You are a supervisor in a neurologic care unit. One morning, you receive a report from the night-shift registered nurses, Nurse Caldwell and Nurse Jones. Neither of the nurses reports anything out of the ordinary, except that a young patient with a head injury has been particularly belligerent and offensive in his language. This young man was especially annoying because he appeared rational and then would suddenly become abusive. His language was particularly vulgar. You recognize that this is fairly normal behavior in a patient with a head injury, but yesterday morning, his behavior was so offensive to his neurosurgeons that one of them threatened to wash his mouth out with soap.
After both night nurses leave the unit, you receive a phone call from the house night supervisor who relates the following information: When the supervisor made the usual rounds to the neuro unit, Nurse Caldwell was on a coffee break and Nurse Jones was in the unit with two licensed vocational nurses/licensed practical nurses. Nurse Jones reported that Nurse Caldwell became very upset with the patient with head injury because of his abusive and vulgar language and had taped his mouth shut with a 4-in piece of adhesive tape. Nurse Jones had observed the behavior and had gone to the patients bedside and removed the piece of tape and suggested that Nurse Caldwell go get a cup of coffee.
The supervisor observed the unit several times following this, and nothing else appeared to be remiss. Stating that no harm had come to the patient, Nurse Jones was reluctant to report the incident but believed that perhaps one of the supervisors should counsel Nurse Caldwell.
You thank the night supervisor and consider the following facts in this case:
Nurse Caldwell has been an excellent nurse but is occasionally judgmental.
Nurse Caldwell is a very religious young woman and has led a rather sheltered life.
Taping a patients mouth with a 4-in piece of adhesive tape is very dangerous, especially for someone with questionable chest and abdominal injuries and neurologic injuries.
Nurse Caldwell has never been reprimanded before.
You call the physician and explain what happened. The physician believes that no harm was done and notes that it is up to you to determine if and how to discipline the employee. He does, however, express significant concern about her judgment to safely care for patients.
You phone the nurse and arrange for a conference with her. She tearfully admits what she did. She states that she lost control. She asks you not to fire her, although she agrees this is a dischargeable offense. You consult with the administration, and everyone agrees that you should be the one to decide the disciplinary action in this case.
QUESTION: Decide what you would do. You have a duty to your patients, the hospital, and your staff. List at least four possible courses of action. Select from among these choices and justify your decision.
Discussion Protocol. Please observe the following 3 x 3 rule: when writing your weekly discussions: – A minimum of three paragraphs per DQ. Each paragraph should have a minimum of three sentences.
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