assignment

NUR4327 Del 6 Material

Disciplinary Action

Disciplinary Process

Issues of nursing practice negligence that have potential civil or criminal liability must be reported to the Board of Nursing. All nursing boards have specific policies on reporting nursing impairment due to drugs and alcohol. Hospitals and agencies often have a “Fit for Duty” standard that addresses both physical and mental health issues. Boards have disciplinary review committees; whose role is to investigate the incident and recommend any disciplinary actions the full Board. The names of nurses under discipline by the board are public record and are used by employers for their own decisions and for future employers and schools invalidating an active-unencumbered license to practice as an RN. Any past or present disciplinary action must be disclosed to employers.

Many of the boards of nursing have adopted an investigative tool referred to as the Taxonomy of Error, Root Cause Analysis and Practice-responsibility (TERAP) for consistency among the boards in assessing and reporting errors into a central database for quality analysis. The TERCAP review does include system breakdowns, particularly insufficient nurse staffing. The nurse, however, is responsible for her practice regardless of system issues.

In the TERCAP report, the data from the first round of use found that over 72% were unintentional errors and that 55% of cases of practice breakdown occurred when a nurse worked in a patient care position for two years or less (Benner et al. 2006). A nurse’s previous disciplinary history predicted future practice breakdown. The most common failures are safe medication administration, documentation, attentiveness/surveillance, clinical responding, prevention, intervention, interpretation of providers’ orders, and professional responsibility as the patient advocate.

Potential Actions

The boards have the authority to recommend the nurse be allowed to continue practice, practice under supervision for a period, or suspend a license until certain conditions are met.

Regardless of the board of nursing decisions, employers have the choice over whether to discipline or fire the employee. Individuals may seek civil prosecution. The District Attorney may seek criminal prosecution.

Malpractice Coverage

The purpose of liability insurance is to spread the risk of economic loss among a group of individuals with shared risk. A fee or premium is paid by the individual member for coverage that includes legal consultation, costs of litigation, and payment of awards. There are limits to various nursing liability policies, so it is essential to read and understand.

Nurses usually work for an employer who has liability insurance to protect their interests. Claims that an employer is directly liable for the actions of the employee commonly state that the employer failed in its duty to ascertain that the employee had the necessary qualifications and ability to render safe care, the employer was unable to supervise the employee properly, and the employer failed to provide employees with the proper training to provide safe care.

The question of whether a nurse should have personal liability insurance is complicated. Nurses who are independent contractors and nurse practitioners benefit from individual insurance policies. Nurses who work for organizations seeking to limit their liability may face them taking the position that the employee was not acting within the scope of their duties, and the insurer may decline to cover the nurse. You may wish to consult with your attorney, financial planner, or a representative from a company that issues nursing liability policies to determine if an individual insurance policy is right for you.

Source(s)

Benner et al. (2006). TERCAP: Creating a national database on nursing errors. Retrieved from https://www.ncsbn.org/Harvard_Health_Policy_Review.pdf

Erstad, W. (2018, October 29). Civil law vs. criminal law: Breaking down the differences. Retrieved from https://www.rasmussen.edu/degrees/justice-studies/blog/civil-law-versus-criminal-law/

Justia. (n.d.) Stages of a criminal case. Retrieved from https://www.justia.com/criminal/docs/stages-of-a-criminal-case/

World Health Organization. (2014). Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK214359/

Minimizing Legal Risk

Every nurse should be aware of the risks involved in nursing practice and should take measures to protect themselves and their license. Five chief nursing officers were interviewed on how nurses can minimize their legal risks in nursing practice. Here are their recommendations.

Know your scope of practice and the best way to do this is to have recent publications from your professional nursing association, often free to members. Professional membership and attendance at continuing education is an excellent way to stay up to date. Considering the cost of a lawsuit or your nursing license, this is a small expense.

Review the policies and procedures and confirm that they are consistent with current standards and guidelines for evidence-based practice. If they are not, make a suggestion to your managers that supports a need for practice change and amending policies and procedures. Make sure that all the policies and procedures are readily available, particularly with new nursing staff during and after orientation. It pays to have these readily accessible in your electronic health record system for decision support.

Follow your organization policy and procedures and document your actions and patient response to the plan of care. If you do not know what to do, follow your chain of command and document your conversation. If you are still not comfortable with a policy or procedure, you have the right to refuse and report to the administration why you are making that decision. Make sure to report your actions immediately if you refuse. If you are overwhelmed on a shift, ask for help by following your chain of command. Do not risk your patient’s health or your nursing license for failure to provide adequate care.

Managing Environmental Risks

Survey your nursing environment for environmental risks such as non-functioning equipment, frayed electrical outlets, leaks or slick surfaces that increase the risk for patient falls. If you have new equipment or software, ask for assistance.

Keep your cell phone in your locker. Your cell phone is not a secure device for messaging of private patient or hospital communication. Texting your colleague to ask for help on your device is not considered evidence in a court of law. Therefore, secure messaging systems like Voicera are used to ask for assistance.

Follow all regulations issued by the Occupational Safety and Health Administration regarding environmental protection, which includes fire-safety procedures, handling hazardous materials, personal protective equipment, slips/trips/falls, workplace harassment and violence, latex allergy, and radiation exposure.

Follow labor relations policies, which are spelled out in the employee handbook and the human relations policies. These policies are related to hiring and discipline practices, which can result in litigation for the hospital and you individually. When in doubt, consult with the Human Resource Officer.

Supervision and Documentation

Supervise your unlicensed personnel and evaluate their work with both a regular rounding and dropping in on patient care. If there is a problem, address it immediately in a private area. A great resource is “Crucial Conversations” by Kerry Patterson. Focus on the well-being of the patient, not the person. Be open to feedback and insights from UAPs.

Document when communication with physicians or other professionals is at odds with what you think best as the patient advocate. If you have a question on medications, ask first – confirm with the pharmacy. The patient is your responsibility.

If you have personal issues that are putting you at risk for drug or alcohol abuse, most employers have confidential support with outside agencies. Reach out before you compromise your critical thinking. If other colleagues express concern, pay attention. Nursing leadership wants to support you and your value as an individual as well as a nursing professional.

Remember, the authority for the practice of nursing is based upon social responsibility, which means that the nurse is accountable to the public for providing culturally sensitive, safe, timely, efficient, patient-centered, quality, and effective nursing care for individuals, families, and populations across the continuum of care. To do otherwise jeopardizes your license to practice and the image of the nursing profession.

Source(s)

Healthcare team. [Photograph]. Retrieved from Encyclopedia Britannica Image Quest. https://quest.eb.com/search/132_1434736/1/132_1434736/cite

Lazzarotti, J. (2019). Policies. Retrieved from https://www.healthcareworkplaceupdate.com/category/policies/

Occupational Safety & Health Administration. (n.d.) Hospital eTool. Retrieved from https://www.osha.gov/SLTC/etools/hospital/

Policy & Politics in Nursing and Health Care (7th ed.), Chapter 63 (pp 523-532)