In a question of ethics, student suspended over medical scrubs

(Concord Monitor) All Heather Stickney wants is to be a nurse.

Stickney, 30, has dreamed of working in an operating room as a first assistant to a surgeon since she was a teenager. She’s currently a licensed nurse’s assistant and is a little more than one semester away from finishing a program at NHTI that would qualify her to sit for her licensing exam and become a registered nurse.

But since early last month, her dream has been on hold and may be in doubt.

Two years into the program, Stickney was suspended last month after taking home scrubs she had worn during a rotation at Catholic Medical Center. If her appeals of the suspension are rejected by college administrators, she may not be able to afford to start the year over again in the fall, and doesn’t know when or if she could earn her degree, she said.

Her professor and clinical adviser failed Stickney on the grounds that she had stolen the scrubs and then lied about it. Stickney says it was a misunderstanding, citing an unblemished academic record and testimonials from other students and nurses. Her first appeal to the department chairwoman was denied, but she’s filed for a second with another administrator.

“My clinical skills are exceptional. I have never once made an error,” she said. “My career could be over, all over a pair of scrubs. It just doesn’t make sense to take someone who could be a really great nurse away from patients who I could help.”

Stickney’s path toward a degree has been a long one.

She first decided to become a nurse after seeing the care her father had received when he was diagnosed with cancer 15 years ago.

“Those nurses were there with him when we had to leave. I want to be the person who is there for my patients. Their families can’t always be there, but I can, and I can be an exceptional nurse. They are keeping a great nurse from patients who could benefit from my skills,” she said.

After she graduated from Manchester Central High School in 2001, and after cancer treatments exhausted her parents’ assets, she scraped together money on her own to pay for college applications.

NHTI’s reputation as one of the best nursing schools in the state put it at the top of her list. She spent one semester there before she was overwhelmed trying to work enough hours to pay for tuition and living expenses. She started again a few years ago, completed her general studies requirements and started the nursing program.

Her skills during the clinical rotation were especially good, she said, because it was the second time she’s taken the course. Last fall, not long before the end of the year, she had to stop attending class for a medical leave when doctors found she had a severe endometriosis. She had to pay in full for that semester, even though she didn’t get academic credit because she hadn’t finished.

But at the foundation of her clinical skills is her desire to care for patients, her friends and fellow nurses wrote in letters supporting her appeal.

“I would trust Heather with my life, and my children’s life,” Erica Kowalski wrote.

Another friend left the nursing program after observing nurses who “seemed to be unpleasant people who did not enjoy their jobs.”

“Heather is one of the few people whom I have met who I feel genuinely cares about her patients,” Taury Anderson wrote. “Heather’s enthusiasm for the task of being a nursing student and her impressive capacity for applying her text book knowledge has always astounded me. If anyone was meant to be a nurse, she is.”

NHTI spokesman Alan Blake said student privacy-protection laws prevent him and other administrators from discussing individual cases, but that the college has “a significant chain of appeals process to remove what might become personal biases or unresolvable differences in communication.”

What exactly happened the day Stickney took the scrubs depends on who’s telling the story. During her clinical rotation on Nov. 8, Stickney alerted staff to the deteriorating condition of a patient, who was rushed to emergency surgery. Staff allowed her to borrow a set of operating room scrubs from the hospital linen department and observe the procedure.

“I was on cloud nine,” she said. “It was just the best day.”

She said she wanted to keep the scrubs as a memento, but her clinical advisor Karen Tetreault said she had to return them.

When she went down to the linen department, Stickney told the man she found there about her day, and again asked if she could keep the scrubs. He said yes. She went back to her classmates and Tetreault, who asked her if she still had the scrubs, Stickney said.

She said she thought Tetreault was joking, and that it was obvious that the scrubs were stuffed in her jacket.

Tetreault did not return a phone call for this story, but Stickney provided the Monitor with Tetreault’s own written synopsis of the incident submitted in the first appeal.

It turned out the man Stickney spoke to didn’t work in the linen department, he was just there on his break. He told Tetreault later that he thought Stickney meant she would return the scrubs the next day.

Tetreault said in her report the scrubs were hidden and it wasn’t until she went to the linen department that she knew Stickney still had them. Six days later, she gave Stickney an administrative failure in her evaluation, which suspended her from the class, and the nursing program.

“I briefly discussed the event with the student and informed her that she would be receiving a clinical warning at the very least,” Tetreault wrote. “I also questioned that if she chose to lie about scrubs would she also lie about a med error or other patient incident.”

That’s the line all nursing educators and supervisors walk, wondering when a mistake is a mistake – or a character flaw that could put patients at risk.

Character matters

Sometimes, conversations about ethical dilemmas are explicit in nursing classes. Gene Harkless has been teaching nursing at UNH for 27 years and is the department chairwoman. When her class discussed the recent accusations of drug diversion at Exeter Hospital, they talked about how and when a nurse should report a colleague suspected of diverting medications, or a supervisor who made a judgment they disagreed with.

Every case is judged on its own merits, especially against the concerns about whether patient safety is at risk, but “basic dishonesty and stealing are generally accepted in our community as something you don’t do,” Harkless said.

“When you understand the work of nurses, you understand we work at the direct interface of care with patients, at their most vulnerable moments,” she said. “We work in individuals’ homes, we have access to addictive substances. We’re there to enact and follow and adapt plans of care. We are the fulcrum of care. We must be trusted, we must have our actions align with our voice. We cannot have a mistrust in the nursing realm.”

Kathleen Polley-Payne, associate dean of nursing and chief nurse administrator at Southern New Hampshire University, agreed that the standards can seem high and the discipline inflexible, but it’s for a reason.

“We tend to err on the side of caution because we worry that nurses care for patients when they are at an extremely vulnerable time. We have to know your character is unimpeached,” she said.

“We all make errors, but will you come right out and tell somebody? The most important thing is how do we fix the error for the patient.”

In her 32-year career as a nurse and nursing supervisor, she said no one incident has led to a nurse or student’s suspension unless that person did something egregious like bringing a weapon to work or striking a patient.

“It would be so much easier if it were all clear, that if you do this, this will happen, but just like every patient is unique, every circumstance is unique,” she said.

“Nursing as an industry struggles with this, but the fear is really that patient who cannot speak for themselves, cannot advocate for themselves and the thought that a nurse could do something wrong and not tell the truth about it.”

An annual poll of which profession Americans trust the most was released on Monday, with nurses earning top marks for the 10th straight year.

“Nurses are very aware of the Gallup poll, and we are all very proud of the public’s trust in us,” Polley-Payne said. “That is just another reason we are so protective of our patients.”

Stickney said patient care is the reason she wants to get back to class and keep working for her degree. As a licensed nurse’s assistant, she can check patients’ vital signs and dressings on wounds, but she can’t administer medication or oversee any procedures.

“It’s just out of line with my skills now. I can do so much more and I may never be able to, because of a misunderstanding about a pair of scrubs,” she said. “The punishment just doesn’t fit the crime.”

If her latest appeal is not granted, she’s not sure if she can afford to start over next year, she said.

Even if she does prevail, she’s in an uncertain position, trying to catch up on the course work she’s missed, including a test and several lectures. She’s still studying for the final exam on Wednesday, just in case.

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