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    Nurses Negligence Assignment Help

    Nurses Negligence Assignment Help

     By Eileen M. Croke, EdD, ANP, LNC-C Nurses, Negligence,

    and Malpractice An analysis based on more than 250 cases against nurses. ore and more nurses are being named defendants in malpractice lawsuits, according to the National Practitioner Data Bank (NPDB). From 1998 to 2001, for instance, the number of malpractice payments made by nurses increased from 253 to 413 (see Figure

    1, page 55).

    The trend shows no 1-3 signs of stopping,

    despite efforts by nursing educators to inform nurses and student nurses of their legal and professional responsibilities and lim- itations. A charge of negligence against a nurse can arise from almost any action or failure to act that results in patient injury—most often, an unin- tentional failure to adhere to a standard of clinical practice—and may lead to a malpractice lawsuit. This article analyzes cases decided between 1995 and 2001 and iden- tifies the actions and issues that prompted charges of negligence that led to malpractice lawsuits against nurses, as well as the areas of nursing practice named most frequently in the complaints. (This article does not address criminal cases arising from intentional acts, such as assault, bat- tery, or false imprisonment, for which nurses have been arrested and sometimes prosecuted.)


    The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines negligence as a “failure to use such care as a reasonably prudent and careful person would use under similar circumstances.” Eileen M. Croke is assistant professor of nursing at California State University, Long Beach. Contact author: ecroke

    1@cs.com.page 57).

    (These categories are not mutually exclu-

    “[W]hile we cannot say with certainty that Mr. Hall sive; in one of the cases discussed below, two kinds would not have been injured if the nurse had not of negligence are involved.) been negligent, we believe that the jury could rea- The following are summaries of five randomly sonably conclude that her negligence played a sig- selected malpractice cases in which nurses were nificant part in allowing Mr. Hall to be injured by named as defendants. They illustrate the range of the use of Orthoblock for his ACF surgery. All that actions that result in breaches of the standards of care. one has to assume here is that the hospital would Failure to follow standards of care. Standards not have allowed the surgery to take place, and we such as hospital policies have evolved to protect do not regard this assumption as requiring a leap of

    11 consumers from substandard care. In defining faith.” acceptable levels of care—the ordinary and reason- Failure to use equipment in a responsible man- able care required to ensure that no unnecessary ner. Nurses must know the safety features, capabil- 2 harm comes to patients —standards of care provide ities, and limitations of any equipment they use, as criteria for determining whether a nurse has well as its hazards. Nurses must follow the manu- breached duty in the care owed to the patient. facturers’ usage recommendations and refrain from Standards of care are derived from sources such as modifying the equipment. The Safe Medical Devices state boards of nursing, professional nursing associ- Act of 1990 requires that all medical device–related ations (for example, the ANA and the National adverse incidents that result in death or serious ill- League for Nursing), hospital policies and proce- ness or injury be reported to the manufacturer and dures, and the guidelines of federal organizations the Food and Drug Administration within 10 work- 2 (for example,

    JCAHO and the Centers for Medicare ing days. and Medicaid Services).

    In Chin v. St. Barnabas Medical Center (1988), In Hall v. Arthur (1998), the United States Court the Superior Court of New Jersey, Appellate of Appeals for the Eighth Circuit upheld a trial Division, reversed a trial court’s judgment against a court’s decision, which held a hospital liable because physician alone and said that other hospital person- 12 of a nurse’s breach of a standard of care in an ante- nel should also be held liable. The case involved 11 rior cervical diskectomy and fusion (ACF). In the the death of a 45-year-old woman, Ms. Chin, from trial, the plaintiff’s argument focused on the use of a massive air embolism during a diagnostic hys- Orthoblock, a ceramic substance used to replace teroscopy. The woman’s estate had brought a med- bone in maxillofacial surgery, which was implanted ical malpractice suit against all the providers who in the patient’s spine. (The usual procedure in such had possibly played a role in the events leading to surgery would be to obtain bone from a bone bank her death: the physician who performed the proce- or harvest it from the patient’s hip.) After four dure, three operating room nurses (one scrub nurse months of back difficulties, the patient,

    Mr. Hall, and two circulating nurses),

    the hospital, and the required a second ACF to remove the Orthoblock manufacturer of the hysteroscope, an optical device and have his own bone implanted. with a pump used in examining the uterus. During Hospital policy required that any “unusual the procedure, fluid is pumped continuously into requests” for use of a product undergo review by the uterus to enhance the view of its interior. The department managers to assess the product’s appro- device requires the connection of four tubes: an irri-

    2 priateness. The nurse failed to seek such a review gation tube through which fluid flows into the and ordered the Orthoblock for use in the patient’s uterus, a suction tube that draws fluid out of the ACF. The package insert for the product, presented uterus, a tube that connects a source of compressed as evidence at trial, indicated that Orthoblock was nitrogen to the pump, and an exhaust tube. Because specifically contraindicated for use in spinal proce- one of the tubes was connected to the hysteroscope dures.

    The plaintiff’s attorney argued that the incorrectly, nitrogen was pumped into the patient’s

    nurse’s failure to follow hospital policy contributed uterus, causing a fatal air embolism in the coronary to Mr. Hall’s injury. arteries. On appeal, the hospital did not dispute the jury’s At trial, all parties accepted the theory that the finding of negligence, but asserted that the plaintiff exhaust hose was the source of the gas that killed produced insufficient evidence from which a juror Ms. Chin; who was at fault for attaching the hys- (or “reasonable fact finder”) or judge could con- teroscope incorrectly was disputed. Evidence pre- clude that the nurse’s negligence contributed to Mr. sented at trial revealed that the two nurses assigned Hall’s injury. The appellate court disagreed, stating: to the surgical procedure had neither hospital train- 58 AJN

    a  September 2003

    b Vol. 103, No. 9 http://www.nursingcenter.comsymptoms and the change in behavior to the physi- cular injection and that this practice met the stan- cian. She also testified that when she observed the dard of care. The jury found in favor of the plaintiff patient at midnight, he appeared to be sleeping; she and awarded more than $90,000 in damages. did not reassess his vital signs. On appeal, the defendants (the hospital and the Mr. Busta’s surgeon testified that, because of the nurse) argued that evidence presented at trial mind-altering adverse effects of the patient’s med- demonstrated that the nurse’s breach of the stan- ication, he would have reassessed his patient if he dard of care could not have caused the patient’s had been notified of the changing signs and symp- injury. The appellate court disagreed, stating that toms. Expert testimony opined that the nurse was the nurse experts’ testimony—insufficient by itself negligent in failing to adequately monitor Mr. Busta to support the jury’s decision—did support that on the evening and night before he died, and in fail- decision when combined with the other evidence ing to report the constellation of signs and symp- presented at trial. toms to the surgeon; and that the hospital was Failure to act as a patient advocate. Legal and negligent in failing to maintain a safe environment ethical issues often become entwined in health care

    2 (evidence presented at trial showed that the hospital settings, and nurses must be knowledgeable in both. had not acted on a JCAHO

    directive to restrict the The ANA’s Code of Ethics for Nurses with opening of windows in patients’ rooms). Interpretive Statements provides nurses with a The jury found that the negligence of Columbus framework for ethical decision making and defines Hospital combined with the patient’s contributory the role of the nurse as patient advocate. negligence caused the patient’s injuries and death; According to O’Keefe in

    Nursing Malpractice and the jury apportioned 70% of the liability to the hos- the Law, “Patient rights are the hallmark for advo- pital and 30% to Mr. Busta. The jury found that Mr. cacy of nursing care. Nurses are compelled to strive Busta and his estate were damaged in the amount of for excellent care of patients and the inclusion of 17 $5,000 and his heirs, $800,000. Based on the jury’s their rights in today’s health care system.” It’s apportioned liability, the district court entered a important to note that, as patient advocates, nurses judgment in favor of Mr. Busta’s estate in the may be required to care for patients whose health amount of $3,500 and in favor of his heirs, of care decisions conflict with the nurse’s ethical beliefs. $560,000. In Koeniquer v. Eckrich (1988), the Supreme Failure to document. Documentation—the pur- Court of South Dakota reversed and remanded for pose of which is primarily to communicate patient trial an order of summary judgment in favor of information among providers—must accurately Dakota Midland Hospital by the Circuit Court of 18 reflect the nursing process, showing evidence of the Fifth Judicial Circuit. The case involved the nursing assessment and diagnosis, planning for nurs- death of a patient, Winnifred Scoblic, as a result of ing intervention, implementation and evaluation of sepsis, which was alleged to have developed when

    14, 15 planned interventions, and patient response. she was discharged with a fever some

    11 days after The Court of Appeals of Louisiana, Fourth urinary tract surgery. The plaintiff, Ms. Koeniquer, Circuit, affirmed the trial court’s verdict in Pellerin representing her mother’s estate, initiated a medical v. Humedicenters, a case concerning a failure to malpractice suit against two physicians and Dakota 16 document nursing procedures. The plaintiff had Midland Hospital, alleging deviation from the alleged that an ED nurse administered an injection appropriate standards of care for a patient in post- of meperidine (Demerol) and hydroxyzine pamoate operative urology. (Vistaril) in a substandard manner, causing a lump Ms. Scoblic’s surgery was performed on January 5, at the injection site and continuous pain, which was 1983. Her temperature fluctuated during her post- later diagnosed by a neurologist as cutaneous operative hospital stay and was recorded as 100.2°F gluteal neuropathy. How the injury actually on January 16 at 8:15 AM, after the treating physi- occurred could not be proven at trial. Medical cian had completed rounds. The patient was dis- experts gave conflicting testimony regarding the charged at 10:45 AM on the same day. She was cause of the patient’s nerve injury (either the readmitted to the hospital on January 19 with a hydroxyzine pamoate or the needle could have diagnosis of sepsis. On January 21, she was trans- caused it). Nurse experts opined that the failure to ferred to the University of Minnesota Hospital and document the site and mode of injection fell short of on March 6 died of multiple organ failure. The the standard of care. At trial, the defendant testified plaintiff’s expert witness opined that the nurses that her customary practice was giving an intramus- failed to adequately monitor Ms. Scoblic’s changing 60 AJN

    a  September 2003

     b Vol. 103, No. 9 http://www.nursingcenter.comPRACTICE AREAS


    his or her legal responsibilities. The following can In my case review, I identified 13 specialty practice help nurses reduce potential liability. areas of nurses involved in malpractice cases. As Maintain open, honest,

    respectful relationships and indicated in Figure 3 (page 61), nurses employed in communication with patients and family members. acute care facilities were named as defendants in

    • Patients are less likely to sue if they feel that a 19 such litigation more frequently (153 cases) than nurse has been caring and professional. nurses employed elsewhere (100 cases). In acute

    • Don’t offer opinions when a patient asks what care facilities, seven specialty practice areas were you think is wrong with him—you may be identified. Nurses employed on medical–surgical accused of making a medical diagnosis. units had the highest percentage of involvement in

    • Don’t make a statement that a patient may inter- litigation (32%), followed by nurses employed on pret as an admission of fault or guilt. obstetrics units (16%). (Similar findings were noted

    • Don’t criticize health care providers or their 8 for medical–surgical units in studies by Campazzi actions when you are with patients. 3 and Mayberry and Croke. )

    • Maintain confidentiality in the health care setting. The areas within acute care facilities in which Maintain competence in your specialty area of nurses had the least involvement in litigation include practice. coronary care and intensive care units, operating

    • Attend relevant continuing education classes. rooms, and pediatrics (each with 3% of all cases),

    • Attend relevant hospital in-service programs. followed by recovery rooms (2%) and EDs (1%)

    .• Expand your knowledge and technical skills. 9 10 (Smith and Smith-Pittman identified EDs, obstet- Know legal principles and incorporate them into rics units, psychiatric units, and operating rooms as everyday practice. specialty practice areas associated with high frequen-

    • Keep up to date on your state’s nurse practice act. cies of litigation.)

    • Keep up to date on hospital policies and proce- I identified six specialty practice areas outside dures. acute care in the review. Advanced practice nurses Practice within the bounds of professional licen- employed in independent settings had the highest per- sure. centage of involvement in litigation (9%), followed

    • Perform only the nursing skills allowed within by nurses on transitional care and psychiatric units your scope of practice and that you are compe- and in nursing homes (each with 8%). The areas with tent to perform. least involvement in litigation included home health Know your strengths and weaknesses. Don’t 8 and rehabilitation units (each with 2%). (Campazzi, accept a clinical assignment you don’t feel compe- 9 3 10 Smith, Mayberry and Croke, and Smith-Pittman tent to perform. found that nurses employed in areas outside acute

    • Evaluate your assignment with your supervisor care were named less frequently as defendants in mal- • Accept only those duties you can perform com- practice litigation than nurses employed in acute care, petently but their studies do not reveal a consistent trend as to

    • Let an experienced nurse on the unit assume which specialty practice area accounts for the most responsibilities for the specialized duties. malpractice litigation.)

    • Document all nursing care accurately.

    • If care is not documented, courts assume it was


    not rendered. “Nursing judgment involves the analysis of facts and

    • When documenting care on the patient’s chart, circumstances on a case-by-case basis. To prevent use the FACT mnemonic: be factual, accurate, 20 malpractice, it is essential that the nurse undertake complete, and timely.

    a  this evaluation with regard to everything that he or 14 she does in the clinical setting.” Increasingly, nurses are held accountable to the public for their profes- Complete the CE test for this article by using the mail-in form available in this sional judgment and the outcomes arising from that issue or by going to Online CE at judgment. www.ajnonline.com. Malpractice litigation is both professionally and emotionally devastating and can be financially dis- astrous. Each nurse can take steps to help reduce REFERENCES 1.Springhouse Corporation. Malpractice liability. In: Nurse’s potential liability by using caution and common legal handbook. 4th ed. Springhouse, PA: Springhouse; 2000. sense and by maintaining a heightened awareness of p. 197-236. 62 AJN

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