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Out of frustration, I told a frequent patient to go home while working in triage. If the CNO already suspended me, can my supervisor still terminate me?

Monday January 9, 2012
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Dear Nancy,

While I was working in triage one day, out of frustration I told a “frequent flyer” we would not see her today and sent her home. Because of this mistake, I was suspended by the CNO (my direct supervisor was out of town at the time). When my direct supervisor returned, he decided to terminate me. Aside from the above mistake, I am not in the disciplinary process, am not a “problem child” and have not received any negative feedback regarding my job performance, clinical skills or professionalism. Can my direct supervisor terminate me for something I already was suspended for by his superior?


Nancy Brent replies:

Dear Ellafair,

I assume you were working in triage in the ED of your facility. Your suspension and subsequent termination most likely would be upheld by the facility, regardless of the fact the CNO made the first decision and your direct supervisor made the second. Both, it also is assumed, are nurses, and any decision about patient care in the ED, including your decision not to see a patient (even if he or she is a “frequent flyer”), would result in potential liability for them and you, for injury to or death of the patient. Any violations of laws applicable to an ED’s duty to assess and stabilize a patient before discharging him or her also would be of concern to all three of you. Remember, both of these individuals are in the corporate chain of command, so your direct supervisor is accountable to the CNO, and ultimately so are you.

The major federal law applicable in this regard is the Emergency Medical Treatment and Active Labor Act. You can learn more about this law on several websites: www.cms.gov/EMTALA, www.emtala.com and the Emergency Nurses Association website (www.ena.org), where you can review the ENA’s Position Statements and other valuable information about ED nursing practice (click on the IQSIP tab).

It also is important to look at your facility’s policy on employee conduct and discipline. If you believe your CNO and direct supervisor did not follow the procedures adopted by the facility, you might be able to grieve the two disciplines. You also could consult with a nurse attorney or attorney in your state who can advise you of whether any violations occurred.


Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.