Who is held liable?

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Hi I'm a nursing student and we are having a discussion about legal nursing issues in our I & P class, I was hoping I could get some input here since I think this scenario is hard to define...

Nurse S is a supervisory nurse in a general hospital and Nurse N is S's subordinate. Both are RN's with several years of experience. Nurse S assigns Nurse N to a pediatric unit, and while there, Nurse N negligently administers an overdose of a medication to an infant.

Can nurse S be held liable for Nurse N's conduct?

Who can be held liable if the infant was caused harm by the medication overdose?

I feel that it has nothing to do with Nurse S. Anyone can make a mistake at any time. Just because Nurse S is the supervisor and sent Nurse N to another unit wouldn't make her responsible... am I wrong here?

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No, you're not wrong.....Unless Nurse S knew that Nurse N did not have the experience needed to work in Peds.

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No, you're not wrong.....Unless Nurse S knew that Nurse N did not have the experience needed to work in Peds.

How are the actions of Nurse N the responsiblity of Nurse S.

Is a supervisior responsible for every nurse in the hospital.

It is Nurse N's responsibility to work within her scope of practice and refuse an assignment she is not quailified to do.

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In CA a nurse cannot refuse an assignment, but she can fill out a form that basically says the assignment is accepted even though she considers it unsafe, and that that supervisor has been made aware that Nurse N is not qualified to work Peds. Basically it means that if something happens that an experienced Peds nurse would not allow to happen, then Nurse S is in the hole right along with Nurse N.

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Specializes in Geriatrics and Quality Improvement,.

The floor nurse has the responsibility in this case. But other aspects to look at are: MD order written correctly? Decimil in correct place? Pharmacy that filled order filled correctly? Noted by Pharmacist if filled by Pharmacy aid? Supervisor is noted for responsibility of she was aware that the nurse was unfamiliar with peds(I would drown) and we also have the "Unsafe" paperwork, but the ultimate responsibility lies where the error occured first(med administration if orders are correct) and with everyone that ever touched that chart...see you all in court/arbitration/hearings, even if you were off that day.

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Even if the order was wrong, such as the decimal in the wrong place... as nurses we are responsible for looking up meds we are unfamiliar with and knowing the correct dose range for every med we are about to give. If med order is questionable, it is not to be given. Therefore, if that were the case, it is most definitely nurse N's fault.

Do all hospitals have the "unsafe" paperwork? I think they should. And I also agree that the floor nurse should have the right to refuse an assignment she is uncomfortable with.

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The plaintiff's (patient) attorney will usually name everyone remotely involved in a negligence suit. So, in your scenario, the hospital who employes the nurses (assuming they are employees) will be named; the physician will probably be named and even the pharmaceutical company that manufactures and markets the medication. In the initial complaint, the causes of action will include the various areas or responsibility of each named party. For example, the hospital will be named for the negligent acts of the RN, for the supervisor negligently supervising the nurse, the pharmaceutical company for not having a warning that this drug needs special type of administration. (I am assuming facts to make a point).

Now, the next question should be--will the nursing board get involved? In some jurisdictions, they must be notified if money passes hands in a malpractice suit and then they make a decision if they are going to investigate the nurse regarding whether the practice was within the standard of care. They may choose to investigate both the supervisor and the staff RN.

One of the most important legal lessons you can learn, is that there is no black and white in the law---all shades of grey. A lot of what happens is related to how good the attorneys are, the involvement and philosophy of the companies relative to out of court settlements and any "deep pockets" involved.

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Specializes in ICU, CM, Geriatrics, Management.

Agree with Yoga.

My take on the focus of the original question was the potential liability of the two nurses named in the scenario.

IMO, N would always be liable, and S only if he / she knew (or should have reasonably known) that the general assignment was beyond N's expertise.

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Specializes in CV Surgery Step-down.

We just learned of a very similar (real) case in New Mexico (I think!) where a NP, two RNs and a pharmacist were involved. Criminal charges were filed, two nurses (not the pharmacist) served time in prison. I'll see if I can find it...

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I think if it goes to court they both would have to appear but in the end nurse N would take the brunt of the punishment because she has a license.

Hi I'm a nursing student and we are having a discussion about legal nursing issues in our I & P class, I was hoping I could get some input here since I think this scenario is hard to define...

Nurse S is a supervisory nurse in a general hospital and Nurse N is S's subordinate. Both are RN's with several years of experience. Nurse S assigns Nurse N to a pediatric unit, and while there, Nurse N negligently administers an overdose of a medication to an infant.

Can nurse S be held liable for Nurse N's conduct?

Who can be held liable if the infant was caused harm by the medication overdose?

I feel that it has nothing to do with Nurse S. Anyone can make a mistake at any time. Just because Nurse S is the supervisor and sent Nurse N to another unit wouldn't make her responsible... am I wrong here?

Up Vote Up Vote ×
We just learned of a very similar (real) case in New Mexico (I think!) where a NP, two RNs and a pharmacist were involved. Criminal charges were filed, two nurses (not the pharmacist) served time in prison. I'll see if I can find it...

I believe that this incident occured in Colorado.

Lindarn, RN, BSN, CCRN

Spokane, Washington

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In California the Conscious Sedation policy makes it clear that the registered nurse has the obligation and the right to advocate for the best interests of the patient. This includes refusing to accept an assignment or to administer medication without the requisite knowledge. This includes the assessment as well as giving the correct dose using the "five rights":

http://www.rn.ca.gov/practice/pdf/npr-b-06.pdf

The Floating Policy clearly states, ""If the RN is not clinically competent the RN license can be disciplined."

Also "Nursing administrator, supervisors, and managers may have their license subject to discipling if the do not ensure assignment of clinically competent RN staff."

And, "If the RN is not clinically competent she/he should not accept the assignment."

http://www.rn.ca.gov/practice/pdf/npr-b-21.pdf

Thus you may be risking your job by refusing an assignment. Your license is protected. What I do is agree to go help on the unit but NOT accept responsibility for patients. I will do anything the charge or other competent RN asks so long as I know how. I will not give medication to a child.

IF the nurse told the supervisor he or she is not competent and the supervisor insists on forcing an assignment then the supervisot puts his or her license at risk. The form is proof you informed the supervisor.

I have never had a charge nurse refuse to give the meds when I floated to peds. Another nurse is assigned the patients and I just help. Communication is the key. Say the words, "I am not competent" and offer to help.

Here is an ADO from the District of Columbia Nurses Association:

http://www.dcna.org/adoform.pdf#search='Assignment%20Despite%20Objection'

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