Two supervisory nurses in a correctional facility were counting an expensive drug used for Hepatitis C, Sovaldi, for an inmate.
Because the drug was so expensive, the facility required that it be treated as a controlled substance and pills were counted daily. While doing so, one of them accidentally tipped over the bottle and 12 of the pills fell to the floor. Since the pills came in contact with the floor, the nurses believed they should be discarded. The pills were picked up the from the floor and they disposed of them in the sharps container. The nurses then informed the pharmacist on duty that a refill of the medication would be necessary.
Due to the high cost of the pills, the pharmacist immediately contacted their supervisor, who in turn contacted the head physician of the facility responsible for patient care. The physician then called one of the nurses and told her to remove the pills from the sharps container.
With the help of the facility's health services administrator and the director of nursing, the two nurses laid a paper towel on a table, unlocked the container and shook it until the 12 pills fell on the paper towel. Along with the pills, syringes, lancets and diabetic testing strips tumbled out as well. Once the pills were out, other medical waste was still in the container, but the group did not explore what that waste was.
The two nurses then wrapped the pills in a paper towel and took them to their office, where the on-duty pharmacist and the nurses viewed the pills. The pharmacist thought the pills looked fine and this "eyeball test" became their standard of practice for the state of the pills.
The pills were later given to the inmate with no ill effects and without any knowledge of what had happened to the pills. However, when one of the two supervisory nurses involved with the disposal of the pills heard they had been given to the inmate, she contacted the state's Division of Professional Regulation.
Professional disciplinary proceedings initiated
Allegations of unprofessional conduct were brought against the two nurses (along with the head physician). During the administrative hearing, the nurses testified it was the pharmacist who was the expert on whether the pills could be administered to the inmate and they, therefore, were following his directions.
The nurses testified they were aware of the nursing standard of practice not to administer medications that were spilled or contaminated by falling to the floor. In addition, they both knew of the facility standard of administering spilled medication and to place non-controlled medications into a trash can or sharps container.
The hearing officer ruled the nurses were under orders by the physician and pharmacist to place the pills back into its container and, therefore, were not easily able to disobey that directive.
Even so, the hearing officer determined the nurses "were obligated to exercise independent judgment" in their nursing practice and, therefore, ruled they should have "objected to what was happening or taken steps to avoid it." As a result, the hearing officer held the nurses violated the definition of professional conduct in the state practice act and also violated the rule requiring nurses to take appropriate action to safeguard their patients. The nurses were placed on probation for 90 days and were required to take courses in pharmacology and nursing ethics.
Nurses appeal hearing officer's ruling
The nurses' appeal to the Superior Court of Delaware resulted in an interesting decision. Because there was no evidence of harm to the inmate during the administrative hearing, the court ruled in favor of the nurses, nullified their discipline and held that the state must prove the nurses' conduct put the inmate at risk.
Board of Nursing appeals Superior Court ruling
The Delaware Supreme Court reversed the Superior Court's ruling, holding that the board applied the correct standard of practice to the nurses' conduct and its decision to discipline them rested on substantial evidence.
Why this case is important for your practice
This case stands for many principles that affect your nursing practice. The following tips are important to remember whether you're an RN, LPN or advanced practice nurse:
- A board of nursing has the authority to discipline nurses based on the nurse practice act and rules.
- You, and you alone, are accountable for your own practice, in spite of potential negative employer reaction to you doing so, as I discussed in this blog post: Is a nurse's gender and training equally important when treating a victim of sexual assault?
- It is almost impossible to try to shift the burden of your professional responsibility to another.
- Actual harm is not required when there is a violation of the act or rules.
- Anyone can file a complaint against you, including your own colleagues.
- Know and comply with your state nurse practice act and its rules.
- Know and comply with your facility's policies governing medication administration.
- You always have a duty to protect your patients from harm or the risk of harm.
Read more about this interesting case, "Delaware Board of Nursing v. Christine Mulry Francis and Angela L. Caldwell," here.
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