Legal Implications for Nursing

Legal Terms

• Negligence– A general term that refers to conduct that does

not show due care– Occurs when someone fails to do something that

a reasonably prudent person would do in a similar situation

– Four essential characteristics• Duty• Breach of duty• Harm• Causation

Legal Terms

• Duty– Duty of a professional toward an individual– That duty is established when the nurse

patient relationship is started

• Breach of duty– Nursing care fell below acceptable

standards or the nurse was negligent

Legal Terms

• Harm– The patient has been injured in some way

• Causation– The breach of duty caused the harm

Legal Terms

• Malpractice– Specific type of negligence– Applied to professionals who fail to follow

a standard of care prevalent for the profession and thereby harms another person

– Ranges from being negligent when caring for a patient to betraying a confidence

Legal Terms

• Standard of Care– Level of care a reasonably prudent nurse

would have maintained• Standards of care change with each new

medical advance• Must keep up with the latest information in

your field• Must read journals, attend conferences• Be familiar with the policy and procedure

manuals and clinical pathways in your facility

Legal Terms

• Liability– And obligation or debt that can be

enforced by law– In cases of malpractice a person found

guilty of a tort is considered legally liable, or legally responsible for the outcome

Liability

• Common sources of liability– Most malpractice claims come from routine

functions• Falls• Medication errors• Burns• Failure to observe• Failure to notify MD• MDs failure to respond• Violation of policies and procedures• Defective equipment• Improper pt teaching

Liability

• Falls– Identify pt who is at risk for a fall and take

action• Blind• Elderly• Sedated• Dizzy• Confused• Immediately post-op

Liability

• Document use of– Restraints– Side rails– Monitoring of pt

• Use care with restraints– Side rails are considered a restraint– May be chemical or physical– Should use the least restrictive method– Continually monitor the pt– Careful documentation

Liability

• Medication errors– Perhaps 98,000 Americans dies each year from

med errors– Remember the five rights

• Right patient, drug, dose, time, route• Check the med label three times before administering

the med• Know the correct dose• Know the correct route• Know the potential side effects• Clarify any order with the physician who ordered the

drug

Liability

• Burns– Hot water– Heating pads– Heating lamps– Sitz bath

Liability

• Failure to observe– Keep monitors on the pt–Monitor vital signs after administration of

pain meds–Monitor pt closely and report any

complications

Liability

• Failure to notify the physician–Must communicate any pertinent

information to the pt’s MD in a timely manner

–Must speak with MD, not leave messages– Should go up the chain of command if

unable to get MD– Notify MD if there is a change in the pt’s

condition

Liability

• Physician's failure to respond– If you feel that the MD does not respond in

a satisfactory manner, must notify the supervisor, hospital administrator, or medical director

Liability

• Violation of policies and procedures– You are responsible for knowing them

• Defective equipment–Must select the appropriate equipment for

a particular pt or procedure–Maintain that equipment– Use the equipment properly– Report any problems immediately

Liability

• Improper patient teaching– Liable for what you teach or fail to teach– Give written instructions to reinforce the

verbal instructions– Document teaching in the chart–Must provide it in the patient’s primary

language

Incident Reports

• Allows hospital administration to identify problems within the hospital system

• Alert administration of an event that may end up in a lawsuit

• Important to fill out one to identify problematic situations and create a safe environment

• Keep statements factual, objective, do not draw conclusions

• Do not mention incident report in charting• May or may not be allowed into court

• Remember that patients who feel that doctors and nurses have done their best are not as likely to sue as a patient who feels ignored or neglected– A little kindness goes a long way!