One of the major stressors in the practice of nursing is the presence of nurses at the fault lines between hospitals, physicians and patients and a sometimes confusing array of demands on a nurses primary loyalty, where the interests of a hospital and/or a physician conflict with that of a patient. The practice of nursing is now a heavily regulated profession governed by individual state nursing codes and overseen by State nursing boards who have the power to issue or withdraw licenses to practice nursing. Included in most state nursing statutes and regulations are general obligations to patients and their families to provide care, counseling and teaching to assist the patient in acquiring and maintaining good health or in dealing with poor health.
A nurse, in providing his or her care for a patient, generally operates under the direction, supervision and control of a physician who is the “captain of the ship” in caring for a patient. Obviously, ships do not run very well if the crew are free to challenge the authority of the captain and mutinous crewmen are sometimes dealt with harshly.
In Dixie L. Deerman v. Beverly California Corporation, 518 S.E. 2d. 804 (N.C. App., 1999), Ms. Deerman, a registered nurse, advised the family of a patient that she would “reconsider the choice of physicians” for a patient whose condition was deteriorating and for whom she was unable to secure the attention of the patients’ physician. As a result, she was fired by Beverly California Corporation who of course has an interest in maintaining the good will of referring physicians.
Mrs. Deerman, recognizing that she was an “at will” employee of Beverly that could be terminated for “no reason at all”, filed suit against Beverly for terminating her for reasons that violated the public policy of the State of North Carolina. In other words, they did what they had the right to do for the wrong reason. The court, reviewing the imperatives of the North Carolina Nursing Board on the care, teaching and counseling of patients, concluded that Ms. Deerman’s termination was in violation of the public policy of the State of North Carolina and reinstated Ms. Deerman’s wrongful termination case which had been dismissed on summary judgment.
While one can perceive of cases in which a nurse wrongfully interferes in the relationship between a physician and a patient, here the nurse’s comments were not gratuitous in that she was specifically asked by the patients family and the physician in question had been unresponsive to the nurses importuning regarding the deteriorating condition of the patient. It is almost always the best defense and it is always the best policy to act in the best interests of the patient based on the knowledge that is currently available.
