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Negligence In Nursing Defined, Described, Destroyed Brian Dixon Devry University Abstract In the past the word negligence normally only encompassed the wrongs of a physician and at that time there was a distinct division between a nurse and a physician. The roles of nurses today however have changed quite drastically. Today’s nurses have assumed many functions and responsibilities that were previously performed solely by the physician.
As the roles of nurses have advanced and the profession has become much more specialized and independent from physicians, the liability for negligence has shifted from solely being a physicians concern to one that encompasses the nursing profession also. We are going to take a look at negligence as it pertains to today’s nurses. First by defining negligence as it pertains to the nursing profession, next looking at a scenario where there was negligence on the part of the nurse, and finally looking at what can be done to avoid negligence in nursing while performing duties. Defining Negligence
Negligence in nursing is the failure of a nurse to act as a reasonably prudent person under the same or similar circumstances, which causes or results in harm to the patient. The elements of negligence are: (1) duty; (2) breach of duty; (3) causation; and (4) injury and damages. Duty is nurses, as employees, agreeing to and completing their assignments. Breach of duty is the failure of the nurse to follow the standards of care found in the hospital’s policies and procedures, authoritative nursing textbooks, Board of Registered Nursing (BRN), and the nursing specialty association guidelines/standards.
Standards of Care can be defined as care that is taught in nursing schools, with reference text books, and the hospital policy and procedure manuals. It is also the nurse’s responsibility to obtain continual knowledge of the on going changes in health care. Many states mandate continued education in order to maintain licensing in that state. Causation is the act or incident of negligence has to have caused harm to the patient. One can ask the question if this act had or had not occurred would the results have been the same.
The next question is what the nurse did about the error or omission of her action. This is where injury and damages become a factor in negligence. The action of lack of action has to have caused harm to the patient for it to be considered negligent. An example would be a nurse gives the wrong does of insulin. A blood sugar is checked and found to be 30. The nurse follows the standards of care for hypoglycemia. The attending physician is notified, and the patient is monitored and the blood sugar returns to normal in 1 hour. In this instance, there are no residual damages.
Therefore although there was a mistake made, there was no negligence on the part of the nurse. Case of Negligence Lets take a quick look at an actual case that was brought up against a nurse for negligence. A nurse was assigned to the patient and was to place an intravenous catheter. The nurse was having difficulty finding veins in the woman’s arms. The nurse attempted twice to start a line in and was successful on the third attempt. It was the policy of the hospital at that time, that a nurse may attempt an intravenous catheter insertion no more than two times before calling for assistance.
For the remainder of the patient’s treatment at the hospital, it would be documented that the patient complained of discomfort at the IV site and tolerated it poorly. When pain or potential complications are reported, the site should be thoroughly evaluated for signs of a problem. If symptoms persist, the placement of another line at an alternate site should be offered for continued Intravenous Therapy. There was no indication in the hospital record, that other signs/symptoms of a complication existed other than the pain/discomfort.
This may have been positional due to the location of the IV site in the patient’s hand. There was no indication that placement of another line was either offered to, or refused by the patient. This particular case was taken to court and eventually settled, but it is an example of what little it takes for there to be a case for negligence. It is obvious that this nurse did not want to cause any undo harm to this patient, the nurse was just performing their duties and did not do so to the standards of the patient.
However, the nurse did not follow procedure that was set up by the hospital concerning the amount of times may be attempted to insert and IV. Therefore there was just cause for the negligence suit Negligent Actions There are many areas of the nurses daily work life that, if a conscious effort is not made there could be a case brought up for negligence on the part of the nurse or nurses such areas are: safety, medication errors, nursing assessment, competent knowledge regarding medical procedures, use of equipment, communication, documentation, and failure to follow established health system’s policies and procedures.
This is not a complete list of all the areas that there may be negligence but it is some of the most common that are brought up in negligence cases against nurses. The following are some of the same as above, but, are the 4 most common areas of negligence in nursing and are provided with examples if not followed could lead to negligent behavior: 1. Use of equipment: Nurses must know the safety features, capabilities, and limitations of any equipment they use, as well as its hazards.
Nurses must follow the manufacturers’ usage recommendations and refrain from modifying the equipment. The Safe Medical Devices Act of 1990 requires that all medical device-related adverse incidents that result in death or serious illness or injury be reported to the manufacturer and the Food and Drug Administration within 10 working days 2. Communication: Changes in the health status of a patient can be gradual or sudden and nurses are usually the first to see the changes and take action.
A nurse’s accuracy in assessing and monitoring the situation, and her timely reporting of changes in health status to a physician can often mean the difference between life and death. Vital aspects of communication besides timeliness in reporting the change include persistence in notifying the physician of the change, and accuracy in communicating the nature and degree of the change. 3. Documentation: The purpose of which is primarily to communicate patient information among providers, must accurately reflect the nursing process, howing evidence of nursing assessment and diagnosis, planning for nursing intervention, implementation and evaluation of planned interventions, and patient response. 4. Failure to follow established health system’s policies and procedures: Standards such as hospital policies have evolved to protect consumers from substandard care. In defining acceptable levels of care or the ordinary and reasonable care required to ensure that no unnecessary harm comes to patients, standards of care provide criteria for determining whether a nurse has breached duty in the care owed to the patient.
Standards of care are derived from sources such as state boards of nursing, professional nursing associations, hospital policies and procedures, and the guidelines of federal organizations. The above as stated before are just the four most common things in the daily work environment of a nurse that come up in suits against nurses in negligence cases. Since today’s nurses have become so specialized and advanced in their duties and procedures they performed, they are and should be held responsible for their actions, as much so if not more so than the doctors for whom they are working for.
Nurses are the backbone of patient care and if they become complacent and lackadaisical in their jobs people get hurt and can even die. Bibliography Springhouse Cooperation, Nurse’s Legal Handbook (Fifth Edition), 2004, Lippincott, Williams and Wilkens, Ambler Pa http://www. nursefriendly. com, Clinical Nursing Malpractice Case Studies, January 29, 2002, Coleman v. East Jefferson General Hosp O’Keefe, M, Nursing practice and the law: avoiding malpractice and other legal risks. 2001, F. A. Davis Co. Philadelphia, Pa