Nurse as Clinician
While nurse-as-custodian claims continue to be asserted, plaintiff’s lawyers have now begun to pursue claims that focus on the nurse as a clinician, responsible for using professional judgment in the course of treatment.
In these claims, nurses are perceived as highly skilled and educated professionals who are charged with making clinical observations, exercising discretion and taking appropriate treatment actions based upon a patient’s changing clinical picture. This shift reflects, to some extent, the increasing number and importance of specialties and areas of expertise within the profession. The following are examples of the new paradigm of nursing claims:
- Following a fall by a geriatric patient, the nurse is sued for failure to change the service plan despite increasing problems with gait and behavior.
- A child is born with profound brain damage, and the nurse is alleged to have failed to properly interpret fetal monitoring strips.
- A lawsuit charges the nurse with failure to appreciate a patient’s risk for skin breakdown and to take appropriate preventive measures.
- After a patient experiences adverse drug reactions, the family alleges that the nurse failed to properly administer and provide the correct dosage.
- A patient in the emergency department has a cardiac arrest, and a lawsuit is filed alleging that the triage nurse failed to appreciate acute cardiac symptomatology.
This shift has afforded increasing opportunities for plaintiff’s attorneys to name nurses as defendants in medical malpractice lawsuits. Mistakes made by nurses in their role as “custodian” were infrequent, and such mistakes led to easily understood claims that could be resolved without resorting to litigation. However, the new generation of “clinician” claims permits nurses to be included in any case in which a patient receiving complex treatment has a poor outcome.”
It is no secret that the number of nurses named in lawsuits is increasing. One other trend is for the nurse or nurses to be the only named defendants left in the case after the physician and employer has been excused from the case. This is increasing the demand for nurses to be able to act appropriately as clinicians. Examples include increasing numbers of cases involving catheter-related bloodstream infection and I.V. medication adverse events.
We have seen a decrease in Infusion Teams in many hospitals, putting the responsibility for safe administration of all I.V. fluids and medications in the hands of the primary care nurse. These cases are also holding the nurse accountable for the outcomes of his/her actions. In addition to cases involving mechanical catheter problems that produced a local complication such as extravasation, there is an increase is cases involving monitoring for adverse reactions to I.V. medications such as ototoxicity, nephrotoxicity, red man syndrome, and cardiac arrhythmias. Protect yourself by knowing and performing the correct process for I.V. medication administration. But also know the possible adverse events that can happen with each I.V. medication and document all components of your assessment to identify and reduce those adverse events.
Nurses are required to act as clinicians rather than simply caring out the tasks prescribed by the physician. This requires knowledge and critical thinking along with psychomotor skills of catheter insertion. Click on the link below to download the complete report on nurse claims.