Nurse’s Malpractice Leading to Fatal Outcome

Look at the legal malpractice case study. Describe the case and discuss the standard of care that the parties will be held to in this case. How will the standards of care and the Nurse Practice Act be applied in a court of law if the case is sued?

The case study represents a case of malpractice that led to the patient’s death. There is a series of wrong actions contributing to the consequences. Firstly, the patient was not informed that death could be a result of surgery. Secondly, the nurse, Kelly, did not chart the vital signs; the hypotensive episode had not been reported as well. Moreover, Joseph Alcoff was a potential threat to the patient since he had been suspected of alcohol abuse; it is unclear whether his testimony is true.

According to the Academy of Medical-Surgical Nurses (2018), nurses should use the standards of medical-surgical nursing practice to increase the patient’s quality of life. In this case, it was not possible as Kelly had not worked at that unit before. The Florida nursing law manual (2008) reports that nurses must take vital signs as stated in the Nurse Practice Act; this rule might have been violated since Kelly did not chart them. Maloney (2016) points out that standards of care apply to all nurses and require caregivers to conduct a proper assessment and diagnosis of the patient. If the case is sued, it can be proven that the staff involved in the case did not follow these standards.

After reviewing the ANA position statement on “Rights of Registered Nurses when Considering a Patient Assignment,” discuss the legal and ethical implications of accepting assignments. When delegating assignments to unlicensed personnel, what considerations need to be considered? What insurance issues come into play? Analyze the legal principle of Respondeat Superior.

According to the American Nurses Association (2009), nurses have the legal rights to accept or reject in writing to any patient assignment that puts any of the involved parties at serious risk of harm. It means that there are no legal obstructions for a nurse to refuse to care for an individual. However, from the ethical point of view, such a caregiver’s decision can be considered discrimination against a patient and result in contract termination.

When delegating assignments to unlicensed personnel, it is necessary to consider the education, competence, and physical and emotional abilities of those who will perform them, as it can cause adverse consequences for caregivers (Edwards, 2018). It is also crucial to ensure that the actions of an unlicensed person are supervised. The licensed medical professional should consult the patient to identify their needs before delegating nursing tasks.

These measures can prevent the possible adverse consequences and ensure the best quality of patient care. The Legal Information Institute (n.d.) states that Respondeat Superior holds an employer legally responsible for the wrongful acts of an employee. However, the doctrine does not apply to independent contractors including those not paid for the job, such as interns. It means that hospitals have limited insurance coverage, which has to be considered while delegating assignments as well.

Take the malpractice case assigned and discuss the defenses that may be raised in that case. Discuss how the incident could have been prevented. What risk management techniques could have been used before and after the adverse patient occurrence? Respond to the other case scenario.

Sheridan (2016) notes that around 60% of physicians are sued during their career, thus, raising a defense it is not uncommon. The possible defense that may be raised in the case is that medical professionals are not responsible for the circumstances if they are not fully informed of a patient’s history and provide them with wrong treatment. It could be the reason the patient failed to tolerate respiratory therapy. Moreover, the fact that the patient felt worse during treatment is not considered malpractice.

To prevent the incident, the patient should have been told about the risks involved in the surgery. Moreover, the hypotensive episode must have been reported to the registered nurse, and Kelly should have charted the vital signs and the time of assessment. Risk management techniques that could have been used before the adverse patient occurrence include team training in monitoring and response to such issues, calling in more staff to care for patients during busy shifts, and developing clear post-operative care guidelines (Vincent & Amalberti, 2016). It is necessary to consider the sequence of wrong actions, and involve necessary training to manage the future risks for patients with similar conditions (Schiff et al., 2017).

Analyze the advantages and disadvantages of charting by exception when faced with a malpractice lawsuit. Discuss how you would correct mistakes in a medical chart and the formatting of your documentation when witnessing an adverse patient occurrence (APO). What APOs have to be reported in your state? How would charting corrections be perceived in a court of law? What are the implications for handling of forensic issues?

The primary advantage of charting by exception is that such methods of documentation provide caregivers with the opportunity to use their time efficiently. Its significant disadvantage in case of a malpractice lawsuit because sometimes medical professionals can unintentionally ignore the conditions that are conventionally normal but are abnormal for the patient. Moreover, charting by exception can involve vague or incomplete inquiries that can be poorly interpreted in a court of law. Its use instead of clinical notes can be perceived as an attempt to conceal some medical data.

When witnessing an adverse patient occurrence, it is necessary to check the charting carefully before filling it in to minimize the number of mistakes. In a court of law, charting corrections may be perceived as an attempt to conceal the facts or hide medical errors. Florida Agency for Health Care Administration (2014) states that hospitals must report adverse incidents within 15 calendar days after their occurrence. In Florida, medical staff must report death, brain or spinal damage, and wrong or unnecessary surgical procedure, including surgical repair, removing foreign objects, wrong-site surgery, and procedure on the wrong patient (Jones & Slosburg, 2017). Sturgeon (2015) notes nurses can improve the quality of investigation by providing clear forensic data.

Assume that you have knowledge that the nurse working with you on your unit has been illegally using drugs. What are your obligations to disclose this? What are your obligations to the institution you work for? Are there any places you could refer the nurse to? What are the implications for this nurse’s license? Are there any potential risks to your license? If so, what?

If caregivers suspect their coworker in drug abuse, they should perform their ethical duty to notify the nurse manager about this case. According to Toney-Butler and Siela (2018), in America, most states require a nurse to disclose the information about the medical professionals involved in drug abuse to the authorities. In Florida, any person suspecting that a caregiver is impaired must report it to the Intervention Project for Nurses or the Florida Department of Health. It means that the nursing staff is obliged to disclose the cases of abuse by Mandatory Reporting Law. My obligations to the institution I work for is to report the drug abuse providing the detailed evidence of it.

According to the Florida Department of State (2015), in the State of Florida, the Department of Health approves the treatment programs or providers. Consultants should assist the department in intervention and evaluation of the case, and monitoring of the caregiver’s treatment (Florida Department of State, 2015). Some cases of drug abuse can be the grounds for the denial of the nurse’s license (Zuleta-Alarcón et al., 2017). Caregivers suspecting their coworkers in drug abuse should avoid making false accusations and provide as much evidence as possible.

Choose one topic from the following list and evaluate how the chosen topic impacts your role as an advanced practice nurse. What are the legal implications related to your practice? These topics are discussed in this week’s chapter readings from the book. Analyze how understanding of the chosen topic will impact your future practice.

Bruen (2017) defines sexual harassment as unwanted sexual attention, requests for sexual favors or other verbal or physical gestures of a sexual nature. Nurses are at high risk OF harassment as they work closely with patients and coworkers, which can lead to emotional or physical attachments (Bruen, 2017). The US Department of State (n.d.) states that employees, including nurses, are encouraged to report the unfavorable conduct to responsible officials.

The possible resolutions include mediation, filing a grievance or an Equal Employment Opportunity complaint. Lockhart (2016) suggests that every medical institution and the organizations providing nursing education should have a policy statement on sexual harassment. Such policies may help nurses indicate the cases of inappropriate behavior and report them, which can result in the improvement of their position.

The understanding of the topic of sexual harassment will significantly affect my future practice, as I will be able to indicate not obvious forms of harassment, including inappropriate jokes, and protect myself from unwanted conduct. I also think that learning about the forms of sexual harassment will help me to determine personal boundaries and create healthier relationships with the patients and my coworkers. Finally, the understanding of the chosen topic will prevent me from being guilty if such situations occur.

References

Academy of Medical-Surgical Nurses. (2018). Scope and standards of medical-surgical nursing practice (6th ed.). Sewell, NJ: Jannetti Publications.

American Nurses Association. (2009). Patient safety: Rights of registered nurses when considering a patient assignment. Web.

Bruen, J. (2017). Sexual harassment towards nurses in their working environment; patients as the perpetrators. Web.

Edwards, S. T., Helfrich, C. D., Grembowski, D., Hulen, E., Clinton, W. L., Wood, G. B.,… & Stewart, G. (2018). Task delegation and burnout trade-offs among primary care providers and nurses in veterans affairs patient aligned care teams (VA PACTs). The Journal of the American Board of Family Medicine, 31(1), 83-93.

Florida Agency for Health Care Administration. (2014). Adverse incident report process. Web.

Florida Department of State. (2015). Approved impaired practitioner programs. Web.

Florida nursing law manual. (2008). The Florida Nurse Practice Act and the scope of nursing. Web.

Jones, S., & Slosburg, D. (2017). Florida risk management and related regulations (4th ed.). Tallahassee, FL: The Florida Society of Ambulatory Surgical Centers.

Legal Information Institute. (n.d.). Respondeat Superior. Web.

Lockhart, L. (2016). Sexual harassment in the workplace. Nursing Made Incredibly Easy, 14. Web.

Maloney, P. (2016). Nursing professional development: Standards of professional practice. Journal for Nurses in Professional Development, 32(6), 327-330.

Schiff, G. D., Reyes Nieva, H., Griswold, P., Leydon, N., Ling, J., Federico, F.,… & Yoon, C. (2017). Randomized trial of reducing ambulatory malpractice and safety risk. Medical Care, 55(8), 797-805.

Sheridan, A. (2016). You are not alone: Ten strategies for surviving a malpractice lawsuit. The Permanente Journal, 20(3), 107-108.

Sturgeon, S. (2015). Strangulation assessment, evidence collection, and documentation guidelines for forensic nurse examiners: A pilot project. Web.

The US Department of State. (n.d.). Sexual harassment policy. Web.

Toney-Butler, T. J., & Siela, D. (2018). Recognizing alcohol and drug impairment in the workplace in Florida. Web.

Vincent, C., & Amalberti, R. (2016). Safer healthcare. Cham, Switzerland: Springer.

Zuleta-Alarcón, A., Coffman, J. C., Soghomonyan, S., Papadimos, T. J., Bergese, S. D., & Moran, K. R. (2017). Non-opioid anesthetic drug abuse among anesthesia care providers: a narrative review. Canadian Journal of Anesthesia/Journal Canadien D’anesthésie, 64(2), 169-184.