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

Nurses Activism

Published

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/

Specializes in Oncology/Haemetology/HIV.
In regards to interns: Isn't that a student being exposed to the clinical rotation for the first time? It took me two run throughs with IV's before I could set one up as fast myself. Sounds as if the nurses at your hospital are teaching medical students.

Territorial rights are fought for in blood by nurses in the NICU. It wouldn't suprise me at all if even the RT asked for help as not to step on any toes in that bloodbath.

It has nothing to do with setting it up fast, it has to do with them coming to me because they (interns, residents and SubI's) being able to set them up AT ALL!!!!!!!!!. And if they have difficulty setting them up while in training, when they have their most hospital experience, do you really think that they will know much about the process after a few years in an office, where they have little to no regular experience in the process.

As I do not work NICU, I have no input to that. But as a med/surg nurse, teaching interns takes time away from my other patients. And I spent an hour or so of my own time after shift or on break time lost to make it up. An independant MD would be helpful.

The point is that MDs have no business testifying to NURSING standards of care as they are hardly experts at it.

Specializes in ER.

What about the docs that routinely give the order "don't take any more vital signs tonight" or "don't call me again on this patient" with a patient's BP in the 70's. He thinks we are obligated to follow those orders (NOT) and a reasonable and prudent nurse on the stand would say the complete opposite.

When I worked in a teaching hospital the docs were expressly forbidden to touch IV pumps because of the risk of changing the settings or giving a bolus and not knowing it. Probably everyone has dealt with a situation where the patient says "I'll just tell the doctor to make you..." when they wanted to go out to smoke, or be fed, or have 15 visitors at a time, and the stupid MD has said "sure" and you have to deal with the family on some ridiculous issue.

Obviously docs do not know the standards that nurses must live by, and in some cases, the hospital policies we have to enforce. In court I think we deserve someone who knows the role inside out.

From Ellenester

You are correct.

My experience has been only with medical professionals. The residents I've worked with as a respiratory therapist were not taught my job in medical school either, but they were far from incapable of doing it. They are used to getting thrown to the wolves I'm sure. To suggest that they are incapable of having expertise in medical care after 4 years of graduate education in medicine is what's insulting. To say that an MD with residency years on top of that experience is incapable of understanding the process of patient care as to be an expert....well, if that's true, God help us all.

#1 - Our respiratory therapists (who are wonderful and I wouldn't ever want to do without), spend a tremendous amount of time correcting problems created by overzealous residents making major ventilator changes.

#2 - To suggest that a new resident has expertise in medical care after 4 years of medical school is hilarious, particularly since they have so little time at the bedside during medical school. Residency is usually a very humbling experience for them, since they realize how little they actually know once they embark upon it. It takes years of practical experience in order to become and expert in anything. I certainly didn't consider myself an expert in nursing after 4 years of nursing school and I still wouldn't proclaim to know much about other specialities. I doubt even the most arrogant of interns would state that they were "experts" on patient care after a few months on the job.

#3 - You are confounding two varibles in attempt to make your argument that doctors are more qualified to attest to the quality of nursing care than nurses. Patient care as a whole requires a team-oriented, multi-discipline approach. Nursing care is only one component of patient care, and it is the aspect where nurses are the experts.

Peeps, I get the impression that you have a very negative view of nurses, like we have too much power that we don't deserve. I also hear you saying that physicians with any level of training are beyond reproach, know everything, and should always be trusted over a nurse. This mentality shows a great deal of inexperience on your part and I don't know who you think takes care of patients in the hospital, but it sure as heck isn't the doctor.

Yes, that was 15 years ago when last I experienced decapitation at the swift blade of an NICU nurse. They would even go as far to dictate where one could stand or walk. Ask a question and thier eyes would roll back in thier sockets as if possesed by the devil herself and you wouldn't get anything but judgemental silence until she finally ripped whatever it was out of your hand while bumping you aside, only to pretty much do it the same way you were. Maybe I just got assigned to the most difficult nurses as a student and that put me off, but I turned down 1/3 more pay (which still was crap anyway) to work in there full time.

I imagine that neonatology wasn't a very popular clinical rotation for student doctors either.

Ya know, in regards to the anesthesiologist that said he didn't know how to hang an IV, he must have been jerking your chain. Sure, most of what they do in an OR is read magazines for $200,000 a year but they have to know how to handle IV's. IV medication is what they do isn't it?

No, he knew how to give meds and could find a vein and start an IV better than anyone I have ever seen but, he just had never set up an IV from start to finish before (he didn't know which hole to use on a bag with three). It makes sense when you consider that all the OR patients had their IVs started by nurses on the ward or on admit. And even when we have to call a doc for a hard stick, we have to have everything set up when they get there so they can just poke and stick on some tegederm and leave. I even set up everything for the residents that are just learning to put IVs in babies cause it saves me time.

Our med students don't do an NICU rotation. It's just too specialized, though they are allowed in level 2. We take residents and even they come in without the practical knowledge they need to function. A lot of the time when I call a new resident it goes like this:

Me: "Patient has blah blah wrong"

Resident "Uh huh....... Well.... Maybe I should call the fellow...(this will take at least an hour)"

Me: "In the meantime do you want me to blah blah....."

Resident: "Um, ok."

Me: "So I can write that as a verbal order?"

Resident: "Ok, sure"

There was a lot of serious discussion about limiting the unit to year 2 residents and above. The residents come out of med school with a ton of theoretical knowledge (certainly more than I have, especially on these bizarro syndromes), but are kind of thrown to the wolves as far as hands on working goes. Calling them experts on patient care is just ludicrous at that point, no matter how much time they spent in med school. They have to grow and learn FAST in the unit. Most of them do, but there are some that are truly scary (Thank God for the fellows and staff!).

Our RT students actually do very well because they are always right beside a real RT. Our RT vacancy rate only goes up when one of them has a baby:) I think the NICU is a different place, and I have had my share of run ins with nasty nurses there too!

Specializes in cardiac ICU.

Whether or not you believe that medicine and nursing are separate, in practical terms, this is a huge victory for nurses. Doctors certainly don't mind unloading liability onto nurses, and I can't help but feel that a NURSE expert witness (even if hired by the plaintiff) is fairer to the nurse defendant.

Fergus,

You sound like a very reasonable person to work with.

The concept of someone like an anesthesiologist not being current on everything that has to do with IVs is difficult to wrap my mind around. I believe what you're saying, yet, the visualization of such a professional that uses IVs for a living not knowing how to set one up without help, that's disturbing. Staying current, even with procedure seldom seen, is the job of every person with any degree or certification. Not knowing which "thingy" does what causes morbidity from the worst disease of all........inaction.

Some people have made examples of medical students not knowing thier butt from a hole in the ground. I think that's to be expected of anyone with no clinical experience. i'm not talking about that sort of person being an 'expert'. What I was referring to is someone who has gone through graduate level medical training and has enough clinical hours to know what those "thingys" do. If someone is going to waste all that education to sit on thier butt while abdicating expertise because they think there's a job description.....well, that's just sad. When referring to 'nursing care', where does it end and 'medical care' begin? Why would the ultimate responsibility fall to a medical doctor but not the title of 'expert'?

How is it possible to be in charge of medical care and not know how it works? It's analagous to firing a gun but not knowing what the bullet does when it passes out of the barrel even though you're a certified marksman.

Sounds like the graduates of medical schools are looking for comfortable job descriptions instead of leadership in your hospitals. I can see how this attitude might force nurses to take the lead for them.

By Mellowone

If you were walking through the mall, and suddently went into v-tach, would you want a critical care nurse or an internal med doctor to be the one that helps you out?

I would want someone who cares more about knowing what to do in such a situation........and has prepared for that event should it arise.

I don't want someone who wears the title proudly but rather takes responsibility for knowing the expectations of that title.

Actualy anyone with an inservice with one of those automatic defib devices would be just fine.

Specializes in Nursing Education.

I think one has to look at both nursing and medicine as different professions. Where does one start and one end? Not sure that is a question that even needs to be asked. Nurses are responsible for the patients overall response to care and their environment. When asking a physician to define a standard of nursing care, I would think that few could list decent examples.

When we ask about defining a standard of nursing care, we are talking about care that is provided by a prudent professional that holds like title. How can a physician evaluate the standard of care when they are not nurses. In addition, you make reference in your post that physicians are the managers of care. This is not the case. The registered nurse is the manager and coordinator of a patient's care. To assume that the physician has knowledge about nursing care and all that goes into our professional assessment of care as nurses is simply wrong. I am certain that a physician can not tell you the standard of nursing care for wound management, or pain control or and the list can go on and on. How many physicians can detail a nursing care plan or evaluate an educational care plan to provide patient teaching. Perhaps physicians know how to perform the skills, but they are not knowledgeable about what goes into each of these elements as a standard of care. Perhaps the physician can testify to what they would expect the outcomes to be for wound management or pain control, but I would submit that most physicians would not have the slightest clue about the elements that go into the standard of care for these and other issues with patients. Besides, if I was on trial for whatever reason and they brough in a physician to testify to the nursing standard of care, I would be very fearful of the outcome of the case.

This does not take away from what a physician knows, but it makes it very clear that nursing is an independent profession that is not interdependent on physicians or on Medicine as a whole. To assume anything else would be in error.

Fergus,

You sound like a very reasonable person to work with.

The concept of someone like an anesthesiologist not being current on everything that has to do with IVs is difficult to wrap my mind around. I believe what you're saying, yet, the visualization of such a professional that uses IVs for a living not knowing how to set one up without help, that's disturbing. Staying current, even with procedure seldom seen, is the job of every person with any degree or certification. Not knowing which "thingy" does what causes morbidity from the worst disease of all........inaction.

Some people have made examples of medical students not knowing thier butt from a hole in the ground. I think that's to be expected of anyone with no clinical experience. i'm not talking about that sort of person being an 'expert'. What I was referring to is someone who has gone through graduate level medical training and has enough clinical hours to know what those "thingys" do. If someone is going to waste all that education to sit on thier butt while abdicating expertise because they think there's a job description.....well, that's just sad. When referring to 'nursing care', where does it end and 'medical care' begin? Why would the ultimate responsibility fall to a medical doctor but not the title of 'expert'?

How is it possible to be in charge of medical care and not know how it works? It's analagous to firing a gun but not knowing what the bullet does when it passes out of the barrel even though you're a certified marksman.

Sounds like the graduates of medical schools are looking for comfortable job descriptions instead of leadership in your hospitals. I can see how this attitude might force nurses to take the lead for them.

I think I am reasonable to work with:)

Peeps, doctors do not have "ultimate responsibility". If a nurse screws up, it's the nurses butt not the docs. That's why they aren't experts in what nurses do. That's why the standards in malpractice for nurses is "What would a prudent NURSE have done?", not "what does the doc think?". Docs are great and needed, but they aren't the "boss" (I don't know a better word to describe what you seem to think docs do). I can't go into court after screwing up and say "Well the doc told me and he's the expert". I'd have my lisence for about 2 seconds more! I have a responsibility to refuse to do perform any dangerous doctors' orders.

I think you'll find a lot of professions that are intertwined, but that doesn't mean one person is an expert in the role of the other. Lawyers and cops are a good example. Where one profession ends and the other begins depends on specifics, and there are sometimes overlapping areas.

Specializes in Oncology/Haemetology/HIV.

When referring to 'nursing care', where does it end and 'medical care' begin? Why would the ultimate responsibility fall to a medical doctor but not the title of 'expert'?

How is it possible to be in charge of medical care and not know how it works? It's analagous to firing a gun but not knowing what the bullet does when it passes out of the barrel even though you're a certified marksman.

For one, MDs are not "in charge" of Nursing Care, nor completely in charge of medical care. They are merely part of a collaborative effort.

And the ultimate responsibility does not always fall to the MD, but frequently to the hospital or Nursing.

Donald Trump is "in charge" of many real estate projects.....but he probably doesn't know Jack about how to build most of those Buildings.

Doctors not in charge of patient care, as in ultimate responsibility for the patient's overall treatment.

Why spend 10 years completing medical school when one can just become a nurse in two and gain much more of the responsibility?

Those poor idiots are just throwing their money away!

Not to be inciting a riot here but I have never known a doctor (not a student)that does not feel that they are in charge of a patients care. A physician pays a third of thier salary for because they ARE responsible.

You have put thought into your posts and I really appreciate that you're being civil. Maybe it's changed alot since I've been away? I'll find out when I return from medic school and work with an ambulance crew.

Specializes in Oncology/Haemetology/HIV.

Peeps,

You seem to have alot of issues with nurses that do not have much to do with us here.

You might think about working those issues out or they will come back to haunt you.

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