A nurse says she failed to recognize a patient's cardiac rhythm change and, as a result, was suspended and reported to the state board of nursing. According to the nurse, the patient was asymptomatic and had a rate that was within normal limits while she was monitoring him. She also stated that other staff members who had been involved in more egregious incidents only received an incident report. She wants to know what to do.
Document everything
One of the first issues I see in this situation is the time period when the RN was monitoring the patient. She stated that she monitored the patient from 8:11 p.m. to 9:11 p.m., and the alleged failure occurred at 9:05 p.m. The exact time the tele tech returned to monitor the patient was not documented. The time and other information would have been documented if the RN and the tele tech had used recommended hand-off communication protocols. The Joint Commission defines a hand-off as "a transfer and acceptance of patient care responsibility achieved through effective communication. It is a real-time process of passing patient-specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient's care."
When a nurse relieves a team member of patient care, there should be documentation of the hand off in the patient's medical record. Generally, hand offs are done face-to-face and verbally. Other hand offs can include a combination of written documentation and verbal checklists. Computer hand offs also exist, but are less common.
Whatever the form of the hand-off communication, it should appear in the patient's medical record with the time and date it took place.
File a grievance
A second issue I identified was the RN's grievance of the suspension through the employer's grievance procedure. This process is very important, not only in the possibility of reversing the suspension, but also with the report to the board of nursing. Grievances are a way to question or appeal a decision in the employment setting when that decision affects your job security. The RN availed herself of this process, but she didn't indicate what the outcome was. Even so, it was an essential step for her in trying to remove this discipline from her work record. Grieving such a decision is also essential in order to potentially prevail in a board of nursing disciplinary action against the RN. As you may know, when a report is filed with the board of nursing, the board investigates to determine if the nurse practice act or its rules have been violated. The nurse's employment records are subpoenaed and evaluated for such a violation when a report involves workplace conduct.
Regardless of whether the outcome of the grievance process was in the RN's favor, the fact that she grieved the suspension showed that she thought it was unfair. Silence (not grieving an employment discipline) can be seen as acquiescence.
Hire an attorney
The RN should have retained a nurse attorney or attorney to help her with the grievance process. Most employers do not allow attorneys to participate in this process, but an attorney could have worked "behind the scenes" to help her prepare her grievance. If she didn't retain an attorney for the grievance process, she should retain one to represent her before the board of nursing. As I have written consistently in my blogs, legal representation is vital when there has been a report to the board of nursing. The nurse declared that other staff nurses received less serious disciplinary actions for more egregious patient care issues than hers. If this is true, she should consult with a nurse attorney or attorney who practices in the area of employment law in order to determine whether or not she was treated differently based on a protected class under Title VII of the Civil Rights Act of 1964. The act prohibits an employer from making employment decisions that discriminate against employees based on race, color, religion, sex, and national origin.
Tips for successful hand-off communications
Keep these tips about hand offs in mind:
- Organize in your mind what you are going to communicate during a hand off.
- Speak clearly and concisely.
- Provide accurate, up-to-date, and specific information about the patient's condition (e.g., patient did not complain of any pain, medications administered).
- Conduct the hand off in a place free of interruption or distractions.
- Ensure your colleague understands the patient information you shared and make time for any questions or concerns.
- Make sure your colleagues have your contact information so they can reach you if they have questions.
Hand offs are important to continuity of care, so if you have time, consider helping to develop policies and procedures that standardize hand-off communications to make them more effective for everyone. To start a conversation about important issues like this one with your fellow nurses, download the Nurse.com social networking app. 
