Having difficulty dealing with a heavy workload on a day when the nursing unit had numerous visitors, the grievor placed one particularly unruly patient in a room where he could not be observed. Her offence was foundto be an error in judgment, but not patient abuse.
A nurse was fired after she temporarily removed a demented and wheelchair-bound patient who was acting out from a busy hallway into a room housing a waste disposal unit. The employer said the nurse’s actions were an affront to the dignity of a vulnerable patient and a violation of professional standards of care.
An acute medicine nurse since 2004, D.D. worked in the hospital’s Unit 5, where care was provided for patients with medical and behavioural issues, including dementia.
Nurses worked 12-hour shifts in teams caring for each other’s patients during breaks and mealtimes. While the desired ratio for care was one nurse for five patients, that ratio could stretch to one nurse for every 10 patients during breaks and at mealtimes.
M — one of D.D.’s patients — had been admitted from a long-term care facility because of his aggressive behaviour. A large man, M suffered from an acquired brain injury and dementia. Frequently confused and resistant, M was non-verbal except for loud moaning and wailing. He frequently hit out at people and represented a physical threat to others. Two people at least were required to transfer M, who was typically restrained in his wheelchair by a lap belt. M required 24/7 care and frequent monitoring.
Returning from her noontime break on Sunday, May 2, D.D. found M sitting in his wheelchair in the hallway across from the nurses’ station where he could be monitored.
Sunday was busy with many visitors. Situated where he was, M was in the way. His feet stuck out into the hallway. After 2:30 p.m., M was becoming agitated. By about 5:00 he was vocalizing loudly and shaking the arms of his chair. He threw a juice box and hit out at D.D. when she tried to tighten his lap belt. There were concerns about the safety of visitors to the ward, including children, who had to pass by M.
10 patients in her care
D.D. returned from her dinner break at 6:00 p.m. Covering for her partner, D.D. now had 10 patients in her care. M was loud and visibly agitated. Sedatives administered through the day had not calmed him down. Efforts at communicating with him to understand what was aggravating him had produced no insights.
When D.D. overheard hospital staff complaining about the difficulties of having to work around M, she had had enough. There were 30 patients and only three staff members on the floor. It took four staff to get M into bed.
D.D. wheeled M into the macerator room, which was adjacent to the nursing station.
The macerator is a machine used to liquefy and dispose of the human waste from bedpans. The room also contained some lockers, a sink and a trashcan. Infection control protocols or gloves were not required to enter the room, which did not have a call bell.
D.D. tilted M back in his chair next to the lockers and locked the wheels. He could not be seen from the nursing station but he could be heard. D.D. checked on M three or four times in the 20-minute period that he was in the macerator room.
While on break, D.D.’s supervisor was notified that D.D. had put M in the macerator room. The supervisor immediately investigated. The supervisor found M in his typical state, vocalizing but otherwise in no difficulties.
The supervisor could not remove M by herself as he was striking out, so she called D.D. to help. The supervisor told D.D. that M could not be left in the macerator room. They returned him briefly to the hall and later — with the help of more staff — to his bed.
Supervisor did not report incident
The supervisor did not report the incident and neither did D.D. However, the incident was reported to the Nurse manager on Monday.
D.D. was called into an investigational meeting on May 4 and asked to explain why she put M in the macerator room.
Two days later, D.D. was fired. The termination letter alleged professional misconduct and said that D.D. had failed to attend to her patient’s therapeutic needs and to ensure a safe environment.
The union grieved.
There was no dispute that D.D.’s actions were inappropriate and that she was guilty of a serious error in judgment, the Arbitrator said.
Technically her actions did constitute abuse and the employer was right to act to protect its patients from abuse and insist on adherence to recognized standards of care.
However, termination was excessive in the circumstances, the Arbitrator said.
This was not a case of physical abuse. In fact, there was a therapeutic reason behind her action. D.D. removed M from the busy hallway because she believed that overstimulation was contributing to his agitation. This was an error in judgment but not an act of abuse, the Arbitrator said.
Moreover, while D.D.’s supervisor told her that it was not appropriate to park M in the macerator room, she was not moved to make a report about D.D.’s improvisation.
No malice
Also, unlike cases where abuse has been established, there was no abuse of power here, ill will or malice, the Arbitrator said.
“In this case there is no evidence that the grievor was motivated by anything other than consideration of all the competing patient interests she had to attend to and her belief that removing M from the hallway to a quiet place where he would be safe would be a positive influence on him and would protect the safety of others around him.”
In all the circumstances, the Arbitrator said that a five-day suspension was the appropriate discipline for D.D.’s error in professional judgment.
D.D. was reinstated with no loss of seniority and compensated for lost wages.
Reference: Joseph Brant Memorial Hospital and Ontario Nurses Association. Margo R. Newman — Sole Arbitrator. David Brady for the Employer. Rob Dobrucki for the Union. July 15, 2011. 30 pp.
