I have been working on exploring legal cases that have given direction to nursing practice. Many cases have been key to changes in practice and professional standards. Often though the cases do not give absolute direction, especially in negligence actions where the point is to identify fault. It is then up to the party found at fault to change or adapt protocols that left the way open for harm to occur.
Too often even when a nurse is found at fault it is a combination of circumstances, system pressures and other health staff orders than underpin the disaster. Unlike Coronial Inquests where the cause of death is examined and the Coroner will make clear recommendations for changes, civil law cases need to be interpreted.
There are many cases where nurses have either been named as a defendant or called to give their account. Most, are as you would expect are in the USA. There has been a considerable increase in the number of cases there against nurses over the last decade.
Frequently such cases are later analysed and summarised to inform the profession and publications then propose the procedures that might lessen or limit risks. One of these is “Nurses and Nurse Malpractice” newsletter published by an American insurance company and the Nurses Services Organisation.
They provide as case studies the facts and findings of court cases involving nurses to guide organisations and professionals in adopting risk management strategies. One recurring theme over time has been the situation of a nurse “failing to monitor” or “failing to assess the client”. A finding often linked to these is “failure to notify the doctor of a change in patient condition”.
This has been a finding against nurses in cases in Europe, Australia and New Zealand. When you read the transcripts (as a nurse) it is often possible to see just why assessment or adequate monitoring has not been carried out. Violent patient, short staffing, client transfer and confused handovers and too often, lack of documentation to actually support the nurse’s claim that in fact observations were maintained.
It is sometimes impossible to perform all the tasks and satisfy all the demands placed on us. Yet it should be noted that the courts, if given good professional information can relate to those pressures and make judgements that accept the realities we work with. One case really reflected that, but it should be noted it was only the nurse’s documentation that saved her. There were gaps in the required 15 minute observations that the nurse was tasked to perform. The nurse had recorded these later, clearly identifying the reason for the omission and findings of the extended assessment she carried out on the next observation.
The documentation this nurse provided gave the court certainty she was working within her scope and had met standards expected. She had gone back and picked up the pieces not just moved on.
In Australia the former Health Care Complaints Commission of NSW published a series of case studies drawn from its experience with investigations and legal actions. Among the comprehensive range of issues one particularly caught my attention. The problem was the admission into an acute hospital a lady with dementia who had a history of wandering. “Within hours of admission, Mrs J wandered from the hospital. Family members raised concerns about the need for a safer environment. The family felt their concerns were not taken seriously and nursing staff were rude. Mrs J wandered from hospital again. Mrs J’s family was not advised about the incident and found out only when a family member called to speak to her. The family searched for Mrs J, located her and took her back to hospital.” Sound familiar?
Again the purpose of this publication was to provide guidance to organisations to limit the risks of future occurrences and to protect patients. Implementation of such strategies also protected staff. Education of staff about dementia and how to manage wandering behaviour was just one of these strategies.
Another source of complaints was how nurses spoke to clients or families. What frustrated, thoughtless, tired or angry nurses underestimate is client or family reaction to a throwaway line. A snappy retort or cross response. We often feel we are the victims of bad behaviour, rudeness or unrealistic demands and when pushed a step to far say something that to us, is both justified and rapidly forgotten, to them what was said even how it was said is grounds for complaint.
The sensitivity of clients and families is often overlooked when all we are trying to do is everything! We develop rapport and trust with our nursing communication. We are good communicators but even the best of us can be pushed into an ill-considered response. The number of complaints made about nurse’s comments that were interpreted very negatively was significant. A muttered aside, behind a mask was interpreted by a client who did not actually hear what was said but in the context of the way the nurse treated him, as racist and demeaning. It is a minefield out there so be mindful and always professional.
If there are new procedures and policies consider that they may be the result of remedying a problem not just another burden to shoulder.
There are some fabulous webinar recordings by Pam Savage regarding Nurses and the Law on the Nurses for Nurses Network . The Nurses for Nurses Network provides good information and CPD on an array of nursing topics in a range of easy learning ways including webinars and quizzes on the latest information that Nurses need to know – remember the Nurses for Nurses Network was created by Australian Nurses for Nurses ! www.nursesfornurses.com.au
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