NSG/547 Week 6: Termination and Employment Law, sample paper

When the Final Warning Is Not Enough: Terminating a Perioperative Nurse Lawfully, and the Employment Laws a Nurse Administrator Must Know Before Acting

[Student Name]

University of Phoenix

NSG/547: Human Resources Management

Week 6 Assignment

[Instructor Name]

[Date]

The hospital, its staff and the case are a composite written for a model paper.

In Week 5, a perioperative nurse received a written final warning after twice skipping the surgical time-out despite prior coaching. Three weeks later, the nurse was observed skipping the time-out again, in a case in which the wrong side was nearly prepped before a scrub technician spoke up. This paper describes the decision to terminate and the legal questions that had to be answered before acting.

Confirming the Grounds

The first question is whether termination is justified by the facts and consistent with policy. The behavior was observed by two people and documented the same day. It followed coaching and a written final warning that stated termination would follow another violation. The time-out is a hospital policy and an accreditation requirement, and the near miss shows the risk was real. Under the just culture framework used in Week 5, repeated conscious disregard of a known, substantial risk after coaching is reckless behavior that supports discipline (Marx, 2001). The director reviewed the file with human resources to confirm that all steps were documented.

Checking Consistency

The second question is whether the decision is consistent with how others have been treated. Human resources reviewed the past three years of discipline for universal protocol violations across the hospital. Two other nurses had received final warnings; neither repeated the behavior. No one had been retained after a repeat violation following a final warning. The decision is consistent. Consistency is the administrator's best protection against a discrimination claim, because unequal treatment of similar conduct is what such claims usually rest on.

Legal Check 1: Discrimination

Federal law prohibits employment decisions based on race, color, religion, sex or national origin (Civil Rights Act of 1964, Title VII, 2018), on disability (Americans With Disabilities Act of 1990, 2018) and, for anyone aged 40 or over, on age (Age Discrimination in Employment Act of 1967, 2018). The nurse is 58. The decision is based on documented conduct applied consistently, and nothing in the file refers to age or any other protected characteristic. Human resources confirmed that the nurse had not raised a discrimination complaint.

Legal Check 2: Disability and Accommodation

The director asked whether the nurse had disclosed any medical condition or requested accommodation that could relate to the behavior. None had been disclosed. If the nurse had disclosed a condition affecting judgment or memory, the hospital would have needed to consider whether a reasonable accommodation was possible before terminating, while still holding the nurse to safety standards.

Legal Check 3: Family and Medical Leave

The director confirmed that the nurse was not on, or recently returned from, protected family or medical leave, and had not requested it. Terminations close to protected leave invite claims of interference or retaliation and require especially careful review (Family and Medical Leave Act of 1993, 2018).

Legal Check 4: Labor Relations and Retaliation

The hospital's nurses are not unionized, but federal labor law protects employees who act together over working conditions, whether or not a union represents them (National Labor Relations Act, 2018). The director confirmed that the nurse had not recently joined with colleagues in raising concerns about surgeon pressure or working conditions. The nurse's reason for skipping the time-out, that one surgeon pressured staff to start quickly, was a safety concern the hospital had already taken up with medical staff leadership. Termination for the nurse's own violation is distinct from any retaliation for raising concerns, but the director documented that the surgeon's conduct was addressed separately, to make that distinction clear.

Legal Check 5: At-Will Status and Policy

The state follows at-will employment, but the hospital's policy on progressive discipline creates expectations about process. The hospital followed its own policy at every step, which matters because departing from one's own policy can undermine a termination even in an at-will state.

The Termination Meeting

The meeting was held privately at the start of the nurse's shift, with the director and a human resources representative present. It was brief and factual: the director stated the decision, the reason, the prior warning and the final observation; human resources explained final pay, benefits continuation and the return of hospital property. The nurse was given the opportunity to respond, and the response was recorded. The director did not debate the decision but listened. The nurse's access to systems was ended at the close of the meeting.

Documentation and Reporting

The termination letter restated the facts and the policy. The file contains the observations, the prior coaching and warning and the meeting notes. The state's nurse practice act requires employers to report terminations for practice that may endanger patients; after review with the hospital's legal counsel and the chief nursing officer, the hospital reported the termination to the board of nursing, stating facts without characterization.

If the Nurse Contests the Decision

The nurse may use the hospital's grievance process or file a complaint with an agency. The file, the consistency review and the legal checks prepared before the meeting are what the hospital would rely on. The director will not discuss the case with staff or references beyond confirming dates of employment and position, following hospital policy.

Unemployment and References

Whether the nurse receives unemployment benefits is decided by the state, not the hospital. Human resources will respond to the state's inquiry with the documented facts. Reference requests will be handled centrally by human resources to ensure consistent, lawful responses.

What the Administrator Learned

The case also prompted reflection on the system. The surgeon pressure that the nurse cited was real, and the hospital's response, addressing it through the medical staff and reinforcing support for anyone who stops a case, is as important as the termination. Holding an individual accountable for reckless behavior and fixing the conditions that invited it are both parts of a just culture (Marx, 2001).

Timing of the Decision

The decision was made promptly, within a week of the final observation, because delay after a safety violation sends a message that the rule does not matter, and because allowing the nurse to continue working in the meantime would have exposed patients to further risk. The nurse was placed on paid administrative leave during the review.

Supporting the Team

Terminations affect remaining staff. Without discussing the individual, the director reminded staff at a meeting of the time-out's importance and the support available to anyone pressured to skip it, and thanked the scrub technician privately for speaking up.

Conclusion

Termination was justified by documented, repeated reckless behavior after coaching and a final warning, and it was consistent with prior decisions. Before acting, the director checked discrimination, disability, leave, labor relations, retaliation and policy, conducted a brief, respectful meeting with human resources and documented and reported the decision as required. Treating the law as a set of questions to answer before acting protects patients, the organization and the employee's right to fair treatment.

References

Age Discrimination in Employment Act of 1967, 29 U.S.C. § 621 et seq. (2018).

Americans With Disabilities Act of 1990, 42 U.S.C. § 12101 et seq. (2018).

Civil Rights Act of 1964, Title VII, 42 U.S.C. § 2000e et seq. (2018).

Family and Medical Leave Act of 1993, 29 U.S.C. § 2601 et seq. (2018).

Marx, D. (2001). Patient safety and the "just culture": A primer for health care executives. Columbia University.

National Labor Relations Act, 29 U.S.C. § 151 et seq. (2018).