Nurses, Negligence, and Malpractice

Article Content

More and more nurses are being named defendants in

malpractice lawsuits, according to the National Practitioner
Data Bank (NPDB). From 1998 to 2001, for instance, the
number of malpractice payments made by nurses increased
from 253 to 413 (see Figure 1, page 55). The trend shows no
signs of stopping, 1-3 despite efforts by nursing educators to
inform nurses and student nurses of their legal and
professional responsibilities and limitations. A charge of
negligence against a nurse can arise from almost any action or failure to act that results
in patient injury-most often, an unintentional failure to adhere to a standard of clinical
practice-and may lead to a malpractice lawsuit.
  
This article analyzes cases decided between 1995 and 2001 and identifies the
actions and issues that prompted charges of negligence that led to malpractice lawsuits
against nurses, as well as the areas of nursing practice named most frequently in the
complaints. (This article does not address criminal cases arising from intentional acts,
such as assault, battery, or false imprisonment, for which nurses have been arrested
and sometimes prosecuted.)

DEFINING AND TRACKING MALPRACTICE

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
defines negligence as a "failure to use such care as a reasonably prudent and careful
person would use under similar circumstances." JCAHO defines malpractice as
"improper or unethical conduct or unreasonable lack of skill by a holder of a professional
or official position; often applied to physicians, dentists, lawyers, and public officers to
denote negligent or unskillful performance of duties when professional skills are
obligatory. Malpractice is a cause of action for which damages are
allowed."4 Malpractice is defined variously under state nurse practice acts, institutional
policies, and federal guidelines such as JCAHO standards, all of which may be taken
into consideration in court.
 
Several factors have contributed to the increase in the number of malpractice cases
against nurses.
 
* Delegation. As a result of cost-containment efforts in hospitals and HMOs, nurses are
delegating more of their tasks to unlicensed assistive personnel. Delegation of some of
these tasks may be considered negligence according to a given facility's standards of
care or a state's nurse practice act.
* Early discharge. Patients are being discharged from hospitals at earlier stages of
recovery and with conditions requiring more acute and intensive nursing care. 5 Nurses
may be sued for not providing care or not making referrals appropriate to the patient's
condition.
 
* The nursing shortage and hospital downsizing have contributed to greater
workloads for nurses, increasing the likelihood of error.
 
* Advances in technology require nurses to have knowledge of a variety of
technologies' capabilities, limitations, and safety features.
 
* Increased autonomy and responsibility of hospital nurses in the exercise of
advanced nursing skills have also brought about greater risk of error and liability.
 
* Better-informed consumers are more likely to be aware of malpractice issues and to
recognize insufficient or inappropriate care.
 
* Expanded legal definitions of liability have held all professionals to higher
standards of accountability. 1 For example, because of the expanded scope of practice
of advanced practice nurses, courts have held them to a medical standard of care. 2
 
 
In 1990 the NPDB began collecting information about health care practitioners
who, as the result of judgments in malpractice suits, have entered into settlements, had
disciplinary action taken against them that resulted in licenses being revoked or
privileges to practice being limited, or had to pay monetary awards (or whose employers
or insurance carriers have had to pay monetary awards). 1 (Established in 1986 and
regulated by the Bureau of Health Professions, the Health Resources and Services
Administration, and the U.S. Department of Health and Human Services, the NPDB
assists eligible agencies such as state licensing boards, hospitals, and HMOs in
checking the qualifications of practitioners whom the agencies wish to hire or to whom
they wish to grant licenses, membership, or clinical privileges. 6)
 
The NPDB classifies RNs into four categories: nonspecialized RNs, nurse
anesthetists, nurse midwives, and nurse practitioners. According to the data bank, RNs
have been responsible for 3,615 malpractice payments over the history of the NPDB
(only those cases reported to the NPDB between September 1, 1990, and December
31, 2001, are included). Nonspecialized RNs made the most malpractice payments
(2,311 or 63.9%), followed by nurse anesthetists (820 or 22.7%), and nurse midwives
(296 or 8.2%). Nurse practitioners made the fewest malpractice payments (188 or
5.2%). (For numbers pertaining to 198 through 2001, see Figure 1. Annual reports of
the NPDB are available online at http://www.npdb-hipdb.com.)
 
Acts of commission or omission that plaintiffs commonly alleged 20 years ago
continue to be alleged causes of nursing negligence. 1,3 According to the NPDB's
annual reports, from 1990 through 2001 the majority of payments in malpractice suits
resulted from the following nursing negligence issues: among nonspecialized RNs,
problems relating to monitoring, treatment, medication, obstetrics, and surgery; among
nurse anesthetists, problems relating to anesthesia; among nurse midwives, problems
relating to obstetrics; and among nurse practitioners, problems relating to diagnosis and
treatment.
 
A 1997 study identified the following nursing negligence issues as the bases of
settlements or verdicts in favor of plaintiffs: failure to communicate adequate information
to the physician; inadequate patient assessment, nursing interventions, or nursing care;
medication errors; inadequate infection control; and unsafe or improper use of
equipment. 7 (Similar negligence issues were identified in studies by Campazzi
[1980], 8 Smith [1989], 9 Mayberry and Croke [1996], 3 and Smith-Pittman [1998]. 10)
 
It's important to note that a payment or claim made in a malpractice action shouldn't be
construed as a presumption of the provider's guilt. As a fact sheet from the NPDB
states, "settlement of a medical malpractice claim may occur for reasons that do not
necessarily reflect negatively on the professional competence or conduct"6 of the
provider. For example, a nurse's insurance policy might allow the insurance carrier to
settle without the policyholder's consent. 
 ARTICLE ANALYSIS

Nursing is a profession that alleviates pain and promotes health of people. Since the
primary aim of nursing is to care for others, it is considered a value laden profession. This
specific nature of nursing requires nurses to do what is right during the practice of the profession.
However, every day, nurses encounter complex situations and conflicts which leads to
negligence and malpractice. Nursing and healthcare continues to change on a daily basis. The
one thing that has remained constant during these changes is maintaining the safety of the
patients. By maintaining their safety, nurses must safeguard their selves by keeping up-to-date
with the changes relating to medical treatments.

The Principle of Stewardship and Role of Nurse as Stewards hit into my mind when I
think of the article, Nurses, Negligence and Practices. This refers to the execution of
responsibility of the health care practitioners to look after, provide necessary health care services
and promote the health and life of those entrusted to their care. As a nurse, we should not allow
ourselves to be irresponsible towards helping uplift patient’s optimal health and wellness. We
should know our role as individuals who provide care to others. By maintaining a keen
assessment, a keen awareness of the treatment and procedures we need to imply. In short, we
need to be intellectually alert. Much more than that, we must see situations as if we are the ones
playing the role of the patients.

The article is also interconnected with Accountability, which is one of the 4 core values
of a professional nurse. Taking ownership over your practice including every mistake, error in
judgement or failure to communicate. We must take full responsibility and be accountable with
every decision we make and every action we do to the patient relating to healthcare. We need to
have conscience and fully equipped wisdom to not blame anyone for our own ignorance and
negligence.

The Principle of Beneficence, nurses have a duty to be a benefit to the patience, as well
as to take positive steps to prevent and to remove harm from the patient. These duties are viewed
as rational and self-evident and are widely accepted as the proper goals of medicine. This is at
the very heart of nurses that a patient can enter into a relationship with one whom society has
licensed as competent to provide medical care. With that, nurses must not break their trust and do
what is best for the patients.

“To do no harm.” that is what Non maleficence denotes. It is truly essential to take in to
consideration what the patient needs and what patients truly looking for. It’s important to take
patients well-being above all. It is hard for nurses to keep patients unexposed to harm, but they
must act according to their profession to still instill the optimal level of healthcare services even
do they have done something wrong. Moreover, the principle of non maleficence requires that a
health practitioner should not intentionally create a harm or injury to the patient, either through
acts of commission and omission. We consider it negligent if one imposes a careless or
unreasonable risk of harm upon another. Providing a proper standard of care that avoids or
minimizes the risk of harm is supported not only by the commonly held moral convictions, but
by the laws of society as well. This principle affirms the need for medical competence. It is clear
that medical mistakes may occur; however, this principle articulates a fundamental commitment
on the part of health care professionals to protect their patients from harm.

Working on a safer way to ensure the prevention of malpractice is what should be worked
on to promote a safe and comfortable environment for the people. There are many errors that
malpractice portrays in the healthcare field such handling medical situations and what we must
do now is to never stop learning, never stop craving for knowledge because as all people know
“Knowledge is Power”. With knowledge we can help save lives, build a better world where
negativity will not grow and foster and it will not endanger humanity.