Problem: PAVING HER WAY TO HEAVEN

The nurse-plaintiff in Kirk v. Mercy Hosp. Tri-County 2 was employed as a charge nurse with supervisory duties. A short time after one of her patients had been admitted to the hospital, the nurse diagnosed that the patient was suffering from toxic shock syndrome. The nurse believed that the physician would order antibiotics. After a period of time had passed without having received those orders from the physician, she discussed the patient's situation with the director of nursing. The nurse was told by the director to document what had happened. She was told to report the facts and stay out of the matter. The nurse discussed the patient's condition and lack of orders with the chief of staff. Although the chief of staff took appropriate steps to treat the patient, the patient died. A member of the patient's family had told the nursing director that the nurse-plaintiff offered to obtain the medical records. The nursing director was later told that the nurseplaintiff had told the family member that the physician was "paving [the patient's] way to heaven." The director terminated the plaintiff.

After her termination, the nurse received a service letter from the hospital that directed her to refrain from making any further false statements about the hospital and its staff. The trial court entered a summary judgment for the defendant, stating that there were no triable issues of fact, and there was no public policy exception to the nurse's at-will termination. The nurse appealed. The Missouri Court of Appeals held that the Nursing Practice Act provided a clear mandate of public policy that the nurses had a duty to provide the best possible care to patients. Public policy clearly mandates that a nurse has an obligation to serve the best interests of patients; therefore, if the plaintiff refused to follow her supervisor's orders to stay out of a case where the patient was dying from a lack of proper medical treatment, there would be no grounds for her discharge under the public policy exception to the employment-at-will doctrine. Pursuant to the Nursing Practice Act, the plaintiff risked discipline if she ignored improper treatment of the patient. Her persistence in attempting to get the proper treatment for the patient was her absolute duty. The hospital could not lawfully require that she stay out of a case that would have obvious injurious consequences to the patient. Public policy, as defined in case law, holds that no one can lawfully do that which tends to be injurious to the public or against the public good.

Ethical and Legal Issues

1. Describe the ethical and legal issues in this case.

2. Did the hospital violate the rights and responsibilities of the nurse? Explain your answer.

3. Would the nurse's professional code of ethics support her actions in this case? Explain your answer.