Devon was employed as a staff nurse at a 300-bed tertiary care facility
Case Study:
Devon was employed as a staff nurse at a 300-bed tertiary care facility. The hospital’s staffing plan for weather emergencies consisted of a three (3) tier disaster response team. Nurses were assigned, based on personal preference, to disaster tiers 1, 2, or 3. Tiers 1 and 2 were considered essential personnel and would be expected to report to the hospital, usually 24 hours prior to a disaster, to provide patient care during the hours before, during, and after (usually 12 hours) the disaster’s arrival and departure. During this time, the hospital would initiate a lock-in mode whereby no essential personnel would be allowed to leave the hospital premises. The lock-in phase would end immediately after the weather stabilized; however, essential personnel would not be allowed to leave until Tier 3 relief arrived. It was the responsibility of the personnel assigned to Tier 3 to provide a recovery and relief period for the personnel of Tiers 1 and 2.
Devon and his wife were preparing for tornadoes in the forecast over the next 48 hours. During that time, Devon received a phone call from a colleague (also a friend) working at the hospital, who was a Tier 1 member, requesting that Devon stops by a local store to purchase basic toiletries and drop them off to him. Devon agreed and arrived at the hospital with his friend’s supplies. While at the hospital, the announcement was made that an F5 tornado was detected on radar. As a result, more than 75% of the essential personnel from Tiers 1 and 2 were seeking shelter and had notified the hospital of their inability to fulfill their obligation as disaster response team members.
Devon’s wife has ventricular tachycardia and depends on antidysrhythmic drugs. Therefore, Devon had never agreed to designation as essential personnel (Tiers 1 and 2). In addition, Devon had never failed to report to work as Tier 3 relief personnel. The shortage of nurses prompted the hospital administrators to locate alternative personnel for the critical lock-in period. While at the hospital, Devon is recognized by a nursing administrator who pleaded with Devon to stay and assist during this crucial time. Devon explains why he cannot stay and is assured by the administrator that his wife will have her medical needs attended to as needed without providing detailed plans.
There were more than 2,000 employees, clients, and family members sheltered in the hospital during the tornado. Due to wind-damaged bridges and highways, fallen trees, and downed power lines, the hospital became virtually inaccessible to those from the outside. Therefore, there would be no Tier 3 nursing relief. Devon completed his final 12-hour shift when his wife informed him that she was experiencing chest pain and syncope and her prescriptions had only a one day supply remaining. Devon is informed by the administrator that if his wife’s condition worsens she will be cared for medically (again without providing specific details), but leaving the hospital at that time will constitute job abandonment and would, therefore, be reported to the Missouri State Board of Nursing for possible disciplinary action.
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