Poor leadership in a surgery center can lead to dire consequences. Here is an example of what happens when a surgery center administrator is too casual and friendly with nurses or other staff:

“We had an instance where a nurse decided to play doctor,” says Beverly Kirchner, BSN, RN, CNOR, CASC, chief compliance officer at SurgeryDirect in Denver. “When someone is the preadmission nurse, interviewing patients, and getting their disease history, it’s easy for the nurse to come back and decide the patient needs something.”

However, the nurse must contact the physician first. In this case, the nurse skipped that step. “We had a preadmission nurse one time who discovered the patient had a heart condition. She decided to have the patient get an ECG and cardiac clearance before the patient arrived at the facility,” Kirchner recalls.

The nurse had crossed the line of playing doctor without a license. “When this didn’t go her way, [the nurse] went to the medical director and manipulated the medical director against the physician,” Kirchner says. “That leader was very close to the nurse, and it was a struggle for her to separate what needed to be done vs. the friendship.”

The medical director had been friendly and loving to her staff, but she crossed the line between leadership and friendship. This created an atmosphere in which this particular nurse felt empowered to make decisions beyond her scope of responsibility. Then, the whole situation went from bad to worse. Not only did the patient not need cardiac clearance, he became quite irate about his whole situation — to the point of threatening to bomb the facility.

In the end, although there was no bomb or any harm, there were repercussions. The patient had to answer to law enforcement. Meanwhile, both the nurse and medical director eventually left the facility, their nursing licenses were jeopardized, and their friendship was destroyed.

“If the nurse thought the patient did not meet our admission criteria due to heart disease, she should have gone back to the surgeon,” Kirchner says. “This was a tragic incident that occurred ... had [the medical director] been a good leader and set boundaries, it wouldn’t have happened.”