February 28, 2006 -- Today the Denver Post ran a very good piece by business columnist Al Lewis about the situation of veteran Colorado ICU nurse Donna Jaynes. Jaynes was fired after reportedly complaining about care issues at her hospital. Jaynes sued the hospital, which has argued that Jaynes was fired because she was a "confrontacious" "problem" employee, and that in any case, there is no statutory protection in Colorado for hospital whistle-blowers. The piece focuses on a bill pending in the Colorado legislature that would create such protection for nurses, who may risk their jobs if they speak up about dangerous conditions. Thus, the column's headline is: "First aid for 'problem' nurses."
The column says that in Jaynes's 27 years as a nurse, she has filed more than 30 reports about the care environment, "complaining of medication errors, inadequate sterilization practices and inappropriate behavior of co-workers." She feels this is part of her job. The piece notes that in the ICUs where Jaynes has generally worked, "mistakes can end in deaths." Jaynes told Lewis that at the start of her career, her reporting was "usually accepted favorably" as a way to improve care. But since the advent of managed care cost-cutting, she says, "they don't like nurses complaining about quality." Jaynes was apparently fired after objecting in 2000 to the care a patient was getting following abdominal surgery. Jaynes says the patient was "mistakenly allowed food," resulting in an "irregular heartbeat," and that he should have been moved to a cardiac unit right away. Apparently the physicians involved "debated" this, and Jaynes "filed a report." The patient was eventually moved, and so was Jaynes, "[t]o the unemployment line."
Jaynes filed suit, arguing that her firing was retaliatory. Her wrongful termination case was dismissed by a lower court, though she has appealed. According to a quote Lewis says is from a deposition in the case, the hospital has argued that Jaynes was fired for being "[a]ntagonistic, rude, confrontacious - challenges authority - seeks confrontations, not a team player, disrespectful, passive/aggressive, manipulative, suspicious of patients, staff, families." Lewis says that may all be true. But he is clearly a little skeptical that Jaynes was fired for all these things so late in her career, as opposed to simply because she had "a message that nobody wanted to hear." However, it's not clear from his piece how long Jaynes had worked at this particular hospital, which could be relevant. Lewis does quote Morgan Carroll, the state legislator sponsoring the proposed whistle-blower law, as noting that these are the kind of things an employer will likely say about any whistle-blower. And according to Lewis, the hospital has argued that there is no statutory protection in Colorado for health care workers, and that the courts should not intervene in this legislative area.
Not surprisingly, the Colorado Health & Hospital Association opposes Carroll's whistle-blower bill, which is called "The Health Workers Protection Act," arguing that current law is adequate. The piece reports that Jaynes' attorney Barry Roseman finds this darkly comic--the individual hospital says there's no legal protection, while its association says what there is is adequate. The piece notes that few nurses have spoken up in favor of Carroll's bill, which Carroll says is because many fear retribution. Lewis does quote a couple nurses who have "come forward." Nurse Linda Hayes says that (in Lewis's words) "hospitals have increasingly put profits before patients as they have changed hands from churches to corporations." Hayes also confirms the risk of retribution if "they believe you are upsetting anything in the hospital." Lewis quotes nurse Rebecca Matthys as saying she often must "choose whether I am going to report what's happening or whether I'm going to keep my job."
The piece does a good job of highlighting the dilemma in which nurses and other care givers often find themselves in considering whether and how to improve the quality of care in the managed care era. Lewis recognizes how important the views of a nurse can be, noting what can happen when there are mistakes in the ICU. And he actually lists some of the important care issues Jaynes has complained about. Though the piece does not say so, nurses' patient advocacy may require that some things be pursued through the kind of formal reports Jaynes has apparently filed over the years, particularly where a nurse meets real resistance on a critical care issue. It's clear that Lewis' sympathies lie with the nurses here, and not with the hospitals. There is no comment from them except the material from the Jaynes case court papers. In particular, it might have been helpful to hear why the hospital association thinks current law is adequate. The piece could also have used more detail about how Jaynes's firing occurred.
Lewis might also have pursed why the managed care era is especially difficult for nurses who see unaddressed quality issues, beyond the implication that money is all that matters in hospitals now. Of course, cost-cutting has led to hospital denursification, which in turn has created serious quality concerns in many clinical settings. Nurse short-staffing has a proven negative effect on patient outcomes. And short-staffing itself has driven many of the remaining nurses from the bedside. At the same time, as Suzanne Gordon explained in "Nursing Against the Odds," managed care has weakened nurses' institutional power within many hospitals. So many nurses have even less leverage than before to pursue quality concerns. Some problems actually stem from nurses' own continuing lack of power and respect. Many nurses must move heaven and earth to get those with more power to listen to their concerns about patients--such as the need for a post-surgical patient with cardiac problems to be moved to a cardiac unit.
We thank Al Lewis and the Denver Post for his column. Please post your thoughts and experiences on Al Lewis' blog on whistleblower protection for nursing by clicking here.
See the column "First aid for 'problem' nurses." in the February 28, 2006 edition of the Denver Post.
Al Lewis can be reached at email@example.com. (Please copy us at firstname.lastname@example.org if you write. Thank you.)