I am a new nurse who has been working in an ED for seven months. This is my second career. I was just accused of unsafe nursing. I was told they could not tell me what the unsafe nursing practice was, but I was taken off the schedule until a meeting next week, before my scheduled shift. I am being forced to burn through two days’ PTO for the time off.
I believe the unsafe nursing accusation stems from this: I had an older patient who was an accidental morphine overdose. When the patient arrived, the blood pressure was 82/44. It remained low, in spite of 5 liters of fluid within a six-hour period of time. The last blood pressure was 79/39. The patient was lucid and coherent, in spite of the low blood pressure. I did not alert the physician when the blood pressure did not rise after the fluids because the blood pressure was really no worse than upon arrival and the morphine was extended release. How can they take me off the schedule and not tell me what my unsafe practice was? How do I defend myself? What rights do I have?
Dear Nancy replies:
One of the basic principles of fairness when one is accused of anything is that all necessary information concerning the accusation is provided to the accused so the person can defend herself. It seems strange indeed no one has shared with you what exactly it is you did that is considered unsafe.
Having said this, it is pretty clear one thing you might have wanted to do was to alert the physician about the patient’s blood pressure not rising. You do have a duty to inform a physician about the patient’s condition when monitoring a patient. Despite your rationale for not doing so, this may be the issue insofar as the “unsafe practice” is concerned. Had the blood work not been done, or orders for more fluids not been given, who knows what would have happened to the patient.
Moreover, sharing your observation about the blood pressure would have placed the obligation on the physician whether to order additional treatment. Documenting your contact with the physician, and his response, would most probably have placed you in the clear in this situation, from the information you included in your question.
You need to be able to counter whatever allegations are placed against you and to do so, you need all the information forming the basis of this allegation. Before the meeting, you might want to review the employee handbook to determine what the employer’s policy is regarding being taken off of the schedule and allegations of unsafe practice. There also may be required guidelines for the meeting.
You also can seek the specific advice of a nurse attorney or other attorney in your state who knows nursing practice and who works with nurse employees. One source for identifying a nurse attorney is The American Association of Nurse Attorneys website (www.taana.org). On its home page, scroll down to the lawyer referral tab and then follow the instructions for identifying those members who are listed and work with nurses.
Another resource might be the Emergency Nurses Association (www.ena.org). The association may have a list of nurse attorneys and/or attorneys who defend ED nurses in various legal scenarios. Becoming a member of this association might be very helpful since ED nursing is your second career.