Florida ICU Nurse Fired After Standing Up for Patient Safety

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Registered nurse Julie Griffin was fired after she stood up for patient safety and against the breach of official hospital standards in the ICU where she worked. She has filed a Florida Whistle-Blower Act lawsuit against the hospital and also a suit against the hospital group for unlawful dismissal.

No continuous monitoring of CVICU patients

Julie Griffin started working at the cardiovascular ICU at Westside Regional Medical Centre hospital in 2017. This hospital is part of HCA Health the largest, and one of the most profitable, hospital groups in the US.

While there were standing orders for continuous monitoring of all ICU patients Griffin soon found that spilt-screen monitoring allowed for continuous monitoring of only two patients at a time. When a nurse was busy in one patient’s room she could set the screen to monitor one other patient in another room. However, nurses where often assigned additional patients who they could then not monitor.

While the telemetry for all patients in the 12-bed CVICU was displayed at the nurses’ station, there was often no-one available to watch the monitors and alert the nurse of changes in the health status of their unmonitored patient.

Griffin was aware of at least two possibly preventable deaths that occurred because of the absence of continuous monitoring.

Griffin harassed after speaking up for patient safety

“I knew that my ethical responsibilities to the patient couldn’t be met,” Griffin said. She explained that the other nurses on the unit shared her concerns but were afraid to speak up and possibly risk their jobs. She didn’t say anything for a while but eventually decided to take action.

“I literally thought the problem of no continuous monitoring would be corrected. I thought maybe this is just a local thing, maybe the people up at the top, maybe they don’t know. And that’s why I went to corporate. But that showed me I was naive. I believe this policy came from the top.”

After filing her complaint, Griffin was continually harassed, once even threatened up close by the Director of the Unit after she challenged him about throwing her personal coffee mug in the waste bin. She filed an incident report and the HR department even agreed that the Director had been in the wrong.

About four months later a day came when she refused to take a third patient because of the status and needs of her other two patients.  Another nurse on the unit even pointed out to the Director that one of her patients was being transferred and that she could then take on a second patient.

Still, the Director insisted that Griffin take the third patient but she refused again, providing valid reasons. Within hours she was placed on administrative leave and her services were terminated two weeks later.

Hospitals put profits before quality care

In the lawsuit, Griffin also reported that nurses were required to falsify medical records in order for the hospital to continue receiving federal funds. They had to sign off electronic medical records stating that the standard of continuous monitoring of cardiac patients had been met, while this was in fact not true. The hospital also received Medicare payments while not meeting the regulated minimum ratio of one nurse to two patients in ICU.

This case was reported on Hospital Watchdog, an advocacy group for hospital safety. The report points out that Westside Regional hospital is rated among the lowest 6% in the country by the Centers for Medicare and Medicaid Service (CMS). The HCA group is also well-known to state and federal oversight personnel and in legal circles for the criminal and civil litigation levied against the hospital chain.

In comments on the article, many healthcare providers spoke out about the system whereby hospital groups put profits before patient safety.  Also about the government “payment system that focuses on uneducated customer service opinions for determining reimbursement” rather than on sound medical practice and patient safety.

Anonymous reporting of patient safety issues

Nurses often remain silent because they fear retaliation from management should they complain or file incident reports. You can, however, direct complaints to the state department of health or lodge an anonymous complaint against a hospital to the Joint Commision using this link: Report a Patient Safety Concern or Event

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4 COMMENTS

  1. I believe that you have misquoted or made a misstatement regarding the HCA facility not being in compliance with the “regulated minimum staffing ratio of one nurse to two patients in the ICU”.

    You will note, in the content provided by the ANA, (accessed at: https://www.nursingworld.org/practice-policy/advocacy/state/nurse-staffing/) that the Federal government makes broad statements regarding staffing ratios and allows for several options for hospitals to attain a level of compliance. Sadly, only CA has drawn a solid line in the sand and taken a measurable stance on this topic.
    A Federal regulation has been in place for some time, 42 Code of Federal Regulations (42CFR 482.23(b) which requires hospitals certified to participate in Medicare to “have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed”. This nebulous language and the continued failure of Congress to enact a federal law, The Registered Nurse Staffing Act, has resulted in states taking action to ensure there is optimal nurse staffing appropriate to patients’ needs.

    State staffing laws tend to fall into one of three general approaches:
    The first is to require hospitals to have nurse driven staffing committees that create staffing plans that are reflective of the needs of the patient population, and match the skills and experience of the staff.
    The second approach is for legislators to mandate specific nurse to patient ratios in legislation or regulation.
    A third approach is requiring facilities to disclose staffing levels to the public and/or to a regulatory body.
    ANA supports a legislative model in which nurses are empowered to create staffing plans specific to each unit. This approach aids in establishing staffing levels that are flexible and account for changes including:
    -intensity of patient’s needs,
    -the number of admissions, discharges, and transfers during a shift,
    -level of experience of nursing staff,
    -layout of the unit,
    -and availability of resources (e.g., ancillary staff, technology).
    Establishing minimum, upwardly adjustable staffing levels in statute will also help the committee in achieving safe and appropriate staffing plans.

    States with Staffing Laws
    14 states currently addressed nurse staffing in hospitals in law / regulations: CA, CT, IL, MA, MN, NV, NJ, NY, OH, OR, RI, TX, VT, and WA.

    7 states require hospitals to have staffing committees responsible for plans (nurse-driven ratios) and staffing policy – CT, IL, NV, OH, OR, TX, WA.
    CA is the only state that stipulates in law and regulations a required minimum nurse to patient ratios to be maintained at all times by unit. MA passed a law specific to ICU requiring a 1:1 or 1:2 nurse to patient ratio depending on stability of the patient.
    MN requires a CNO or designee develop a core staffing plan with input from others. The requirements are similar to Joint Commission standards.
    5 states require some form of disclosure and / or public reporting – IL, NJ, NY, RI, VT
    Other limited efforts
    NM (2012) charged specific stakeholder groups to recommended staffing standards to the legislature; the department of health is to collect information about the hospitals that adopt standards and report the cost of implementing an oversight program.
    NC (2009) requested a study in the use of mandatory overtime as a staffing tool. No subsequent action taken.
    DC and ME (2004) – passed legislation; later amended from original intent; staffing mandate removed

  2. Hospital lobbyists and the for-profit money that backs them will always leave behind broad-stroked regulations to do two things: 1) protect their investment; and 2) Write policy protecting themselves from legal ramifications. PERIOD. This issue for nurses, who out of every person in the healthcare industry (owners, contributors, board directors, physicians, pharmacists, social workers, CNA’s, investors, etc., etc., etc.,) are literally there at the bedside, in charge of, responsible for, and taking care of patients EVERYDAY. Nurses are the most populus group (approximately 40%) of healthcare providers in the country. They wake up and live their lives FOR THE PATIENT. This is evidenced by the most recent Gallup poll rating nursing the most trusted profession for the 17th year in a row! Yet every day, nurses are subjected to violence from patients or their families, physicians, and even their supposed peers. Even so, nurses continue to clock in and go to work caring for everyone and anyone. Because we, as nurses, make up the single-most majority of the expenditure of any institution, we are the “low-hanging fruit” from which cost-cutting in plucked from. I have been in this business for more than 20 years, in at least 10 hospitals and as positions. Hospitals have many policies which are nothing more than window dressings. When JCOHA comes to visit, they love to show them off. When something untoward occurs at the hospital, the administrators, again, love to show them off. I can assure you that these policies are in place to do to things: 1) Prevent litigation; and 2) increase profit. You often find that although these policies exist, they are rarely implemented due to cost or impracticability. In every hospital that I’ve worked (mostly emergency), they’ve had policies that address overcrowding, sudden influx of patients, full in-house hospital beds so that patients who were admitted could not be moved out of the ED, etc. NONE OF THEM ACTUALLY ABIDED BY THEIR POLICY! When someone attempted to enact this policy, he/she was met with everything from a “ok” to “we’ll get on it.” Nothing would happen. When publicly pushed, their PR person would always say “we have policies in place that protect our patients whose safety is our utmost priority” or some bullshit to that respect. Meanwhile, nurses in the facility are caring for 3-5 critical patients at a time in the ED, 6-8 on a cardiac monitoring floor, and 7-10 on a non-acute floor. Not to mention the 6-8 emergency room patient per nurse. Safety, it’s all about patient safety. But the only ones who live this first-hand, day after day, shift after shift, are the nurses. I apologize for my poorly written rant and its lack of citations (although all can be easily looked up) but there will be no apology for the content. I love being a nurse. I love helping people. I do not love how nurses are treated by some administrations and some members of the public.

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