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ARRIVAL ETHICS
In a recent Indiana case, a hospital created a new position of “Nurse Liaison in the Emergency Department” and the position was given to an oncology nurse. Her role was to “arrive” patients presenting to the ED, discuss with the patient the chief complaint, instruct the registration clerk as to the complaint, and amend the complaint if not present at the time of the patient’s arrival. This placed the nurse in a position of being the first provider to see an arriving patient – a constructive form of triage.
On multiple occasions, the oncology nurse asked registration clerks to delay arrival times in the records. She was told by management not to do this again. When she continued this behavior, she was suspended and escorted from the hospital, then ultimately terminated. The terminated nurse filed a lawsuit against the hospital alleging wrongful termination, defamation, and other claims. The hospital’s motion for summary judgment was denied but certified for appeal by the trial court. The appellate court reversed and sent the case back to the trial court to dismiss the case.
The hospital was right to terminate her because she did contribute to potential delay in treatment and patient endangerment, but I question its placement of a non-ED nurse in this position in the first place. Hospital management does not always understand that triage is where you want to place your most experienced ED nurses. It is not the place for an inpatient nurse. It is not the place for an oncology nurse with no ED background. This new position should have been open only to ED nurses with substantial experience in the specialty. Assessing chief complaints is serious business for which she was unqualified.
Clinical protocols for instituting interventions require an accurate notation of arrival times. Patients presenting with chest pain must have a timely EKG performed to assess myocardial infarction. Adequate and timely care cannot be provided if arrival times are inaccurate. As a former ED nurse myself, and as a former manager of other ED nurses, I cannot imagine someone who understands the “time is muscle” urgency in cardiac events altering patient arrival times. This is not only unsafe practice; it is a betrayal of nursing ethics and of our core mission to function as patient advocates. The nurse admitted asking clerks to delay arrival times in the records, but denied that this conduct was unethical. I disagree. Contributing to an inaccurate timeline of events and potentially delaying critical interventions cannot be seen as ethical practice.
Upon licensure renewal, she needed to report her termination from the hospital. A hearing was conducted for her renewal. Although her license remains unencumbered and without a disciplinary history in Indiana, I think it is unlikely that she would be so fortunate in my states. The nursing boards where I represent nurses take falsified documentation and patient endangerment quite seriously. Given the clear evidence of such professional misconduct, a New York or Pennsylvania nurse engaging in this behavior would probably be subject to license suspension and mandatory education in ethics, delegation, and documentation. At least.
To read the court’s analysis of the case, its discussion of her claims, and related employment law issues, refer to Cmty. Found. of Nw. Ind., Inc. v. Miranda (Ind. App., 2019) available at
https://casetext.com/case/cmty-found-of-nw-ind-inc-v-miranda
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