Although I feel that this could probably blow up on me, I will say that professional RNs are educated and required by their nurse practice act and SOP to obtain admission assessments and histories. The RN, if she/he is one, is responsible to not only take such relevant information down and be aware of the implications of it, he or she is also required to report these findings directly, by face or by phone, with a physician supervising the medical care of the patient and to in fact indicate that she has done so. He/she would be required, by professional practice, to communicate the potential concern to the nursing supervisor as well. Communication is vital in healthcare. We all know this. Also, if one doesn't document something, by law, it wasn't considered done. Knowing, however, that communication is vital for safe practice, he/she must follow-up on the given information in a timely manner and document that carefully as well. You'd think to at least cover her/his own butt, he/she would have included the date, time, and fact that she made the covering physician aware, what the doc's orders were and the effects of the interventions, if there were any ordered. You keep it simple, but it still has to be documented.
Everyone needs to function to the level of their SOP, always keeping best practices in mind. Supposedly the nurse was given this relevant information from the patient. If the nurse documented this fine, but the nurse is responsible to go beyond that. None of us practices in a vacuum. Part of his/her plan of action, interventions, and evaluation of those depends on her/him communicating such relevant and information to the physician in charge. It is b/c he or she can and should be held to maintaining the SOP by law under his/her licensure that he or she should then also document responses of the communicated information and medical plan from the physician.
It's a team mission caring for sick people and helping to maintain or optimize wellness for people. It's not about who is the ultimate boss. I can dig and do respect the physician in charge, and I have no problems communicating with her or him. I also have no problems documenting, b/c it's absolutely essential. It's about working together for the sake of the patients and others. At the very least, the nurse had an ethical, public-health responsibility to report this and document adequately. Personally, if I were the nurse manager and/or director over this nurse, he/she would be pulled in for administrative action. The nurse fell short of not only good sense, but what the law considers as her responsibility under her/his license. I'd be surprised if the nurse doesn't get some kind of disciplinary action if it proves true that she didn't report the information to the physician, document that information, and follow-up appropriately with it.
As for the physician, I'm not one yet; therefore, I will just report what the news shared, and that I personally feel that if people are educated to take relevant histories--and in light of the abundant news, they would pay special attention and ask relevant questions--following CDC guidelines. I wasn't there and I don't know what was going on with the physician. But I do think that the nurse had an obligation to report this information to the physician, if indeed he or she did not. If so, why the nurse didn't report and follow-up is beyond me. It's not like this Ebola business hasn't been media-blasted everywhere. But yea. Unless one was there or has all the pertinent information, it's unfair to state absolute judgments. In practice, we get stressed or become too comfortable. This scare should get people's attention though and make them think twice.
I also agree that this patient probably knew when he left Liberia that he was putting others at risk, but he probably was scared and wanted to hightail it out of there to the US ASAP. I mean, who wouldn't want to go where they would get the best care and the best treatments for survival? I think that is why he communicated this to the ED nurse after omitting that information before leaving Africa--that is, if all the information given proves true. He probably didn't expect the nurse or anyone else to drop the ball.
