Mike is running late again. The last time he spoke with his supervisor, he promised he would be on time. Mike even left his home 20 minutes earlier than usual, but there was an accident on his commute. The job is very important to Mike. He is the sole provider for his wife and newborn baby, but his supervisor told him that if he continued to be late he might face termination. Upon arriving, Mike observes a spill on the floor. He must make a decision: stop and make sure the spill is cleaned up or ignore it all together. If he safeguards the spill, surely he will be late clocking in and could face losing his job. Anyway, the spill is in another work area, and perhaps it will be cleaned up while he is clocking in. What decision should he make?

Mike stops in at the front desk to have housekeeping paged. Housekeeping routinely takes 3-5 minutes to arrive on site, but he does not have the time to simply wait. Using the telephone at the front desk, he calls to notify his supervisor that he is in the building, but needed to stop to assist with a spill in the main lobby. His supervisor thanked him for calling and asked Mike if the time could be made up at the end of his shift. Appreciatively, Mike agreed.

Mike decides to clock in so he does not face losing his job. He is making every effort to keep his job and cannot afford to be terminated. Besides, he has a list of things he needs to accomplish from yesterday in addition to his assignment for the day. Certainly someone else who is responsible for the area will take care of the spill soon.

Later, Mike is asked to go to a patient’s room to gather some patient information. He learns the patient was admitted to the hospital after falling in the lobby this morning. The patient is in a lot of pain and appears to have a broken hip from the injury. The patient goes on to describe the incident and asks him why this would happen in the hospital. She states, "I thought the hospital was a safe place. Don’t they have programs to prevent these things?"

A wave of guilt floods over Mike. He questions himself, “Could I have prevented this from happening?" Mike is now faced with a new dilemma. Should he admit to his supervisor what occurred upon his arrival to work this morning? What if by his admission, he is terminated anyway?

Mike is running late again. The last time he spoke with his supervisor, he promised he would be on time. Mike even left his home 20 minutes earlier than usual, but there was an accident on his commute. The job is very important to Mike. He is the sole provider for his wife and newborn baby, but his supervisor told him that if he continued to be late he might face termination.

Upon arriving, Mike observes a spill on the floor. He must make a decision: stop and make sure the spill is cleaned up or ignore it all together. If he safeguards the spill, surely he will be late clocking in and could face losing his job. Anyway, the spill is in another work area, and perhaps it will be cleaned up while he is clocking in. What decision should he make?

  • What are the potential risks associated with Mike's decisions?
  • In what ways might Mike’s decision impact both patient care and procedural policies?
  • What, if any, legal consequences might occur for both Mike and the hospital where he is employed?
  • If Mike called in to inform that he was on site, but would be late clocking in due to a spill on the floor in the lobby, would this be acceptable considering the most recent conversation about his attendance?
  • What, if anything, could Mike have done differently?
  • How much coaching and investment should be made for this one employee to perform the most fundamental functions of his job?
  • Are there additional considerations the manager should make?
  • Alternatively, if Mike did not communicate the spill with his supervisor or anyone else, what would this mean for his level of ethical consideration and risk management?
  • Could he be trusted to perform the essential functions of his position with sound judgment?

Additionally, a member of Risk Management viewed the video of the patient's fall as a part of documenting an incident report. Mike was noticed on the video passing by the spill just minutes before a guest slipped and fell down. He seemingly stared at the spill and appeared to slow down to consider possible risks. If Mike neglected to confess proper care for the spill after learning of the patient's fall, how would you address this?

The patient is preparing to be discharged, but there has been a spill that led to the patient falling. You now need to explain that the discharge will be delayed until a full assessment has been completed. Additionally, educational materials and instructions need to be provided to the patient. A family member is present to help with discharge and follow-up instructions due to a language barrier.



The patient is sitting in the room waiting for instructions and discharge orders. The patient is getting anxious, having already waited for some time, and wants to leave. The patient does not speak English and is having a difficult time understanding why an assessment needs to be done just for falling down.

  • Given that the patient speaks and understands very little English, what other forms of communication might be used to provide patient education?
  • How would you assess if the patient understands the discharge instructions?
  • How will the actions of the staff member either negatively or positively impact patient care and the patient care experience?
  • What ethical values or decisions did the staff member make that do not align with the patient education policy?