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10 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G S E P T E M B E R 2 0 1 5 CALIFORNIA I n september, registered nurses in California won an important legal victory when a state appeals court decided that RNs who speak up and advocate for their patients and their own licenses under the California Nursing Prac- tice Act are indeed protected by and can sue employers under state whistle-blower laws. While courts have found in favor of RNs before in similar cases, this was the first such decision to be officially published by a court, meaning that the case can be cited by other nurses as precedent, or the rule, by which all other situations should be decided. While this particular decision simply allowed a nurse's lawsuit to move forward and the actual case must still go to trial, workers' rights attorneys are calling it a big win for healthcare workers because the published opinion means that similar lawsuits will now make it to court and cannot be easily dismissed. With this deci- sion, hospitals and other healthcare institu- tions may think twice before retaliating against employees who speak out on behalf of patient care and safety because they may need to defend their actions in court. The decision from the Fourth Appellate District of the California Court of Appeal, titled Nosal-Tabor v. Sharp Chula Vista Medical Center, came about after Karen Nosal-Tabor, an RN at Sharp Chula Vista Medical Center, a hospital near San Diego, was fired for refusing to conduct cardiac stress tests on patients without a cardiologist physically present or very close by, and with- out a standardized procedure as required by the California Board of Registered Nursing when RN practice overlaps onto what might be considered the practice of medicine. Nosal-Tabor, who had worked at the facility for more than 20 years, had never even been written up for anything in her career with Sharp Chula Vista and even won a systemwide caring award in 1993. As the only full-time RN in the cardiac stress lab since 2002, Nosal-Tabor grew increasingly worried for the safety of her patients, 90 percent of whom were coming directly from the emergency department with heart problems. Though certain cardiologists would sometimes attend the testing of their patients and she always requested that they be present, cardiologists around 2004 stopped coming to the tests. She recognized that she herself had not had any formal train- ing, nor her competency to perform such tests on her own evaluated. She was also dismayed that many of these same patients were being discharged without a cardiologist actually having read their test results. She was performing about six to eight tests every shift. "It was totally, completely dangerous," said Nosal-Tabor in a recent interview. "I've done stress testing a long time, and it has induced heart attacks. That's what we're doing." In her time in the lab, she has witnessed several myocardial infarctions, and multiple respiratory arrests from the chemical version of the stress test. After doing lots of research into what was required by the BRN before nurses could perform such procedures and how other hospitals conducted their tests, Nosal-Tabor started objecting to the practice by bringing up the issue with her manager and supervisors. They responded in a haphazard way, but still never fulfilled the standardized procedure requirements of the BRN. She decided to formally file a compliance report in October 2011, and the following week was disci- plined for a whole list of supposed offenses. Her union, United Nurs- es Associations of California (UNAC), offered no help. After more disciplinary actions and being put on administrative leave, Sharp fired Nosal-Tabor in April 2012. By that time, Nosal-Tabor had already sought the advice of local employment law attorney David A. Miller. Miller said he was impressed with Nosal-Tabor the moment he heard her story because she had tried so hard to correct the problem within her employer's proper channels before going to him. "I appreciated her professionalism and her diligence," said Miller, who notes that his office has seen a huge uptick in the number of complaints brought by healthcare workers against employers. "She is what nursing requires: caring concern, pursuit of knowledge, making sure what you are doing for your patients is the best." After she was fired, Miller brought a civil suit against Sharp under various state codes intended to protect whistle-blowers. The hospital asked the court to dismiss the case, claiming that it did comply with the standard- ized procedure rule, and the judge did. Nosal- Tabor next appealed to a higher court, which found in her favor and published its decision. Miller said that "there's been so little law showing us how to interpret or apply the nursing practice act. I'm glad this decision is going to help people, and help the people who are helping us. Particularly in the healthcare industry, you need to know that you are protected if you speak up for patients if you see something wrong." Nosal-Tabor said she will be glad to get her day in court and that she just wanted the hospital to stop putting patients in danger. "Our number one job is to be patient advo- cates and protect patients; to do the right thing," she said. "You always have to, at the end of the day, do the right thing to protect people." —Lucia Hwang NEWS BRIEFS Major legal victory for California RNs