Hospital Policies: Do They Always Apply in Emergency Situations?

School Nurse Conflict Mission

Mary Jackson did exactly what a professional RN should do -- she tended to the injured children that were her responsibility. It happened that her efforts spilled over into a hospital emergency room, which technically she did not have the legal right to practice in. But still, she acted according to the values that she was trained in and moreover, as a professional healthcare employee of a school, she knew these children and her instincts were to boldly provide triage and other emergency procedures to help the children. In addition, Mary is not just an RN, she is a Nurse Practitioner specializing in pediatrics, and her skills and training are well beyond those of an RN. Hence, she deserves respect and she deserves the benefit of the doubt when she acts in behalf of the children she is contractually and morally obliged to protect and care for.

The fact that the hospital is now questioning the legality of her presence in the emergency room puts Mary on the defensive albeit the real legal heat is on Dr. Edmond Yee and the Chief Nursing Officer Beatriz Garcia-Chavez for permitting Mary to work in the hospital without the proper credentials. Still, while the questions being raised are legitimate, the situation that Mary Jackson participated in was by any definition an emergency, and in most states a nurse is covered under Good Samaritan laws when she or he provides assistance to injure people in a disaster or an emergency -- in particular nurses are protected by Good Samaritan laws when an "unplanned act" occurs (Northrop, 1990, 51). The more "formalized and planned a rescue becomes, the less you appear to be a spontaneous Good Samaritan" (Northrop, 51).

Do Good Samaritan Laws Protect the Nurse in Emergencies?

According to the peer-reviewed journal Nursing90, all states have Good Samaritan laws but those laws aren't all uniform, of course. In New York State, for example, the Good Samaritan law "…relieves nurses of liability for injuries that may have resulted from negligent nursing care at the scene of an accident or during another emergency" (Northtrop, 1990). In this case of course Mary was not negligent at all. And in fact a chemical spill is a terrifyingly dangerous emergency, because no one really knows at the time what the fumes from that spill have done to the lungs of the children. It is already known the children have suffered from burns, respiratory distress, and hydrogen chloride is an extremely toxic substance, but the real question is not whether Mary had the legal right to serve the children; the most pertinent question is, should the hospital staff insisted that Mary go through the facility's credentialing process.

And even though Mary's work was excellent and there is no reason for her to be sued for gross negligence or malpractice, under New Jersey laws nurses and paramedics are "…immune from liability for negligence that occurs while…'rendering advance life-support services in good faith and in accordance with the law" (Northrop, 51). Certainly providing life-support services was exactly what Mary was doing.

Cathy A. Klein (MSN, MSEd, APN) writes in the peer-reviewed journal the Nurse Practitioner that it is not likely that any Board of Nursing would discipline a nurse practitioner for "…doing what is necessary for the best interest of the patient in the disaster situation when adequate resources and qualified staff are unavailable" (Klein, 2006, 56). Klein goes on to say that it is very unlikely that any plaintiff would "prevail in a lawsuit under the same conditions" (56). The reality is that a nurse practitioner showing that she or he did the best possible work under emergency conditions "…would most likely be a sympathetic defendant in a lawsuit" (Klein, 56).

But what about Hospital Staff that didn't follow Protocol?

Okay it is clear that Mary was perfectly in her right to do what she did, and since she had the permission of the ER Nurse Manager Carl Lauderback, she cannot be faulted. But how should the hospital respond to the situation with Yee and Lauderback and Garcia-Chavez, all of whom were in accord that taking Mary away from the services she was performing would possible jeopardize the health of the children?

First of all, the question as to whether there was an adequate credentialing professional in the building is valid. Edmond Yee is quoted as saying this was "the biggest disaster we've ever seen in Riverbend City," and the person in charge of credentialing "…is in completely over her head. If she is doing emergency credentialing, it will take hours because she doesn't know what she is doing."