Nursing as a practice often comes with several challenges which make the practitioners potentially liable and subject to a lawsuit. According to HG Legal Resources Standards of Care in Nursing , nurses operate under standards of care, which form the baseline of quality care. Failure to comply with the set standards makes the nurses liable for negligence and potentially risk lawsuit. Furthermore, policies and regulations of health facilities under which nurses operate may prevent them from carrying out a procedure or making a decision deemed moral. Several cases occur that hold nurses solely liable or and other health practitioners, and the result is a legal battle –this indicates how the law impacts nursing practice. This paper looks into three cases that occurred and clarifies as to whether the specific nurses and physicians were accountable, and further gives the direction presumed correct for each case thereby elaborating the impact the law has on nursing.
Case Study 1
In this particular case, Judy was a suicidal patient who had to be monitored since, at any given point in time; the thought of killing herself always lingered on her mind. Nurses would not be liable for suicide if they uphold the standard care required for suicidal patients (Guido, 2014). In this case, the nurse was not negligent for unlocking the door for Judy to shower since she had noted that the patient had become reasonable and that she was disturbed by her appearance as she had not bathed for several days. Although she had opened the bathroom door, the nurse still had Judy under the 15-minute suicide checks. Furthermore, cleaning up would possibly give the patient a positive self-image which would temporarily help eradicate suicide thoughts from the patient's mind. Additionally, the act indicated that the nurse cared for Judy.
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It was below the standard of care of the nurse to leave the bathroom door unlocked upon the arrival of the psychiatrist. Guido (2014) states that nurses can become liable and face a lawsuit if they fail to assess the conditions around a suicidal patient. To provide maximum safety for a patient like Judy who had previously shown an overt suicidal behavior, it was upon the nurse to ensure that the patient could not access any material with which she could harm herself. By leaving the bathroom door open, the nurse had created an opportunity for Judy to harm herself after the psychiatrist had left.
Health facilities have policies and procedures to ensure an environmental risk assessment is carried out to identify features in the environment around suicidal patients with which they can harm or kill themselves. Consequently, necessary action is then taken to minimize such risks including implementation of procedures like one-on-one monitoring (15-minute observation protocol), enhanced communication among practitioners as well as training staff involved in monitoring highly suicidal patients (Watts, Shiner, Young-Xu, & Mills, 2016). In this instance, communication between the psychiatrist and the nurse could have prevented death.
In the case, the nurse checked on the patient roughly 15 minutes after the psychiatrist had left, which indicates that she observed the 15-minute observation protocol under which the patient was. The nurse was in an ethical dilemma of wanting to prevent injury to the patient while at the same time, attempting to enhance the quality of her life (Guido, 2014). Therefore, she let her shower. The hospital would not be liable, and neither would the two health providers since the observation protocol was adhered to. On the other hand, allowing the patient to shower was in good faith, a strategy to help her gain a positive self-image which would improve her recovery.
Case Study 2
In the case, the nurse was negligent in the advice she gave to Mr. Gonzalez concerning his condition. To avoid lawsuits from outcomes of their practice, telenursing, nurses have to maintain current knowledge and keep updating the same for disease processes, therapies, and medications to manage such procedures as well as possible complications during the treatment (Guido, 2014). The advice she gave to the patient through telenursing was below the standard of care and indicated that she had little knowledge and information about the situation.
The nurse was within the scope of practice regarding the advice she gave the patient. Guido (2004) states that nurses are expected to educate patients on diseases, medications, and complications that may result from treatment and therapies. Nurses have to be knowledgeable about the latest medical treatments for them to proffer correct advice relating to medication to patients. The information has to be in good faith and above the standard of care failure to which results in negligence.
The nurse should have instructed the patient to visit a local emergency center. The root cause of the problem would have been discovered and addressed earlier instead of issuing the wrong healthcare advice. The nurse was not sure about the situation and should not have advised because no liability could be incurred if she honestly refrained from giving information that would be wrong (Guido, 2014). She should have informed the patient to visit the local emergency center immediately, which would have been within her scope of work.
In deciding the case, both the physician and the nurse would be liable. As a health care provider, the physician has a duty to provide quality and competent care failure to which he would face a lawsuit (Guido, 2014). Medical malpractice by a surgeon is a legal offense (Moffett, & Moore, 2011). The surgical procedure the physician carried out led to the perforation of the patient’s intestines, which indicated incompetence and negligence. A nurse can be held liable if they fail to assess a situation and give the correct healthcare advice through telenursing, and as such, a lawsuit can be filed against her. The nurse offered health care advice that was below the acceptable nursing standards, which poses a danger to the patient’s health (Guido, 2014). In this case, the surgical center, through its nurse, had provided a medical service which was inadequate and unreasonable for use by the patient under the situation he was in. Thus, both the nurse and the physician are implicated. The facility also failed to give the patient emergency health care services when he called and becomes liable as well.
Case Study 3
In this last case, the standards of care for Mr. Aburu would involve keeping him for 24 hours in the acute care facility. As with any other post-operative care, Mr. Aburu was to be observed by qualified personnel applying strategies to prevent surgical site infection and other complications (Anderson, Kaye, Classen, Arias, Podgorny, Burstin, & Yokoe, 2008). Such a patient should be monitored, assessed, and observed with telenursing between the two health facilities (Liddle, 2013). Based on the post-operation conditions of the patient, a prudent nurse would have checked the wound hourly and ensure that the patient receives care that is of standard, bearing in mind the complications that would develop if the patient was not well cared for.
The lawsuit should not center primarily on the surgeon but the nursing home as well. The nursing home administrator had agreed that the patient could adequately be cared for in the nursing home only to be handled even by unlicensed personnel none of whom examined the dressing until one personnel noticed blood on his bed sheets. Therefore, how Mr. Aburu was treated when he got back to the nursing home was below the standards of care required for post-operative nursing.
In deciding the case, the surgeon would be liable for having insisted the patient to be kept under observation in the acute care facility even though care could still be provided for him in the nursing home. If he had been held for 24 hours in the facility postoperatively, his bleeding could have been detected earlier and handled appropriately. The nursing home would also be liable for not having provided the standards of care that the patient required upon return from the operation.
Conclusion
Law greatly impacts nursing. Nurses and other medical practitioners are often held liable when they fail to offer standard health care, as observed in Mr. Gonzalez’s case. However, there exist instances where even following hospital policies and procedures and standards of care provided by the caregivers, the results may not be positive, as seen in Judy’s case. In such scenarios, practitioners would not take responsibility since they had followed the required standard procedures in providing healthcare services. Nurses can offer correct health information to patients to the best of their knowledge, but they can be held liable if the information is wrong. Therefore, they always have to assess situations carefully before giving advice, or they can choose to arrange necessary referrals to which they would not face legal action. Additionally, to be considered prudent, a nurse may offer additional services not included in the nursing care plan to patients.
References
Anderson, D., Kaye, K., Classen, D., Arias, K., Podgorny, K., Burstin, H., . . . Yokoe, D. (2008). Strategies to Prevent Surgical Site Infections in Acute Care Hospitals. Infection Control and Hospital Epidemiology, 29 (S1), S51-S61. Doi:10.1086/591064
Moffett, P., & Moore, G. (2011). The standard of care: legal history and definitions: the bad and good news. The western journal of emergency medicine , 12 (1), 109–112. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088386/pdf/wjem12_1p0109.pdf
Guido, G. W. (2014). Legal and Ethical Issues in Nursing (6 th Ed.). Upper Saddle River, NJ: Prentice Hall.
HG Legal Resources (n.d.). Retrieved from https://www.hg.org/legal-articles/standards-of-care-in-nursing-6237
Watts, B. V., Shiner, B., Young-Xu, Y., & Mills, P. D. (2016). Sustained effectiveness of the mental health environment of care checklist to decrease inpatient suicide. Psychiatric Services , 68 (4), 405-407. Retrieved from; https://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.201600080
Liddle C (2013) Postoperative care 1: principles of monitoring postoperative patients. Nursing Times ; 109: 22, 24-26. Retrieved from; https://www.nursingtimes.net/clinical-archive/critical-care/postoperative-care-1-principles-of-monitoring-postoperative-patients/5059272.article
