherwise, no bed or accepting doctor makes this a huge EMTALA violation.

It could have been an ER to ER transfer.

RNforLongTime · Aug 17, 2014

The ER docs where I used to work would send up pt's ALL THE TIME that weren't 'stable'. Got one pt, being admitted with uncontrolled Afib COMPLETELY untreated in the ER. In fact, the ER nurse didn't even have the pt on a cardiac monitor in the ER and the pt was transported to ICU with just their ER tech! On top of that, the pt arrived to me FULLY CLOTHED!! Put pt on monitor and HR is 150-180!!!!!! Nurse told me in report that this pt's HR was in the 120's.

icuRNmaggie, BSN, RN · Aug 17, 2014

It could have been an ER to ER transfer.

I have never known of a community hospital ER to float a transvenous pacemaker.

The patient needed ICU management and it would be an EMTALA violation to send him to another ER. By Federal law patients are supposed to go to the appropriate level of care.

This fiasco is a perfect example of why we have to have EMTALA regulations.

I have to say that if the facts in that article are true, I have empathy for the nurse who had this mess dumped in her lap and every physician and hospital involved should be fined under EMTALA.

RNIBCLC · Aug 17, 2014

Hopefully she has a good attorney who is familiar with Emtala. I suspect this will get settled so as to not expose the hospitals own involvement.

ChristineN, BSN, RN · Aug 17, 2014

If the pt was a transfer from a community hospital, why did they even stop in the ER, he should have had a bed number and been admitted directly to CCU, otherwise, no bed or accepting doctor makes this a huge EMTALA violation.

We get transfers all the time at my facility that come and board in ER. Not an EMTLA violation since they are accepted and covered by an inpt attending, they just have no bed upstairs

icuRNmaggie, BSN, RN · Aug 17, 2014

We get transfers all the time at my facility that come and board in ER. Not an EMTLA violation since they are accepted and covered by an inpt attending, they just have no bed upstairs

It is if the ER staff remove the pacemaker generator and cables and the patient deteriorates.

SionainnRN · Aug 17, 2014

It is if the ER staff remove the pacemaker generator and cables and the patient deteriorates.

The emt team took the pacemaker equipment back to the original hospital. The pt was being externally paced and therefore wasn't emergent. The nurse completely overstepped her bounds by striping and rigging the internal pacer. She's beyond lucky the pt didn't die. From what the article says there is no emtala violation. Just a nurse who should have waited for cardio to come up.

icuRNmaggie, BSN, RN · Aug 17, 2014

The emt team took the pacemaker equipment back to the original hospital. The pt was being externally paced and therefore wasn't emergent. The nurse completely overstepped her bounds by striping and rigging the internal pacer. She's beyond lucky the pt didn't die. From what the article says there is no emtala violation. Just a nurse who should have waited for cardio to come up.

Since when do EMTs manage transvenous pacemakers?

External pacing for symptomatic bradycardia most certainly is emergent. And painful.

Transferring a patient to a unit or department where the staff don't know the difference or know how to manage a TVP is the wrong level of care which is the very definition of an EMTALA violation.

What if that was your parent who required a TVP due to a new Mobitz II or 3rd degree block in the setting of a myocardial infarction with hemodynamic instability. Not emergent?

Let's turn it off and see what happens?

SionainnRN · Aug 17, 2014

Since when do EMTs manage transvenous pacemakers?
External pacing for symptomatic bradycardia most certainly is emergent. And painful.
Transferring a patient to a unit or department where the staff don't know the difference or know how to manage a TVP is the wrong level of care which is the very definition of an EMTALA violation.
What if that was your parent who required a TVP due to a new Mobitz II or 3rd degree block in the setting of a myocardial infarction with hemodynamic instability. Not emergent?
Let's turn it off and see what happens?

It was off and if the pt was that sick then cardio should have been at bedside. The pt was maintaining their vitals with external pacing. The pt wasn't coding, and if they were, and they had tried everything they could think of, then it would have been worth trying to rig the internal pacer. But that wasn't the situation.

From the information in the article the nurse absolutely practiced outside her scope.