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Hospitals Should Review Joint Commission Standards in Light of DC Nurse Firings

Scott Wallask, for HealthLeaders Media, March 8, 2010

The firings of 15 nurses and six other essential personnel by Washington (DC) Hospital Center for failing to show up to work during blizzards opens the door to discuss what The Joint Commission expects of hospitals and staff during an emergency.

The staffers, who have been fired, called in when storms dumped more than 40 inches of snow on the DC area between Feb. 5 and Feb. 11. Hospital officials said they offered transportation for the nurses and also alerted staff beforehand that they should make accommodations, such as staying at the hospital, when the storms hit.

Nurses United of the National Capital Region, a union that represents nurses from Washington Hospital Center, has filed a labor grievance with the facility over the firings.

Joint Commission emergency management standard EM.02.02.07 comes into play with this situation. The standard sets a variety of provisions on how a hospital manages staff roles and responsibilities during a disaster. The idea is that an organization and its workers must be able to adapt from normal routines when dealing with an emergency.

Some specific provisions that might have been considered by area hospitals during the blizzards include the following:

  • A facility's emergency operations plan must describe how the hospital will handle staff support activities, including housing, transportation, and mental health. In other words, it may fall to an organization to find sleeping quarters for employees who get stranded at the hospital because of inclement weather, and a facility may also need to consider whether it will travel out to workers' homes to pick them up. To accommodate workers who spent the night at Washington Hospital Center during one of the storms, the facility offered 7,300 meal vouchers and found sleeping arrangements for 2,200 workers at various times.

  • The emergency operations plan must describe how the hospital will support the needs of employees' families, including child care, elder care, communication, and pet care. Clearly babysitting services, which appear to have played a role in at least some of the absenteeism at Washington Hospital Center, are a big concern to address ahead of time in The Joint Commission's eyes. About 250 nurses at Washington Hospital Center didn't arrive for their shifts during the storms, The Washington Post reported. It seems likely some of the nurses who didn't get fired had childcare issues that were taken into consideration, although it's not clear how much leeway was granted in that regard.

Another Joint Commission standard requires hospitals to annually review the findings of their "hazard vulnerability analysis." This analysis weighs the risks of a given emergency against the likelihood of it happening, and then ranks the resulting consequences.

The Washington Hospital Center situation should prompt all medical facilities to reconsider any findings in the hazard vulnerability analysis that hinge on staff members showing up to work. Weather-related emergencies would be one area to review again with a critical eye in the analysis, but also look at terrorist threats that could lead to worried workers either staying with family members or avoiding public areas, such as hospitals, out of fear of follow-up attacks.


Scott Wallask is senior managing editor for the Hospital Safety Center. He can be reached at swallask@hcpro.com.

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