Managing Risk and Protecting Against Nurse Liability

While malpractice liability for nurses cannot always be entirely prevented, many risks can be predicted and managed. Nursing Practice Acts and the legal standard of care for nurses create the required level of conduct for nurses, coupled with the policies and procedures in the nurse’s health care setting. Some aspects of the nurse’s job are particularly ripe for mistakes and potential liability. These high risk functions include administering medications, monitoring the patient’s condition, and communicating with other health care professionals.
Administering medications is an area in which nurses must use diligent attention to detail and good judgment to avoid accusations of negligence. Nurses need a working knowledge of the medications they administer, including how medications affect patients and interact with other medications. Nurses must carefully read medication labels to ensure that the correct medication is being administered at the correct time by the correct method (i.e. oral versus injection) to the correct patient in the correct dosages and only in correct combination with any other medications. In one court case, a nurse gave an oral dose of metronidazole antibiotic instead of the ordered milk of magnesia because she failed to carefully read the labels of the bottles that were kept in close proximity in the hospital medicine room. Furthermore, nurses should never blindly follow an incomplete physician’s order or one that appears to be incorrect. Where a physician’s order presents any uncertainty whatsoever, nurses should clarify the order with the physician to ensure its accuracy and completeness and/or pursue the matter though her supervisor or hospital administration. Nurses hold the responsibility of being the last person in the chain of administering medication and are in a position to prevent patient harm in the event physician’s orders are unclear or incorrect.
Another common area of liability occurs when nurses fail to adequately monitor the patient’s safety and condition. Leaving patients unattended and not calling on the assistance of nurse’s aides to supervise patients creates the potential for patient injury. In one case, a nurse left a groggy, post-operative patient unattended to dress himself. The patient fell, sustaining an injury that could have been prevented if the nurse had the patient wait until the nurse was available to assist, or if the nurse had asked a nurses’ aide to assist and supervise the patient. Also, merely monitoring the patient’s condition may not be enough. A nurse is expected to be able to recognize a change in the patient’s condition, appreciate the significance of the change and report that change to the appropriate health care professionals involved in the patient’s care. If a patient’s condition deteriorates, a nurse must respond and communicate the change to appropriate other health care personnel involved in the patient’s care. Finally, documentation of the nurse’s actions and communications related it patient care is critical to minimizing the ultimate liability of the nurse and maximizing the quality of patient care.
Nurses are the on the front line – of ensuring quality patient care and establishing confidence and trust with the patient and family members. Perhaps the most powerful weapon against lawsuits and potential liability for nurses is a kind word and understanding, helpful attitude that may ease the concern of patients and their families related to the patient’s care.