Will I get fired?

Horseshoe, BSN, RN · Jan 30, 2018

I hate it that nursing professionals are using the term "mini stroke" for TIA. A TIA is not actually a stroke, mini or otherwise. I think this term is very confusing to patients and great care should be used when explaining to patient or family what a TIA actually is (as well as what it actually is not).

Agree with others that just passing on information like that was not the wisest thing. I would have gotten a lot more clarification from the outgoing nurse (why did she believe the patient had a TIA, what is the patient's DNR status, was family called with onset of symptoms, what kind of follow up was done, etc.).

Horseshoe, BSN, RN · Jan 30, 2018

I am the charge nurse, the off going nurse told me in report that the patient might have had a stroke and I relayed that message to the daughter.

Did the patient actually have a "stroke" or not? As we know, a "mini stroke" (actually a TIA) is not really a stroke at all, but a temporary ("transient") event with no permanent effects. However, a TIA is very significant because it can signal an impending REAL stroke. Anyone who has a TIA needs important follow up.

Qing · Jan 31, 2018

I don't know if telling the family member that was a good idea. Even though you got report from the nurse, it doesn't mean you say it to the family member. Is there documentation to say that pt had that or anything else to back it up? Referring the family member to speak with the physician overseeing the care is probably the best idea. It saves you the trouble of saying something that you are not sure of and hopefully this investigation does not affect you too bad. Not sure if you will get fired, but be prepared for anything. Do you have legal assistance if you need it just in case?

Katillac, RN · Jan 31, 2018

OK, let's break this down. OP asked if she could get fired for this, and if it's a violation.

If you practice in a right to work state, yes, you can be fired for this, and for anything else your employer doesn't like. Your personnel manual should tell you what the discipline policy is, it's typically a system of steps, but management isn't legally obligated to follow them and they are pretty much in place to protect the facility if they fire someone from a protected class. The good news is that it's unlikely this would be considered firing with cause, so you could collect unemployment.

Next OP asks if it's a violation. It's not a HIPPA violation, assuming the daughter had a right to receive information. Whether it's a violation of facility policies would depend on what the facility policies are, and we can't know that.

But it was a violation of delivering good nursing care and using and common sense. If you'd heard in report the patient MIGHT have just got tired of talking with his overbearing family and played possum, would you have told the daughter that?

I'm just guessing here but I would think what the DON is in fact investigating was what the unusual findings were that led to the nurse saying he had a mini stroke (or stroke - you said one thing in your OP and another in a comment) and whether those findings were reported up and what the response was. Your potential liability here is that especially as charge getting that report, those should have been your questions to the nurse giving report. If whatever the symptoms were didn't advance into something more serious, you lucked out. But if it did, the liability falls on everyone who knew he might have had a stroke, and didn't respond. On the other hand, you also said, "Everything else was done but came out alright." We don't know what that means. Do you?

heynurse1996 · Jan 31, 2018

Wait...so was he ever sent out? Is this a possible dx made by MD based on assessment during rounds? I am concerned for the simple fact that 1. "mini stroke" sounds WAY worse to the layperson than explaining a TIA, and 2. you might have very possibly provided a non MD "Diagnosis". Which is waaaaaay outside our scope of practice as nurses. I'm just wondering where the possible TIA came from...was that just "nurse talk"/speculation in report or actual dx written up by MD. It could very well get you fired not to mention be considered working outside your scope of practice.

wondern, ASN · Jan 31, 2018

Chloe86,

Doctors do the diagnosing so they get to communicate their findings with family and also answer any initial questions for them.

You may have answered that there hasn't been any change and ask her, "What has the doctor told you about your father's condition?"

All that said, if you're in LTC the family may not see the doctor or even know who it is, and it may be very frustrating. Are you a nurse or CNA?

Try not to sweat it too bad. We all make mistakes and you did say 'might' be. Just remember diagnosis is for doctors. They did that work. Let them own it. :specs:

We've got to do something to help our old folks out with more dignity in this society!

Horseshoe, BSN, RN · Jan 31, 2018

OK, let's break this down. OP asked if she could get fired for this, and if it's a violation.
If you practice in a right to work state, yes, you can be fired for this, and for anything else your employer doesn't like. Your personnel manual should tell you what the discipline policy is, it's typically a system of steps, but management isn't legally obligated to follow them and they are pretty much in place to protect the facility if they fire someone from a protected class. The good news is that it's unlikely this would be considered firing with cause, so you could collect unemployment.

You've got some of this wrong. You are describing "at will employment," not "right to work." "Right to work" means that otherwise-qualified employees are entitled to work in unionized workplaces, without joining the associated unions or paying regular union dues.

More about "right to work":

Learn About "Right to Work" States and Laws

Secondly, in many states, the "at will" employment law has an "implied contract exception," meaning that an employer may not fire an employee "when an implied contract is formed between an employer and employee, even though no express, written instrument regarding the employment relationship exists."[29] Proving the terms of an implied contract is often difficult, and the burden of proof is on the fired employee. Implied employment contracts are most often found when an employer's personnel policies or handbooks indicate that an employee will not be fired except for good cause or specify a process for firing. If the employer fires the employee in violation of an implied employment contract, the employer may be found liable for breach of contract.

At-will employment - Wikipedia

It's not easy to challenge the at will employment law using the implied contract exception, but it has been challenged in court successfully in specific cases.

There are other exceptions to the at will employment law:

*for refusing to commit illegal acts â€“ An employer is not permitted to fire an employee because the employee refuses to commit an act that is illegal.
*family or medical leave â€“ federal law permits most employees to take a leave of absence for specific family or medical problems. An employer is not permitted to fire an employee who takes family or medical leave for a reason outlined in the Family and Medical Leave Act of 1993.
*in retaliation against the employee for a protected action taken by the employee â€“ "protected actions" include suing for wrongful termination, testifying as a witness in a wrongful termination case, or even opposing what they believe, whether they can prove it or not, to be wrongful discrimination.[36] In the federal case of Ross v. Vanguard, Raymond Ross successfully sued his employer for firing him due to his allegations of racial discrimination.[37]

Based on the above named exceptions, if the OP were to be fired, it doesn't sound as if the OP has any way to challenge it if she works in an at will employment state.

/username, BSN, RN · Jan 31, 2018

Lots of questions here... How old was the resident? Was it a TIA or an actual stroke? Was he sent out for eval or seen by a physician?

shoregrl · Jan 31, 2018

Doesn't sound like something you should get fired for but, on the other hand, as a nurse, you should not be informing family members of anything diagnosis related....that being said, families are desperate for information and you want to be as helpful as possible. So if you are unsure, the best thing to say is "As a nurse, I can't tell you a diagnosis because I am not a trained diagnostician, That is something you need to hear from the doctor"

If you are a new nurse, learn this lesson.....Report is NOT a reliable source of information! Do not pass along information that you are not 1000% sure of!

guest940422 · Feb 1, 2018

Depends on your institution, typically there is a policy on severity of action vs offense. I doubt if you have never been in trouble before and made an honest mistake you'd actually get fired... if so you probably don't want that job anyway and hey, awesome, unemployment! I would definitely check out your HR policy and procedures though. Even with blatant HIPAA violations (pictures of kids in phones) I've seen nurses put on probation and reported to the board, but not fired and not lose their license. At the end of the day, onboarding your replacement is really expensive!

If you have an EAP make an appointment before you are told to so it shows you are using resources to improve your actions. Write a professional email to your boss requesting a meeting (but not what about never put anything in writing). Ask for feedback about what you could have done differently before you are brought in and questioned. Your willingness to accept and improve from criticism will put you on the high ground and show you have nothing to hide.

You can't hide the fact you were the nurse who said whatever pissed off the family. They will eventually trace it to you with the schedule. The best thing to do is arm yourself with the policy, not discuss it with coworkers to mitigate the rumour mill, and demonstrate you acted in good faith and want to learn from the experience.

Being human is part of working in health care. I once told a family member a patient had Hep C because I thought I was giving the OR report on the phone when the secretary transferred the sister to me for an update.

applewhitern, BSN, RN · Feb 1, 2018

Good grief, how ridiculous. First, the family member should have talked to the DOCTOR, not the DON. Second, why did the family member talk to the nurse, instead of the doctor, in the first place? (They ask your opinion, then get mad about it.) Plus, if you used the word "might," then that wasn't saying the patient definitely had a TIA. Yes, they are certainly over-reacting, and looking for something somebody did wrong. Makes me sick how family does stuff like this. You didn't diagnose the patient, you simply said what you were told in report. I've learned to just say, "you'll have to talk to the doctor," and give them the doctor's office phone number if needed. Many times a family member says they "can't be there when the doctor makes rounds," but I still don't give them any information because of stuff like this. If the doctor said the same thing, no one would get upset, but let a nurse say anything, and they are flamed for it.