Legal issues

Read this scenario then answer the questions that follow.

NOTE: If your state (California) has its own version of a Safe Harbor law, you may apply it to this activity instead. In the responses, note that you are applying your state’s Safe Harbor provision. Additionally you must include the exact wording of your state’s Safe Harbor provision so the Academic Coach will have access to that information.

   You, the RN, arrive early on your regular orthopedic unit. Your Charge Nurse comes to you and says that you need to go to the cardiac step-down unit. You protest, but she says she has no control over the situation and that you at least need to go to the step-down unit and see what is going on. You arrive at the step-down unit. The House Supervisor is present with the unit Charge Nurse. You are told that the unit is very understaffed that day and that you must take patients. You protest that you have worked only orthopedics for the past 10 years- that you do not know the current cardiac drugs and side effects, the current treatments and post-treatment care and that you have never had to read the type of cardiac monitoring strips that are generated on all the patients on this unit. The House Supervisor tells you to not worry. She explains as follows:

• There are monitoring techs who are responsible for reading the strips.
• You have access to a PDR and Pharmacy if you have questions about the drugs.
• A nurse with recent experience on this floor will be able to go around with you to orient you for about two hours. (That nurse must return to his regular floor in two hours.)]

 

You again express concerns that you are not qualified to take this assignment. The House Supervisor takes you aside and says, “We need you to step up and help out here. We need team players in situations like this. If you refuse, I’m going to have to discuss your refusal with the Director of Nursing and your unit manager — it may not be good for your career here at this hospital. Besides, do you think you are the first nurse who ever had to take patients in a less than perfect circumstance? The patients are worse off if you refuse.”

 

Reluctantly, you accept the assignment. About 5 hours into the 12-hour shift, you mis-titrate a cardiac drug. The patient codes, never regains consciousness and is transferred to ICU. The patient dies 3 hours after being transferred.

 

Two weeks later, you are called to Human Resources. Your unit manager, the House Supervisor, and an HR representative are there. You are told that you are being reported to the state’s Board of Nursing due to the negative outcome of your patient.

 

1. What were your four options as to taking or refusing the assignment?

 

2. Was this a situation in which you should have claimed Safe Harbor?

 

3. Other than Safe Harbor, what Board Rule should you have considered when told to take the assignment?

 

4. Should the hospital have sent you to the Peer Review Committee before reporting you to the Board? If so, what Board Rule was violated?

 

5. How should you have responded (from a legal/patient safety/license protection perspective) in response to each of these statements?

a)     “You will get a two-hour orientation.”

b)     “The monitor tech will be responsible for reading the strips.”

c)     “You need to be a team player or you may suffer employment consequences.”