You’re fired…the title alone brings chills to one’s spine. Chances are that you’ve hired and fired your fare share of people; perhaps the fit was not a good one, or performance was in question. Perhaps productivity, outcomes, ethics, or commitment was the problem. Like you, I’ve also hired and terminated staff in a diversity of professional settings. Never, however, was I more challenged than in firing a family member’s caregiver. Let me set the record straight. As a registered nurse, I am the primary caregiver, and rest assured that my intention, my heart, my focus, and my skills are top notch and in the right place. As a beneficiary of infusion care, the patient was assigned a home care nurse from a local agency (with alleged skills in infusion care), to complete blood draws, change a PICC dressing weekly, and take vital signs. Not wishing to upstage the assigned nurse, I held back, although he was aware of my credentials. I observed quietly, offered helpful feedback as deemed appropriate, suggested resources from the literature and Standards of Practice. When he crossed the line, stating that something that was clearly a safety issue and of utmost importance was, “not a problem,” I, too, crossed the line, called the service, and fired him. Outcomes matter…across the continuum of care.

When time and outcomes matter...It is a numbers game – outcomes that is!  Our western healthcare model is the best system in the world, when one needs tertiary care. As patients, we assume that admission to a healthcare facility or service ensures a good outcome, a safe environment, a quality patient experience. Unfortunately, that is not always the case, and mistakes do happen, things do go unnoticed, and desired outcomes are not achieved. Regardless of the clinical setting in which care is delivered, we, as nurses, care for individuals, families and communities.  Regardless of our best efforts, mistakes do happen. Patient safety is the number one priority in healthcare and nurses play a key role in building and sustaining cultures of safety in hospitals and healthcare organizations. While substantial progress has been made, patients still experience preventable harm. Nurses can transform healthcare and patient safety through leadership, education, advocacy, influence, direct care and interprofessional collaboration. They can speak up when they see something; they can have a voice. What I know is…all nurses should comply with established Scope and Standards of Practice to ensure positive outcomes. All nurses are held accountable, and yes, a home health nurse and agency can be fired.