Professional Documents
Culture Documents
Care Nursing
Governmental Organizations Overview
Legislative Branch
◦ Create and modify statutes
Executive Branch
◦ Write and enforce regulations
Judicial Branch
◦ Interpret statutes and regulations
Most common against nurses and employers is negligence by a professional, called malpractice.
Nursing Malpractice Case
The distressed patient and/or family file a lawsuit against the nurse in a civil court.
The nurse becomes a defendant.
◦ Legal representation obtained
Discovery phase
◦ Written answers to written questions
Depositions
◦ Oral testimony
Trial
Elements of Malpractice
Duty
Breach of Duty
Damages
Causation
Duty
Legal relationship between two or more parties
Contractual relationship between the patient and the health care facility
Duty of individual nurse confirmed by the nurse’s name in the patient’s records
A nurse has a duty to provide reasonable care within established standard of care.
Breach of Duty
After the establishment of duty, the plaintiff must show the nurse violated that duty.
Negligence is determined by comparing the nurse’s conduct with established standard of care
(SOC).
If the nurse fails to have met the SOC, he or she has violated his or her duty to the patient.
Negligence can be “ordinary” or “gross.”
◦ Gross negligence indicates the nurse willfully and consciously ignored a known risk of harm for the
patient.
Causation
Malpractice law requires a causal relationship between the nurse’s breach of SOC and injury to
the patient.
The plaintiff has to show the injury or harm occurred as a result of the nurse’s action or inaction.
“Proximate cause” has to be established.
Damages
The intent of malpractice law is to make the injured party “whole.”
Most courts award monetary “damages” to compensate the plaintiff for their injuries
Economic damages
Noneconomic damages
◦ Pain and suffering
◦ Many states place limits on the amount of monetary awards.
Common Cases in Critical Care
Failure to comply with reasonable SOC
◦ Case study
Criminal liability
◦ Case study
Vicarious Liability
Vicarious liability means to hold someone responsible for the actions of another.
Includes
◦ Respondeat superior
◦ Corporate liability
◦ Negligent supervision
◦ Rule of personal liability
Respondeat Superior
“Let the master answer for the sins of the servant.”
Hospitals are held liable for the negligence of their employees.
Applies when hospital employees act within their scope of employment
Does not apply in situations involving temporary personnel or typically to physicians
Corporate Liability
Corporate liability occurs when a hospital is found liable for its own unreasonable conduct.
Example:
◦ Chronically understaffed or injury occurs as a result of being understaffed
◦ Floating nurses not competent in area they are floated to
Negligence Supervision
Negligence supervision is claimed when a supervisor fails to reasonably supervise people under
his or her direction.
Example:
◦ A nurse being floated to an ICU but is not skilled or trained in ICU is delegated invasive procedures by
the charge nurse.
◦ Charge nurse may be found liable if an injury occurred to the patient.
Captain of the Ship Doctrine
Physicians used to be considered the “captain of the ship.”
◦ Nurses were expected to follow any order.
Policy statements should exist in hospitals that indicate the manner of resolving the issue of
“questionable” medical order.
◦ An order that is wrong can harm the patient.
◦ Initially clarification of order
◦ Clear chain of command
Establishment of Protocols
Critical care nurses may perform medical acts without direct supervision of the physician, but
the act must have established protocols.
Protocols should be in compliance with NPA.
Should reflect current SOC
Liability for Defective Equipment
The Safe Medical Devices Act requires user facilities to report to the manufacturer medical
device malfunctions that result in serious illness, injury, or death.
Required to report to FDA a death
Nurses must participate in the reporting, even if due to user error.
Nurses have a duty not to use equipment that is defective.
◦ Case study
Autonomy
Laws protecting autonomy include “informed consent.”
A nurse witnesses a signed consent form.
◦ Witness signature only when you sign
Document in the nurse’s notes stating, “consent procedure witnessed” if present during the
consent procedure.
Decision-Making of Incompetent Patient
Advance directives
State laws identify next of kin for decision making.
Living wills
Durable power of attorney for health care
Issues Involving Life Support Measures
DNR orders
◦ No “slow codes”
Highly skilled
◦ Competent skills
Caring
◦ Holistic nursing
AACN
Evaluating data drives decision making.
Determine trends, issues, and policy
Advocacy implications affect critical care nursing practice, patients, and families.
Defining Nursing Professionalism
True profession
Level of entry to nursing
Personal responsibility and accountability to professional role
Term “professionalist”
◦ Strive to build solid foundation for their calling
◦ Ethical, academic, political, and socioeconomic
Characteristics of a Profession
Services provided to humanity and welfare of society
Special body of knowledge
Services provided involve intellectual activities
Practitioners educated in higher learning
Motivated by service
Code of ethics
Supports standard of care
Professionalism Among Critical Care
Nurses
Critical care nursing characteristics
◦ Professional beliefs
◦ Decision making
◦ Level of education
◦ Membership of professional nursing organizations
◦ Certifications
Defining Nursing Excellence
“Excellence” is “best practice.”
No single definition of excellence
Definition may include dynamic process.
Six attributes for advanced-practice nursing
◦ Values, vision, mastery, passion, action, and balance
Healthy Work Environment
Skilled communication
True collaboration
Effective decision making
Appropriate staffing
Meaningful recognition
Authentic leadership
Personal Mastery
Commitment to lifelong learning.
Seek feedback and peer review.
Seek a degree higher education.
Demonstrate competence through certification.
Certification
Certification validates clinical competency.
◦ Process of achieving highest recognition of excellence
Perception among nurses gives autonomy and control over practice, enhances collaboration,
and results in higher patient satisfaction.
Passion
Enthusiastically striving for what is best
Goes beyond 8 to 12 hour shift
Examples:
◦ Bring research to bedside
◦ Updating protocols and procedures