In part 1 of this blog, I shared facts to analyze the standard of care. I described a case of a man seen in the ER. The patient had a significant change in his condition on discharge, yet was sent home anyway and subsequently died.
Did the ER nurse meet the nursing standard of care? Let’s look at what happened.
Emergency department nursing standard of care issues the RN should have questioned
- Patients who receive IV Toradol and are on a chronic Coumadin dose should be closely monitored.
- The nurse should have questioned the administration of IV Toradol, and then if she went ahead and gave it, should have been monitoring the patient’s vital signs and level of consciousness much more closely.
- The nurse did not assess vital signs within 30 minutes of giving the pain medication to determine if the pain medication administration was effective and if the initial hypertension was a product of the patient’s pain.
- Upon obtaining the significantly elevated blood pressure reading, after the discharge order was written, the RN should have brought the vital signs readings to the attention of the resident/attending and questioned the appropriateness of discharging the patient at that time. Part of this discussion should have then been to be to reiterate the patient’s decreased level of consciousness and a concern with discharging a patient with such a decreased level of consciousness (they had assumed his somnolence was due to the IV Dilaudid).
- Since the physician wrote the orders for the Toradol IV and the Discharge Order, did that negate any responsibility for the actions of the Registered Nurse?
BOTTOM LINE: THE PATIENT SHOULD NOT HAVE BEEN DISCHARGED HOME.
The nurse as patient advocate
The nurse serves as an advocate for the patient. Health care is a team effort; not an individual effort. Every part of the healthcare team has a responsibility to give the patient the best possible care; the care that a prudent and reasonable healthcare provider would administer. The ANA (American Nurses’ Association) describes this duty of advocacy as follows in the Code of Ethics for Nurses with Interpretive Statements, modified in 2015:
“Nurses must be alert to and take appropriate action in all instances of incompetent, unethical illegal or impaired practices or actions that place the rights or best interest of the patient in jeopardy. To function effectively in this role, nurses must be knowledgeable about the Code of Ethics with Interpretive Statements, standards of practice of the profession, relevant federal, state, and local laws and regulations, and the employing organization’s policies and procedures… When practices in the healthcare delivery system or organization threaten the welfare of the patient, nurses should express their concern to the responsible manager or administrator or if indicated, to an appropriate higher authority with the institution or agency or to an appropriate external authority.”
Potter and Perry in their Fundamentals of Nursing wrote the following:
“Nurses may share liability for errors made by physicians. . . . A nurse should not proceed to perform a physician’s order if it is foreseeable that harm will come to the client” (Potter & Perry, 1997).
Nursing standard of care: Conclusion
Summarizing this concept of the nursing standard of care, I suggest that when you are evaluating possible medical malpractice keep in mind that the care of the patient is done by a healthcare TEAM. All of those team members are responsible for seeing that the patient receives that best possible care.
The opposing counsel asked me, “So you think you know more than a doctor?”
I replied, a healthcare team was caring for the patient. The physicians had many more patients for which they were responsible. The nurse caring for the patient had all of the pieces of the puzzle regarding his care. It was her responsibility to come forward and discuss any concerns she might have had regarding the patient’s condition.
This case settled before trial.
Code of Ethics for Nurses with Interpretive Statements. (2015). American Nurses Publications.
Potter, P. A., & Perry, A. G. (1997). Fundamentals of Nursing: Concepts, Process, and Practice. Mosby.
Carol Alvin provided this guest blog. She is a legal nurse consultant at Alvinandassociateslnc.com. Carol spent all of her time in her 31 ½ years at the bedside where she had a passion for patient care but also a passion for teaching the nurses and residents that worked alongside of her. Sign up for her free report, 10 Necessary Facts You Need to Know When Reviewing a Chest Pain Case at www.alvinandassociateslnc.com
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