When can a patient sue an emergency nurse?
There is no question about it: ED nurses are more likely to be sued now than a decade ago.
"Ten years ago, 20% of all malpractice suits named a nurse as either the only defendant or as one of many defendants," says Teri J. Cox, RN, MS, CLNC, president and owner of Point Pleasant, NJ-based TCK Consulting and former director of emergency services at Bellevue Hospital/New York University Medical Center in New York City. "Today, the number has risen to over 40%," she adds.
As ED nurses take on more responsibilities, some which were once considered the physicians' duty, they are at a higher risk for being sued for malpractice," says Cox. For example, most ED nurses now put in intravenous (IV) catheters. They would be liable if the IV infiltrated or the patient developed any complications of IV therapy, she points out. Likewise, triage nurses are liable if they don't appreciate the severity of the patient's illness.
"A nurse is expected to understand anatomy, physiology, pharmacology, normal ranges of vital signs and other physiological tests," Cox says. "Nurses are no longer absolved of poor practice by saying, 'I was just following the doctor's orders.'"
In order for a patient or their family to successfully sue you, however, the attorney must determine if these four elements of a malpractice case are present, says Cox:
• Duty to provide care.
A relationship must be established between the defendant and the plaintiff. For example, the ED nurse was assigned to assess and manage Patient A with an unknown chest injury.
• Breach of duty.
Breach of duty means that the ED nurse failed to do what a reasonable and prudent ED nurse would have done in the same or similar circumstances. For example, Patient A should be assessed at least every 15 minutes or more, including vital signs, patent airway, breath sounds, and complaints of pain. If any of the patients' vitals are abnormal and if their vital signs continue to be abnormal or deteriorate, the ED nurse should communicate this to the physician, receive a plan of care from the physician, and follow up on this plan.
"This would be considered reasonable care by the state's Nurse Practice Act. If the above standards are not met, the ER nurse would be found to be in breach of duty," says Cox.
• Damages and/or injury from the breach of duty.
"The extent of these injuries will determine the amount of economic damages, noneconomic damages, and punitive damages," says Cox. For example, if Patient A suffered a respiratory arrest and responded to resuscitation attempts but remains in a vegetative state, and recovery of any significance is not expected, damages could include medical expenses, loss of wages, pain and suffering, and loss of companionship.
• Proximate causation.
A reasonable connection must exist between the breach of duty and the alleged damages. If the ED nurse assigned to assess Patient A does nothing about this patient's deteriorating vital signs and does not follow through with reporting this deterioration to the assigned physician, breach of duty exits.
"In addition, if this patient went into respiratory distress, had a respiratory arrest, became anoxic, which resulted in permanent brain damage as a result of her breach, there is causation," says Cox. "Thus, all four elements exist."
If you are found guilty of malpractice, your insurance carrier is required by law to report this payment to the National Practitioner Data Bank. "This is true whether your insurance company has to pay $1 or $1 million," she explains.
The data bank contains every payment made to settle malpractice suits against any health professional. "This data bank is available to health care agencies when you are seeking employment and state licensing boards when you are seeking to renew your license," says Cox. "The nurse cannot change this report but can add a statement to dispute it."
It might not be scientific, but it's a well-accepted truth: Patients who like you are less likely to sue you. "Patients are less likely to sue if they feel that you actively listened to their complaints and addressed their concerns in an empathetic way," says Ann Robinson, MSN, RN, CEN, LNC, principal of Robinson Consulting, a Cambridge, MD-based legal nurse consulting company.
CNE can help you avoid a lawsuit Here is another reason to fulfill your continuing nursing education (CNE) requirements: It can decrease your legal risks. "You are less likely to get included in a suit if the plaintiff's lawyer knows you have kept abreast of research, read your professional journals, and met your CE requirements," says Teri J. Cox, RN, MS, CLNC, president and owner of Point Pleasant, NJ-based TCK Consulting and former director of emergency services at Bellevue Hospital/New York University Medical Center in New York City. [Editor's note: For information on participating in the ED Nursing's CNE program, contact customer service at (800) 688-2421 or [email protected].] |
Do you know the standard of care for your patient? Many emergency nurses don't "What I'm seeing is a trend of lack in emergency nurses who don't know the standard of care," says Christine Macaulay, RN, MSN, CEN, nursing practice and safety specialist at The Children's Hospital of Philadelphia. "We are seeing a lot more novice people in EDs now, with opening the doors to new graduates in EDs." Standards of care are established by the state you are licensed and practicing in and are defined by the Nurse Practice Act of that state, explains Teri J. Cox, RN, MS, CLNC, president and owner of Point Pleasant, NJ-based TCK Consulting and former director of emergency services at Bellevue Hospital/New York University Medical Center in New York City. Other definitive evidence of Standards of Care is state and federal laws, accrediting agencies, professional associations, and scientific literature. "The health care facility's policy and procedures are additional sources of standards, but are not considered definitive," says Cox. "You are bound by state and federal statutes. Read and understand your state's Nurse Practice Act," she says. That will be the standard by which your professional behavior will be judged." Standard of care at triage is symptom-dependent, says Elisabeth Ridgely, RN, LNCC, a Telford, PA-based emergency nurse and legal nurse consultant. For example, a patient with difficulty breathing should receive an oxygen saturation level assessment, and a chest pain patient should receive an immediate EKG. Debra A. Gray, RN, MSN, LNC, principal of Gray's Analysis, a Beaverton, OR, legal nurse consulting company, says you should be familiar with the following:
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About to deviate from ED policy? Think again "Do not imperil your patients' safety by taking shortcuts or omitting steps in a procedure, such as breaches in infection control standards, or lab specimen collection, in order to save time," says Debra A. Gray, RN, MSN, LNC, principal of Gray's Analysis, a Beaverton, OR, legal nurse consulting company. Instead, if the protocol, pathway, procedure, or policy is outdated, inaccurate, unnecessarily long, conflicts with other policies, or fails to take into account needed contingencies, promptly bring this to the attention of your supervisor. "Work to have the needed changes made," she says. "Patient safety is paramount." |
Are you a charge nurse? Your legal risks are bigger ED charge nurses are being sued for negligence more often than in the past, says Debra A. Gray, RN, MSN, LNC, principal of Gray's Analysis, a Beaverton, OR, legal nurse consulting company. "Charge nurses need to be fully aware of the responsibilities of their role," she says. "They are not simply an extra pair of hands or a resource person." As a charge nurse, you need to look at crowding and other issues that affect patient safety on the unit, because you are ultimately responsible for everything that happens during your time in charge, says Gray. "Charge nurses need to be clinical experts, well informed about policies and procedures and, through continuous monitoring, anticipate problems, such as crowding, before they happen," she explains. Gray gives the example of an Oregon hospital that reduced mortality rates by improving communication from paramedics on the way to the ED for patients with heart attack symptoms. "This 'heads-up' communication allowed more time to make staffing adjustments and have more cardiac care doctors and nurses available when needed," she says. "Such staffing adjustments are one tool that the charge nurse can actively employ to lessen crowding in the ED." |
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