You are the manager of a well-baby newborn nursery. Among your staff is 79-year-old LVN/LPN Mary Jones, who has worked for the hospital for 50 years. No mandatory retirement age exists. This has not been a problem in the past, but Mary’s general health is now making this a problem for your unit. Mary has grown physically fragile. Cataracts cloud her vision, and she suffers from hypertension. Last month, she began to prepare a little girl for circumcision because she did not read the armband properly. Your staff has become increasingly upset over Mary’s inability to fulfill her job duties. The physicians, however, support Mary and found the circumcision incident humorous. Last week, you requested that Mary have a physical examination, at hospital expense, to determine her physical ability to continue working. You were not particularly surprised when she returned with medical approval. Her physician spoke sharply with you. Admitting privately that Mary’s health was rapidly failing, the physician told you that working was Mary’s only reason for living and left you with these words: “Force Mary to retire, and she will die within the year.” ASSIGNMENT: Using your knowledge of age discrimination, patient safety, employee rights, and management responsibilities, decide on an appropriate course of action for this case. Be creative and think beyond the obvious. Be able to support your decisions.

 

You have been the nursing coordinator of cardiac services at a medium-sized urban hospital for the last 6 months. Among the hospital’s cardiac services are open-heart surgery, invasive and noninvasive diagnostic testing, and a comprehensive rehabilitation program. The open-heart surgery program was implemented a little over a year ago. During the last 3 months, you have begun to feel uneasy about the mortality rate of postoperative cardiac patients at your facility. An audit of medical records shows a unit mortality rate that is approximately 30% above national norms. You approach the unit medical director with your findings. He becomes defensive and states that there have been a few freakish situations to skew the results but that the open-heart program is one of the best in the state. When you question him about examining the statistics further, he becomes very angry and turns to leave the room. At the door, he stops and says, “Remember that these patients are leaving the operating room alive. They are dying on your unit. If you stir up trouble, you are going to be sorry.” ASSIGNMENT:  Outline your plan. Identify areas in your data gathering that may have been misleading or that may have skewed your findings. If you believe action is still warranted, what are the personal and professional risks involved? How well developed is your power base to undertake these risks? To whom do you have the greatest responsibility?