Malpractice, Negligence and Nursing Law: The Definitive Guide (2023)

More nurses are named defendants in misconduct lawsuits, according to the National Professional Data Bank (NPDB).

Between 1998 and 2001, the number of malpractice payments made by nurses increased from 253 to 413.

Despite the efforts of nursing educators, nursing students, and practicing nurses to educate themselves about their professional and legal boundaries and responsibilities, it shows no signs of ending.

Nurses can be accused of negligence for omissions or actions that result in injury to the patient and result in a malpractice lawsuit.

This is often due to inadvertent non-compliance with the rules of clinical practice.

In this article you will find an analysis of the cases decided between 1995 and 2001, as well as what actions and issues gave rise to malpractice allegations that led to malpractice lawsuits against nurses.

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You'll also find out which areas of nursing work were most frequently reported.

This article does not include criminal cases based on intentional acts for which nurses were arrested and sometimes prosecuted.

Defining and tracking misconduct

The Joint Commission on Accreditation of Health Care Organizations (JCAHO) defines negligence as "the lack of care that a reasonably prudent and prudent person would use in similar circumstances."

Misconduct is defined by the JCAHO as “improper or unethical conduct or unreasonable lack of skill on the part of any official or professional office holder; It is often applied to doctors, dentists, lawyers, and government officials to indicate negligent or improper performance of their duties when professional skills are required.

Negligence is a cause of action that is eligible for damages."

There are various definitions of misconduct based on institutional guidelines, state standards for nursing practice, or federal guidelines such as JCAHO.

All of them can be considered in court.

The increase in the number of malpractice cases against nurses is the result of several factors.

Delegation

Due to cost reduction efforts at HMOs and hospitals, nurses are outsourcing some of their duties to support underlicensed staff.

Depending on the standards of care in a facility or the country's nursing practice law, this may be considered negligence.

early discharge

Patients are being discharged home with conditions that require more intensive and acute care or in the early stages of recovery.

Nurses can be sued if they fail to make appropriate referrals based on the patient's condition or if they fail to provide care.

Nursing shortage and reduction of hospitals

As a result, the workload of the nursing team increased, increasing the probability of errors.

technical progress

Caregivers must understand the limitations, capabilities, and safety features of the technology.

Greater autonomy and responsibility of hospital nurses

Nurses exercise advanced nursing skills with greater autonomy, which can lead to increased responsibility and risk of error.

More informed consumers

When consumers are better informed, they may be aware of bad practices and be able to identify inadequate or inappropriate care.

Expanded Legal Responsibility Definitions

This means that all professionals are committed to high standards.

For example, although graduate nurses have an expanded scope of practice, courts can bind them to a standard of care.

In 1990, the NPDB began collecting information on healthcare professionals who were being penalized as a result of verdicts in malpractice lawsuits.

This has led to license revocation or restricted practice.

Some had to pay cash bonuses (or their employers or insurance companies).

The NPDB was created in 1986 by the Health Resources and Services Administration, the Health Professions Office, and the US Department of Health and Human Services was created.

It supports authorities such as hospitals, admissions offices or HMOs in verifying the qualifications of professionals who wish to hire authorities, grant memberships, licenses or clinical privileges.

RNs are divided into four categories by the NPDB:

• Obstetric Nurses.
• nurse anesthetist.
• nurse.
• Non-specialized RN.

According to the database, RNs have made 3,615 misconduct payments in the history of the NPDB.

This only includes cases reported to the NPDB from September 1, 1990 to December 31, 2001.

Most malpractice payments were made by non-specialist nurses (2,311 or 63.9%).

They were followed by anesthesiologists with 820 or 22.7% and midwives with 296 or 8.2%.

The lowest number of malpractice payments was made by nurses with 188 or 5.2%.

Cases of alleged negligence continue to involve acts of commission or omission commonly alleged by plaintiffs for 20 years.

According to NPDB annual reports, the following negligence cases generated the most payments in malpractice claims between 1990 and 2001:

Among non-specialized newborns:

• Problems related to -
  • Supervision.
  • Treatment.
  • obstetrics.
  • Medicine.
  • Operation.

Among nurse anesthesiologists:

• Problems related to anesthesia.

Among the midwives:

• Obstetrics related problems.

Among the caregivers:

• Problems related to diagnosis and treatment.

The following neglect of care issues were identified as grounds for judgments or settlements in favor of the plaintiffs (in the 1997 study):

• Inadequate assessment of the patient.
• Inadequate infection control.
• Not providing adequate information to the doctor.
• medication errors.
• nursing interventions.
• Unsafe or improper use of equipment.
• Careful.

It should be noted that any claim or payment made in a malpractice proceeding should not be construed as a presumption of provider association.

According to the NPDB, "Resolution of a medical malpractice claim may be made for reasons that do not necessarily negatively impact professional competence or conduct."

For example, a provider's insurance company may bill under the terms of the nurse's insurance policy without the policyholder's consent.

case summary

Over 350 summaries of appeals, trials, and supreme courts have been reviewed from multiple sources.

Sources included NPDB, regional summaries and reports, FindLaw and MedLaw web portals, and various books, newsletters, and magazines.

The analysis only includes cases that meet the following criteria:

• Nurses engaged in the practice of nursing as defined in your state's nursing practice law.
• Nurses who have been sued in civil lawsuits caused by unintentional (non-criminal) acts.
• Trials from 1995 to 2001.

The analysis includes 253 case summaries.

Summaries provide information about malpractice types, practice areas, and case outcomes such as settlements or jury verdicts.

Freelancers paid the monetary rewards or their employers paid on the professionals' behalf.

This is the process taught by respondeat superior, which is Latin for responding to the teacher.

This means that the employer is responsible for the actions of employees in the context of employment.

Most reported cases of malpractice occurred in acute care hospitals, that is, 60%.

Another 40% occurred in long-term care facilities, 18% in rehabilitation and transition rooms and nursing homes, 8% in psychiatric facilities.

Ambulatory health authorities and private physicians' offices accounted for 2% each.

The remaining 9% are advanced practice nurses such as B. midwives, registered nurses, and anesthesiologists.

The big difference between long-term care units and critical care units is the greater number of specialties in critical care units.

It is also based on the condition of patients in areas such as emergency rooms, intensive care and obstetrics, operating rooms and recovery rooms, surgical medical units, and coronary care.

In these settings, patients with rapidly changing conditions may become more ill and require immediate care.

negligence

The case analysis identified six main categories of negligence issues that give rise to wrongdoing claims.

The following terms were used in the documentation describing the negligent behavior:

• Mangel an.
• failure too.
• Ineffective.
• incorrect.
• Incomplete.

Categories of negligence include:

• Irresponsible use of devices.
• breach of service rules.
• No documentes.
• Communication error.
• Failing to act as an advocate for the patient.
• Errors in the evaluation and follow-up.

Below are summaries of five random malpractice cases in which nurses were charged.

They represent a variety of acts that result in breaches of standards of care.

breach of standards of care

Standards, like hospital policies, have evolved to ensure that consumers are protected from substandard care.

The standards of care establish the criteria used to determine whether a nurse has breached a duty in the care that she is obligated to provide to patients.

The acceptable level of care includes appropriate and usual care necessary to ensure that no harm is done to patients.

Standards of care are defined by agencies such as state boards of nursing, guidelines from federal organizations, and hospital policies and procedures.

Professional nursing associations such as the ANA or the National League for Nursing may also set guidelines.

1998 caso Hall vs. Arthur.

A lower court decision, upheld by the United States Court of Appeals for the Eighth Circuit, holding the hospital liable for violating the standard of nursing care during an ACF (Anterior Cervical Discectomy and Fusion).

The author's argument focused on the use of the orthoblock.

It is a ceramic substance used as a bone substitute in oral and maxillofacial surgery.

It was implanted into the patient's spine.

In such an operation, the usual procedure is to remove a bone from the patient's hip or obtain it from a bone bank.

After suffering from back problems for four months, the patient, Mr. Hall, needed a second ACF to have his own bone implanted in place of the orthoblock.

In accordance with hospital policy, any unusual requests to use the product must be reviewed by department heads to determine if the product is appropriate.

The nurse did not request such a review and ordered the use of an orthoblock in the patient's ACF.

The product package insert was submitted as evidence and stated that the orthoblock was contraindicated for spinal surgery.

Therefore, the plaintiff's lawyer's argument was that the nurse did not follow hospital guidelines, resulting in Mr. Sala.

The hospital did not challenge the jury's negligence decision, but stated that the evidence presented by the plaintiff was insufficient for the judge to conclude that Mr. Hall was caused by the nurse's negligence.

The Court of Appeal disagreed, saying that while it could not say with certainty that Mr Hall would not have been injured if the nurse had not been negligent. He considered that the negligence of the nurse played a significant role in the patient's injury, the orthoblock.

The assumption was that otherwise the operation would not have been approved by the hospital.

Irresponsible use of equipment.

Caregivers should be aware of the safety features, limitations, capabilities, and dangers of any equipment they work with.

You must follow the manufacturer's recommendations for use and refrain from modifying them.

Under the Safe Medical Devices Act of 1990, all incidents involving medical devices that may result in serious illness, injury, or death must be reported to the Food and Drug Administration and to the manufacturer within 10 business days.

Chin vs. Chin Case Chin Street St. Louis Barnabas Medical Center.

The lower court verdict against the doctor was reversed by the New Jersey Superior Court Appellate Division.

They defined that other hospital employees should be held accountable.

The case was based on the death of Ms. Chin, a 45-year-old woman.

Death was caused by a massive gas embolism during diagnostic hysteroscopy.

The malpractice lawsuit was filed by the woman's estate against the vendors who allegedly played a role in the events that caused her death.

The service providers were the treating physician, a surgical nurse, and two circulatory nurses, as well as the hospital and the manufacturer of the hysteroscope.

The hysteroscope is an optical pump device used to examine the uterus.

During the procedure, fluid is continually pumped into the uterus to improve the view inside.

The device must be connected to four hoses:

• An irrigation tube that directs fluid into the uterus.
• A suction tube that sucks fluid out of the uterus.
• An exhaust pipe.
• The tubing that connects the compressed nitrogen source to the pump.

One of the tubes was incorrectly connected to the hysteroscope and nitrogen was pumped into the patient's uterus, causing a fatal gas embolism in her coronary arteries.

At trial, all parties agreed that the source of the gas that killed the patient was the exhaust hose.

However, there was a dispute as to whose fault it was for incorrectly positioning the hysteroscope.

Based on the evidence presented, the two nurses assigned to the procedure were inexperienced in the use of a hysteroscope.

They also lacked hospital training.

It was verified that the nursing assistant mentioned the providers, but was unaware of the lack of experience of the other nurses.

No expert opinion on the standard of care was submitted to the study.

At the conclusion of the hearing, the judge instructed the jury to use their "common knowledge" to determine whether the nurses had evaded their duty to care for Ms. Chin.

The common knowledge standard applies to matters where the common knowledge and experience of a lay person, without expert opinion, would lead a jury to conclude that due diligence has been breached.

The jury was also informed that Ms. Chin, who was unconscious during the proceedings, was not at fault for her own death.

In addition, each defendant had to prove that he was not guilty.

Plaintiff was awarded $2,000,000 in damages by the jury.

The jury also found the defendants liable as follows:

20% – the doctor.

25% – the experienced circulatory nurse.

20% – the inexperienced nurse.

35% – the hospital.

The manufacturer and the surgical nurse were released from liability.

Immediately after the sentence was pronounced, the investigating judge agreed to the request of the hospital, which questioned the validity of the application of the generally accepted norm in this treatment.

The judge blamed only the doctor.

In granting the hospital liens, the judge declared that the application of the common knowledge standard was incorrect.

However, upon the doctor's appeal, the Court of Appeals reversed the lower court's decision and reinstated the original jury verdict.

This means that not all of the defendants have proven innocence in the statement of Ms. Chin.

It was also established that the lower court did not rule on the well-known standard request.

Evaluation and monitoring errors and communication errors

A patient's health can change gradually or suddenly.

Nurses are often the first to notice and act on changes.

Accurate monitoring and assessment of the caregiver's abilities, as well as timely reporting of changes in condition to a physician, can be a matter of life and death.

In addition to timely reporting, issues such as accuracy in reporting the extent and nature of changes and persistence in reporting to the physician are critical.

1996 Busta v. Columbus Hospital Corporation case.

The judgment and orders of the District Court for the Eighth Circuit were affirmed by the Montana Supreme Court.

The Lord. Busta was a post-op patient at Columbus Hospital in Great Falls.

However, he died from injuries sustained when he fell from a third-story window.

The responsible nurse for Mr. Busta testified in court that he had an episode of high blood pressure and tachycardia during his last visit that night.

He also behaved in an atypical manner, refusing any care and prescribed medication and wishing for isolation.

His medications were known to have side effects including anxiety, confusion, and psychosis.

The nurse did not inform the doctor about the change in behavior and symptoms.

He also testified that the patient was asleep at midnight during the examination and did not reassess the patient's vital signs.

The patient's surgeon stated that if he had been informed of the change in symptoms and signs, he would have reassessed Mr. Busta for the effects of the mind-altering drugs.

According to the expert, the nurse negligently failed to monitor the patient the night before he died and did not report the change in symptoms and signs to the surgeon.

Furthermore, the hospital was found to be negligent in failing to provide a safe environment.

Based on the evidence presented at trial, it was concluded that the hospital had not followed JCAHO guidelines for restricting window opening in patient rooms.

The jury concluded that the patient's injuries and death were the result of Columbus Hospital's negligence along with the patient's negligence.

The jury awarded 70% of the responsibility to the hospital and 30% to Mr. Busto.

Damage to Mr. Busta was estimated at $5,000 and $800,000 to his heirs.

Based on the jury's assigned liability, the court found in favor of Mr. Busta for $560,000 and his estate for $3,500.

documentation error

The purpose of documentation is to communicate information about a patient between providers.

It must accurately reflect the care process, including diagnostic tests and evaluation.

It must include the planning of nursing interventions, as well as the performance and evaluation of these interventions and the patient's response.

Pellerin v Humidicenters, a case involving failure to document care procedures.

The lower court's ruling was upheld by the Louisiana Court of Appeals, Fourth Circuit.

The author alleged that an injection of hydroxyzine pamoate (Vistaril) and meperidine (Demerol) was administered poorly by an emergency room nurse.

This caused a lump at the injection site and constant pain, which a neurologist later diagnosed as gluteal cutaneous neuropathy.

The lawsuit was unable to prove exactly how the injury occurred.

Statements from medical experts about the cause of the patient's nerve damage were contradictory.

It could have been caused by the needle or the hydroxyzine pamoate.

According to nursing experts, standards of care were neglected due to lack of documentation on injection type and site.

The defendant testified in court that it was her usual practice to give an intramuscular injection and that this was within the standards of care.

The jury found in favor of the author.

Over $90,000 in damages were awarded.

On appeal, the defendant hospital and nurse argued that the evidence presented demonstrated that the nurse's failure to meet the standard of care could not have caused harm to the patient.

The Court of Appeal disagreed.

The nurse's testimony, which was insufficient to support the jury's decision, was found, along with the other evidence at trial, not to support the decision.

Failing to act as a patient advocate

Ethical and legal issues can be skewed in healthcare, and nurses need to be well-versed in both.

OCode of Ethics for Nurses with Interpretive Statementsby ANAprovides guidance on ethical decision making and defines the nurse as a patient advocate.

As O'Keefe states inerrors of care and law,In nursing, patients' rights are the symbol of advocacy.

Nurses should aim to provide excellent patient care and the inclusion of their rights in the modern healthcare system.

In particular, as patient advocates, nurses may need to care for patients whose healthcare decisions may conflict with the nurse's ethical beliefs.

Koeniquer v. Eckrich, 1988.

The 5th Circuit District Court's order in favor of Dakota Midland Hospital was reversed and quashed by the South Dakota Supreme Court.

The case was based on the death of Winnifred Scoblic.

The patient died of sepsis, which would have developed when she was discharged with fever about 11 days after urinary tract surgery.

The complainant, Ms. Koeniquer, represented her mother's estate and filed a malpractice lawsuit against Dakota Midland Hospital and two doctors.

He stated that they deviated from the appropriate standards of care in postoperative urology.

Mrs. Scoblic's operation took place on January 5, 1983.

During her postoperative stay, her temperature fluctuated and was 100.2 degrees F at 8:15 a.m. m. of January 16.

He checked in after his attending physician finished his rounds.

Lady. Scoblic was released at 10:45 a.m. the same day.

On January 19, he was admitted again with sepsis.

On January 21, the patient was transferred to the Hospital of the University of Minnesota.

On March 6, he died of multiple organ failure.

Plaintiffs' specialist stated that the nurses failed to adequately monitor Ms. Scoblic and provide adequate postoperative care.

However, they claimed to have told the doctor about her elevated temperature and the resulting cut and drain condition.

They reported the day of discharge, but such report was not documented.

The expert witness also affirmed that the patient's discharge and the lack of orientation to control her temperature were cases of omission of the patient's defense.

The hospital argued that it was the doctor's decision to discharge the patient.

However, the hospital's director of nursing testified that sometimes it is the responsibility of the nurse to challenge the doctor's order.

This is especially true if the patient's condition has changed significantly.

The Director also confirmed the specialist's statement that it was the nurse's responsibility to independently assess the patient's condition and convey any concerns to the physician.

If the nurse believed that the doctor's decision was incorrect, she should have called other authorities.

The hospital's argument that a doctor decided to discharge the patient was accepted by the court, so the hospital was not an adequate response to the lawsuit.

However, the state Supreme Court ruled that the recording of expert testimony showed that nurses had a responsibility to try to delay the patient's discharge due to her changing symptoms.

However, the records did not contain any evidence that a nurse questioned or disagreed with the doctor's decision.

The court held that it was the duty of the nurses to challenge the doctor's order if they felt it was in the best interest of the patient to do so.

They would have to delay your discharge if they felt you deviated from the appropriate standards of care.

As a result, the nurse neglected her duty as a patient advocate.

Areas of activity mentioned in the complaints

This review identified 13 nursing specialties that were part of a malpractice process.

Intensive care unit nurses were named defendants, involved in 153 cases, compared to nurses employed in other areas in 100 cases.

Seven specialized acute care practice areas have been identified.

The highest percentage (32%) of participation included nurses from medical-surgical units, followed by nurses from obstetric units (16%).

Nursing staff in intensive care units were less involved in the following areas:

• Operating rooms – 3%.
• Intensive care – 3%.
• Coronary care – 3%.
• Pediatrics – 3%.
• Recovery rooms - 2%.
• OF 1%.

Outside of intensive care, six areas of activity were identified.

The highest percentage of litigation participation included advanced practice nurses working in independent settings (9%).

Then there were nurses in psychiatric wards, transitional care, and nursing homes (8% each).

Less affected areas included rehabilitation centers and home care centers (2% each).

Reduce potential liability

The nursing assessment includes a case-by-case analysis of the circumstances and facts.

To prevent medical malpractice, nurses must initiate this evaluation of everything they do in the clinical setting.

Nurses are increasingly responsible for their judgment and the results to which it leads.

Negligence lawsuits can be emotionally, professionally, and financially disastrous.

Any caregiver can take steps to reduce potential liability by exercising common sense, caution, and increased awareness of their legal responsibilities.

Caregivers can do the following to reduce potential liability:

• Maintain honest, open, and respectful relationships and communications with patients and their families:
  • When patients feel that a nurse was professional and caring, they are less likely to complain.
  • Avoid expressing opinions when a patient asks you what's wrong.
    You may be accused of making a diagnosis.
  • Avoid statements that could be construed as an admission of guilt or guilt on the part of the patient.
  • When talking to patients, do not criticize the actions or the health professionals themselves.
  • Stay safe in healthcare.
• Maintain proficiency in your practice specialty:
  • Expand your knowledge and technical skills.
  • Participate in relevant in-service and continuing education courses and programs at the hospital.

• Stay on top of the legal fundamentals and apply them in your daily practice:
  • Stay up to date on hospital policies and procedures.
  • Keep up with your state's nursing law.
• Keep your practice within the limits of your license:
  • Perform only those skills that you have mastered and that your field of activity allows you.
• Know your strengths and weaknesses.
  Do not accept a clinical assignment for which you do not feel competent.
  • Evaluate your task with the manager.
  • Accept only assignments for which you are competent.
  • Let an experienced nurse take care of specialized tasks.
  • Keep accurate records of care.
  • If the care is not recorded, the courts will assume it was not provided.
  • Use the FACT mnemonic while documenting care in the patient record: factual, accurate, complete, and timely.

Six main categories of negligence leading to wrongdoing claims

breach of standards of care

Including:

• Without elaboration of a care plan or completion of the access test.
• Non-compliance with standard institutional policies, procedures and protocols.
• Failure to comply with physician's orders, written or oral.

Irresponsible use of equipment.

Including:

• Non-compliance with the equipment manufacturer's recommendations.
• Could not verify that the device is secure before using it.
• Error in the correct placement of the devices for treatment.
• Could not learn how the device works.

communication error

Including:

• Not informing the doctor in a timely manner when circumstances so require.
• Not listening and acting on a patient's complaints.
• Lack of effective communication with the patient.
• Failing to obtain approval of treatment from higher medical authorities.

documentation error

Including failure to include the following in the patient record:

• Response to treatment and evolution.
• injuries
• Medical orders from a physician.
• Relevant information on the evaluation of care.
• Information obtained through telephone conversations with physicians, including the content of the communication, the timing, and the actions taken.

Errors in evaluation and follow-up

Including:

• Failure to monitor the patient's ongoing progress.
• Lack of implementation of a care plan.
• Errors in the interpretation of the signs and symptoms of a patient.
• A shift evaluation could not be completed.

Failing to act as a patient advocate

Including:

• Not providing a safe environment.
• Do not challenge discharge orders when the patient's condition warrants it.
• Failure to fill an illegible or incomplete medical prescription.

What to do if you receive a complaint

First inform your insurance company.

A complaint is a legal request by the author to initiate an action.

This includes a statement of the alleged cause or causes of action against the defendant and a formal declaration.

This may be the first indication that a nurse is being named as a defendant in a civil lawsuit.

After notification of the accident, the caregiver must inform their insurer and employer.

Usually, they hire a lawyer to handle the case.

If the caregiver does not have liability insurance, he or she should hire an attorney.

The nurse can only discuss the case with the designated defense attorney and no one else.

When notifying the insurer of their liability, the caregiver must provide a written description of the facts.

It must contain the place, time and circumstances of the event, as well as the list of addresses and names of the injured party and witnesses.

Once summoned, the caregiver must provide the insurer with all relevant documents within the time frames specified and described in the liability insurance policy.

If the nurse does not notify the insurer within this time, coverage may be denied.