Being a Naive Nurse Will Get You Thrown to the Wolves

In matters related to practice, errors, or sentinel events, are nurses far too naïve when it comes to dealing with their employers, regulatory bodies, or police? Nurses falsely assume that all of these authorities will act in, or at least be mindful of, their best interests. The thought that any of them might act solely in their own self-interest (at best) or in bad faith (at worst), is probably beyond most of us. The fact is none of them have a nurse’s interest as their top priority, if in fact they consider it all. Aside from a duty to ensure patient safety, hospitals have a legal, fiduciary obligation to protect themselves from liability issues and legal action. Regulatory bodies act in the public interest. Police decide if behaviour is criminal and lay charges. We should not be shocked (but often are) when any of these lie, manipulate or misrepresent themselves to gain a nurse’s trust and coöperation in order to pursue their own agenda. Woe to the nurse who trusts authority to do right by them!

I’ve written about the Winkler nurses, where this seems the case, and about Brian Sinclair’s death in a Winnipeg emergency department waiting room; here I fear the police will use information obtained from the triage nurses in the original investigation against those same nurses, information incidentally given in good faith that no charges were pending. Or think about what happened to Gita Proudman, who was unjustly charged with killing a dying infant in 1998. The charges were withdrawn over a year later.

Or consider this case, in which  an employer and police  have accused two nurses of deliberately cutting umbilical catheters, a type of intravenous used on newborns:

Two Sunrise Children’s Hospital nurses whose licenses were suspended because of disrupted catheters — which left one newborn in critical condition — are targets of a Las Vegas police investigation into “intentional patient harm,” State Board of Nursing records reveal.

Another infant had to undergo an emergency procedure as a result of a catheter disruption, the hospital reported.

Registered nurses Jessica May Rice and Sharon Ochoa-Reyes were suspended by nursing board President Doreen Begley “in the interest of public health, safety and/or welfare” after the regulatory agency received notice on June 10 from law enforcement officials that each nurse was a “person of interest” in an “ongoing criminal investigation,” according to documents obtained Tuesday under the Nevada public records law.

[snip]

Katherine Ramsland, a criminologist at DeSales University in Pennsylvania who has long studied health care workers who run afoul of the law, said Sunrise officials now must study incidents and deaths in the neonatal unit “over many months and perhaps years.”

Sunrise officials would not say how many infants had what medical officials term “unexpected outcomes” when Rice or Ochoa-Reyes was on duty in the neonatal unit.

Ramsland said nurses who do harm to patients are very good at covering up what they do. “Often they’re not caught for years,” she said.

Nurses who harm patients are known as “Angels of Death” because after they are caught they say they were putting patients out of their misery.

Angels of death?* Seems straight-forward, doesn’t it? But some salient points in this case: the nurses had complained to the hospital in good faith about problems with the umbilical catheters; the hospital ignored their complaints until infants began to suffer complications from the catheters, when they fired the nurses and called the police to investigate; the hospital in fact knew about problems with the catheters, but was dilatory in addressing the issue; the hospital refused to consider testing the catheters for product failure, but chose instead to have a “forensic analysis” attempt to prove the lines were intentionally cut to build a case against the nurses; the hospital contacted the manufacturers about potential problems, yet refused to disclose the email communications with the manufacturer; problems with the lines ended when the hospital changed manufacturers; and the Food and Drug Administration had issued advisories about the problem previously. Significantly, after initially pulling the nurse’s licences, the Nevada State Board of Nursing reinstated them in September, citing a complete lack of evidence of negligence or wrong doing. The police investigation, unfortunately, is continuing.

Read carefully what the nurses have to say about this nightmare:

Both nurses now say they realize they were naïve in dealing with authorities. Both agreed to police interviews and polygraphs because they said they had nothing to hide.

But in separate interviews with police, each said a detective ended up yelling that she enjoyed killing babies.

“I couldn’t believe what I was hearing,” Ochoa-Reyes said. “I told them over and over I would never do such a thing.”

Rice said she listened to a police detective rant and rave about her being a baby killer for four hours.

Finally, she said, the detective told her to leave when she kept repeating that she would never hurt a child. [Emphasis mine.]

Let me return to Gina Proudman for a moment, who wrote about her experience for the Registered Nurses Association of Ontario:

[I] am the nurse who had that charge against her withdrawn on November 9,1999. I had held a dying baby, who had no one there to hold him, and he died in my arms. I was naïve. When the police wanted me to answer a few questions, I said of course, I had nothing to hide. For that same reason, I did not take a lawyer with me.

Needless to say, that was a serious error in judgement. That particular piece of naiveté resulted in a charge of second degree murder, complete with a nine-day period of time spent in a segregated cell.

*****     *****     *****

What did I do wrong? My first, and biggest, mistake, was not getting a lawyer immediately. When the situation was presented to me by management, I knew it was serious, but I felt that since I was not guilty of anything, I did not need a lawyer. I felt that obtaining one would make me appear guilty (a view that was reinforced by the police when I made mention of possibly bringing an attorney). Wrong. If anyone needs a lawyer, it is an innocent person. You need someone to discuss with you whether or not you will give a statement to police, and if you will, what the content of that statement will be.

Do not give a statement without having discussed it with a lawyer first. The innocent can be easily manipulated because of a desire to clear their name. There is a strong belief that the police and people in authority really are seeking the truth. As I discovered, this is not always the case, and one has to protect oneself immediately. [Emphasis mine.]

You see the common theme. We trust too much. The lawyer of Sharon Ochoa-Reyes is fairly clear the hospital is trying to scapegoat the nurses for avoiding, and then covering up a known problem with a medical device, in order to escape their own liability. Did the hospital act in bad faith towards its nurses? From my particular perch, it looks like it. Here lies a lesson for all nurses: ultimately, your employer will only ever act in its own interest. And ditto for regulatory bodies and the police.

Nurses are sometimes deceived by the perception of commonality, that employers and the rest always have our best interests — our professional lives or even the care and safety of our patients — at heart. It isn’t true, and all nurses need to develop a high degree of skepticism and critical evaluation to navigate a minefield of competing and conflicting goals and agendas. It’s important to remember why nurses are frequently thrown to the wolves: we’re relatively small fish in the hospital food chain, we tend act passively, even when accused of negligence and malfeasance, and we are too deferent to authority. When bitten we tend not to bite back. We scarcely even bark. This must change, and I think it is changing as nurses clearly and forcefully advocate for their profession and for themselves.

However, to some degree we can also take practical measures to protect ourselves. Clear, accurate and timely documentation and charting is essential (and obvious) for nurses to protect themselves, and is something none of ever give priority to. But we never think to take notes, even immediately afterwards, when meeting with a manager or some other administrator, or documenting for our own records concerns about practice or equipment. Membership in a professional organization is essential, especially if like the RNAO they offer a degree of legal advice. Don’t hesitate to enlist your union to back you, or if the police or a regulatory body comes to investigate, a lawyer. In short, nurses must always aggressively defend themselves, because in the end, no one else will.

[Many thanks to the ever diligent Vernon Dutton (Twitter ~ Flickr) for pointing out the Nevada cases to me. His take can be found here.]

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*Nurse stereotyping at its best. The expert here also has an abiding interest in ghosts.

[UPDATE: some minor wording changes for clarity.]