liability that a nurse encounters on the job. It provides a discussion about the legal risks involved in various health care settings for nurses. There were eight sources used to complete this paper.
For years, there have been reports of a nationwide shortage of nurses. Hospitals, medical offices and nursing homes are constantly trying to attract nurses with better hours, better benefits and sign on bonuses, but the media continues to report a shortage of nurses in almost all areas. One of the reasons for the shortage may be nurses leaving the profession for various reasons including the liability that working as a nurse creates.
Nurses have many different duties regardless of the environment that they work in. They may be required to assess patients, take vital statistics, advise the physicians on the findings, handle patient phone calls and administer medications. Many of the duties that they perform carry a risk of liability to them (Ashby, 1997). There are several reasons that these duties increase the legal liability of the nurse. If a patient is treated by a nurse and that patient suffers illness, injury or death that can be related back to the treatment given by the nurse, the nurse may indeed be held liable. In addition to the possibility of nursing errors, there is a liability by the very virtue of the job itself.
Medication administration is one of the most time-consuming aspects of nursing practice (Ashby, 1997). Expertise in medication calculation and administration is essential to the treatment of all patients; however, many nurses experience difficulty when calculating medications. In this study, 56.4% of nurses could not calculate medications correctly in 90% of the problems, suggesting the need for regular self-testing of medication calculation skills. Continuing education programs implemented for identified medication calculation errors influences nursing practice and patient care outcomes (Ashby, 1997). "
The administration of medications creates a legal liability for the nurses who fill them and the nurses who give them.
Each time a nurse has to measure or administer medication to a patient he or she produces a legal liability. If the nurse mixes the medication incorrectly or administers it to the wrong patient there is legal liability. In addition to mistakes made directly by the nurse there are legal liabilities of the nurse that can be caused by other personnel. One of those with regards to medication is if the doctor orders the wrong medication. If this happens, the nurse may find himself or herself named in a lawsuit with an allegation that the nurse should have realized that the wrong medication had been ordered.
A second liability that the nurse may encounter is that the patient may have a bad reaction to the medications and blame the nurse. People have many sensitivities to medications and it is possible for a nurse to administer a medication that harms the patient. It doesn't mean the nurse was negligent, if the patient did not inform the nurse or the registrar of sensitivities. If the nurse follows orders and administers the ordered medication in a correct manner but the patient becomes ill or dies the nurse may be accused of negligence. When a patient is injured or dies there are many emotions involved. The family members are shocked and they have a desire to find fault with someone tangible. Each time a nurse administers medication he or she is exposing himself to legal liability.
There are many instances that can place a nurse under a legal liability risk.
In a recent study regarding medication issues in surgical nursing 100 surgical nurses were assessed to see what their rate of error when it comes to medication administration was.
A sample of 100 practicing medical-surgical nurses from a 380 bed hospital in the Midwest were approached to participate in the study. Over a 6-week period, 62 (62%) of these nurses consented to participate in the study and became study subjects. All subjects signed a consent form to participate in the study (Ashby, 1997)."
The primary question posed in this study was: How many practicing medical-surgical nurses lacked the skills necessary to calculate medications correctly in 90% of the problems? Test scores on the Bayne-Bindler Medication Calculation Test ranged from 45% to 100%. The median score on the test was 85% and the mean was 82%. Twenty-seven (43.5%) of the nurses attained a score of 90% or more on the medication calculation test. Thirty-five (56.4%) of the nurses lacked the skills necessary to calculate medications correctly in 90% of the problems (Ashby, 1997). "
The study concluded that surgical nurses make more errors in IV medications than in other types and that they make more errors than their non-surgical counterparts.
Nurses are keenly aware that they serve "as the final checkpoint in the system" for administering medications (Adams & Burleson, 1992). Nurses rely on professional and personal rituals, hospital policies and procedures, action plans, as well as advice from their colleagues to prevent them from making errors (Keill & Johnson, 1993). At times these preventive strategies fail, leaving nurses distressed by their mistakes and searching for additional tactics to prevent future errors (Ashby, 1997)."
Medication is not the only area of medicine that nurses place themselves in legal liability situations. There are several areas of the field that create a liability risk to those in the nursing profession.
Nurses place themselves at risk each time they perform their position, whether they work in a hospital setting, medical office, home health care or other environment.
In this extraordinary Pennsylvania case, nurses attending an obstetrical patient committed numerous violations of hospital policies in the treatment given a patient. The patient died. The patient's estate brought suit against the hospital under the doctrine of Respondeat Superior (Tammelleo, 2001). "
The above case illustrates several ways that nurses are risking legal liability in the course of their daily job. Human error in the nursing profession can have devastating effects. The impact can be life altering and irreversible.
One such case was a labor and delivery nurse who failed to recognize signs of PIH in a woman who arrived at the hospital in labor. The patient complained of a headache and had a family history of PIH but was kept waiting for several hours before being admitted by the nurses to the floor. To further complicate the situation the nurses, who were supposed to perform a complete evaluation every three hours, got busy and put it off until the woman was in a room for 14 hours without being examined. Her bp had been documented at 181/100 before she was admitted to the floor and still the nurses ignored her in the labor and deliver area (Tammelleo, 2001). She ended up with an emergency C-section due to the negligent care and monitoring by the nurses. She formed blood clots in her lungs and ended up in a coma in ICU. The labor and delivery nurses became defendants in a law suit. It didn't end there.
Throughout her stay in the ICU, the patient's endotracheal tube was consistently malpositioned. Further, the patient was not diagnosed with multiple pulmonary emboli, and the hospital's residents and nurses again failed to timely order appropriate deep thrombosis prophylaxis. The patient developed Adult Respiratory Distress Syndrome (ARDS) and died on January 4, 1994, at the age of 26(Tammelleo, 2001)."
The suit was brought against various nurses and doctors at the hospital.
This case and similar cases illustrate the importance of nurses following protocol for symptoms of serious situations. It also underscores what can happen to a nurse that fails to do so or allows a chain of events to cause harm to a patient.
The patient's estate brought suit against the hospital, and all non-hospital personnel who attended to the patient. Prior to trial, some defendants were dismissed. The plaintiff entered into a joint tortfeasor release with all of the remaining defendants except the hospital (Tammelleo, 2001). The case went to trial against the hospital. The trial court allowed the jury to hear evidence relating to the patient's entire course of medical care in order to render a verdict apportioning total responsibility among the hospital and the settling defendants (Tammelleo, 2001). In July 1999, an eight day jury trial culminated in a verdict in favor of the plaintiff in the sum of $1,100,000 which was comprised of a $200,000 award for the wrongful death action and a $900,00 award for the survivor action (Tammelleo, 2001)."
Nurses who find themselves in legal situations are often faced by expert witnesses on the stand who are former nurses renting themselves out to trial attorneys (Nursing, 1996).
There is not a nursing environment where a legal liability is a risk. Nurses who work in hospitals deal with patients who can be severely ill, those who work in a doctor office come in contact with chronically ill patients and those in the home healthcare setting often dealt with terminally ill patients.
There continues to be a shortage of nurses in America and…