Area of Least/Most Lawsuits in Nursing...

RNperdiem, RN · Sep 27, 2007

I work in ICU and have worked in med-surg. I have never heard of a nurse being sued. It might not be that common, or maybe that is my perception.

shannonFNP, BSN, MSN, RN · Sep 27, 2007

This is a GREAT topic! I'd like to know the answer to this as well. I'm considering being a CRNA... but I'm scared to death of the legal risks of the anaesthesia! I'm wondering about the OR as well. Please, someone wise and seasoned share your two cents :)

fergus51 · Sep 27, 2007

I've been told L&D is the most litigious area of nursing. I really think the fear of litigation is overblown though.

caroladybelle, BSN, RN · Sep 27, 2007

To my understanding, nurses rarely get sued directly. It is usually the MD or the hospital with the nurses caught in the crossfire. But if you get caught in the crossfire, it can be hellish on your life.

As a new nurse, I got "caught" in the crossfire on an Ortho/neuro case. MD with LOOONG history of problems with postop care of his patient, has a patient that spikes temps 4-5 days after surgery, along with several days of suspected CSF leak and lower extremity neuro changes. MD orders cultures on every bodily orifice/fluid BUT the wound....it also has to be something other than the MDs fault. All are negative. Staff keep requesting to culture the wound - surgeon refuses. Staff finally call when MD off service and get orders....Bingo!!!!!! positive cultures. Unfortunately for the patient, not soon enough intervention.

Case comes up 3 years after incident...I am working 500 miles from the facility. I get repeatedly called for depositions, to the point of it becoming harassment. The facility is not happy that I will not (nor will most staff) cover the surgeon's gluteus and have all thoroughly documented about the issues.

Though I am not charged in the case, after the 4th trip of 500 miles, I get ticked and notify my malpractice insurance who manages to halt the harassment.

Second story:

A classmate and close friend was working as a grad nurse at a women's health care pavillion/pre and postpartum, L&D, etc. The very first day after receiving her official license, she sat down to report. Before report has even been completed, a code is called - it was the very first code at the facility. The patient, who had undergone a relatively benign surgery, seized and stopped breathing. The patient is coded, recovers heart beat and respirations but is permanently neurologically damaged to the point of being in a permanent vegetative state. At no time did my classmate touch the patient and she had not even gotten report on her, but she was present in the code room and would have been caring for the patient after shift report.

Would you believe that she repeatedly got called and had to take time off from her job (cases usually come up 2-4 years after the incident) for deposition? Most of which involved grilling her about what went on in report.

I would not think that school nursing would be safe from lawsuits, not with parents suing over every little thing. Nor is any area of nursing. Though I have not seen any lawsuits in my current department yet (oncology). People often threaten lawsuits when grieving, but few lawyers take those on as the patients usually are considered poorer outcome to begin with.

Gottago · Sep 28, 2007

Clarification: Lawsuits directly or indirectly involving nurses, but the question of the nurse's liability is involved in the lawsuit.

Editorial Team / Admin · Sep 28, 2007

the areas of nursing most vulnerable are anesthesia and midwifery. rns in ob (l and d), those working solely in monitoring capacities (fetal heart, telemetry, etc.), and medication administration are also included in high litigation areas.

of course, the apn other than crna and cnm are subject to increased litigation, but the latter two more so.

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 follow the soc
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 communicate across the healthcare provider spectrum
failure to monitor
failure to act as patient advocate
failure to provide a safe environment

we all need to know our individual nurse practice act (npa), adhere diligently within our sop, know the soc for our specialty area(s), question authority, educate ourselves, and make sound, safe, and practical nursing judgments for all our patients.

and, i realize that we all strive to provide the best possible care for our patients.

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

Elvish, BSN, DNP, RN, NP · Sep 28, 2007

My mom used to work (paralegal) for a med-mal attorney and she says the #1 factor in people choose NOT to sue, in a poor outcome, is whether or not they like the care provider(s). I don't know if that's true or not, but it's certainly worth thinking about.

Sometimes people really do have cases and/or really will follow through on a threat to sue. Most people, though, just want to feel like their concerns are being addressed. And then there is that 0.3% that would not be happy if God Himself were their RN for the night....

momthenRN · Sep 28, 2007

I was a charge nurse in the SICU on nights. Each Intensive care unit would send a nurse to the floor code to work with the TC pacer and help with the code. I went with several nurses and we worked on a postop accident woman with pelvic fractures. She had a drug and alcohol abuse history as well as depression and a history of a suicide attempt. We were unable to save her that night. 4 years later, I was called in on the case for several depositions (I was no longer at this hospital either) and each time they were trying to make me the "expert witness" to try to implicate the nurse and hospital on lack of procedure and neglect. It was humilating. I kept having to say, "well, what does the policy SAY, or it says right here in the manual that,....The family lost that case but still. It was stressful and not even my patient! I just ran there to help!!!

Neveranurseagain, RN · Sep 28, 2007

I am an RN, and I just finished litigation with several MD's and RN's over my husbands death. I am unable to go into detail due to a confidentiality clause in the settlement. But I will let you know what was viewed as problems with his care by the RN's and what happened afterward.

1. No documentation--nothing charted by TWO RN's on a major incident that happened during shift change while in report in the ER.

2. MD not notified of major incident in ER

3. Charted deteriorating condition, but RN was not aware it was deteriorating.

4. Failure to call MD as pt. deteriorated over a 12 hour period

5. Actually, all the common issues SirI posted.

Two of the 3 RN's in question were travel nurses that had worked several 12 hr shifts in a row. They were on auto pilot, and just went through the motions of nursing while in the ER.

A simple, I'm sorry goes a very long way. Instead, the hospital and MD's became afraid of me and the issue, and I was on my own. When I felt it was time to DC my husband (after 5 days) off the vent, I had to ask his RN to please call the MD so I could make some arrangements. It was me that brought up organ donation. Not a single RN, caseworker, MD had said a word to me about the subject about DCing him from the vent. I had a difficult time trying to figure out how to approach the subject. I agonized for several days and didn't really know at what point it should be done. The last few hours before I made the decision were surreal.There were, however, a few RN's and one MD who privately expressed their condolences and would talk to me when no one was around. They did not discuss the incident but provided me with support and were very caring. I will forever hold them in my heart as they were the true healthcare professionals.

Hospitals, healthcare providers and malpractice insurance companies need to re evaluate their approach on how to deal with patients and families after a major issue. A special team trained in post malpractice techniques should be assigned to the family to communicate what is happening. A team approach also helps provide a "witness" as to what is said, and the family also encouraged to have 2 people when speaking with staff. This team would also be responsible to ensure that all of the families needs are being met and any prevention of any further problems. If the family had any questions regarding what happened, they would call the team. By using a team, it would also relieve the RN's caring for the pt. The RN would know they could focus on pt care and the family and not be afraid of having the family try to discuss the incident with them. Any discussion about the incident would be referred to the team. After leaving the hospital several times to go to a hotel to shower and try to sleep, I found out not from the hospital, but another patients family, that rooms were available at the hospital for families. Everyone was so afraid to talk to me that the rooms were never offered. I had never felt so alone in my life, at the time of my greatest need.

As we all know, medical incidents do happen. Care, comfort and open communication still needs to be provided to the pt. as well as the family.

I do not feel I can ever work as an RN again. For more info, read my first thread. I do appreciate being able to view nursing from a distance at allnurses.com.

sweetbeet · Sep 28, 2007

A simple, I'm sorry goes a very long way. Instead, the hospital and MD's became afraid of me and the issue, and I was on my own....There were, however, a few RN's and one MD who privately expressed their condolences and would talk to me when no one was around. They did not discuss the incident but provided me with support and were very caring. I will forever hold them in my heart as they were the true healthcare professionals.

I was a paralegal for a personal injury/med mal attorney (currently a nursing student now). What you said is true, a sorry does go a long way. Most often clients would refuse to bring other doctors or wish to really pursue a nurse if they liked the practitioner or felt a connection with them. More often than not, it's not only the patient I think you need to tend to, but also the family. The family is usually going to be the determining factor in a lawsuit. They were conscious and able to see what was going on. So if MD's choose to blow off the family, they do so at their own peril.

Sheri257 · Sep 28, 2007

I work in a California state prison and I don't know all of the details but, a nurse is being sued right now for not referring an inmate to the MD for a knee injury. Putting an inmate on what we call the Doctor's Line to be seen is pretty easy but, I guess she thought he was faking.

I'd say corrections, at least in California, is pretty high risk for litigation because right now we're under federal court appointed receivership for care. The inmates have all of these law firms out of San Francisco that will sue the state at the drop of a hat because the state has deep pockets and they've gotten some pretty big damage awards so ...

You really have to CYA. If I ever have any doubts ... I go ahead and put the inmate on the Doctor's Line and, of course, if the case is emergent send them to our ER right away. These inmates have nothing but time on their hands and they do love to sue the state for everything.

:uhoh3: