Union Representative Joe Florida International W
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CASE STUDY 12-1 To Report or Not to Report? Joe’s Dilemma
Lonnie K. Williams
Joe was recently appointed as the chief nursing officer (CNO) of a 25-bed rural community hospital that was unionized. The former CNO of 42 years had recently retired and recommended Joe for the position. This was Joe’s first CNO position after graduation with a master’s degree in business administration. His previous management experience was as a nurse manager of the facility for 2 years, where he was one of two BSN graduates. He has 6 years of nursing experience.
The staff at the facility have multiple years of experience, and all are residents of the community or adjoining towns. The staff is close-knit and supportive of each other and their families. Additionally, the newly appointed chief executive officer (CEO) is from an academic medical center and has managed ambulatory care services at that facility.
During Joe’s first week of employment as the CNO, he was approached by the housekeeping supervisor, who requested an appointment to discuss a situation. Joe eagerly agreed and met with the supervisor. The supervisor stated that over a period of 3 years she and other housekeeping staff had observed the evening shift registered nurse (RN) injecting herself with medications in the upper thigh and often discarding the syringes in the employee lounge. When she was asked if she was okay, she always replied, “This is only for my condition.” The housekeeping supervisor also said that many of the housekeeping staff often said patients complained of pain, even though this RN had administered pain medication “using a needle.” The supervisor stated that this had previously been discussed with the retired CNO, but no changes occurred. Joe told the supervisor he would handle the situation.
Joe was at a loss about the best course of action. Should he confront the nurse, investigate further, make a note of this meeting in the RN’s personnel file, make a note for his management files, or even request the supervisor to complete a memorandum stating the information? Joe decided that he would observe the RN himself and initiate a pain management performance improvement project.
During the first few weeks of the quality improvement initiative, patients repeatedly complained about increased pain. Joe observed that the RN had several syringes in her lab coat pocket as she walked toward patient rooms. When Joe confronted the nurse, she stated, “These are for patients and not for you to worry about because I am the staff RN and you are the boss. If there is a problem, just call my union representative.”
Joe remained at a loss for the best course of action and decided to discuss the issue with the chief of pharmacy, who was the RN’s spouse. The chief of pharmacy said not to worry because patients have complained about her for years, and they get discharged home with plenty of medications for pain. Joe elected not to discuss this with anyone else, including the CEO. He received a call later that evening from a facility that he had recently interviewed with for a service line job. He had taken the CNO position as an interim position while he waited for an offer from that facility. Joe eagerly accepted the new position with a start date later that week. Joe abruptly resigned from the CNO position without addressing the issue.
Case Study Questions
1. What is the first action that Joe neglected from a legal and ethical perspective?
2. What course of action should Joe have initiated, and what legal issues did he incur for himself and the facility?
3. Review the reporting responsibilities of any licensed RN to state licensing boards and identify actions that Joe should have initiated after the first discussion with the housekeeping supervisor. What actions would you take if you were in Joe’s position?