Critical care nursing and team communication – perfect together
Communication and collaboration are responsibilities of not only the nurses, but also of the physicians. The team must mutually update each other on information from diagnostic studies, and physiological and psychosocial parameters affecting the patient or family. Daily multidisciplinary rounds, end-of-shift reporting, and timely and appropriate telephone calls combine to maintain an environment essential in a setting where a patient’s condition changes rapidly and often. Critically ill patients need a highly functional and communicative team.
Several studies have shown that the implementation of an integrated medical record, clinical pathways and protocols, and other products of a more collaborative arrangement may improve patient outcomes.
Unit-based protocols and standing orders
Unit-based protocols and standing orders are frequently used in the critical care unit. These documents serve as a guide for the critical care nurse, permitting rapid intervention when life-threatening symptoms are present. Protocols and standing orders should be dated and signed by the physician, and periodically updated as changes in medical and nursing practice mandate.
The highly sophisticated nature of critical care nursing and team communication and the expanded scope of clinical practice make nurses vulnerable to liability.
There is no question the critical care nurse can be held to a higher standard of care than the staff nurse on a regular unit.
Interdependence of the Team
The critical care nurse is often required to perform highly technical procedures without the direct and immediate supervision of a physician. These activities must be based on established protocols created by medical and nursing departments of the hospital. The protocols should be reviewed frequently so healthcare professionals can determine if they reflect current medical and nursing standards of care. Unit protocols and procedures serve as evidence to assist with the establishment of the applicable standard of care.
The legal responsibility of critical care nurses is the same as that of other nurses, i.e., they are responsible for their own conduct, including any negligence or tort. However, the complexity of patient problems, their rapidly changing condition, and ongoing technological innovations place a higher demand on the critical care nurse. Critical care nursing and team communication – whether effective or dysfunctional – profoundly affects care.
Critical Care Nurses Diagnose
To complicate matters further, gray areas of legal authority surround certain situations, such as when the nurse makes the clinical diagnosis of a dysrhythmia, and implements standing orders. In essence he or she is making a medical diagnosis – independent of the physician – and treating it based on established protocol.
If the patient’s outcome is a good recovery, no questions are raised. If the opposite occurs and the patient dies, can the nurse be found guilty of practicing medicine? This is the vacuum in which critical care nursing and team communication is practiced and the uncertainty that attorneys face as they review critical care malpractice suits.
The Joint Commission requires the appointment of a medical director for each ICU. Legal nurse consultants and attorneys must not lose sight of the fact that, more often than not, nurses are the overall protectors and primary caregivers of the patients admitted to the critical care unit. But, critical care nursing is a multidisciplinary team approach and open communication should exist among the physicians, the critical care nurse, and other health team members, including the medical director.
Modified from Kathy Ashton and Jenny Beerman, Critical Care Nursing Malpractice, in Iyer, Levin, Ashton and Powell, Nursing Malpractice, Fourth Edition. Order your copy here.