Dear Nancy,
Can a nurse be terminated or demoted for not doing a task she is uncomfortable performing? At my previous facility a new supervisor did not give an IV of succinylcholine because she was uncomfortable doing so. She asked an ICU nurse to push the medication prior to intubation. It was not a code blue or rapid response situation. Was it legal to demote this supervisor? I was present at the patient's bedside when the above incident occurred. Barbara
Dear Barbara,
It would be impossible to comment on your supervisor's demotion since all of the factors resulting in the demotion are not known. However, I can respond to your fear of being demoted or terminated. It is within an employer's power to demote or terminate any at-will employee for a good reason or for no reason, unless the employer is unlawfully discriminating against the employee. However, the employee has the ability to grieve that demotion or termination through the employer's established grievance policy. One of the key issues in the grievance will be why the employee refused to carry out an order. Being uncomfortable with carrying out an order if the nurse has not had experience in doing a procedure or if the nurse, in her professional judgment, believes the treatment or medication may harm the patient, or the order is coming from a healthcare provider who is not able to order such a medication or treatment are all examples of acceptable reasons not to carry out an order. If, however, the nurse is refusing to do so because the nurse does not like the person giving the order or because the nurse has had personal problems in the past with the one who is ordering the medication or treatment, then such a refusal would not be acceptable. Because you are a licensed professional nurse, you have an obligation to your patient, under your state nurse practice act, your code of ethics, and the law, not to expose a patient to a known risk. If you breach your duties, you could be disciplined by your state board of nursing and, if the patient is injured, you may be named in a lawsuit filed by the patient and/or his family. You might want to take a CE course that focuses on how to handle orders you believe to be unsafe for the patient. There are ways in which the refusal can be managed so you are placed in the best position you can be, for both you and your patients. Cordially, Nancy
