The grievor responded to a distraught mother by by-passing hospital procedures. There was no harm caused, or even any danger, but the breach of professional standards was so serious that her firing was upheld.
A nurse was fired after it came to light that she performed a medical procedure on an infant without proper authorization.
A Registered Nurse (RN), J.D. began working in the pediatric unit at a large regional hospital in 1997. She performed her job competently. There was no discipline on her record.
In May 2010, J.D. became involved in the care of a prematurely born infant who required feeding through a nasogastric (NG) tube. Inserting an NG tube, which requires changing every three or four days, is considered a medical procedure. J.D. had changed the infant’s NG tube a couple of times over the course of his stay at the hospital.
The infant was discharged from the hospital in September. There was plan in place for his regular return to the unit and a “standing order” for the replacement of his NG tube on Tuesdays and Fridays. Should he require the replacement of his NG tube outside of clinic hours, the procedure was to be done at the hospital’s emergency department.
J.D. worked Sept. 25, 2010 — two days before the infant was to undergo surgery to implant a more permanent NG tube. J.D. took a call from the infant’s mother who said she was bringing the infant in to the hospital because he had pulled out his NG tube. J.D. told the boy’s mother that she would call and alert emergency to fast-track them. As the infant was scheduled for surgery in two days, it was not appropriate to expose a “fragile” baby to potential infection while waiting in emergency. However, J.D.’s call was delayed.
The emergency room was backed up. Instead of waiting and registering the infant, the mother brought the baby directly to the pediatric unit.
Mother distraught, infant fussing
The mother was distraught, the infant was fussing and the woman’s two-year-old child, who also present, was “busy.”
When J.D. informed the woman that she needed to return to emergency in order to properly register, the woman complained that people there were coughing and throwing up and that she did not want to expose the infant to the conditions that were present in emergency.
J.D. then directed the mother to an adjacent treatment room where she performed the procedure herself, using an NG tube that was supplied by the mother.
The procedure was completed without any complications. There was nothing to suggest the infant suffered any ill effects. However, no chart was prepared, no doctor was consulted nor was there any documentation for the visit.
At work the next day, J.D. told a fellow RN about what she had done. J.D. protested and became upset when the colleague told J.D. that she was compelled to report the incident.
An investigation was conducted. J.D. was fired. The union grieved.
The union acknowledged that J.D.’s conduct warranted discipline. However, the union argued that discharge was unreasonably harsh in the circumstances. J.D. was motivated by a sincere desire to alleviate the infant’s discomfort and the mother’s anxiety.
Breaches of policy, standards of practice
She may have breached professional standards and statutory provisions, but the rationale for those provisions — to prohibit nurses from performing certain procedures in order to protect patients from reasonably foreseeable harm — was not applicable here. There was a standing order in place to authorize the procedure that J.D. performed, the union said. At worst, she was guilty of an error in judgment. Given her long service and discipline-free record, reinstatement was appropriate.
The employer said J.D. was guilty of egregious, significant, cumulative breaches of policy and procedure, standards of practice and legislation, which put both the baby and the hospital at risk. Termination was warranted, the employer said.
The Arbitrator agreed.
It is understood that health-care professionals are held to a high standard of conduct, the Arbitrator said. However, that standard is not perfection. There is potential for the Arbitrator to exercise discretion and replace a termination in favour of the application of corrective discipline for violations of procedure.
Conduct that is deemed to be careless or negligent and reflective of an error in judgment tends to garner more favourable considerations of the worker’s motives or good intentions, the Arbitrator said.
But that was not the case here, the Arbitrator said.
“[J.D.] knowingly violated a number of fundamental Hospital and professional rules of procedure and policy without any apparent regard for the actual or potential consequences of her actions. She knew that [the infant] had not been registered as a patient, which is an essential requirement in her practice. She knew there was no chart associated with the baby’s visit and she took no steps to prepare even a rudimentary one, although she knew it was her professional and legal responsibility to chart treatment at the time.”
J.D. knew she was not properly authorized to perform the procedure. She used an NG tube supplied by the mother from an unknown source knowing the baby was “fragile” and scheduled for surgery within 48 hours.
J.D.’s deliberate disregard of her duty to safeguard her employer’s interests by adhering to established standards and practices destroyed the essential trust at the core of the employment relationship.
Termination was a reasonable penalty in the circumstances, the Arbitrator said.
Moreover, this was not a case for the exercise of the Arbitrator’s discretion to reduce the penalty.
Whatever J.D.’s failings were in the moment, she compounded them by not reporting the incident.
“As problematic as her willful disregard of important Hospital procedures and policies was, which one can perhaps understand as an all-too-human weakness in the factual circumstances of the present case, her failure to promptly report the matter as one of potential harm … shows that her concern was less for [the infant] than it was for herself.”
The grievance was dismissed.
Reference: Royal Victoria Hospital and Ontario Nurses Association. Gordon F. Luborsky — Sole Arbitrator. John D’Orsay for the Association. Clifford J. Hart for the Employer. Aug. 25, 2011. 24 pp.
