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Combating racism in healthcare

Nurse managers and their staff often face racism in the work place. In 2013, Minority Nurse reported that almost half of minority nurses said they experienced barriers in their career because of their race and educational background. In addition to institutional barriers, there is also the problem of patient racism, where patients refuse care based on the race or ethnicity of the provider. As a nurse, you might be put in the unenviable position of deciding how to handle one of these situations. Do you refuse care to the patient? Do you acquiesce to the patient’s unreasonable demand?

A Cautionary Tale

Plainfield Healthcare Center was faced with a similar dilemma, when some residents of the facility refused care from nonwhite staff members. The center had a policy of honoring such racial preferences, citing the patient’s right to select their providers.

For Brenda Chaney, a CNA at Plainfield Healthcare Center, this caused issues with both her workplace experience and patient safety. Patients verbalized their preference on a regular basis, causing distress and a hostile work environment for Chaney. Additionally, the policy created safety risks for the patients; Chaney shared one such situation: after finding that a patient fell and couldn’t get up, instead of assisting the patient herself, she had to hunt for nonblack staff members to help the resident return to her bed.

Chaney responded to a call one morning from a resident who was struggling to get out of bed. The patient refused her help, and when she eventually helped another staff member with the patient, the staff member reported that Chaney used profanity when helping the patient. After investigating the complaint, they found no evidence to substantiate the complaint, and the resident’s roommate heard no profanity during the incident. Despite this, Chaney was still terminated.

After her termination, Chaney filed a lawsuit under Title VII of the Civil Rights Act of 1964, where she alleged that Plainfield Healthcare Center’s adherence to resident’s racial bias was illegal and contributed to a hostile work environment. The suit was supported by the Equal Employment Opportunity Commission. After an appeals process, the 7th U.S. Circuit Court of Appeals sided with Chaney and found the practice of allowing patients to refuse care based on race in violation of Title VII. Both parties eventually settled the case, with Chaney receiving $150,000 settlement.

Preventative Measures

The New England Journal of Medicine published an article that provides some useful information about how to handle patient racism. The authors point out that there are a number of concerns to take into account, both legally and ethically. The situation pits a number of rights and laws against each other, including the patient’s right to refuse medical care, laws that require hospitals to provide medical care in emergency situations, and employment rights that dictate that hospitals cannot make staff decisions based on race. Nurses that have been reassigned based on a patient’s racial demands have successfully sued their employers, but if a patient doesn’t receive proper medical attention in a timely manner, facilities are equally liable.

The journal lays out five factors to consider when faced with this difficult situation:

  • The patient’s medical condition: If the patient is unstable, treat the patient right away, regardless of the patient’s preference. It is possible that their current condition is impairing their mental faculties.
  • The patient’s decision-making capacity: Try to assess if the patient is capable of making decisions for themselves; psychosis or dementia are important factors to consider. If the patient lacks decision-making capacity, try to persuade the patient to reconsider their request.
  • Reasons for the request: If there are clinical or ethnically appropriate reasons for reassigning staff, that should be taken into consideration. For example, if there are language barriers or religious concerns, it might be reasonable to accommodate the patient.
  • Effect on the provider: Always take into account the effect a decision might have on the employee. “For many minority health care workers, expressions of patients’ racial preferences are painful and degrading indignities, which cumulatively contribute to moral distress and burnout,” according to the article. Always try to support staff when possible, and discuss their preferences when deciding how to respond.
  • Options for responding: In some situations, staffing might dictate your decision. If the department is understaffed and you cannot provide proper coverage by reassigning, try to persuade the patient.

If faced with a non-emergency situation and a patient is deemed capable of making decisions, the article suggests that it may be best to suggest that the patient seek care elsewhere; though that also has its risks depending on the availability of other treatment.

For more information on this difficult issue, including a useful decision-making tool, read the New England Journal of Medicine’s full article.

ANA comes out against latest GOP healthcare proposal

In a statement released today, the American Nurses Association (ANA) said that the organization “adamantly opposes” the Graham-Cassidy healthcare proposal being considered in the Senate.

The ANA expressed major concerns about the Senate’s proposal, saying that it would make severe cuts to Medicaid, erode protections for pre-existing conditions and other essential health benefits, and wipe out subsidies for the purchase of private health coverage.

ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, gave the following statement: “ANA denounces the latest Senate proposal as its worst yet. This proposal limits care for those that need it most and fuels greater uncertainty in the insurance market. It poses a serious threat to patients’ care, especially those that need coverage for illnesses or pre-existing conditions. Patients deserve better and we won’t rest until they get it.”

Nurse’s controversial arrest sparks outrage and reform

Last week, body-cam footage was released of a Salt Lake City detective arresting a nurse for refusing to let them draw blood from their unconscious patient. Alex Wubbels, RN, the head nurse at the University of Utah Hospital’s burn unit, was following hospital policy and state regulations by refusing consent, but she was still handcuffed and arrested despite protests from the hospital staff.

Shortly after footage of the incident was released, The American Nurses Association (ANA) issued the following statement, “The ANA is outraged that a registered nurse was handcuffed and arrested by a police officer for following her hospital’s policy and the law, and is calling for the Salt Lake City Police Department to conduct a full investigation, make amends to the nurse, and take action to prevent future abuses.”

In the video, Wubbels consulted with her supervisors and presented details about the hospital’s policy, which states that that blood could not be taken from an unconscious patient unless a warrant was issued for the blood draw or the patient consents. The officer stated that they had implied consent to get the sample; however, implied consent has not been Utah law for over a decade, and the Supreme Court ruled against warrantless blood tests in 2016. When Wubbels and the hospital staff continued to refuse, the officer grew irritated and made the arrest.

“It is outrageous and unacceptable that a nurse should be treated in this way for following her professional duty to advocate on behalf of the patient as well as following the policies of her employer and the law,” said ANA President Pam Cipriano, PhD, RN, NEA-BC, FAAN.

In a press conference last week, Wubbels’ lawyer Karra Porter called her arrest unlawful: “The law is well-established. And it’s not what we were hearing in the video,” she said. “I don’t know what was driving this situation.”

In the same conference, Wubbels gave the following statement: “I want to see people do the right thing first and I want to see this be a civil discourse. If that’s not something that’s going to happen and there is refusal to acknowledge the need for growth and the need for re-education, then we will likely be forced to take [legal action]. But people need to know that this is out there.”

The mayor and police chief of Salt Lake City have apologized to Ms. Wubbels, and have agreed to perform an investigation of the incident. The police officer involved and his supervisor have been suspended as well.

Because of this incident, facilities throughout the country are reassessing their policies. The University of Utah has already changed their policy so that nurses will no longer have direct contact with the police, and other facilities are hoping to do the same.

Nurses file for collective action over lunchbreak dispute

Nurses at Methodist Health claim that the hospital docks lunch pay for breaks they aren’t able to take.

Robert Straka, a nurse at Methodist Health in Dallas, filed a collective action lawsuit in August against his employer. The issue in question is the hospital policy that dictates that nurses should be allotted 30 minutes every shift to take an uninterrupted break. He argues that nurses are still expected to care for patients during their break, and would often get pulled away to perform duties. Straka filed on behalf of almost one thousand nurses across Methodist’s five facilities.

Meanwhile, Methodist argues that this is not the case, and questioned the plaintiff’s interpretation of the rules. They’ve requested that the charges be dropped in a response sent last week. The judge in the case has mandated that each party meet and produce a report next month, that would outline settlement options and hopefully come to a resolution.

Do you get a dedicated lunch break in your hospital? Send me an email at kmichek@hcpro.com and I’ll share the results (anonymous, of course) with your colleagues.
Read more here.

Featured webcast: Drug Diversion in Healthcare: Improve Security and Avoid Fines

Phcpro_live_webcast-iconreventing the theft of controlled substances at hospitals continues to be an tremendous issue even with increased security measures. Failed drug diversion programs in hospitals have led to record fines and in the midst of heightened scrutiny over drug security, hospitals must improve their processes to avoid litigation.

On Thursday, April 26 from 1–2:30 p.m. Eastern Time, join us for a live webinar with expert speaker Kimberly New, JD, a nurse, attorney, and consultant who specializes in helping hospitals prevent, detect, and respond to drug diversion.

During this program, New will discuss drug diversion by healthcare personnel and present specific steps facilities can take to minimize the risk of patient harm. She will discuss fundamental components of a diversion prevention, detection, and response program through an overview of the scope of the problem, including case studies. New will also review regulatory standards and best practices relating to controlled substance security and diversion responses. She will additionally provide tips on how to promote a culture in which all employees play a significant role in the deterrence effort.

At the conclusion of this program, participants will be able to:

  • Identify risk factors and signs of employee drug diversion
  • Fully comply with regulatory requirements of the DEA and other accrediting organizations
  • Train staff on how to report suspected abuse and who to report it to
  • Create a culture of accountability and develop an effective drug diversion prevention plan

Don’t miss this opportunity to hear practical advice and have complex regulations simplified in this program suitable for your whole organization. For more information or to order the webcast on demand, call HCPro customer service at 800-650-6787 or visit the HCPro Marketplace.

Dealing with racism in patients

Nurse managers and their staff often face racism in the work place; Minority Nurse reported that almost half of minority nurses said they have experienced barriers in their career because of their race and educational background. In addition to institutional barriers, there is also the problem of patient racism, where patients refuse care based on the race or ethnicity of the provider. As a nurse, you might be put in the unenviable position of deciding how to handle one of these situations. Do you refuse care to the patient? Do you acquiesce to the patient’s unreasonable demand?

The New England Journal of Medicine published an article last week that provides some useful information about how to handle patient racism. The authors point out that there are a number of concerns to take into account, both legally and ethically. The situation pits a number of rights and laws against each other, including the patient’s right to refuse medical care, laws that require hospitals to provide medical care in emergency situations, and employment rights that dictate that hospitals cannot make staff decisions based on race. Nurses that have been reassigned based on a patient’s racial demands have successfully sued their employers, but if a patient doesn’t receive proper medical attention in a timely manner, facilities are equally liable.

The journal lays out five factors to consider when faced with this difficult situation:

  • The patient’s medical condition: If the patient is unstable, treat the patient right away, regardless of the patient’s preference. It is possible that their current condition is impairing their mental faculties.
  • The patient’s decision-making capacity: Try to assess if the patient is capable of making decisions for themselves; psychosis or dementia are important factors to consider. If the patient lacks decision-making capacity, try to persuade the patient to reconsider their request.
  • Reasons for the request: If there are clinical or ethnically appropriate reasons for reassigning staff, that should be taken into consideration. For example, if there are language barriers or religious concerns, it might be reasonable to accommodate the patient.
  • Effect on the provider: Always take into account the effect a decision might have on the employee. “For many minority health care workers, expressions of patients’ racial preferences are painful and degrading indignities, which cumulatively contribute to moral distress and burnout,” according to the article. Always try to support staff when possible, and discuss their preferences when deciding how to respond.
  • Options for responding: In some situations, staffing might dictate your decision. If the department is understaffed and you cannot provide proper coverage by reassigning, try to persuade the patient.

If faced with a non-emergency situation and a patient is deemed capable of making decisions, the article suggests that it may be best to suggest that the patient seek care elsewhere; though that also has its risks depending on the availability of other treatment.

For more information on this difficult issue, including a useful decision-making tool, read the New England Journal of Medicine’s full article.

Incident Reports: What You Need to Know (Part Two)

Incidents reports are a pain to fill out, but vital for documenting what happened and for protecting yourself and your staff. This week, we’re republishing a popular post full of best practices, provided by Patricia A. Duclos-Miller, MS, RN, CNA, BC.

incident graphic2Yesterday we looked at the purpose of the incident report and the value of documenting facts as well as the patient’s responses to care in the nursing progress notes (see Incident Reports: Part One). Today we’ll look at eight risk reduction recommendations you should follow to limit the number of incidents you face. We’ll also give you a check list of tips for writing incident reports should adverse events occur. (I’ll make the checklist available as a PDF download in a few days, so check back for the link.)

RISK REDUCTION RECOMMENDATIONS FOR NURSE MANAGERS

  1. Be sure that everyone is clear as to who is managing the patient. This is especially critical in complicated cases with numerous consults. One of the major factors in adverse events is fragmentation or lack of clear communication between providers. Therefore, use the medical record as a communication tool for all providers and encourage your staff to read notes from other providers and disciplines.
  2. Be sure staff understand and utilize the chain of command when necessary. They are considered patient advocates and must speak on behalf of the patient to ensure quality patient care. Documentation of the chain of command process should be factual and blameless.
  3. Advise your staff never to create notes at home concerning the event. They should not discuss the event with other care providers without having someone from risk management present, unless the discussion is in a quality-review process or in the presence of the facility’s attorney.
  4. If an adverse event occurs, the staff must know that attention to patient needs is first and foremost. If a patient is injured, nursing and medical interventions take precedence over everything else.
  5. Follow the organization’s policy on medical-event disclosure. It is important that staff understand who is designated to inform the patient/family. Documentation should include who was present during the discussion, what information was discussed, and all of the patient/family responses.
  6. Ensure that the patient/family receives compassionate care and that everyone involved maintains a professional relationship.
  7. If an adverse event occurs, contact the risk manager. Discuss the case discretely, because conversations are not protected under a quality statute or attorney-client privilege, and therefore may be discoverable.
  8. Work with the risk manager. The risk manager can help you and your staff promote patient safety and proactive strategies to avoid injuries.

[more]

Incident Reports: What You Need to Know (Part One)

Incidents reports are a pain to fill out, but vital for documenting what happened and for protecting yourself and your staff. This week, we’re republishing installments of a popular post chock full of best practices, provided by Patricia A. Duclos-Miller, MS, RN, CNA, BC.

incident graphic2If you and your staff think that incident reports are more trouble than they’re worth, you could not be more wrong.

We work in high-stress, fast-paced environments. It is your responsibility as a member of the nursing management team to understand the importance of incident reports, to ensure that your staff completes them, and to investigate incidents to avoid any further occurrences. Your investigation will also provide possible defense if during your investigation you identify a system failure and take the necessary corrective action(s).

The purpose of the incident report is to refresh the memories of both the nurse manager/supervisor and the staff nurse. While the clinical record is patient-focused, the incident report is incident-focused. The benefit to you and your staff is [more]

Another way to avoid the legal hot seat

Keep certifications and trainings current

How often do you review staff certifications and trainings to make sure they’re current?

checklist2

Now choose the best answer: continually, very frequently, or every week.

If certifications and trainings have lapsed and a patient is injured, those records become evidence against the hospital. And you will find yourself in the hot seat.

Let’s look at how expired certifications and unaddressed competencies can come home to roost. Imagine that your unit is sued in a wrongful death action after unsuccessful emergency resuscitation efforts. The attorney for the patient’s family discovers that one of the nurses working the code wasn’t current in CPR. That out-of-date certification raises doubts about [more]

Free Download: Job Description Update Confirmation

As promised, you can now download the very practical and simple tool  I mentioned in last week’s post (Not My Job: The legal perspective on updating job descriptions). I’ve created a Word file of the standard job description update letter, which you’ll find here. Don’t let its simplicity fool you; this is useful tool for legal risk reduction.

downloadicon2About the Word file: You can customize it to include your organization’s logo, address, and such. Use it as a simple way to document that your staff members understand changes in responsibilities and duties included in their job descriptions.

When you incorporate new practices or adapt to new standards that are reflected in updated job descriptions, you’ll simply ask each staff member to sign the letter acknowledging and committing to adhere to the revised job description, and place a copy in each employee’s file.

Many thanks to Dinah Brothers for this tool…


Dinah Brothers, RN, JD, is the author of The Essential Legal Handbook for Nurses (just released), sold as a set of 10 handbooks for staff nurses,  and The Nurse Manager’s Legal Companion (release: July 2015), a book offering nurse managers guidance on everything from employment law to dealing with whistleblowers and everything in between.