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.
Preventing 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.
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.
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.
Yesterday 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
- 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.
- 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.
- 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.
- 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.
- 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.
- Ensure that the patient/family receives compassionate care and that everyone involved maintains a professional relationship.
- 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.
- Work with the risk manager. The risk manager can help you and your staff promote patient safety and proactive strategies to avoid injuries.
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.
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]
Keep certifications and trainings current
How often do you review staff certifications and trainings to make sure they’re current?
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]
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.
About 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.
As a nurse manager, how often do you review the duties and responsibilities laid out in your staff job descriptions? The human resources department may “own” the files, but you probably review them when you have an open position. From a legal perspective, though, job descriptions deserve more regular scrutiny to ensure that duties align with your organization’s policies and procedures, and meet the standard of care.
For example, if new procedures have been introduced, staff must be trained, competencies documented, and job descriptions updated to support the revised standard of care. In the event of a patient injury, one of the first things the patient’s attorney will do is look for gaps in the standard of care, so you must be proactive in this area.
Dinah Brothers, RN, JD, suggests that, at a minimum, you review your staff’s job descriptions once a year. In addition, you must revise your staff’s job descriptions whenever any one of the following occurs:
- When there are professionally recognized changes to the standard of care
- When new medical advancements are accepted and implemented at your facility
- When new technology is implemented in your facility
- When policies and procedures change in your facility that impact the nurse’s role and/or job responsibilities change