Nurses in North Carolina can now be sued for following doctors’ orders when they cause harm to the patient.
On Friday, August 19, 2022, a narrowly-split North Carolina Supreme Court struck down a 90-year-old precedent that protected nurses from liability. The opinion of the three justices in favor of overturning the ruling stated that because nursing had evolved, the decision was necessary. The two dissenting justices countered that holding nurses accountable for physicians’ decisions would create “liability without causation.” How this latest ruling will affect future cases is unclear. The full legal briefing can be found here.
Although the nurse involved in this case was a CRNA, based on the court's opinion I don't think it a stretch that this could be applied in a case involving a non-advanced practice nurse.
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Justice Michael Morgan, for the majority 3-2 opinion, wrote, “Due to the evolution of the medical profession’s recognition of the increased specialization and independence of nurses in the treatment of patients over the course of the ensuing ninety years since this Court’s issuance of the Byrd opinion, we determine that it is timely and appropriate to overrule Byrd as it is applied to the facts of this case.”
I cannot find the same language in the non-CRNA version of the practice act in N.C. I'm still confused as to why judges are making this decision instead of the board of nursing since the language is clear that the CRNA is liable. All of us who work in the health care professions know that this is a very arcane subject even for us!
All of this just makes me think that those outside of healthcare really have no idea when it comes to advanced practice providers. You get a judge that hears nurse in a title and they're thinking of course you'd treat them same as any other nurse. Makes me think of the first time I saw a PA years before I was a nurse and they introduced themselves as a "physician assistant" and I thought OK this is the assistant I see before the doctor. I was guilty of it once, too. ?
Specializes in orthopedic/trauma, Informatics, diabetes.
I came to look for this topic because as a charge RN, this weekend, a floor nurse felt uncomfortable doing something because of this issue. I wish we had more guidance.
Our management sent an email that they were discussing how this might affect all, but in the mean time, should we all get our own insurance? I never thought twice about it until now.
I came to look for this topic because as a charge RN, this weekend, a floor nurse felt uncomfortable doing something because of this issue. I wish we had more guidance.
Our management sent an email that they were discussing how this might affect all, but in the mean time, should we all get our own insurance? I never thought twice about it until now.
This is exactly why I called the title clickbait. This particular article had nothing with do with floor nurses as this lawsuit revolved around CRNA liability.
Insurance is a whole different thing. Personally I don't feel the cost, limitations, and exposure to additional risk is worth it.
As much as everything's been overhyped lately nothing has changed. Don't do anything grossly negligent, do the right thing, and we'll all be okay. If something's questionable seek additional resources, run it up the chain of command, and document.
Specializes in orthopedic/trauma, Informatics, diabetes.
14 hours ago, MaxAttack said:
17 hours ago, mmc51264 said:
I came to look for this topic because as a charge RN, this weekend, a floor nurse felt uncomfortable doing something because of this issue. I wish we had more guidance.
Our management sent an email that they were discussing how this might affect all, but in the mean time, should we all get our own insurance? I never thought twice about it until now.
This is exactly why I called the title clickbait. This particular article had nothing with do with floor nurses as this lawsuit revolved around CRNA liability.
When I was able to look up the case, I feel the same way. And of course, people overreact.
My understanding is that in my state regular RNs' can be sued for negligence for following physician orders that they would be expected to know, with an expected RN level of knowledge, are likely to harm the patient or that would be contraindicated for the patient, if harm results to the patient that could be related to the care they provided. In my state, to my knowledge, following physician orders does not absolve an RN of responsibility for the care an RN provides - RNs' are expected to determine that the order is appropriate for the patient and is not contraindicated, and that it meets the standard of care, before they carry it out.
My understanding is that in my state regular RNs' can be sued for negligence for following physician orders that they would be expected to know, with an expected RN level of knowledge, are likely to harm the patient or that would be contraindicated for the patient, if harm results to the patient that could be related to the care they provided. In my state, to my knowledge, following physician orders does not absolve an RN of responsibility for the care an RN provides - RNs' are expected to determine that the order is appropriate for the patient and is not contraindicated, and that it meets the standard of care, before they carry it out.
I think that's pretty standard across the board. We're not in the clear if we push labetalol on a patient with a HR in the 30's just because a provider ordered it.
It's the terrible wording of the article. This particular case is about advanced practice providers and essentially asks if there's a substantial difference between a RN and CRNA and if so should there be a difference in liability.
In particular, it asks if a modern CRNA is the same as a nurse envisioned in this 1932 case:
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In Byrd v. Hospital, 202 N.C. 337, 162 S.E. 738 (1932), while holding that a nurse who obeys the orders of a physician in charge of a patient is not ordinarily liable, the Court recognized that if an order of a physician to a nurse is "so obviously negligent as to lead any reasonable person to anticipate that substantial injury would result to the patient by the execution of such order" the nurse may be held liable.
MaxAttack, BSN, RN
563 Posts
All of this just makes me think that those outside of healthcare really have no idea when it comes to advanced practice providers. You get a judge that hears nurse in a title and they're thinking of course you'd treat them same as any other nurse. Makes me think of the first time I saw a PA years before I was a nurse and they introduced themselves as a "physician assistant" and I thought OK this is the assistant I see before the doctor. I was guilty of it once, too. ?