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.