Legal Liability in Nursing: Risks and Responsibilities

Introduction: Nursing Liability and the Shortage Crisis

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 reports of shortages persist across almost all areas. One of the reasons for the shortage may be nurses leaving the profession for various reasons, including the legal liability that working as a nurse creates.

Nurses have many different duties regardless of the environment in which they work. They may be required to assess patients, record vital statistics, advise physicians on findings, handle patient phone calls, and administer medications. Many of the duties they perform carry a risk of liability (Ashby, 1997). If a patient is treated by a nurse and that patient suffers illness, injury, or death that can be traced back to the care given, the nurse may be held liable. In addition to the possibility of nursing errors, there is a liability inherent in the nature of the job itself.

Nursing as a profession carries unique legal exposure precisely because nurses serve as a critical interface between patients and the broader healthcare system. Understanding these risks is essential for anyone entering or already working in the field.

Medication Administration and Legal Risk

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. Continuing education programs implemented to address identified medication calculation errors can positively influence nursing practice and patient care outcomes (Ashby, 1997).

Each time a nurse measures or administers medication to a patient, a potential legal liability is created. 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, legal risks can also arise from the actions of other personnel. For example, if a physician orders the wrong medication, the nurse may still be named in a lawsuit on the grounds that he or she should have recognized the error.

A second liability arises when a patient has a bad reaction to a medication and blames the nurse. People have many sensitivities to medications, and it is possible for a nurse to administer a medication that harms the patient through no act of negligence — for instance, when the patient did not inform the nurse or the admitting staff of known sensitivities. Even if the nurse follows orders and administers the medication correctly, the patient's illness or death may still result in an accusation of negligence. When a patient is injured or dies, family members are often in shock and seek to assign blame to someone tangible. Each time a nurse administers medication, he or she is exposed to potential legal liability.

A study examining medication issues among surgical nurses assessed 100 surgical nurses to determine their rate of error in medication administration. A sample of 100 practicing medical-surgical nurses from a 380-bed hospital in the Midwest were approached to participate. Over a six-week period, 62 (62%) of these nurses consented to participate and became study subjects. All subjects signed a consent form to participate in the study (Ashby, 1997).

Research on Medication Calculation Errors

The primary question posed 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 was 85% and the mean was 82%. Twenty-seven nurses (43.5%) attained a score of 90% or higher. Thirty-five nurses (56.4%) 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 intravenous medications than in other types, and that they make more errors than their non-surgical counterparts. These findings suggest the need for regular self-testing of medication calculation skills among practicing nurses.

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 practices, hospital policies and procedures, action plans, and advice from colleagues to prevent 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 in which nurses place themselves in legal jeopardy. Several areas of the field create liability risks for those in the nursing profession.

Conclusion: Protecting Oneself from Legal Liability

The nursing profession has always been promoted as glamorous, fulfilling, and rewarding. It is all of those things, but as people enter the field it is important to remember the significance of protecting oneself from a legal standpoint. Doing this can include developing a consistent habit of following procedure and protocol, remaining continuously educated, and reporting anything that one believes is unwarranted or unethical. These actions may offer meaningful protection when nurses face legal liability in the daily course of their jobs.