legal issues facing nursing leaders

Legal Issues Facing Nursing Leaders : 

Legal Issues Facing Nursing Leaders Jon Robbins September 24, 2010

Why are legal issues so important? : 

Why are legal issues so important? “Over the years nursing practice has expanded dramatically and as a result nursing roles and responsibilities have changed. Nurses are being held increasingly accountable and responsible for their actions. Subsequently, more nurses are being named defendants in malpractice lawsuits” (Lippincott, Williams and Wilkins, 2009, pg.3)

Learning Objectives : 

Learning Objectives Identify the source of laws affecting nurses Identify common legal issues that affect nurses Discuss methods for preventing common legal issues

Sources of Law : 

Sources of Law The legal guidelines that nurses follow come from: Statutory Law Regulatory Law Common Law (Lippincott, Williams and Wilkins, 2009)

Sources of Law : 

Sources of Law Statutory Laws Are a result of elected legislative bodies Regulatory Laws: Are laws that reflect decisions made by administrative bodies Common Laws: Result from judicial decisions (Lippincott, Williams and Wilkins, 2009)

Common Legal Issues in Nursing : 

Common Legal Issues in Nursing Torts Intentional vs. Unintentional Advanced Directives Restraints HIPAA Informed Consent

Torts : 

Torts Intentional: Invasion of Privacy False Imprisonment Assault Battery Libel and Slander Unintentional: Negligence Malpractice

Who Is To Blame For Negligence? : 

Who Is To Blame For Negligence? The Organization? The Nurse? The Physician? The Nurse Manager? Everyone?

Extending Liability : 

Extending Liability Joint Liability Organizations, physicians, nurses Nursing Managers Are not automatically held liable for all acts of negligence of those they supervise, but they may be held liable if they were negligent in their supervision of those employees when they committed the negligent acts. (Brook, 2006)

Salica v. Tucson Heart Hospital : 

Salica v. Tucson Heart Hospital A Case of Negligence A 55 year-old male presented to the ED with chest px and SOB. He is treated and admitted. Patient's cardiologist agrees to see him in the ED An internist and a pulmonologist were called to see the pt Internist = cardiac component but primary dx of pneumonia Pulmonologist = mitral valve disease causing cardiac decomposition Pt cardiologist did not arrive until that evening, more than 12 hours after the pt arrived in the ED Cardiologist = Mitral valve regurgitation, TEE in am, O2, lasix Two hours after lasix was administered the patient's urine production did not increase and the O2 sat dropped below 90% The nurse switched to a non-rebreathing mask (Legal Eagle Eye Newsletter. 2010)

Salica v. Tucson Heart Hospital : 

Salica v. Tucson Heart Hospital A Case of Negligence With no increase in urine production and a drop in oxygen saturation it was clear that the patient was deteriorating The cardiologist saw the pt at 9pm and the nurse did not report the patient’s deteriorating condition to any physician until 6am When an internist arrived at 8am the pt was transferred to the ICU A TEE showed papillary muscle rupture and mitral valve issues While in pt was in the ICU a cardiothoracic surgeon was called to perform emergency surgery By the time these measures we taken the patient’s O2 sats had dropped drastically, he was in shock and his chances of survival, according to the medical expert, had decreased from over 90% to less than 20% The pt eventually died from complications following the cardiac surgery. (Legal Eagle Eye Newsletter. 2010)

Salica v. Tucson Heart Hospital : 

Salica v. Tucson Heart Hospital The Court of Appeals of Arizona upheld the jury verdict for the patient's family which assigned liability for the patient’s death 60% to the hospital (for the night nurse’s failure to act) and 40% to the patient’s cardiologist. “A number of medical interventions should and would have been initiated promptly if a physician had been alerted to the patient's worsening condition.” (Court of Appeals of Arizona, May 27, 2010) The nurse’s failure to report the patient’s condition cost the hospital $600,000 in damages Case: Salica v. Tucson Heart Hosp.,_P.3d_, 2010 WL2108492 (Ariz. App., May 27, 2010) (Legal Eagle Eye Newsletter. 2010)

How to protect yourself : 

How to protect yourself Signatures Are Golden Document, Document, Document Report It or Tort It Rights to Privacy Your Dosing What?! (Medi-Smart Webpage, 2010)

Legal Responsibilities of Nurse Managers : 

Legal Responsibilities of Nurse Managers Reporting dangerous understaffing Checking staff credentials and qualifications Carrying out appropriate discipline Quality control of nursing practice at the unit level (Marquis and Huston, 2009)

Example of Quality Control of Nursing Practice : 

Example of Quality Control of Nursing Practice What has to be reported? Improper or substandard medical care Child or elder abuse Gunshot wounds Communicable diseases (Marquis and Huston, 2009)

Prevention Is The Key : 

Prevention Is The Key Make your staff aware of what their responsibilities and limitations are State nursing practice acts define the scope of nursing practice Remind staff of hospital policies If hospital policy says you do something, you better do it Example: Reporting to physician when patient’s oxygen saturation drops to a certain level Be careful with incident reports Never put an incident report in a patient’s chart

Professional Liability Insurance : 

Professional Liability Insurance Every nurse should purchase insurance even if they are covered by their employer Protect your career by purchasing your own coverage Link to the ANA’s page on professional liability: http://www.nursingworld.org/mainmenucategories/anamarketplace/discounts/financialandinsurance/professionalliabilityinsurance.aspx

References : 

References Brook, P.S. (2006). Taking Heat For An Error. Nursing2006, 36(3), 10. Legal Eagle Eye Newsletter. (2010). Cardiac Care: Nurse Failed To Report Status, Held Partially To Blame For Patient’s Death. E-Newsletter Legal Eagle Eye Newsletter, For the Nursing Profession, July 2010 (18)7, np. Retrieved from http://www.nursinglaw.com/ Lippincott, Williams and Wilkins. (2008). Evidence Based Nursing Guide to Legal and Professional Issues. New York: Author Marquis, Bessie L. and Huston, Carol J. (2009). Leadership Roles and Management Functions in Nursing, 6th Ed. Philadelphia: Lippincott, Williams and Wilkins. Medi-Smart, Nursing Education Resources. http://www.medi-smart.com/nursing-articles/nursing-law/legal-issues, Retrieved September 20, 2010 Potter, P., & Perry, A. (2009). Fundamentals of Nursing (7th ed.). St. Louis: Mosby-Elsevier Brook, P.S. (2006). Taking Heat For An Error. Nursing2006, 36(3), 10. Legal Eagle Eye Newsletter. (2010). Cardiac Care: Nurse Failed To Report Status, Held Partially To Blame For Patient’s Death. E-Newsletter Legal Eagle Eye Newsletter, For the Nursing Profession, July 2010 (18)7, np. Retrieved from http://www.nursinglaw.com/ Lippincott, Williams and Wilkins. (2008). Evidence Based Nursing Guide to Legal and Professional Issues. New York: Author Marquis, Bessie L. and Huston, Carol J. (2009). Leadership Roles and Management Functions in Nursing, 6th Ed. Philadelphia: Lippincott, Williams and Wilkins. Medi-Smart, Nursing Education Resources. http://www.medi-smart.com/nursing-articles/nursing-law/legal-issues, Retrieved September 20, 2010 Potter, P., & Perry, A. (2009). Fundamentals of Nursing (7th ed.). St. Louis: Mosby-Elsevier