The well-known Finnerty case involved a registered nurse going by the name of Ellen Hughes Finnerty and the Board of Registered Nursing. Finnerty made a petition to the board requiring it to withdraw its disciplinary decision for incompetence and gross negligence. The reprimanding was connected to an incident in which the nurse failed to act according to the orders of a resident physician. The order was to immediately intubate a patient in his room. Instead, Finnerty moved the patient to the ICU then performed the intubation. The court found this an incompetent and grossly negligent act and denied her the petition based on substantial evidence.
On an early August morning, Finnerty was working as a resource nurse at the Huntington Memorial Hospital. James C. was a patient in station 25 (sub-acute unit). He was a 55-year-old man suffering from Down’s syndrome along many other illnesses. The patient started experiencing respiratory complications. A nurse under whose care he was, called for assistance from his respiratory therapist, and primary care physician.
The physician gave an order that the patient be transferred to the ICU for respiratory failure impending code and that his stat be intubated. Later, the nurse paged the medical intern on call and informed him of the physician’s orders. Finnerty accompanied another respiratory therapist and examined the patient. She did not discuss her observations with the doctor, who directed James’ transfer to the ICU. She left to call the ICU for a bed reservation.
Later, one of the respiratory therapists came back with lab results indicating acidosis and insufficient blood oxygenation thus deeming the patient too unstable to be moved. Finnerty paged the resident on duty to help with the decision of intubating the patient. On arrival, Finnerty was assisting the respiratory therapists prepare for transportation. The resident found the patient cyanotic and needing to be intubated. She instructed the therapist to obtain the required supplies. Finnerty told the doctor that she could not intubate the patient on the floor and that the patient needed to be taken to the ICU. Even with the resident’s insisting on immediate intubation, Finnerty proceeded to unplug the bed and maneuver it out of the room. All personnel followed the patient as Finnerty and Lee took him to the ICU.
The transportation was without any device monitoring the patient’s cardiac status or crucial signs. Oxygen was given through a portable tank during the five-minute move. Upon arrival, the intubation was successful but the vital signs, which were normal when he arrived, began to fluctuate and the patient eventually died.
A couple of days after this incident, Finnerty’s employment at the hospital were terminated for the reasons aforementioned. The hospital’s reason for discharging her was also that she placed the put the patient’s life at risk by transporting him without a secure airway or a cardiac monitor. She argued that she did not get a direct order by the physician.
Her subsequent legal doing against the hospital was settled upon an agreement to cancel her termination in exchange for her acceptance to resign. In 2005, the Board of Registered Nursing filed an accusation alleging unprofessionalism, negligence, and misconduct and sought the revocation of Finnerty’s license.
LETTER TO ANA
Dear American Nursing Association,
Following the occurrence of this incident and based on these facts, Finnerty was more of a negligent nurse than a vigorous advocate. She replaced the judgment of the two attending doctors for her own clinical one. Her conduct resulted in a failure of provision of care or jeopardy of the client’s health costing him his life.
The ANA should formulate regulations that clearly define what nurses are required to do in an emergency. For example, whose decision should be final in an urgent situation? It should also give the penalties to be accorded upon breach of these policies. The association must also strive to ensure that the paradigms of nursing practice are met and that the nurses employed are competent.
Aside from this, ANA must also administer licenses to nurses only after overseeing exams, which must include practicals to observe how they would carry themselves in their career. Enforcement and interpretation of a state nurse practice act is also another thing they should consider.
Considering Finnerty’s incident, ANA has a duty to investigate the complaints regarding nurses’ compliance with the law of nursing practice and hold hearings for holders of licenses. The board must also determine as well as administer disciplinary actions on the basis of violation of the law. It is also their duty to advice nurses such as Finnerty with complaints filed against them by the state board of nursing. For instance, they can seek the services of the Association of Nurse Attorneys to provide the necessary referrals or resources.
In conclusion, though they state that they do not represent nurses involved in cases with boards of nursing of the state, this should be one of their responsibilities as a nursing association. They should also support nurses who raise concerns on behalf of patients who make reports about unsafe medical practices.
Veatch, R. M. (1977). Case studies in medical ethics. Cambridge, Mass: Harvard University Press.
National Council of State Boards of Nursing (U.S.). (1983). Practical nurse role delineation and validation study for the National Council Licensure Examination for Practical Nurses, National Council of State Boards of Nursing. Monterey, Calif: CTB/McGraw-Hill.
American Medical Association, American Medical Association. Southern Illinois University at Carbondale & Southern Illinois University at Carbondale. (2008). Code of medical ethics of the American Medical Association: Current opinions with annotations. Chicago: AMA Press.