Question

Chapter 8 Nursing Law and Liability 185 Issues in Practice continued Questions for Thought • Do you agree with the jury's decision against the nurse? Why? • The nurse has a legal and ethical obligation (fidelity) to follow the physician's order. Is there ever a situation when the nurse can ignore a physician's order? • Under what legal principle was the hospital held liable for the nurse's actions • What other actions might the nurse have taken, besides putting up the side rails, to prevent the patient from falling?

please respond in well mannered, organized response with clarification and subjective data.

Answer 1

I completely agree with the Jury's decision as nursing staffs also have independent responsibility for the patient. Nursing is a profession with its own body of knowledge, theories, ethical framework and principles A Nurse is neither orderly nor an assistant of a physician, and all nursing actions or interventions of the nurse should be guided by professional values such as Accountability, Responsibility, AUTONOMY, Competence, and PATIENT SAFETY. Nurses are accountable to ensure the principles of beneficence and nonmaleficence in their practice.

It is true that Nurses have a professional responsibility to implement a Doctor's order but not in all situations. If a physician's order can harm a patient, and the Nurse is fully aware and knowledgable(based on science) about the potential harm and is confident that the same is supported by Nursing practice laws, nursing science, and medical science, he/she should ignore the order. This must be noted in the chart and recorded and reported properly. Most organizations have clear protocols on how to handle this kind of situation some recommend to call the next line manager and some instructs nurses to discuss a senior colleague and take the proper decision. While assigned with many patients in the same unit doctors may ask to provide more time and attention to their own patients (Primary Consultants ) here also Nurse can use her/his own nursing judgment and prioritize patients according to the nursing needs and manage their time based on the nursing rationale. It goes without saying that the Nurse should care for all the people assigned to him/her.

According to the legal rule of vicarious liability, any employers -including hospitals- is liable for its employees' negligence. So, the hospital is legally liable for any malpractice committed by a physician, nurse, or other health care providers who are employed by the hospital

The nurse should do a Fall Risk assessment and see risk of fall in the patients.It is important for nurses to perform a standardized fall-risk assessment -eg Morse Scale -during the admission of every patient and whenever the patient’s condition changes. Identifying patients at high risk for falls during transitions of care should be of primary importance

Should assess for history of falls

Mke sure that the call bell is accessible and visible.The bedside or over-the-bed table is in reach and its wheels are locked, the bed is in its lowest position

Also make sure that  the floor is free of clutter and trip or slip hazards, and an auditory alert (ie, a signal device the patient can hear that reminds the patient to stay in bed or call for the nurse).

Frequent rounds to ensure patient is safe.

Also ask the care givers to stay vigilant.