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/

I'm sure you haven't, but until they can physically force me to do their bidding I will not risk my lisence or my patient's health by performing unsafe orders. Believe me, there are more areas of grey than most people realize. Physicians are just one piece of the puzzle. That's why residencies are set up the way they are (because if the resident is ordering something I think is unsafe, I can go to the fellow, then the staff). A few physicians like to think nurses simply work for them (though this attitude is rare where I work), but I work on my own lisence as an employee of the hospital. I am responsible to my patient, my employer and my board of nursing not to any doctor I work with. That's why I say they aren't my "boss". They do not have the power to hire or fire me or even evaluate my work performance and I don't work under their supervision or on their lisence.

Physicians are responsible for what THEY DO (and that is managing medical care of their patients), that's why they pay so much for . They are not responsible for what I do. I am. Seriously Peeps, can you imagine me going into court and saying "well the doc told me to" as a defense against malpractice?

By Fergus

Physicians are responsible for what THEY DO (and that is managing medical care of their patients), that's why they pay so much for malpractice insurance. They are not responsible for what I do. I am.

How do doctors manage the medical care of thier patients without managing what nurses do to fulfill that obligation?

I don't see a nursing license making a nurse into a private contractor. If that was the case you wouldn't have a need to go to the attending. If doctors weren't above nurses in a hierarchy there would be no basis for writing an order in the first place would there?

On the other hand,

If a nursing license granted authority, as an expert, over any decision that was within a nurses scope of practice as outlined by the BON, wouldn't that include the management of a patient's overall care? Patient care is what nurses do and according to the argument, more specialized than what a doctor is trained at. Nurses actualy do the procedures that orders are written for by doctors and have an allowance in the scope of practice as written by the BON to be protected from reprisals should they refuse to carry out that order. Are protections under the license which the BON has approved a declaration of expertise in patient care?

OR

Is the license which is granted a physician the legal authority to write the order or any order to prescribe anything the physician deems appropriate to be carried out by everyone from housekeeping to allied health, a declaration of expertise in overall patient care? Is its authority dependent on the opinnion of the nurse that is granted protection to refuse by the BON?

When it comes to determining patient care expertise, hierarchy is precedent in determinig appropriate actions. Hierarchy must have an origination point and that point is the granting authority which conveys that declaration to the individual.

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.

Specializes in Oncology/Haemetology/HIV.

Peeps,

We have tried to explain it to you and you just are not getting it. And for the matter, a heirachy ideal has absolutely nothing to do with the topic of this thread, though it seems to have hijacked it.

The care of a patient is a shared responsibility, with neither group having to dominate over the other. There is no need for one group to dominate the other. There is no need for a heirachy of one group (medicine) over another (nursing). They work together in a partnership for the best care of the patient.

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.

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.

Here is an excellent site that explains what the legal standard of care is for nurses:

http://www.continuingeducation.com/nursing/lawstoknow/standard.html

Specializes in Inpatient Acute Rehab.
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!!!

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.

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.

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 :)

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? :rotfl:

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

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.

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