Legal Chapter 9-Nursing and the Law AND Good Samaritan Law – Flashcards
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Broadening Scope of Nursing Practice
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• Refers to permissible boundaries of practice for health care professionals, defined in state statutes, which define the actions, duties, & limits of nurses in their particular roles.
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Role of nurse continues to expand due to:
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- shortage of primary care physicians - ever-increasing specialization - improved technology - public demand - expectations within the profession itself.
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Requirements for Nursing Licensure
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- Reciprocity • agreement between states whereby a nurse licensing board in one state recognizes licensees of another state . - Endorsement • boards determine whether out-of-state nurses' qualifications are equivalent to their own state requirements at the time of initial licensure. - Waiver • When applicants do not meet all the requirements for licensure but have equivalent qualifications, the specific prerequisites of education, experience, or examination may be waived. - Examination • Some states will not recognize out-of state licensed nurses & make it mandatory that all applicants pass a licensing examination. • Suspension & Revocation
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Suspension and Revocation- violations may include:
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- procurement of a license by fraud - unprofessional, dishonorable, immoral, or illegal conduct - performance of specific actions prohibited by statute - malpractice.
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Practicing without a License
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• Health care orgs are required to verify each nurse's license is current. • Mere fact that an unlicensed practitioner is hired will not generally in & of itself impose additional liability unless a patient suffered harm as a result of an unlicensed nurse's negligence.
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American Nurses Association
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• National professional organization of graduate RNs. • Membership is available to all graduate nurses who are licensed in any jurisdiction of the United States.
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Purpose of the ANA is to:
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- foster high standards of nursing practice - promote professional & educational advancement of nurses & welfare of nurses to the end that all people may have better nursing care. • National League for Nursing • Purpose to foster develop & improve hospital, public health, & other organized nursing services & nursing education through coordinated action of nurses, allied professional groups, citizens, agencies, & schools.
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Nurse Anesthetists
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• Administration of anesthesia by a nurse anesthetist requires special training and certification. • Nurse-administered anesthesia was the first expanded role for nurses requiring certification. • Oversight & availability of an anesthesiologist are required by most organizations. • Major risks for nurse anesthetists include - improper placement of an airway - failure to recognize significant changes in a patient's condition - improper use of anesthetics
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Nurse Practitioners
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• RNs who have completed ed to engage in primary health care decision making. • Trained in delivery of primary health care & assessment of psychosocial & physical health problems such as the performance of routine examinations & ordering of routine diagnostic tests. • NPs negligence imputed to physician - See text case: Adams v. Krueger
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Clinical Nurse Specialist - I
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• Clinical nurse specialist is a professional RN with an advanced academic degree, experience, and expertise in a clinical specialty (e.g., obstetrics, pediatrics, psychiatry). • CNS acts as a resource for the management of patients with complex needs and conditions. • The CNS participates in staff development activities related to his or her clinical specialty & makes recommendations to establish standards of care for those patients.
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Nurse Midwife - I
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• Nurse midwives provide comprehensive prenatal care including delivery for patients who are at low risk for complications. • They often manage normal prenatal, intrapartum, & postpartum care. • Provided that there are no complications, normal newborns are also cared for by a nurse midwife. • Nurse midwives often provide primary care for women's issues from puberty to postmenopaus.
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Nurse Manager
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• Chief nursing officer has responsibility for: - maintaining standards of practice - maintaining current p & ps - recommending staffing levels - coordinating & integrating nursing services with other patient care services - selecting nursing staff - developing orientation and training programs. • Failure to supervise - can lead to disciplinary action
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Special-Duty Nurse
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• A health care professional employed by a patient or patient's family to perform nursing care for the patient. • If a master-servant relationship exists between the org & special-duty nurse, doctrine of respondeat superior may be applied to impose liability on the org for nurse's negligent acts
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Float Nurse
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• Nurse who rotates from unit to unit based on staffing needs. • "Floaters" can benefit an understaffed unit, but they also may present a liability as well if they are assigned to work in an area outside their expertise. • If a patient is injured because of a floater's negligence, the standard of care required of the floater will be that required of a nurse on the assigned patient care unit.
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Nursing Assistants
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• An aide who has been certified & trained to assist patients with activities of daily living under the direction & supervision of an RN or LPN. • Nursing assistants help with positioning, turning, lifting & performing a variety of tests * treatments. • Failure to follow policy & safe practices - patient scalded - patient falls - patient transfer
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Agency Staff
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• Orgs are at risk for negligent conduct of agency staff. • Important that org be sure that agency workers have necessary skills & competencies to carry out duties & responsibilities assigned by org.
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Student Nurses
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• Student nurses are entrusted with the responsibility of providing nursing care to patients. • Students are personally liable for their own negligent acts, & the facility is liable for their acts on basis of respondeat superior. • Student nurse are held to the standard of a competent professional nurse when performing nursing duties
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Medications Errors - I
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• Failure to administer drugs • Failure to document drug wastage • Administering unprescribed drugs • Administration of wrong drug • Failure to clarify orders • Ambiguous orders
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Medications Errors - II
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• Administering the wrong dosage • Negligent drug overdose • Administering Drugs by Wrong Route • Failure to Discontinue a Drug • Failure to Identify the Correct Patient • Failure to Note an Order Change
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Negligent Injection
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• Nurse negligently injected the tetracycline into or adjacent to the sciatic nerve, causing the patient to permanently lose the normal use of the right foot. - ED - Permanent injuries - Negligent injection of Tetracycline
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Failure to Follow Physician's Orders
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• Nurses caused permanent drop foot to the patient. • They failed to follow the doctor's verbal orders to watch the patient closely & to place him in one continuous passive motion machine at a time during physical therapy.
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Failure to Record Patient's Care
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Nurse admitted she failed to record site & mode of injection in ED records. According to testimony of two experts, failing to record this information is below standard of care for nursing. Although these omissions could not have affected administration of the injection, they tend to indicate that in this instance the nurse did not follow accepted procedure while performing her job.
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Failure to identify Correct Patient
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• Surgical staples removed-wrong patient Meena v. Wilburn - Chart was not checked - Wrist band was not checked - Wrist band was not checked against chart
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BURNS
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Negligent use of a Bovie plate led to liability in Monk v. Doctors Hospital, in which a nurse had been instructed by the physician to set up a Bovie machine. The nurse placed the contact plate of the Bovie machine under the patient's right calf in a negligent manner and the patient suffered burns. The patient introduced instruction manuals, issued by the manufacturer, supporting a claim that the plate was placed improperly placed. These manuals had been available to the hospital.
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Infections
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• Cross Contamination • Failure to Notify Physician • Failure to follow established procedures - Infection control - Sterile technique - Decubitus ulcers
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Example of Inappropriate Care - I
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• Plastic cup as arm guard? - Morris alleged from personal observation that the laceration to her daughter's arm was caused by the jagged edges of a plastic cup that had been split & placed on her arm to guard an IV site.
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Delay in Treatment
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• When minutes count! • Nurses Delay contacting obstetrician - Text Case: Howerton v. Mary Immaculate - Patient suffers - At trial, expert witness opined that labor & delivery room nurses should have immediately gone to the patient when they were notified of worsening pain, evaluate her condition, & notify her physician
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Failure to Follow Instructions
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• Failure of a nurse to follow the instructions of a supervising nurse to wait for her assistance before performing a procedure can result in revocation of the nurse's license. • Heart monitor was connected incorrectly & resulted in an electrical shock to the infant. • Dangers of electric cords are within the realm of common knowledge. • Record showed the nurse failed to exercise ordinary care in connecting the infant.
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TWO STANDARDS: WHICH IS RIGHT?
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• When faced with dilemma of 2 standards for rendering patient care, an org may find it more attractive to adopt the 1 least restrictive or labor intensive. This could prove to be a costly decision for both patient & org by increasing - the risk of patient injury - organization's exposure to corporate liability for any injury suffered from following the less restrictive standard.
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Failure to Monitor Vital Signs
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• Evidence presented indicated that the standard of care would require that fetal heartbeats be monitored every 10 minutes following removal of the fetal monitor. The evidence presented indicated that this did not occur.
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Failure to Report: Physician's Negligence
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• Note changes in patient's condition • Report changes in patient's condition - Prompt notification required - Physician failure to respond - Need to report "all" patient symptoms
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Failure to Question Discharge
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• Premature Discharge - A nurse has a duty to question the discharge of a patient if he or she has reason to believe that such discharge could be injurious to the health of the patient. • See text case: Koeniguer v. Eckrich • Failure to Question Discharge Swollen Beyond Recognition • The hospital's negligence is based on acts of omission, by failing to have the patient examined by a physician and by discharging her in pain. • The evidence presented a woman conscious of her last days on earth, swollen beyond recognition, tubes exiting almost every orifice of her body, in severe pain, and who deteriorated to the point where she could not verbally communicate with loved ones.
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Failure to Note Changes in Patient's Condition - I
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• Nurses have responsibility to observe the condition of patients under their care & report any pertinent findings to the attending physician. • Failure to note changes in a patient's condition can lead to liability on the part of the nurse & organization.
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Failure to Note Changes in Patient's Condition - II
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• Nurse assigned to monitor a postsurgical patient, left the patient, & failed to recognize the patient stopped breathing. The nurse had been assigned to monitor the patient in the recovery room. She delegated that duty to another nurse & failed to verify the nurse accepted the responsibility.
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Prompt Notification Required
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• Physician inserted a catheter into the wrong artery in the patient's right leg. This compromised the blood flow to the leg, causing loss of pulse & sensation. • This error was compounded when hospital nurses on the patient's floor were unable to reach the physician for 6 hours & never attempted to reach a backup physician, to alert them of the patient's deteriorating condition. - See text case: Cuervo v. Mercy Hospital, Inc.
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Failure to Report Deteriorating Condition
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• An organization's policies & procedures should prescribe guidelines for staff members to follow when confronted with a physician or other health care professional whose action or inaction jeopardizes the well-being of a patient. - See text case: Goff v. Doctors General Hospital
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Failure to Report Patient Symptoms
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• Hospital's nurse was negligent in failing to inform the physician of all the patient's symptoms, to conduct a proper examination of the plaintiff, & to follow the directions of the physician. - See text case: Citizens Hospital Association v. Schoulin
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Timely Reporting of Patient Symptoms
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• Court held that there was sufficient evidence to authorize the jury to find that the nurse was negligent in failing to timely notify the physician that delivery of plaintiff's child was imminent. This delay resulted in an unattended childbirth with consequent injuries. The trial court had awarded the plaintiff $15,000.
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Failure to Report Defective Equipment
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• Failure to report defective equipment can cause a nurse to be held liable for negligence if the failure to report is the proximate cause of a patient's injuries. • The defect must be known & not hidden from sight.
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Failure to Correctly Transcribe Telephone Orders
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• Periodic contradictions between what physicians claim they ordered & what nurses allege they ordered. • Orders should be read back for verification purposes. • Questionable orders must be verified with prescribing physician. • Physicians must authenticate their verbal order(s) by signing the written order in the medical record. • Nurses who disagree with a physician's order should not carry out an obviously erroneous order. • Report to the supervisor concerns with a particular order.
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Switching Infants
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• Inadvertent or negligent switching of infants can lead to liability for damages. Damages in the amount of $110,000 were awarded for the inadvertent switching of two babies born at the same time in De Leon Lopez v. Corporacion Insular de Seguros. • Follow org p & p in patient identification process. • Always verify infant's identification badge with mother's
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Patient Falls & Restraints
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• Among senior citizens, falls represent the fifth leading cause of death, and the mortality rate from falls increases significantly with age. • Text cases - Proper use of Restraints - Failure to Raise Bedrails - Patient Fall: Safe Procedures Followed - Fall from Examination Table
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Negligent Care - I Brandon v. HMA, Inc. v. Bradshaw
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• Failure to - properly monitor patient - report vital information to patient • Allowed condition to deteriorate - to critical stage - before implementing urgent care - Implementing life support
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Improper Sterilization
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• The patient in Howard v. Alexandria Hosp. brought a medical malpractice action against the hospital, seeking damages arising out of an operation performed with unsterile instruments. • Nurse in charge of the autoclave used to sterilize instruments was alleged not to have properly monitored the sterilization process. - See text case: Howard v. Alexandria Hosp
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review questions....
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1. Describe how the scope of nursing is changing. 2. Describe how the roles of a nurse anesthetist, clinical nurse specialist, nurse practitioner, and nurse midwife differ. 3. Describe the various medication errors that can occur in the administration of medications. 4. If a nurse disagrees with a physician's written orders, discuss what action the nurse should take to protect the patient's safety. 5. Discuss why it is important to report significant changes in a patient's condition to the treating physician.
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Good Samaritan Law
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-Liability for emergency medical assistance by medically trained persons -Immunity from law suit
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Emergency Medical Assistance
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1. Care given in a place not usually where care is available 2. Given voluntarily without expectation of pay 3. If care is not given, patient would have serious physical impairment or death 4. Medically trained person licensed in US to practice medicine - MD, DO, RN, EMT, Dr. of Chiropractic 5. Qualified by Am Red Cross within 3 years 6. Victim cannot sue unless acts of omission violate reasonable professional care under the circumstances 7. Person giving care need not arrange for further care nor follow-through 8. Does not establish doctor - patient relationship
