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I am being blamed for inappropriately discharging a patient, even though a certified nurse midwife gave the order. It’s making it tough to find a job, so what should I do?

Monday March 19, 2012
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Question:

Dear Nancy,

I worked in a hospital with a certified nurse midwife. There was a situation in which a patient came to the unit complaining of contractions. She previously had a cesarean section and had been followed by an MD during her pregnancy. The CNM and a staff nurse assessed the patient, and the CNM gave me the report because I was the charge nurse. I later found out she did not share all the details. The patient was unassigned, and she wanted to have a VBAC, so the midwife told me she was going to discharge her to go to the hospital where her physician delivers. I asked if we would transfer the patient, but the CNM said she could drive herself. That answer led me to believe the patient was not dilated, bleeding, in pain or her strip was nonreactive. I asked the patient for her OK to remove her from the monitor to go, and she said yes. I went to triage to inform the nurse caring for the patient the CNM had given an order to discharge her. This was verbal but also written down.

I later found out the hospital had been fined $75,000 for this discharge because of an EMTALA violation. Apparently the patient was dilated 4 cm, but neither the CNM nor her nurse told me. Now, the facility is claiming I am at fault. I had to go to peer review for the first time in my 25 years as an RN. I resigned my position as suggested by legal counsel, because I was asked to step down as charge and take anger management classes. The lawyer said I was in the hot seat because the CNM could make money for the hospital, and he felt they would try to fire me. I later found out from a physician the CNM was practicing out of scope. My peer review results were sent to the board with the recommendation no action taken, but I can't get a job since resigning. When I apply for a job, employers are very excited about hiring me until they talk to my previous employer. What should I do?

Karen



Nancy Brent replies:

Dear Karen,

The Emergency Medical Treatment and Active Labor Act (EMTALA) is an important federal law that must be followed. As you know, it prohibits facilities that receive Medicare and Medicaid funds from “dumping patients” because of their inability to pay for ED services. Before any transfer of a patient occurs, the patient must be screened and stabilized. Specific requirements also exist for the transfer.

One of the things you probably learned through this experience is that because each nurse licensee is responsible for his or her own conduct, one can never “rely” on another’s assessment or blindly follow an “order,” especially when involved in an ED where the staff may not have adhered to EMTALA requirements. Another lesson you should carry with you is that one’s documentation of an event such as this must be complete, factual and support the decision to transfer a patient in accordance with EMTALA. Your assessment of the patient before discharge would have been essential.

Finding a new job when something like this happens is difficult. However, when interviewing for a new job, it is best to be honest about what happened and what you learned from your experience. The “what was learned” part of the interview might be helpful with the next potential employer, so they realize you did learn from this situation and it most likely will not occur again.

Sincerely,
Nancy




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.