Unjustly fired for requesting proper staffing?

[zyft01]

I work in an outpatient surgery center on the night shift for the PACU. Our nurse / pt ratio for PACU is 2:1. Ext Care on the 7p-7a shift is supposed to carry the same ratio. We've never had more than 4 pts / 2 nurses in the past w/o bringing on another RN. Our Ext Care is set up for 3 over-night pts (1 semi-pvt rm & 1 pvt rm). If more than 3 pts stay the night, they stick them in a back corner of the PACU unit. The problem with that is that if you are in the Ext Care unit, you cannot hear the monitors or call bells coming from the PACU unit. When in the PACU unit, you can hear the call bells from Ext Care, but not the monitors.

This particular night, we originally had 3 EC pts sched'd for the night, found out they added another, but then added an 83 y/o partial thyroid lobectomy (which we had never done this case at our facility before) that morning as well. As soon as I found out about the pt case load (5 pts), I called my charge nurse (which was approx 2:30-3p) and asked for another body so I could have an extra set of ears for the monitors for the night. Apparently, according to the administrator, we were being ridiculous, and after refusing to come in if they didn't give us at least a tech in order to make sure the pts were safe, they finally got us an LVN to help us for the night. I told them up front that we could handle the work load, but that it was a pt safety issue and neither of us RN's wkng that night felt comfortable. We were all three very busy that night, but everything turned out find.

In a mtg they requested w/ me the next Mon (charge nurse, DON, & administrator present), they were not happy saying that I was "refusing / threatening abandonment of my scheduled shift". I told them that I was refusing to come in if they didn't give me safe and proper staffing according to the situation and that I felt that my pt's safety and my license could be at risk if I came in w/o another person for the night. I re-explained the monitor and call bell situation and why it was not a safe scenario. I told them that if one of the pts in PACU, mainly the 83 y/o partial thyroidectomy pt, happened to stop breathing while we were dealing w/ pts in the EC unit, we would not know until it was too late. Their response: "it happens all the time in the hospital, you go in and the pt's fine, go back in & they're not breathing. It happens and there's nothing you can do about it." I told them that should not be something that could happen in an surgery center where there are only two RN's in the whole facility all night and that this is not a hospital, these are not "sick" or critical pts. They then told me that as long as I do my scheduled rounds, that my license would be safe if I went back and the pt had stopped breathing and died w/o my knowledge. Of course I then told them that would not make me feel better and I would not be able to live w/ knowing that a pt of mine died simply b/c I could not hear a monitor, which I made them aware of in the first place.

I did not claim "safe harbor" to my employer, but that's basically what I did.

Two days later, I got a call from my charge nurse asking if I would be willing to work the same shift situation in the future, but with their original decision for staffing. I told him that it would depend if they fixed the monitor / call bell situation to make it safer. He reiterated that nothing would change, & would I work it. I stated that I would have to push my case for my pt's safety again if nothing changed. He asked me one last time and said "their decision would remain the same, without any changes, are you saying that you would refuse to work the shift if this were the case". My response: "I guess so b/c I could not in good conscience work in a situation that I know puts my pt's safety at risk".

I was a PRN employee (who had wk'd anywhere from 20-40 hrs/wk for over 2.5 yrs in mult. units of the surgery center), so apparently, they didn't have to tell me that they were firing me. I didn't know for sure for almost over a mth. On my separation form, they wrote that it was a "voluntary separation" (which I did not do voluntarily) and wrote "mutual consent, mgmt/employee unable to come to agreement on pt to employee ratios. Not eligible for rehire at this facility." It was NOT a mutual consent, I was not even made aware that I was no longer to be employed w/ them or that I was not going to ever be able to work there again. I also couldn't believe that they made it sound as if I always disagreed w/ pt to employee ratio(s) rather than just for this situation.

This all happened approx 4.5 mths ago. The big problem is that this surgery center had a parent company in which I used to be a shared employee, but no longer able to work for any of them as such since I got fired. And since they put that I'm not eligible for rehire at that facility, it makes it seem as though I really did something awful rather than just stand up for my pt's safety. Doesn't look good to future potential employers...

Is there anything I can do to get them to retract that from my employee file since I was basically acting from a "safe harbor" stand point? Were they justified in firing me and I'm just being bitter? Just not really sure if there's anything I can do. I've never been fired before in my life for anything, much less for trying to do the right thing....

Thx!

[txredheadnurse, BSN, RN]

If you have professional Liability Insurance call them and ask for guidance. Even if you do have insurance you might want to consider speaking to an attorney familiar with nursing standards in your state.

[MunoRN, RN]

Safe Harbor protects your license, not your job. You're free to refuse an assignment you feel is unsafe, but your employer is free to fire you for insubordination.

What's safe is arguable, but what's normal is taking more than 2 patients in these situations, so I can see your employer's point.

[nurseprnRN, BSN, RN]

I second the motion of calling your malpractice carrier and asking for help from the atty staff there. Perchance a well-worded memo to have the the mischaracterization of your behavior and the "do not rehire" removed would be sufficient. They still wouldn't rehire you, but at least when other potential employers call to confirm your period of employment they won't hear that. (Your atty would have someone call and confirm that by asking them to confirm your status for rehire as if s/he were a potential employer).

And you know what? There are other employers who feel their systems are safer than that and they may welcome you c open arms. Good luck!

[elkpark]

Unfortunately, "proper staffing" is in the eye of the beholder (outside of CA, that is). Since they asked you flat out if you were willing to work with the standard staffing and you said you weren't, I can see why they are calling it a "voluntary separation." You are probably lucky to get away from them -- best wishes!

[morte, LPN, LVN]

It wasn't the number that was at issue. but the inability to monitor from one location.

Safe Harbor protects your license, not your job. You're free to refuse an assignment you feel is unsafe, but your employer is free to fire you for insubordination.

What's safe is arguable, but what's normal is taking more than 2 patients in these situations, so I can see your employer's point.

[wooh, BSN, RN]

If there were two nurses, and two areas, why couldn't one be in each area?

[hope3456, ASN, RN]

I know we can't give/get legal advise on this site - but I would ask your lawyer about suing for wrongful termination. And I suspect your local news media might like to know what happens to nurses who stand up for patient safety.

[blondy2061h, MSN, RN]

If there were two nurses, and two areas, why couldn't one be in each area?

I'm wondering about this too.

[jadelpn, LPN, EMT-B]

Sounds like there's patients all over the shop, in completely different units. Doesn't bode well with trying to continuously monitor them. If it were a matter of "going in and checking" then why monitor? Why noy just go and round? There must be a reason for monitoring. And I am not sure how good the reasoning would be "well, the patient was on the monitor, had an order for continuous monitoring, however, I couldn't see nor hear the monitor continually." a 1:2 ratio is a dream in acute care, however, with no central monitoring, it can be a bit tricky.

In any event, OP do you have a union? If so, use them. I also agree your malpractice insurance is also a thought. Lastly, I would seek assistance with the parent company's HR department. That way, it is not local, and they can get to the bottom of things. Most have an employee relations person. I would stick to the facts, and not subjective information. And that your only goal is to have "not rehireable" taken off your record.

Much luck to you on this!!

[HouTx, BSN, MSN, EdD]

Just one more reason why I strongly advise my 'near and dear' to never have a procedure performed in a free-standing surgical center. I am really on the OP's side in this one, particularly in light of the very cavalier way that the admins told her that if a patient died, it wouldn't be her fault.... areyoukiddingme?

Alarm safety is a huge patient safety issue. Can't believe that anyone would accept a situation in which she would not be able to hear and respond to alarms/monitors for patients under her watch. YIKES. I can only imagine how a plaintiff's attorney would jump on that glaring deficiency.

[AggieNurse99, BSN, RN]

Safe Harbor would not have protected your job. But if you had filed it, you would have whistleblower protection from retaliation if it was made in good faith. Safe Harbor would not have even protected your license or liability if something had gone wrong -- you'd still be held accountable for your actions or lack thereof.

Your employment report as not eligible for rehire is legit for the company - what you can do (after talking to your attorney) is attach a letter to your HR file AND the local healthcare background check "consumer report" firm (here in DFW we have Group One). Your employment as a shared employee may have been contingent on remaining eligible for rehire, you would have to look in your paper work or the HR policies of both employers.

Good luck, and hope you find a good fit - we need more pt safety advocates!