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

[NRSKarenRN, BSN, RN]

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 sullivan v. edward hosp., no. 95409, 2004 wl 228956 (ill. feb. 5, 2004) when the court issued its decision on february 5, 2004. citing extensively to the taana brief and also to the authorities cited by taana, the court ruled that only a nurse is qualified to offer opinion evidence as to the nursing standard of care.

the brief was drafted after almost two years of research by members of the taana litigation section and was written by karen butler, chair of the litigation section. the chicago chapter of taana, particularly, leatrice schmidt, reviewed and submitted the brief. the issue, in brief, was whether a physician, who is not a nurse, should be permitted to offer expert opinion evidence, as to the standard of care for nurses. the taana position is that nurses and only nurses have the authority and responsibility to define the scope and practice of nursing. the illinois trial lawyers also submitted an amicus brief arguing that physicians can do anything a nurse can do and, therefore, a physician can always testify as to the standard of care for nurses. for a copy of the decision, contact the taana national office.http://www.taana.org/

[NRSKarenRN, BSN, RN]

The Illinois Trial Lawyers also submitted an Amicus Brief arguing that physicians can do anything a nurse can do and, therefore, a physician can always testify as to the standard of care for nurses.

Try then placing more Docs in nurses shoes....Don't think they'd last a week, except for a few surgeons I know.

[fergus51]

Amen to that!!! If they can tell me when was the last time they spent 12 hours straight at the bedside, I'll listen to them about nursing standards.

[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.

[Noney]

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.

I really hope you are playing devil's advacate here.

I personally think this is a good thing.

Noney

[Peeps Mcarthur]

Why is it a good thing?

I haven't read the decision but it wouldn't matter anyway. I would rather hear it from a nurse's point of view.

[caroladybelle, BSN, RN]

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.

Because Nursing is discipline that is separate from Medicine. Though the two overlap in responsibilities, they are two separate sciences.

I may administer respiratory treatments, but am I qualified to attest the Respiratory Standards of Care. I may administer medications and be trained in their use, but I am not qualified to be a pharmacist nor to attes to their standards of care.

The separation is an excellant thing.

[fergus51]

Physicians are experts in medical care. They aren't in nursing care and believe me, there are areas that do not overlap. Nurses have their own standards set by their board of nursing and hospital protocols to follow, not to mention specific legislation and their own issues (like patient ratios). Physicians are not experts in any of these areas and don't practice according to them.

If there is a question related to nursing care, it would seem obvious that an expert nurse provide the information. The question in malpractice proceedings here is "what would a prudent nurse have done?". Seems that a nurse would be the one to ask that question. You wouldn't expect a lawyer to talk about police standards, why would you expect a doctor to talk about the standards for a job he has never done?.

[Peeps Mcarthur]

Physicians are experts in medical care. They aren't in nursing care and believe me, there are areas that do not overlap

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.

[OC_An Khe]

Peeps

Following your logic then it would be ok for Nurses to testify as to the quality and correctness of the medical care given by a MD. If this were true and accepted in a court of law (which it isn't) then I would agree that MDs can offer EXPERT testimony

on a profession other than medicine

[Jolie, BSN]

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.

While the physician may be the expert in terms of prescribing a medication, he/she is certainly NOT the expert in terms of preparing, dispensing, administering, monitoring for side effects, etc. Those are the responsibilities of the pharmacist and nurse, who should rightly testify as to the standard of care of these aspects of medication usage.

Let me give an example: I was on injectible fertility drugs. My physician prescribed them to treat the medical condition that was interfering with my ability to conceive. The pharmacist dispensed them, and educated me on their uses and possible side effects. The nurse taught me how to mix the vials of medication with sterile water, prepare the syringe, and inject myself. One evening when my injection was due, I happened to be at work finishing up a procedure with my physician. I knew how to inject myself, but hated to do it, and so asked her if she would mind giving me the shot. She laughed and said that if I prepared it, and then told her how to find the proper landmarks, she might be able to muddle her way thru giving an injection. I thought she was joking, but she confessed that she had NEVER given an IM injection. It was simply not taught in medical school, and had never come up in her practice.

She would have been quite capable of testifying as to the proper uses of injectible fertility drugs, but not to their preparation or administration. Her physician training and experience did not include those aspects of medication usage, where pharmacists and nurses are truly the experts.

Another example: In my OB rotation in nursing school, I had CNM as a clinical instructor. She was newly hired as a nursing instructor, having come from many years in private practice with a group of OB/GYNs. Her focus over those years had become very medical, shifting away from nursing care. She was well versed in all aspects of pregnancy, labor and delivery, but had absolutely no idea of how to administer nursing care. She had spent so many years practicing in a "medical model" that she had no idea of what the routine nursing care of a labor patient should entail. She had no idea of what should be included in a nursing admission assessment, how often vital signs should be taken, what the protocols were as far as electronic fetal monitoring, which patients met the criteria for having peds present at deliveries, she couldn't draw blood, or start IV's, and didn't have a clue as to how to set up IV tubing, use infusion pumps, give a piggyback antibiotic.

She was certainly capable of managing the "medical " aspects of a patient's care, but not the nursing care, especially anything that involved "hands-on" contact with a patient. Aagain, she could testify as to why a particular antibiotic was ordered for a specific patient, but could not give any expert opinion as to how it should be prepared or administered.

[imenid37]

Peeps

Following your logic then it would be ok for Nurses to testify as to the quality and correctness of the medical care given by a MD. If this were true and accepted in a court of law (which it isn't) then I would agree that MDs can offer EXPERT testimony

on a profession other than medicine

Amen to that one!