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Patient-Nurse Relationship and Liability

  • Bond with Patients:
    • Establishing a good rapport with patients decreases the likelihood of lawsuits.
    • In a litigious society, patients may view suing as a way to gain financial wealth.
    • A strong patient relationship can lead to enhanced trust and security for nurses.
  • Nurse Safety and Lawsuits:
    • Good practice and adherence to policies result in a safer environment for nurses.
    • The likelihood of being sued is reduced when nurses practice within their scope and document correctly.
    • A significant portion of nursing lawsuits settle out of court, primarily targeting physicians rather than nurses, due to high malpractice insurance premiums.

High-Risk Areas for Lawsuits

  • Areas with High Litigious Activity:
    • Emergency Room
    • Obstetrics
    • Operating Room (OR)
  • Legal Support for Nurses:
    • Hospitals provide legal teams to support nurses who adhere to policies and protocols.
    • If nurses do not follow established standards, they may lose hospital protection and bear legal costs personally.

Malpractice Insurance

  • Cost and Importance of Insurance:
    • Malpractice insurance costs approximately $137 annually.
    • Historically, nurses paid less (e.g., $50 in the past 38 years).
    • Insurance protects nurses from potential litigation, providing peace of mind.
  • Common Misconceptions:
    • There is a belief that avoiding insurance might prevent being sued; however, nurses can still be implicated in lawsuits.
    • Having malpractice insurance is deemed valuable for personal protection.

Preventing Lawsuits

  • Identifying Liabilities:
    • Nurses should report abnormalities in practice environments that could lead to legal issues.
    • Implementation of fall precautions is a response to identified risks, designed to reduce patient falls.
  • Fall Prevention Strategies:
    • Use of non-slip socks and fall ID wristbands for at-risk patients.
    • Implement bed alarms and assist patients in their first attempts to walk after surgery.
    • Conduct risk assessments for each patient to minimize fall occurrences.

Issues Leading to License Suspension or Revocation

  • Common Causes for License Issues:
    • Drug and alcohol abuse
    • Engagement in fraud or criminal acts
    • Committing deceptive practices
    • Gross or ordinary negligence
    • Physical or mental impairments affecting job performance
  • Case Examples:
    • Personal experiences of theft from colleagues and the impact on nursing careers.
    • Historical instances of older nurses retiring when new technology was implemented, leading to greater opportunities for younger nurses.

Just Culture in Healthcare

  • Concept of Just Culture:
    • Establishes a non-punitive approach to errors, focusing on system flaws rather than personal blame.
    • Encourages reporting incidents to improve safety and avoid recurrence.
  • Incident Reporting:
    • Hospitals use incident reports for systemic evaluations rather than for personal documentation.
    • All staff should feel secure reporting mistakes to foster better safety practices.

Legal Safeguards for Nurses

  • Competent Practice:
    • Nurses must be thoroughly trained and competent in performing clinical duties before engaging directly with patients.
    • Importance of documentation in patient education and instructional activities.
  • Procedure Compliance:
    • Nurses must carry out physician orders while being allowed to seek clarifications when necessary.
    • Adequate staffing is essential for maintaining patient safety and nursing efficacy.

Whistleblowing and Professional Responsibility

  • Reporting Inadequacies:
    • Nurses are encouraged to report unsafe practices, inadequate staff levels, or other concerns to appropriate authorities.
    • Professional liability insurance is recommended for nurses due to its affordability and protective benefits.

Informed Consent and Legal Requirements

  • Informed Consent Essentials:
    • Informed consent must clearly outline risks, benefits, alternatives, and potential consequences.
    • Must be articulated in simple, understandable language for patients.
  • Legal Responsibilities:
    • The healthcare provider must inform patients about the procedure, while nurses ensure documentation and witness the signature.
    • Patients may revoke consent at any time, even if initially signed.

Consent for Minors and Emergency Situations

  • Signing Consent:
    • Competent individuals above the age of 18 can sign their own consent.
    • Special circumstances allow minors or guardians to sign for treatments.
  • Emergency Protocols:
    • Medical teams can treat unconscious patients based on implied consent until legal representatives or advance directives provide contrary instructions.

Advanced Directives and Health Care Proxies

  • Durable Power of Attorney:
    • Appoints someone to make medical decisions on behalf of another who cannot make those decisions.
  • Advance Directive Availability:
    • Hospitals can retrieve existing advance directives if previously filed; patients' preferences remain active unless revoked.

Ethical Considerations and Legal Compliance

  • Balancing Ethics and Law:
    • Nurses must respect patient autonomy while also providing needed medical care.
    • The involvement of ethics committees can assist in the resolution of complex cases.

Negligence and Duty of Care

  • Negligence Defined:
    • Legal terms: duty of care, breach of duty, causation, and damages describe negligence's legal framework.
  • Prevention of Negligence:
    • Consistent documentation and thorough adherence to informed consent practices are paramount in preventing negligent claims.

Understanding Sentinel Events and Near Misses

  • Sentinel Events:
    • Serious events resulting in patient death or severe harm that prompt a review of safety protocols.
  • Near Misses:
    • Situations where a potential error is caught, leading to the need for changes to avoid future incidents.