Read the following case information to draft a memo for this assignment: Human Resource Case Study.

Draft a memo of no more than eight hundred words for the CEO of the hospital to explain at least five of the potential HR issues involving Nurse Cusack, Nurse Minor, Nurse Albert, and the HR department. The memo may be in a list format, identifying the issues and then providing a recommendation on any action to take against the employment of either Nurse Cusack or Nurse Minor.

In the memo, do not address any potential tort or criminal actions. The CEO at this point in the process is only interested in HR issues.

Human Resource Case Study

You are the risk manager for your facility. Your duties include interfacing with other departments in your facility when you have issues involving their staff. You regularly work with the HR staff when issues you uncover in your cases involve current staff.

Your facility is working diligently to improve its standing in the region. You and your fellow administrators are expanding the services that you provide. You have been providing neurosurgical services for quite some time and have a good reputation in the area for your neurosurgical teams performance. In order to retain the best neurosurgeons in the area, you are also enhancing the services provided in your intensive care unit (ICU). At their request, more equipment has been purchased and additional services have been provided since 2015.

In June 2014, Sam Lawson was admitted to your hospital. He was an active 67-year-old husband, father, and grandfather. Despite his age, he still worked regularly as a consultant for the engineering firm he started years before. He enjoyed a fairly good income from his work. In April 2014 he began having headaches. Following an MRI, it was determined that he had a brain tumor. The morphology and other tests revealed that it was most likely benign. He was to undergo surgery for the removal of the benign brain tumor. His prognosis for full recovery was very good.

Dr. Belmont was his neurosurgeon and is a cautious provider. Dr. Belmont was concerned about the possibility of Mr. Lawsons brain swelling following surgery. Therefore, Dr. Belmont placed an intracranial pressure (ICP) monitoring line into the ventricles of his brain. This line allowed the nursing staff to monitor the pressure in Mr. Lawsons brain. They were to alert Dr. Belmont if there were any increases in the ICP beyond acceptable parameters set in the postoperative orders written by Dr. Belmont. Mr. Lawson also had orders for IV morphine for pain or agitation.

After Mr. Lawsons surgery he was sent to ICU. He had orders for monitoring of his vital signs and ICP every 15 minutes for the first hour then every half hour thereafter. In this facility, this intensive monitoring is the standard and followed policies for ICP monitoring. Mr. Lawsons initial postoperative hours were uneventful. He was cared for by a very conscientious nurse, Nurse Albert. At shift change from day shift to evening shift, Nurse Albert noted that she was to be followed by Nurse Cusack. Nurse Cusack would not have been Nurse Alberts initial choice, but she knew that the ICU was short-staffed and there were numerous temporary staffing agency nurses working that evening. Nurse Albert knew that Nurse Cusack had a history of being written up for tardiness, excessive break times and attitude issues. She also did not consider her the most attentive nurse in the ICU.

As part of the patient hand-off, Nurse Albert reported Mr. Lawsons condition to Nurse Cusack. During this transfer discussion, Nurse Albert noted that Nurse Cusack appeared tired, which Nurse Cusack brushed off as a busy day before reporting for her evening shift. When pressed for more assurance by Nurse Albert that she was OK, Nurse Cusack became agitated and said that she was fine. Nurse Albert was concerned but this behavior was the norm that everyone had come to accept for Nurse Cusack, and she chalked up her behavior to Nurse Cusacks explanation that she had had a busy day.

Nurse Cusack assumed Mr. Lawsons care. She did his initial vital signs and ICP reading and seemed to be attentive for the first few hours of the shift. Nurse Minor, the charge nurse, was making rounds that evening. When checking Mr. Lawsons charting, she noted that a set of vital signs and ICP reading had not been recorded for over 40 minutes. Nurse Cusack was not in the patients room so she started looking for Nurse Cusack and found her as she was exiting the bathroom. She seemed a bit confused by Nurse Minors concerns and went back to Mr. Lawsons room. The ICU got very busy and Nurse Minor spent most of the rest of the evening dealing with issues related to the agency nurses and their need for extra attention.

Near the end of the shift, the ICU staff responded to a call for help coming from Mr. Lawsons room. He was unresponsive and one of his pupils was larger than the other, which is an indication of pressure building up in his brain. The ICP monitor had not alarmed. Nurse Cusack exclaimed that the alarm must not be working. When his ICP was checked, it was found to be far above the acceptable range established by Dr. Belmont in the postoperative orders. Dr. Belmont looked at the charting of the vital signs and ICP. All of the vital signs and ICP readings that were recorded appeared to be normal. He could not explain the sudden rise in Mr. Lawsons ICP.

You are now performing a root cause analysis to help determine what happened with the ICP monitor and the events of that evening. During her participation in the meeting, Nurse Cusack breaks down and starts crying. That is when the real story comes out. She has been a morphine addict for years. She states that Nurse Minor is aware of her problem and has been helping her cope with her addiction. Nurse Minor used to work in a drug rehabilitation unit. The evening of Mr. Lawsons surgery, Nurse Cusack was personally using Mr. Lawsons morphine. She had inserted a heparin lock (sometimes called a saline lock) into her leg and hid it with her scrubs. She would sign out Mr. Lawsons morphine then go to the bathroom and inject it in her heparin lock. Nurse Cusack believes that Nurse Minor watched her patients more closely than those of the other nurses. She thinks that is why Nurse Minor found the missed set of vital signs and ICP reading and went looking for her. Once she realized that she was being watched that evening, she fabricated a set of vitals and an ICP reading for the set that had been missed. Because she was actively using morphine that evening, she was not monitoring or recording the vital signs and ICP as ordered. When she noted late that evening that Mr. Lawson was unresponsive, she fabricated the vital signs and ICP readings making it look as if she had been performing the required checks and that all of them had been normal.

You contact HR in order to determine what is in Nurse Cusacks employment file. There is no reference to any disciplinary actions. It is immediately apparent that Nurse Cusack has never been caught using morphine at work. Her performance evaluations are average to poor with occasional reference to not returning from her breaks in a timely manner. She has never been on corrective action. Her license is in good standing. Nurse Minor is still your employee. You request her employment file too. Her file is unremarkable.