Virtues and Values

Legal Risks of Nurses

Evette Grayson

Ashford University

MHA 622 Health Care Ethics & Law

Dr. Jamie Galbreath

April 11, 2022

Legal Risks of Nurses

Over the last century, the role of nurses has continued and continues to evolve. The evolvement and expansion of the role of nurses are due to various factors like shortage of physicians, increase in specialization, improvements in technology, public demand, and expectations of the profession (Pozgar, 2012). This may be considered a good thing as the nursing profession will be highly advanced in the coming decade. However, the expansion of the role of nurses has also increased ethical and legal risks for nurses. An example is that a nurse who exceeds their scope of practice has violated their licensure provisions. Legal risks for nurses have increased with the increase in nursing roles and responsibilities. This paper looks at a case scenario to examine the increase in legal risks for nurses while highlighting the legal risks involved in the case.

What happened?

The case involves the death of a patient, Mr. Ard. Mr. Ard had been admitted to the hospital, where on May 20th, he started feeling nauseated. The patient was in pain and had shortness of breath. Mr. Ard's Wife rang the bell several times in search of help. The nurse responded after a while and gave the patient medication for nausea. However, nausea continued to worsen, with the patient having difficulty breathing. The wife kept ringing the bell for 1.25 hours before anyone responded to the call for help. A code was called, but unfortunately, the patient did not survive the code. The medical records did not show any documentation on May

20th between 5.30 PM and 6.45 PM, which would indicate whether the medical professionals checked the patient's condition.

The patient's wife filed a case for wrongful death action against the hospital. The District Court granted judgment to Mrs. Ard, with the hospital appealing the judgment. Various aspects emerged during the case that is worth noting, including the information provided by the expert witness in general nursing. Ms. Krebs, the expert witness, felt that it would have been evident to the nurses that the patient was at high risk for aspiration based on the physician’s notes. Ms. Florscheim, the nurse, assigned to Mr. Ard, never performed a full assessment of the patient's respiratory and lung status. The records also did not show that an evaluation was completed after the patient vomited.

Why did things go wrong?

Various things went wrong in the case of Mr. Ard. Some of them were highlighted during the case. Ms. Krebs highlighted that a full assessment of the patient’s respiratory and lung status was supposed to be done based on the patient's risk level. The first assessment by the nurse involves assessing the level of consciousness. The rationale behind the assessment is that the level of consciousness is the primary risk factor for aspiration. This was not done by the nurse who was attending to Mr. Ard. An assessment is also needed on the presence of nausea or vomiting. Mrs. Ard had complained that the husband was feeling nauseated. During the court proceedings, it was established that the patient had vomited. The rationale behind the assessment

is that nausea or vomiting will place the patient at the most significant risk of aspiration. However, there was no report of the medication given to the patient for nausea.

The patient's situation worsened or worsened because the standard of care offered to the patient fell below the expectations for a patient with the type of distress. The expected standard of care would require precautionary measures to be put in place to reduce the risk (Kollmeier et al., 2022). Nursing diagnosis includes the risk of infection, risk of short body fluids, and

impairment in breathing. Things got worse when the nurse failed to provide better standards of care. The patient's standards of care would have involved constant monitoring, a full assessment of the patient’s respiratory and lung status, and any other assessment required for a high-risk patient. If the nurse had followed the guidelines for the type of patient, the outcome might have been avoided.

What were the relevant legal issues?

In the definition of medical malpractice, the American Board of Professional Liability Attorneys (2020) refers to a negligent act or omission which causes the patient harm. Negligence may result from diagnosis, treatment, aftercare, or health management errors. There is an increase in nurses being named as defendants in malpractice lawsuits (Croke, 2003). Why the increase? The number of malpractice payments being made by nurses has also increased. Various factors have been attributed to the increase in the number of nurses named defendants in malpractice lawsuits and those making malpractice payments. Lack of education has been named one of the factors for the increase in the number of nurses in malpractice lawsuits. However, the

last three decades have seen an improvement in education for nurses and nurse students. The increase in the role of nurses has also led to an increase in legal risks for nurses.

In the case scenario, various legal issues arise that medical malpractice under the law can be considered. According to the American Board of Professional Liability Attorneys (2020), a claim for medical malpractice must-have characteristics like an injury caused by negligence, a violation of the standard of care, and the injury resulting in significant damage. Standards of care are guidelines offered to nurses that provide a foundation for how they should act, what should be done, and what should not be done in their professional capacity. A violation of the standard

of care emerged from the case where the patient was in distress, and the nurse had to wait for 1.25 hours before responding to the call.

The other legal issue that emerges is that the patient sustained injury due to negligence by the nurse. The District Court ruled in favor of the patient's wife, agreeing that negligence caused the patient's suffering. During the appeal, the two expert witnesses were able to show the standard of care for such a patient. The expert witness for the hospital showed the standard of care may have been below expectations for the level of distress being described. The case also falls under medical malpractice as the injury resulted in significant damage. It led to the death of the patient.

How could the event have been prevented?

The event could have been prevented had the patient's care been within the standards of care prescribed. Various aspects of the case can be regarded as negligent acts and omissions that

led to the event. If the physician's progress reports showed that the patient was at high risk for aspiration, the various assessments should have been done according to the standard of care. These included preventive measures to reduce the risk or care for the patient. These measures would have reduced the risks of aspiration for the patient and avoided the event. Constant monitoring of the patient could also have prevented the event. The nurse assigned to the patient could have discovered more information through constant observation of the patient.

What is your verdict?

My verdict is that the hospital is liable for medical malpractice. The hospital violated the standard of care for the described kind of distress. The patient's wife had called for help several

times when the husband was experiencing shortness of breath. The hospital staff responded 1.25 hours later, which is below the expected standard of care. The nurse might have responded late to

a limited number of nursing staff in the hospital or due to their negligence. The late response and some of the omissions of the nurse and hospital led to the event in the case. The violation of the standard of care led to injury to the patient, and later the injury caused significant damage. The hospital should be held accountable for the actions of its staff. This is based on the policies at the hospital, which can lead to a response happening after 1.25 hours.

References

Croke, Eileen M. EdD, ANP, LNC-C. (2003). Nurses, Negligence, and Malpractice, AJN, American Journal of Nursing: September 2003 - Volume 103 - Issue 9 - p 54-63

Kollmeier, Brett. Michael Keenaghan and Chaddie Doerr. (2022). Aspiration Risk (Nursing). StatPearls.