Markkula Center of Applied Ethics

We've Got You Covered

Case prepared by: Pat Wolfe, Diane Williams, Paula Smith, Sr. Rachela Silvestri, Margaret McLean

Justin Tyme - a registered nurse - joins the unit after successfully completing new employee and unit orientation. He had worked for 10 years in a similar unit at St. Elsewhere but grew tired of the 2 hour daily commute. He is thrilled to be working closer to home. The staff is ecstatic as the unit has been short-handed and the census high.

The staff likes working with Justin. He is a friendly fellow and frequently brings hot donuts and a huge thermos of Peets coffee for the staff. He is always willing to help with lifting and turning patients and often is the first one to respond to patient lights.

Justin does not always follow through on his observations and physician orders; he often misses giving routine meds. The staff has taken to routinely double-checking Justin's orders and the following shift often dispenses the missed meds.

One morning, Dr. Tauk comes in to review the speech consult he ordered the day before on his patient, Mrs. Dee Phagia, prior to ordering her a diet. Dr. Tauk cannot find the consult asks Charity N. Able, RN, to locate it and call him. Charity discovers that the order had never been placed. On follow-up, Charity discovers - not to her surprise - that Justin was the nurse who noted the order. Charity does not talk to the manager but does point out the error to Justin who feels terrible about it.

Over the next month, Justin continues to make intermittent "small" mistakes which cause no harm to patients; and the staff continues to cover.

Today, Dr. L. Ovin comes in and notices that her patient, Mr. Hart, is in atrial fibrilliation. She orders stat IV digoxin and cancels scheduled diagnostic procedures. Mr. Hart remains in atrial fib and, as you review his chart, you discover that Justin missed the last two routine digoxin doses.

What do you do now?

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