| Lisa Ruiz RN, the clinical manager of a 64-bed cardio-pulmonary unit,
was fired from a New Jersey Hospital after speaking up to her immediate
supervisors about poor staffing. She was concerned about both the quantity
and quality of staff. She witnessed unsafe staffing practices, including
a reduction in RN staffing and an increase in unlicensed assistive personnel
(UAP). These UAP were inadequately trained and seemingly committed significant
healthcare errors daily, such as: EKGs not done or done improperly, siderails
left down, wrong labs drawn or blood taken from a patient's arm in which
Heparin was running. She saw one of her patients sitting by an open window,
clearly suffering from an acute episode of angina; a UAP had placed the
patient there, thinking that the sweaty, short of breath patient just needed
to cool off.
In Texas, Stephanie Hohman, RN and Lisa Lippert Gray, RN were retaliated
against by their employer after they reported their concerns in good faith
to the Texas Board of Nurse Examiners. Their concerns were related to
patients' rights, patients being subjected to unnecessary procedures and
possible abuse in the emergency room of their facility. For example, one
14 year old patient, with a bump on the head was subjected to having her
clothing cut off, a rectal and vaginal exam as well as having a urinary
catheter inserted, without explanation and despite her protests. They
were subsequently subjected to abrupt schedule changes, verbal harassment
and unwarranted criticism and reprimands.
In 1996 when Barry Adams, RN, an IV infusion nurse in a Cambridge, Massachusetts
hospital and two other nurses, Marie Waters and Meredith Scannell, documented
incidents of patient neglect and substandard care due to inadequate staffing,
they were harassed at work. Barry Adams was fired. The women, who had
school and child care obligations, both quit and found other jobs.
Now consider the following…
It is 10:30 pm and you are working the last half hour of an 8-day stretch
that includes 3 shifts of mandatory overtime because of staffing problems.
You are exhausted. You can't wait for the next shift to arrive. You think
about your day off tomorrow and that you are planning on sleeping until
noon.
How long can you go on like this you think to yourself? The medical unit
on which you work the evening shift has been very busy for months, maybe
even years. The acuity level of the patients has increased, as has the
census; discharged patients are quickly followed by new admissions. You
know that UAP have replaced RNs and you know that they don't always have
the knowledge or skill to manage the situations that they are in. You're
so busy you really haven't been able to supervise them as they need to
be supervised. You also have been so busy that you know you haven't really
been able to provide the quality care you know you should be providing
to your patients. You're working as fast as you can, you've even begun
to cut corners…not documenting as thoroughly as you did in the past…not
spending enough time with each patient… how long can you keep up
this frenetic pace? You're afraid that in your rush to provide for so
many patients, you're going to make a mistake. You worry that you could
be putting your patients, and your nursing license, in jeopardy.
You've brought up the patient care problems, including the staff shortage
and the limited value of some UAP in staff meetings countless times; you've
complained to your supervisor that you cannot continue to work in this
manner. You've filed "Protest of Assignment forms" repeatedly.
A couple of months ago you started keeping a log of the problems you were
seeing.
Lately, you've even begun to feel like you're being retaliated against
by your supervisor. The day shift position that you applied for was given
to someone else, someone with less education and experience than you.
Your last performance review was pretty negative; your supervisor thinks
you have a "time management" problem…as well as not being
a "team player". You've always had excellent performance reviews
in the past.
Just then your supervisor approaches you and tells you that the nurse,
a float from another unit, who was supposed to relieve you, has called
in sick. She tells you that you are going to have to stay. You tell her
you cannot. You are exhausted and cannot reasonably care for patients
for another shift. You tell your supervisor that she is going to have
to find someone else to stay and that you are refusing to do so. She is
not pleased with your position, but agrees to try to find someone else
from another unit.
After giving report to the one nurse who does appear on the unit for
the night shift, you finally track down the supervisor, who reports that
she was able to get another RN to come in at 3:00 am and you will have
to stay until then. You want to break down in tears, but instead you take
a brief break and go back to work, barely able to function. At 2:45 am
you give report to the nurse who comes in to relieve you and you drag
yourself home to bed, exhausted and downhearted.
You are awakened the next morning at 9:30 by the phone. It is your supervisor,
telling you that you neglected to give a patient a routine medication
last night and that you have been fired.
What do you do now?
This course will explore the whistleblower phenomena in healthcare, address
ethical considerations and specifically address the legal protection from
the New York State Healthcare Whistleblower Protection Law.
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