IL Supreme Court Rules Only Nurses Can Testify on the Standard of Care for Nurses - page 4

from psna enewsletter: the american association of nurse attorneys (taana) recently announced that the illinois supreme court responded positively to taana's amicus brief submitted in the case of... Read More

  1. by   fiestynurse
    Peeps, with all due respect, because you seem like a bright person, you are confused about this issue. As a member of TAANA, I suggest that you obtain a copy of the ruling and read it thoroughly before commenting any further.
  2. by   fergus51
    Quote from Peeps Mcarthur
    By Fergus
    Does the BON hold that authority to convey expertise to a nurse over the medical board which granted the physician the right to give that order to the nurse?

    The hierarchy of patient care clearly rests with the medical board in conveying expertise in patient care.
    Simply put, yes. A nurse is the expert in nursing care. A doctor is an expert in medical care, and in that hierarchy is the expert. Patient care encompasses both and the physician is not the end word on patient care if it is about OT, PT, pharmacy or nursing (that's why nurses, OTs, PTs and pharmacists study their own programs in university and register and monitor their own members). If you haven't gotten the difference with all the examples we have tried to give you, I don't think you ever will.

    You can't seem to get past the order bit. Doesn't the fact that I am obligated to refuse certain orders and don't need orders for a lot of my job (yes, I actually make decisions on my own sometimes without the massa') make you think a little? A doctor's order is not the final word in the hospital just because he wrote it. Our RTs can write orders as well, should they testify about nursing as experts in nursing care? NPs can write orders, should they testify as experts about RTs' or doctors' standards of care? Should lawyers be the experts about policing issues? It seems to me that unless you have an agenda, any logical person would admit that nurses know more about nursing than anyone else and it's hard to claim to be an expert at a job you've never done.
  3. by   fiestynurse
    Here is an excellent site that explains what the legal standard of care is for nurses:

    http://www.continuingeducation.com/n.../standard.html
  4. by   unknown99
    Quote from Peeps Mcarthur
    Uh.......Why wouldn't physicians be the authority in all aspects of patient care?
    What good are nursing standards if not to decide what care a patient receives?

    Seems nursing will further distance themselves from medicine with this precedent.
    Care of the patient involves TOTAL patient care. This is something, in my opinion, that the physician is not an authority in or perhaps even capable of.

    Tell me, when was the last time a doctor put an elderly lady on the bedpan or cleaned her because the c-diff (which was caused by too many antibiotics--which by the way the "authority" prescribed) causes incessant diarrhea???
    When was the last time a doctor held a parent as they cried over the loss of their child??? Or a child over the loss of their parent???
    When was the last time a doctor spoon fed an elderly man for 45 minutes because that's how long it took and he couldn't feed himself?
    When was the last time a physician thought of a way to smuggle in a patient's cat or dog so they could see their beloved pet just one more time before they die???
    When was the last time the physician came in at 0300 to sit with a confused patient to prevent them from harming themselves????
    When was the last time a physiciandid many other things like this?? All of which are considered to be TOTAL PATIENT CARE!!!
  5. by   tmylen
    Quote from Peeps Mcarthur
    A definition of "medical care" would be that under the direction of a physician, so wouldn't that be any care that the physician has written orders for? Can you give an example of something which a physician has written an order for that a nurse is more qualified as an expert in? I guess I can't see what patient care, that is not under a physician's orders, would be needing a nurse to testify as an expert in that nonphysician domain of expertise.

    Of course, psychosocial cause and effect is completely foreign as it is barely mentioned in a physician's training, as far as I know. Since it's not part of a physician's expertise they have no business in overseeing it, or presenting as an expert to testimony about it.

    The incidents that I can see in a court of law would be things like medication errors. In a case where the order was written incorrectly, dispensed in the wrong dosage or form or administered in error. In the foodchain from doctor to pharmicist to nurse administering it, who is the expert? Wouldn't a physician be testifying as to the validity of the order, correct mixture, route and timing of administration? If we are talking about what a nurse should be held accountable for in regards to this medical care, wouldn't an expert in phamacological inteventions be indicated?

    I know this is only one example, so it certainly is not the whole argument, but shouldn't physicians be so called 'experts' in patient care? I believe I know what the overwhelming response on this board would be to that question but I think it needs to be pondered with more than just the typical knee-jerk reaction to expand the nursing empire at all costs.

    At any rate, nurses seem to think that it's a good thing. I'm wondering why.
    If the only care that a patient received had to have an order for that care written by a physician or other surrogate, the patient would be considered to have received a sub-standard level-of-care. The BON in any state delineates a "scope of practice" for nurses. A nurse licensed by a State BON can, independently of a physician's order, initiate nursing care on a patient in any setting for which they are qualified. No, a nurse cannot write a prescription, nor can a pharmacist. A nurse cannot operate as a physician, a pharmacist cannot operate as a nurse, and a physician cannot operate as either. In most states, a physician cannot operate a nursing home unless he is licensed to operate a nursing home.

    For your medication example, if the nurse administers an incorrect order then the nurse is accountable for administration of that order. Now a court may decide liablity based on "any and all". So the hospital may end up paying as they usually have the deepest pocket. That lhas NOTHING to do with the accountability. I believe your argument is overly simplistic and mixing apples with oranges. There is no food chain where the phsician is the at the top and eats everyone else as he sees fit. A hospital becomes liable for the actions of a physician practicing poorly in their hospital when they become aware of the sub-standard pattern of practice. Does this make the hospital the ultimate "expert" on the standard of medical practice? No it doesn't, in case you didn't know. This isn't a "knee-jerk" reaction, this is precedent set in prior rulings. There are "prevailing standards of medical care" in the "community", the definition of which, is the court's attempt to apply some type of standard against which the application of medical care in a particular set of circumstances can be compared. This "prevailing community standard" is based on the what a prudent provider would do in a similar circumstance in the community. Now the community may be defined various ways based on what aspect of care the court is trying to analyze. This standard applies to all providers. Not just physicians, not just nurses, not just pharmacists. But if it is a nursing act that is being evaluated, then the standard that applies consits of what a prudent nurse would do in a similar circumstance in the community. It's not what a doctor says a nurse should do in that circumstance, it is what prudent nurses, practicing nursing, would do in a similar circumstance. In your medication example, a prudent nurse is required to know the right drug, right time, right dose, etc. A pharmacist may know this also. A physician may know this also. A physician does not determine what a nurse should do in a particular circumstance. It is prudent nurses, practicing nursing in the community, operating under a license issued by the state, who set the standard used by the court.

    Now every provider is required to bring a certain set of knowledge and skills to the table when they are practicing within their scope of practice. This knowledge is different for nurses than for doctors. The skills are different also. Nurses are not failed doctors anymore than doctors are promoted nurses. Doctors don't take "Nursing Systems I and II" and then go on to medicine. Nurses don't take "Medical Care 101 but not 102". Medicine and Nursing are appled science which equals technology. True, the science overlaps in a lot of areas. True, the outcome and goals of care overlap in a lot of areas. But Nurses apply the science in a different way than doctors. And Nurses frequently apply a broader range of applicable science to the care of their patients than doctors. Nurses just don't treat kidneys, even dialysis Nurses don't just treat kidneys. True, the Nephrologist and the Dialysis Nurse share the outcome of cleansing the patient's blood of certain waste by-products of metabolism. The physician's order only states what dialysate to use, how much water to take off, etc. And the physician wants the patient to survive the process, go home, and have some modicum of a normal life. But he or she doesn't write "Modicum of Normal Life QD". The patient probably spends from 5 to 7 daytime hours, three days a week at that facility. This is truly part of his or her life. And they are usually dropped 2 to 3 pounds by the end of the session. They get dog-tired and exist in a circumstance that is ripe for depression and not even a modicum of a normal life. So who brings the patient through this weekly gudge routine? The Nurse. If you can't imagine the range of clinical tools, experience, and empathy that requires then you have no business dicussing this. A court proceeding is a world away, or more, from this person's life. And this Nurses's.

    I've said enough. Patient care is much more than orders and protocols. The Nurse brings a unique set of knowledge, skills, experience, and behavioral repetoire to bear on the care of a patient at any point along a wellness continuum. Research studies showing the positive effect Nursing has on patient outcomes are just now starting to appear in the literature. Look up Omaha criteria on any web portal and you will see. Good luck in your EMT career. It sounds like that is exactly the place where you should be.
  6. by   Peeps Mcarthur
    By Sargarcia
    Care of the patient involves TOTAL patient care. This is something, in my opinion, that the physician is not an authority in or perhaps even capable of.
    Being nice to a patient or thier family is not a skill only nurses can perform. It's true that seeing or even hearing of a doctor doing more than the obligatory gestures of kindness is not common place, but perhapse it's because they don't brag about it constantly.
  7. by   nursbee04
    Quote from Peeps Mcarthur
    Being nice to a patient or thier family is not a skill only nurses can perform. It's true that seeing or even hearing of a doctor doing more than the obligatory gestures of kindness is not common place, but perhapse it's because they don't brag about it constantly.
    That's true, doctors can be kind, but when is the last time you saw a physician turn/change/give pericare to a patient? Is that something else they refrain from "bragging" about constantly?

    Peeps, forgive me if I'm wrong, but you seem to devalue nurses in general. The title of this thread is "Supreme Court Rules Only Nurses Can Testify on the Standard of Care for Nurses." Where is the problem with this ruling? Am I missing your point here, or do you actually believe that nurses shouldn't be considered experts in patient care?

    Explanations aside, I am glad this ruling was passed. I think its great
  8. by   Peeps Mcarthur
    Good luck in your EMT career. It sounds like that is exactly the place where you should be.
    That's an interesting comment Tmylen. An EMT career doesn't exactly make me out to be an overachiever-type-A personality now does it?

    I would not waste time pouring through a legal brief to make observations. I would most definitely not wade through nursing doctrine trying to decipher it. Nursing care itself is not complicated but the words used to describe it can seem like rocket science. In nursing's stuggle to evolve It has been nescesscary to breed contempt towards the medical institution from which it was born. Even the mention of 'hierarchy' raises the hackles.

    Contempt towards physicians is understandable considering the pressure nurses are under to perform thier orders and be scrutinized negatively when the procedures are not carried out to thier satisfaction because of circumstances beyond the nurse's control. Once the nurse catches crap from the doctor, she can look forward to catching comparable amounts of crap from the family, her supervisor and eventually the BON.

    It's true, nursing is becoming more specialized................but what kind of specialization is it? With no medical training; nurses are setting a precedent for a future with no medical encroachment for decision making. The precedent is set for the BON to just get that scope of practice expanded. If the BON can get this far, it's only a matter of time.

    I'll be writting orders some day. You can be assured that I'll be scrutinizing my own expertise and that of the nurses I write orders for.

    Congratulations, and good luck
  9. by   smk1
    just a student but it seems to me that even though doctors have authority over medical care of the patient the nurse is the one to carry out most of those orders and order her own applicable nursing care. Yes doctors probably started an IV once or twice (same for sterile dressings injections etc..) but in general taht is no longer their jobs. the point is that in general the nurse takes care of these things and knows the best way to get it done from lots of experience and the doctor hasn't done them in a very long time so why should a doctor testify as to whether a nurse (who does these things on a daily basis) performed the procedure correctly when he probably hasn't done them himself in years. think about if it were you on the stand defending yourself. would you want someone testifying as an expert on a procedure that you performed only to find out that the "expert" hasn't done x procedure in years? (and probably wouldn't be able to do it correctly because of lack of experience) i know i would want a "peer" to evaluate my situation, i would want a nurse who spent a lot of time doing what i do to evaluate my standard of care. That is just fair. I don't thin anyone is trying to denigrate doctors here, they are the "experts" in medical care, but the nurse is the one in most cases to apply their treatments and evaluate their effectiveness. Their education and experience prepares them for this role. Nurses are the "experts" on the standards of nursing care.
  10. by   RNPATL
    Quote from Peeps Mcarthur
    That's an interesting comment Tmylen. An EMT career doesn't exactly make me out to be an overachiever-type-A personality now does it?

    I would not waste time pouring through a legal brief to make observations. I would most definitely not wade through nursing doctrine trying to decipher it. Nursing care itself is not complicated but the words used to describe it can seem like rocket science. In nursing's stuggle to evolve It has been nescesscary to breed contempt towards the medical institution from which it was born. Even the mention of 'hierarchy' raises the hackles.

    Contempt towards physicians is understandable considering the pressure nurses are under to perform thier orders and be scrutinized negatively when the procedures are not carried out to thier satisfaction because of circumstances beyond the nurse's control. Once the nurse catches crap from the doctor, she can look forward to catching comparable amounts of crap from the family, her supervisor and eventually the BON.

    It's true, nursing is becoming more specialized................but what kind of specialization is it? With no medical training; nurses are setting a precedent for a future with no medical encroachment for decision making. The precedent is set for the BON to just get that scope of practice expanded. If the BON can get this far, it's only a matter of time.

    I'll be writting orders some day. You can be assured that I'll be scrutinizing my own expertise and that of the nurses I write orders for.

    Congratulations, and good luck
    Peeps - what scares me about this post is that, according to you, you will be writing orders someday. The fact is not that you will be writing orders, but that you have such contempt for nurses. I have been following this thread from the start. Many of the nurses on this BB have tried to explain to you the difference between medicine and nursing .... and there is a difference. Yet, throughout each of these posts, your response promotes medicine and denegrates nurses. There can be a world with both medical professionals and nursing professionals. Each can have a seperate scope of pracitce and also work in harmony. I have been a nurse for a long time. Over the last 10 years, I have witnessed wonderful changes taking place between nurses and physicians. We are both needed in today's crazy heath care world to meet the expanding needs of the aging baby boomers as well as the very fragile elderly. I am excited to be a part of such a dynamic work in process. Yes, there are parts of the health care delivery system that still suck. But, day after day, people are working to fix the system and make it better.

    Nurses and physicians are an integral part of the framework of making our health care system better. This means that we need and should embrace the advancement of nursing science as well as nursing's evolving role in health care. Putting down the maturation of nursing as a profession is certainly not a way to enter into medicine. I submit that as you go through residency, your best friend and the one who might save your butt will be a nurse. Please remember that.

    Now, as to the original topic on this thread, I applaud the judge who made this ruling. Nursing is the only expert about nursing care. There is no other expert.
  11. by   fergus51
    Peeps, I think this is a case of you reading more into a situation than you should. I get the impression that since you didn't like nursing school you have taken a negative view of everything nursing related, despite the fact that you have never been a nurse. The fact that you think "niceness" is all that differentiates nursing from medicine is evidence of that. I don't understand how you can make a logical argument that a nurse isn't the best person to testify about nursing. Maybe I'm just simple, but it seems like it's better to get it from the horse's mouth than from someone who has never done the job.

    I actually get along really well with the vast majority of the docs I work with, even the residents. There are a few jerks, but that's true of the nurses I work with too. I have never had my care scrutinized by a doctor or "caught crap" from one of them, mainly because, unlike you, they are aware that they are not my supervisor and that I am perfectly competent in MY job (and not anymore interested in taking their job than they are in taking mine). If you want to comment on nurses' reactions to the hierarchy, you might want to actually understand what it is in the real world.
    Last edit by fergus51 on Apr 5, '04
  12. by   nurse_mexia
    I think that is great!!!!
  13. by   Peeps Mcarthur
    I think it's quite a stretch to say that I'm putting nurses down in some way. I don't feel that i'm being contemptable towards nursing. That would certainly be silly since I'm posting on a nursing board now wouldn't it?

    Now, what I DID intend was to say that nursing is blindly gobbling up responsibility just for the sake of having more responsibility and in so doing is setting a precedent that could have consequences not yet considered by the whole.

    I was well aware that my opinnion would draw out the people that think because I don't support everything nursing, then I must hate them. That is fine as long as you quote an example. It seems that it would be quite easy to find a passage in something I've written since I have such contempt.

    I even gave congratulations for the victory........maybe I didn't have any . Is that the problem?? It is a win for nursing and I do not intend to make it a backbiting contest. I would love to make a point about some good comments but it will not come out the way everybody wants. I can't backpeddle on what I said. If you appreciate nothing else, at least appreciate that I am not wishy-washy.

    I may be playing devil's advocate rather than the actual devil.

Must Read Topics


close