Nurses Fired for Denying Patient Care

Community Memorial Hospital has fired four emergency room nurses who refused to care for a critically ill elderly woman unless they were given a $5-an-hour bonus, administrators said.

The nurses, who were not identified, were terminated early Wednesday. Community Memorial’s nursing staff was promptly notified of the firings in a memo that described the nurses’ stand as “an unconscionable act.”

“I’m a nurse, and the reason they were fired was because they refused to provide care to a patient who needed it,” Carol A. Dimse, hospital assistant executive director, said in an interview. “That is totally against everything that nursing stands for.”

The fired nurses could not be reached for comment. But sources familiar with the situation said the nurses felt they had a right to protest unequal pay as long as patients were not jeopardized.

Dimse acknowledged, in fact, that the elderly patient the nurses refused to monitor was cared for at all times by other nurses, albeit tired ones working extra hours.

And Dr. Allen Hooper, director of the emergency room at St. John’s Regional Medical Center in Oxnard, said he thinks the nurses had a right to protest.

“This really doesn’t seem fair,” Hooper said. “As a general statement, as long as care is being provided, one can stand for their own issues.”

Response among Community Memorial nurses was mixed, said one veteran nurse.

“Most of the nurses I talked with thought it was inappropriate that they refused to take care of the patient and that they should have handled the pay thing after the fact,” she said. “But others said they had a right to refuse.”

The dispute is another ripple from a severe nursing shortage that has troubled Ventura County hospitals in recent months, sparking a bidding war for critical care nurses.

Community Memorial hiked the pay of its 50 to 60 intensive care and coronary unit nurses $5 an hour two weeks ago, matching a recent pay increase by the two St. John’s hospitals in Oxnard and Camarillo. The increase upped the wage of such nurses at Community to between $22 and $29 an hour, depending on experience.

But Community had not agreed to pay its emergency room nurses an extra $5 an hour to monitor critically ill patients--precisely the issue the four nurses raised when they reported to work Saturday morning and found the elderly woman in the emergency room.

They refused to take over care for the woman, a fact they acknowledged in statements to administrators, Dimse said.

“They said, ‘We all agreed that we are not going to take [over] and care for this patient unless we get the $5 an hour bonus,’ ” Dimse said. “They basically said, ‘We just decided that this was the time to take a stand.’ ”

Nurses working the night shift continued to care for the elderly woman until a critical care nurse who had already worked a 12-hour shift took over, Dimse said. The woman finally got a permanent bed in a critical care ward three hours later.

Meanwhile, supervisors warned the protesting nurses--who continued to see emergency patients--that their actions could carry serious consequences, Dimse said. They were suspended Monday.

“This is a core responsibility of a health care institution,” said Michael Bakst, executive director at Community Memorial. “This is what hospitals are all about--caring for patients.”

The fired nurses could have avoided the confrontation, Bakst insisted, by providing evidence that emergency nurses at St. John’s received a $5 hourly bonus in such situations.

Once that fact was established Monday, Community agreed to begin paying the bonus to emergency room nurses who are pressed into critical care. “Monday morning we got that [St. John’s] memo from an E.R. nurse and we said, ‘Whammo, OK, we’ll do it,’ ” Bakst said.

In her memo to the nursing staff, Dimse said that she was sure that other nurses would also be appalled by the actions of the four nurses.

“The feedback I’m getting from nurses is positive in support of the hospital,” Dimse said. “They are against what these nurses did, as I am, as any nurse would be.”

The Community Memorial firings follow a series of developments related to the nursing shortage.

Last month, St. John’s Regional Medical Center closed an acute care wing despite record numbers of patients because a shortage of staff nurses pushed the cost of fill-in caregivers so high the Oxnard hospital was losing money.

Countywide, hospitals have been nearly full since December. That has prompted unprecedented numbers of ambulance diversions to other hospitals because of a lack of nurses to serve critical care patients.

Highlighted by a flu epidemic in winter 1998, which left every local hospital overflowing with patients but with too few nurses, the shortage has prompted hospitals to offer better pay and benefits, more convenient work schedules and to pay for nurses’ continuing education.

The shortage exists partly because harried nurses--overworked after hospital cutbacks in the early 1990s--have retired, taken jobs with health maintenance organizations or moved into caring for patients at home.

At the same time, nursing schools are producing fewer highly trained graduates because managed care cuts made it difficult, until recently, for young nurses to get jobs. And women--92% of nurses--are increasingly choosing careers with better pay.

That has left Southern California’s 58 hospitals with 833 registered nursing vacancies, according to a recent study by an industry council. And more than 500 of those are in the highly specialized areas, such as critical care, labor and delivery and operating rooms.