Nurse Jennifer Robbins* was fired—just like that—and after many years of excellent performance reviews. Why? Allegedly she falsified patient records when she failed to execute a physician’s order for telemetry. (Another nurse caught the omission and corrected it on the next shift.) The patient suffered no harm, and the attending physician, when informed, was not concerned. The order was handwritten, abbreviated, and added to a list of other orders. Jennifer admitted she erred in not seeing this order and yet signing the patient’s medical record indicating that all orders had been carried out. However, she was adamant in insisting that she had made an error, and that it was not a falsification.
Why was Jennifer so adamant? First because she made an inadvertent error: there was no malicious intent. In fact, there was no intent of any kind. It was an error, an error in reading a physician’s order. Second, Jennifer was adamant for another, far more personal reason—she could lose her job or her license, or both. As Renee H. Martin writes, “In addition to the threat of a malpractice suit, nurses are aware that discovered and verified medical record falsification could perhaps lead to licensure sanction by the state board of nursing and disciplinary action by the nurse’s employer.”
Jennifer ended up being summarily fired for “falsifying the record”. Why was she fired? It so happened that, several months before her firing, Jennifer was one of the “ring leaders” among the nursing staff: she led a campaign to improve nurse staffing, and even signed a letter to administration in which she (and others) documented ongoing staff complaints about short staffing as compared to other hospitals in the area. While, in accordance with the law and standards from The Joint Commission, the hospital had a written policy regarding nonpunitive actions in regard to errors, the hospital could immediately fire a nurse for falsification of records. Could this be the reason the hospital focused on “falsification” instead of “error”? Did the administration want to punish Jennifer for her previous actions?
According to provision 6 of the Code of Nurses from the American Nurses Association, “The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality care.” Thus the nurses’ actions related to staffing (spearheaded by Jennifer and others) are not only in keeping with the Code of Ethics, but actually required by it. Moreover, the Code’s Interpretive Statements include the following: “Nurses should address concerns about the healthcare environment through appropriate channels and/or regulatory bodies.” A statement related to nurse executives is, “Participation in collective and inter-professional efforts for workplace advocacy to address conditions of employment is appropriate” Thus, any registered nurse, regardless of management title, who attempts to stifle, ignore, or punish nurses for expressing their concerns is, on its face, unethical.” This does not mean that staff nurses are automatically right, but it does mean that they have both a right and a duty to share their concerns with management.
The other day, I found a neat little book from ACTA Publications. Entitled “On the Firing Line: The Manager’s Perspective on the Issue of Terminations and Layoffs in the Light of Catholic Social Teaching,” it’s about “socially responsible” firing. In it, Business Executives for Economic Justice suggest seven considerations for executives and managers:
- Before laying anyone off, look for creative ways to keep workers busy during slow times.
- Structure hiring to anticipate uneven workloads based on historical data (for example, part time, job sharing, contract workers)
- Offer to reduce the workweek to 4 days, at proportionately decreased pay to keep everyone on the payroll during hard times (AT&T did this during the Great Depression, and workers voted to take the shorter workweek and reduced pay rather than to have some workers laid off).
- Pay benefits beyond the time of termination, or allow workers to continue benefit plans at their own cost (not the high costs allowed by the Consolidated Omnibus Budget Reconciliation Act [COBRA]).
- Offer laid-off workers training in self-marketing skills.
- Eliminate the “pink slip” and require that all terminations be done in person.
- Although sometimes firing is the best option, it reflects more on the incompetence of management than the incompetence of workers. If a person is truly incompetent, it can be devastating to his or her self-esteem—and it surely is an indication of problems in your hiring process and/or your management training.
Not surprisingly, Business Executives for Economic Justice do not even consider the justice of firing someone in retaliation for trying to communicate their concerns to management (in this case, about safe staffing levels). The Executives’ concern seems focused on justice—and on the proposition that firing someone almost always is management failure in strategic planning, hiring, continuing education, and supervision. According to an article from the Agency Consulting Group, “Most employee failure can be traced to management failure. No employee wants to perform poorly in their job. They all would like to be proud of their performance and their relationship with their manager. Failure and termination of employees results from poor management communication.”
If management starts labeling errors as fraud, then we can say good-bye to patient safety initiatives. In the absence of an electronic health record, it should not be surprising that a physician’s handwritten note may be misread, misunderstood, or even overlooked. At the very least, a nurse with a history of excellent performance evaluations should not be accused of fraud and summarily fired without due process or recourse, especially when the error is so understandable—and did no harm to the patient.
Jennifer Robbins’s case smells wrong. And it looks wrong. And two wrongs have never made even one right.
*All names and places are fictional to protect the privacy of all involved.
Agency Consulting Group, Inc. Why do employees fail? The Pipeline. 2015. www.agencyconsulting.com/article.asp?linkID=72
American Nurses Association. Code of ethics for nurses with interpretive statements. 2015. www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html
ACTA Publications. On the Firing Line: The Manager’s Perspective on the Issue of Terminations and Layoffs in the Light of Catholic Social Teaching. 1990.
Martin RH. Falsification of records. Advanced Healthcare Network for Nurses. http://nursing.advanceweb.com/Article/Falsification-of-Medical-Records.aspx
Leah Curtin is Executive Editor, Professional Outreach for American Nurse Today.