Emergency Response Protocols | Nurses

Failing to follow established emergency protocols during a critical incident can be a nurse's worst nightmare. Nursing, especially in a hospital or other critical care facility, can demand prompt, precise performance of life-saving protocols. Allegations that you didn't do as you should have done in such a situation can be crushing, especially if the critical incident resulted in a patient's serious injury or death. Failure to follow life-saving protocols can also result in state nursing board discipline, even suspension and revocation of your nursing license. Retain the Lento Law Firm's premier Professional License Defense Team if you face such disciplinary charges. You need our highly qualified attorney representation to protect your license and career. Call 888.535.3686 or complete this contact form now. We will stand by you with the greatest commitment and most effectively, when you most need it.

The Role of Standardized Emergency Nurse Protocols

You might think that nurses shouldn't have to initiate emergency care and that physicians should instead do so. However, that supposition ignores the reality of healthcare facility staffing, where nurses are always present but physicians may not be. Standardized emergency nurse protocols exist for good reasons. The American College of Emergency Physicians has adopted a policy statement endorsing standardized emergency nurse protocols. The college does so expressly because emergency departments and other critical care areas within healthcare facilities often do not have an emergency physician or physician assistant available when patients need preliminary emergency evaluation, triage, and care. The college's policy statement admits that “many facilities” find it necessary for nurses “to begin the evaluation and care of patients under standardized protocols” that are “within their scope of practice.” It might not be the best situation, asking a nurse to do a physician's job, at least preliminarily and within the limited scope of a nurse's own practice. But as you well know, it's a nurse's reality. If you face disciplinary charges alleging you failed to act properly in a critical care incident, let us help you defend the charges. You are in a difficult situation, and we want to help.

Standardized Emergency Nurse Protocols Examples

Standardized emergency nurse protocols cover common critical incidents. That's the purpose of a protocol, to establish in advance the steps that a nurse should take when faced with a common situation, especially one in which the steps need to be performed quickly and precisely, without life-threatening omissions. The American College of Emergency Physicians policy statement on emergency nurse protocols gives these five examples of the areas in which the protocols often arise, and the goals emergency nurse protocols serve:

beginning evaluation and treatment for critically time-sensitive patient conditions, such as an electrocardiogram and aspirin for myocardial ischemia, preparing for physician examination;
initiating and enhancing patient comfort to reduce patient distress, such as acetaminophen for high fever, while awaiting physician evaluation and orders;
reducing the time patients spend in congested emergency departments by initiating testing and treatment before physician arrival and orders;
improving patient safety and outcomes by reducing emergency department time from patient arrival to treatment after physician evaluation and orders; and
improving the patient's overall experience and impression of the facility's commitment to prompt and effective critical care, demonstrating action and intention during gaps in physician availability.

The Sufficiency of an Emergency Nurse Protocols

An emergency nurse protocol sounds like a sure thing, as if every emergency critical care incident had a ready set of reliable steps for a nurse to follow, if only the nurse was competent. Dream on. Perfect protocols exist only in an imaginary world. Patient critical care incidents vary. Every patient and situation is in some respect unique. Protocols can often help when properly developed. However, nurses must constantly adapt protocols to each unique situation, and some protocols just aren't sufficiently clear and well developed to be helpful and effective. We may be able to defend your disciplinary charges by showing that the protocol the charges allege you should have followed was a bad policy. According to the American College of Emergency Physicians policy statement, a sound emergency nurse protocol should have the following features:

physicians and nursing supervisors should have developed the protocol collaboratively with input from pharmacy, risk management, laboratory, hospital administration, and other involved departments;
the facility should have based the protocol on evidence or should have based the protocol on consensus if sufficient evidence does not exist;
the protocol should identify any necessary pre-approving physician or medical staff body for nursing care that would require such pre-approval;
the protocol properly provides for nursing care authorization and reimbursement as if ordered contemporaneously by a physician or physician assistant; and
robust nurse training, education, and continuous quality improvement are in place to support the protocol's appropriate use and updating.

Incidence of Failure to Follow Emergency Protocols

The National Library of Medicine published a study of the incidence of nurse failure to follow emergency protocols. The study found that nurse failures are a common factor in adverse hospital events, occurring in 13.6% of such adverse events. If the study holds generally true across all hospitals and is not anomalous, that percentage means that nurse failures to follow emergency protocols may be responsible for about one out of every six or seven hospital adverse events. Given the high-risk profile of their patient populations, large hospitals with many adverse events may have such nurse failures occurring frequently, even every day or every hour. You are not alone if you face allegations of failure to follow emergency protocols. It may happen far more often than you or others inside and outside of the nursing profession think.

Factors in Pursuing Disciplinary Charges

The high incidence of nurse failures to follow emergency protocols, shown by the above National Library of Medicine study, may work one of two ways relating to disciplinary charges. Disciplinary officials may regard nurse failures of this type as so frequent that they go with the territory. They may not, in other words, blame nurses for failing to follow emergency protocols, knowing that hospital staffing, procedures, and patient populations produce frequent failures. Why blame you in your particular case if failures are so common? On the other hand, the high frequency of nurse failures may be such a cause for concern that disciplinary officials make their discipline a higher priority. Blaming you for your particular case may make your punishment an example to alert and chasten other nurses to follow emergency protocols. Factors influencing whether state nursing board officials pursue disciplinary charges for failure to follow emergency protocols may thus include:

whether your alleged failure differs in any prominent respect from the frequent failures of other nurses in these common critical care incidents;
whether your alleged failure resulted in serious patient injury or death;
whether publication of your discipline would make a suitable example to warn and guide other nurses to follow emergency protocols;
whether patients, their family members, other nurses, or the public are aware of your alleged failure and expecting discipline; and
your attitude toward the incident and toward disciplinary officials, whether indicating understanding and concern or, conversely, irresponsibility and carelessness.

Impact of Failure to Follow Emergency Protocols

The above National Library of Medicine study also examined the impact of nurse failures to follow emergency protocols. The study found that in the 13.6% of adverse events involving nurse failure to follow emergency protocols, the adverse events caused, contributed to, or were associated with patient death or permanent disability in a little more than one-quarter of cases. Taking one-quarter of 13.6% means that a little more than 3% of hospital adverse events result in patient death or permanent disability related to nurse failure to follow emergency protocols. Given the generally high number of hospital adverse events in the patient population visiting the hospital over critical care events, that 3% nurse-caused death or permanent disability may be a very concerning figure, one to which disciplinary officials will give due attention. Let us help you defend your disciplinary charges so that you do not become an example for other nurses.

Preventability of Emergency Protocol Failures

The above National Library of Medicine study also examined whether the nurse's failures to follow emergency protocols were generally preventable. The study found from its own examination of cases that 80% to 90% of the nurse failures were preventable, as other similar studies supported. Apparently, examiners find it relatively easy to blame nurses in these situations of patient death or disability from emergency protocol departures. Beware your scapegoating. Don't let your healthcare facility and disciplinary officials blame you for a failure to follow emergency protocols if the blame lies elsewhere or the incident followed a natural, unpreventable course. Let us put your best disciplinary defense forward.

Causes of Failures to Follow Emergency Protocols

You may not be to blame for failing to follow the emergency nurse protocol that your disciplinary charges allege you should have followed. Nurses can have several reasons for not following an emergency protocol. Those reasons may defeat the disciplinary charges or mitigate any sanction. The National Library of Medicine study cited above also examined why nurses fail to follow emergency protocols or more precisely, why nurses fail to call for emergency response teams. The study found that nurses fail to initiate emergency protocols for events like cardiac ischemia or arrest because of cognitive and socio-cultural barriers. The following barriers may excuse your alleged failure or mitigate any sanctions:

inadequate publication of the adopted protocol;
inadequate training in the use of the protocol;
inadequate training recognizing the need for the protocol;
patient or family member resistance to protocol use;
physician reluctance to respond to emergency calls;
physician discouragement of nurse initiation of protocols;
nurse supervisor discouragement of nurse initiation of protocols;
frequent emergency calls accumulating at once;
recent adoption of an unfamiliar emergency protocol;
complex patient presentation obscuring protocol need;
cognitive decline of the involved nurse from schedule demand; and
physical decline of the involved nurse from schedule demand.

Reporting of Failure to Follow Emergency Protocol

Whether someone reports your alleged failure to follow emergency protocols and who reports the allegations may affect whether you face disciplinary charges. If no one reports your failure, charges may not follow. The National Council of State Boards of Nursing (NCSBN) makes clear that state nursing boards across the country permit anyone to complain about a nurse's misconduct. The NCSBN states that patients, their family members, employer representatives, and your nurse co-workers or other healthcare colleagues are all potential reporters. State nursing boards vary in their rules as to whether your nurse colleagues must report your misconduct. Most do not require such reporting, except in a few states like Colorado, New Mexico, and South Carolina where nurses may have to report colleague misconduct.

Avoiding Charges of Failure to Follow Protocols

Obviously, one way to avoid disciplinary charges is to follow emergency protocols whenever possible. However, your response to concerns over your suspected failure to follow protocols may also influence whether you face disciplinary charges. Retain our attorneys to respond to any such concerns the moment you hear the allegations. We may be able to help you gather, organize, and present your evidence and explanation of the situation to your employer, colleagues, or even the involved patient and the patient's family members in a way that forestalls a disciplinary complaint. Your prompt response with our assistance would itself be an indication that you are a responsible, caring, and committed professional. Swiftly addressing the situation may be far better than letting it fester as if you do not care about the concern.

Responding to Investigation of Protocol Failure

If instead, you learn that a state nursing board investigator has already received a complaint that you failed to follow an emergency protocol, then you may be able to take appropriate steps to head off a formal disciplinary charge. State nursing boards rely on investigation to determine whether to proceed with discipline. The assigned investigator may contact you or your employer for medical records, information, and interviews. Retain us the moment you learn of an investigation. We can notify the investigator and your employer or others involved in the matter of our appearance on your behalf, encouraging them to communicate with us. We can help you gather your exonerating and mitigating evidence to present to the investigator, where we can advocate and negotiate for the dismissal of the complaint without disciplinary charges. We may be able to show that even if you were responsible for the alleged failure to follow protocols, you have already undertaken appropriate informal remedial measures like education, training, counseling, monitoring, and supervision.

Nursing Board Authority to Discipline

Do not doubt the authority of your state nursing board to impose discipline against your license for failure to comply with emergency nurse protocols. State nurse practice acts uniformly authorize state nursing boards to investigate, charge, and discipline for nursing misconduct. Section 4723.28 of the Ohio Nurse Practice Act is an example, authorizing the Ohio Board of Nursing to revoke, suspend, or restrict your license on a wide range of grounds including your failure to practice according to prevailing standards, failure to use standard precautions, or depriving a patient of means of assistance. Just because you face disciplinary charges does not mean that you will suffer license sanctions. As already indicated above, we may be able to make out a strong case that no sanction is necessary, even if you did commit the alleged offense. Your remedial measures may satisfy the state nursing board that you are safe and competent to continue your nursing practice. We may also be able to show that you did not commit the alleged wrong, as follows.

Defenses to Charges of Failure to Follow Protocols

Facing state nursing board disciplinary charges is not the same as suffering discipline. You may well have perfectly valid defenses to your charges that we can assert effectively on your behalf. We may be able to defeat the charges on their face or present such mitigating circumstances that you do not suffer any sanction, even if the charges are largely true. Here are some of the defenses we may be able to present on your behalf, depending on the facts and circumstances in your particular case:

you were not on duty when the situation demanding an emergency nurse protocol arose;
you were not assigned to the patient or department when the demand for the emergency nurse protocol arose;
you were responsibly implementing an emergency nurse protocol to another critical care patient or multiple other critical care patients when the situation arose, such that you were unable to do as the charges allege you should have done without abandoning other emergency critical care obligations;
no protocol existed for the situation with which your assignment presented you;
the protocol that the charges allege you should have adopted and implemented did not apply to the situation presented;
the protocol that the charges allege you should have followed was itself so vague and ambiguous
the protocol that the charges allege you should have followed would have been ineffective in the circumstances presented;
you lacked the equipment, supplies, medication, or personnel to implement the protocol that the charges allege you should have adopted;
the protocol that the charges allege you should have followed would have been beyond the authorized scope of nursing practice under the circumstances;
your supervisor or facility instructed you not to adopt and follow the protocol that the charges allege you should have followed;
the protocol that the charges allege you should have followed required physician pre-approval for the steps the charges allege you failed to take when no physician granted pre-approval; or
the patient or patient's family members refused to consent to your following the protocol that the charges allege you should have followed.

Protective Procedures Against Disciplinary Charges

Your state's nursing practice act must generally provide protective procedures satisfying your constitutional due process rights. Your state nursing board must not arbitrarily deny you of your nursing license and practice, without giving you fair notice of the charges and a fair hearing before an impartial decision maker. Chapter 4723-16 of the Ohio Administrative Code is an example, promulgating Ohio Board of Nursing rules guaranteeing accused nurses notice, hearing, the right to attorney representation, appeals, and other protective measures. Your state nurse practice act and state nursing board rules will provide you with equivalent protections for our highly qualified attorneys to invoke on your behalf for your best disciplinary outcome. Disciplinary charges alleging failure to follow emergency protocols are serious, especially when they involve patient death or serious injury. Let us help you defend your charges.

The Role of License Defense Counsel

Your matter alleging failure to follow emergency protocols carries such significant disciplinary risks that you need our highly qualified, skilled, and experienced attorney representation. Do not retain unqualified local criminal defense counsel. Criminal court laws, rules, and procedures are very different from administrative licensing laws, rules, and procedures. Unskilled representation can complicate your defense and even worsen your disciplinary outcome. Our attorneys know what state nursing board officials expect. We know the remedial measures they may accept in lieu of punitive sanctions. We also know the patient, employer, and public interests they must protect and how to show them that you can do so without punishment. We can invoke your hearing or, if you have already lost your hearing, take available appeals and seek available judicial review.

Premier License Defense Attorneys Available

If you face state nursing board disciplinary charges alleging your failure to follow emergency response protocols, retain the Lento Law Firm's premier Professional License Defense Team for your best disciplinary defense. We have helped hundreds of nurses and other healthcare professionals defend and defeat state board disciplinary charges of all kinds. Call 888.535.3686 or complete this contact form now for the highly qualified representation you need to preserve your nursing license.

Nursing License Issues: Failure to Comply with Emergency Protocol