As a healthcare employer, you are required to ensure you properly implement policies and procedures that are in accordance with the Nursing Practice Act (Bus. & Prof. Code, § 2700 et seq.). In particular, the NPA allows nurses to perform certain functions designated as the “practice of medicine” so long as they are prescribed pursuant to a hospital’s standardized procedures (Bus. & Prof. Code, § 2725 subd. (c).).
The Board of Registered Nursing and the Medical Board of California provide guidelines that govern the content of such procedures, and hospitals must operate in accordance with these guidelines. The standardized procedures must contain specific elements and are required to be adopted by the organization prior to being implemented. If a hospital’s policies and procedures are not clearly defined and exercised as required, this can result in nurses engaging in the illegal practice of medicine.
This particular issue was addressed in Nosal-Tabor v. Sharp Chula Vista Medical Center1. In Nosal-Tabor, the California Court of Appeals overturned the trial court’s grant of summary judgment in favor of the defendant, Sharp Chula Vista Medical Center. The California Court of Appeals ruled that a jury could find in favor of the plaintiff nurse, Karen Nosal-Tabor, for wrongful termination and workplace retaliation. Read on to learn more about the case and how to protect your organized health care system from being sued.
Nosal-Tabor v. Sharp Chula Vista Medical Center Factual Overview
Karen Nosal-Tabor (“Nosal-Tabor”) was a registered nurse (RN) previously employed by Sharp Chula Vista Medical Center (“Sharp”). Nosal-Tabor worked in the cardiology department and performed “nurse-led” cardiac stress testing. A physician was not required to be physically present during this testing.
Nosal-Tabor refused to perform the cardiac testing on several occasions, believing that it constituted the unlawful practice of medicine, because Sharp had not adopted legally adequate standardized procedures for nurses to administer the tests. Sharp insisted that it did, in fact, implement such standardized procedures. Believing that Sharp’s procedures were inadequate, however, Nosal-Tabor continued to refuse to perform the nurse-led stress tests. Her employment was later terminated. Nosal-Tabor filed suit against Sharp for wrongful termination and improper workplace retaliation.
Trial Court Ruling
The trial court granted Sharp’s motion for summary judgment against Nosal-Tabor, concluding that she failed to present “credible evidence that the Standardized Procedures in place at the time of her termination were insufficient.”
California Court of Appeal Holding
Nosal-Tabor filed an appeal arguing that the trial court erred in granting Sharp’s motion for summary judgment. The Court of Appeal reversed the lower court’s decision, holding that the trial court erred in granting summary judgment for Sharp. The Court of Appeal analyzed the documents that Sharp stated were appropriate standardized procedures and concluded that Sharp’s documents failed to include several key elements required by the Board of Registered Nursing and Medical Board of California guidelines.
For example, the court found that Sharp’s procedures lacked a method for evaluating the competence of the registered nurses authorized to perform the cardiac stress tests. In addition, the procedures did not specify a method to maintain a written record of the nurses authorized to perform those tests. Furthermore, the procedures did not provide a method for periodic review. Sharp’s procedures failed to include more than a quarter of the elements required for standardized procedures.
Based on the evidence presented, the court held that a reasonable juror could find that Sharp wrongfully retaliated against Nosa-Tabor for refusing to perform the nurse-led tests, which were in violation of legal guidelines, and wrongfully terminated her employment.
Contact California Health Care Law Attorney
Medical entities are required to ensure their standardized procedures regarding nurse-led medicine is in accordance with Board guidelines. More standardized procedures may come under scrutiny in the future as nurses exercise roles reflecting the practice of medicine. Health care entities should review their standardized procedures on a regular basis to ensure compliance with Board guidelines. If a nurse files a complaint regarding the lack of procedures, it should be taken seriously and addressed as soon as possible.
1 2015 WL 4608224 (filed on August 3, 2015 and ordered published on August 27, 2015).