Litigious Areas of Nursing and the Nurse's Liability

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Litigious Areas of Nursing and the Nurse's Liability

Vulnerable areas of nursing include anesthesia and obstetrics/midwifery. RNs in OB (L and D), those working solely in monitoring capacities (fetal heart, telemetry, etc.), and medication administration (including long term care) are also included in more litigious areas.

Of course, the Advanced Practice Registered Nurse (APRN) other than CRNA and CNM are subject to increased litigation, but the latter two are more vulnerable. And, the Neonatal Nurse Practitioner (NNP) seems to be at high risk secondary to "pain and suffering" issues.

As of recent reports from the 2020 CNA/NSO: Nurse Professional Liability Exposure Claim Report: 4th Edition, Home Care services claims have been on the increase. Issues related to treatment/care are the most frequent allegations.

From the above report:

Quote

The average total incurred of professional liability claims in the 2020 claim report ($210,513) increased more than 4 percent compared to the 2015 claim report.

Many Liability carriers in many states will insure the Nurse Practitioner, but not insure the Certified Nurse Midwife

In some states, APRNs have stricter professional liability requirements whereas their physician counterparts can choose to be uninsured. This can present a problem for the APRN because they can, in turn, be targeted in lawsuits when the physician with whom they work has no coverage.

But, nurses in general can be and often are, at risk.

"The number of Adverse Action Reports (license defense issues) against nurses nearly doubled between 2003 - 2012." - Proliablility

Major Reasons Why more Lawsuits are Being Made Against Nurses

  • Our responsibilities have increased in complexity
  • Higher levels of Standards of Care (SOC)
  • Increased patient expectations
  • Pressure to increase productivity and increased patient load
  • Society has become highly litigious

Most Common Issues

  • Failure to abide by the Nurse Practice Act (NPA)
  • Failure to follow the SOC
  • Failure to adhere to policy/protocol/procedure
  • Failure to document, including lack of documentation, altered documentation, missing or "lost" documentation, incomplete documentation
  • Failure to recognize change in patient condition
  • Failure to appreciate the change in patient condition
  • Failure to report change in patient condition
  • Failure to follow up change in patient condition
  • Failure to communicate across the healthcare provider spectrum
  • Failure to monitor
  • Failure to act as patient advocate
  • Failure to provide a safe environment
  • Failure to respect patients' rights to privacy and confidentiality

Common Reasons for Errors

  • Job overload (poor nurse-patient ratio)
  • Inexperience
  • Ignorance
  • Inadequate patient monitoring
  • Poor nursing judgment/critical thinking
  • Hesitation
  • Faulty communication
  • Ignoring patient complaints
  • Fatigue
  • Breaks in concentration
  • Flaws in the system
  • Inadequate staff training
  • Improper delegation
  • Provision of services beyond scope of practice
  • The nursing shortage
  • Drug diversion and/or substance abuse

Ways to Ensure Safe Practice and Avoid Litigation

  • Be familiar with our individual NPA
  • Adhere diligently within our Scope of Practice (SOP)
  • Know the SOC for our specialty area(s)
  • Question authority
  • Educate ourselves regarding evidenced-based practice
  • Stay abreast of changing trends in nursing through continuing education
  • Educate ourselves regarding medical-legal issues
  • Make sound, safe, and practical nursing judgments for all our patients

A kind word and non-defensive attitude with a patient turns away many a lawsuit.

On a final note...

Protect yourself. Purchase liability insurance.

1 Votes
sirI

About sirI, MSN, APRN, NP

(Editorial Team / Admin)

sirI is an OB-GYN NP-BC, (Emeritus), FNP-BC, and Legal Nurse Consultant. Specialty areas include OB-GYN, trauma, med-legal consulting, forensics, and education.

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Thank you sirI for posting...I'm a new graduated nurse. Currently in my 1 month and 1 week of ED orientation. I came to realize how vulnerable I am as new nurse--that feeling sucks. The only thing that keeps me going and learning is through prayers.

1 Votes
Specializes in Education, FP, LNC, Forensics, ED, OB.

Hi, BimmieBear. Good to hear from you.

Yes, the newness of the nursing career and all new territory as you orient can be very overwhelming sometimes.

Hope you have taken out . Great peace of mind for very little each year.

1 Votes
Specializes in ICU, ER, Staff Dev, Mgt, Legal.

Great advice for everyone, especially about kind words. People don't care about your degree(s) and certification(s). They do care about your kindness and honest concern.

Nurse Pam

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I think this is an excellent blog. Too many of our peers are caught up in "just doing their job" that they forget the legal ramifications of "just doing their job."

I work in a cardiac cath lab and currently am dealing with having our nursing assignments made by a non-nurse who is a RCIS and called a "Team Leader". It bothers me that she is making a nursing judgement in making our assignments because she makes the decision of who works where within the department e.g., circulating cases, pre-case assessment, post-case recovery, angiography, et cetera. There are 9 nurses in our department and I question her ability to know what nurses are capable of and our responsibilities. She makes the decision of who is doing the patient assessments, giving conscious sedation, and watching the monitors. My question is...how will a judge, jury and plantiff's attorney react to the nurse if something happens because this "Team Leader" assigned someone to an area which he or she is incompetent? Is this "Team Leader" practicing nursing without a license??

I'm very upset and outdone because I have worked very hard to get a college education, pass boards, obtain certifications and further my education when I'm taking directives from a person that was on the job trained and doesn't even have college degree!!

1 Votes

You're right to be concerned. As a Legal Nurse Consultant I can tell you that's something I'd be all over in litigation.

Letting non licensed people do jobs that require clinical judgement is foolish.

Your hospital should consult with a CLNC regarding this.

1 Votes
Timehonored RN said:
You're right to be concerned. As a Legal Nurse Consultant I can tell you that's something I'd be all over in litigation.

Letting non licensed people do jobs that require clinical judgement is foolish.

Your hospital should consult with a CLNC regarding this.

That wouldnt make sense to any layperson in society , mustless a healthcare member.

1 Votes
Specializes in CVOR, CVICU, Administration.

Bimmie...be patient with yourself. It will take months to feel comfortable in your new role. Start each shift with a clear head, ask questions when you are not sure and identify your mentors early on. You can get through this!

Doug

1 Votes

As an RN that "won" a medical malpractice settlement after the death of my husband, (if you want to call it winning after your your husband/best friend dies), I can't agree more on how far a kind word goes. Part of the reason that I did litigation was because of the way I was treated after my husband's heart stopped. Almost no one talked to me, except one nurse and one doc. I was treated with silence from what I had thought was my sisterhood of nurses and healthcare workers. The two healthcare providers that did express condolences did so simply by saying, "I'm sorry." Those two words let me know they were the true healthcare providers among the many who treated him.

The nurses had a chance, as sirI puts it, to question authority, yet no one did.

1 Votes

A nurse told me tonight that she is documenting short staff by "two psych techs on shift". Many patients are strict line of sight on the psych unit and two staff members plus nurse, math don't add up. So she says she covers it through documentation. What do you think?

1 Votes
candlecat said:
A nurse told me tonight that she is documenting short staff by "two psych techs on shift". Many patients are strict line of sight on the psych unit and two staff members plus nurse, math don't add up. So she says she covers it through documentation. What do you think?

She can "document" short staffing all she wants, but the courts and BONs have repeatedly held that short staffing is not an excuse or defense for providing less than adequate and safe care. As the RN, your options are to either refuse the assignment in the first place, if the situation is unsafe in your professional judgment, or do your job adequately/competently regardless of the staffing levels. Your acquaintance is not protecting herself in any way by documenting the staffing level. If anything goes wrong, she will be held to the same standard of care and practice regardless of how many or how few techs she had on that shift (and I guarantee you (and her) that no one from the administration is going to step forward and say, "Oh, it wasn't her fault -- we made her work short-staffed" -- they will leave her to dangle in the wind).

1 Votes
Specializes in Education, FP, LNC, Forensics, ED, OB.

elkpark is absolutely correct.

Short-staffing is one major reason for nursing errors, but not a defensible excuse that will hold up in court.

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