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Hello Everyone,
Welcome to Nursing Clinical Case of the Week.
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Andrew Lopez, RN
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******************************************************
For this issue we welcome as a guest reviewer Robert Stein, a legal nurse consultant currently practicing in Florida. We welcome your feedback and please feel free to contact Robert directly by E-mail at bobstein@legalnurseconsultingservices.com or visit his website (below).
This Case Review May Be Cited As:
Stein, Robert W. February 16, 2000. Nurse Advises "Reconsider Choice of
Physicians" An Nurse's Ethical Dilemma. Clinical Case of The Week.
Retrieved (insert date) from the World Wide Web:
http://www.nursefriendly.com/nursing/clinical.cases/2000/021600.htm
******************************************************
Nurse Advises "Reconsider Choice of Physicians" An Nurse's Ethical Dilemma.
Deerman v. Beverly California Corp., 518 S.E.2d 804 - NC (1999)
Robert W. Stein, III, RN, MSHA, CHE, LNC
Legal Nurse Consulting Services, Inc.
http://www.legalnurseconsultingservices.com
Case Scenario:
In this case the nurse providing patient care noted a decline in the patient's condition, evidenced by weight loss, hallucinations, psychiatric symptoms, and acute distress. The findings were documented and attempts were made to contact the attending physician. The attending physician, however, failed to return any of telephone messages.
As the patient's condition continued to deteriorate, the patient's family asked for the nurse's advice about what should be done for the patient. The nurse suggested that they "reconsider the choice of physicians."
The facility promptly fired the nurse after learning of the advice she had given to the patient's family. The nurse brought suit for wrongful termination arguing that as a Registered Nurse she was obligated to provide "teaching and counseling" to her patients and their families.
Legal Issues:
During a typical hospital stay, nurses spend the most time in direct contact with the patient. They are the main intermediary between their patients, their families and the physicians responsible for their medical care & treatment.
Nurses through direct and indirect interactions, know all too well whom the good physicians are, as well as the not-so-good physicians.
The issue raised in this case centered around whether a Registered Nurse, entrusted with the care of a patient, has a defined duty or responsibility to the patient. Specifically, a duty to suggest that the patient or patient's family may want to reconsider their choice of physicians given a declining medical condition and the failure of the physician to respond.
Implications for Nurses
This case highlights an ethical question that every nurse faces at some point in his or her career.
Should you act in a manner that is in the best interest of your patient, or in a manner that will prevent you from being fired?
Should you sacrifice helping one patient in order to keep your job, thus permitting you to help many other patients in the future? What would YOU do in this situation?
Outcome:
In this case, the court found that nurses do not have to make a choice between doing the right thing for their patients or keeping their job.
The court took note of the declining medical condition of the patient and the failure of the physician to respond. Accordingly, it ruled that the nurse's advice to the family that they reconsider their choice of physician was "teaching and counseling." This is specifically defined and required (of a practicing nurse) under the North Carolina Nurse Practice Act.
They elaborated that the nurse had a responsibility to provide accurate and consistent information. This responsibility included providing guidance and counseling to patients and their families.
The court rejected the facility's argument that the nurse had engaged in the practice of Medicine without a license.
It noted that the nurse's actions were defined in the applicable Nursing Scope of Practice and met the minimum requirements set forth in the Nurse Practice Act. The allegation that she was "practicing" Medicine therefore was without merit.
The findings of the court highlight the need for ongoing, accurate, and consistent documentation of the patient's health status and all actions taken.
The complete and timely documentation by the nurse in this case supported and substantiated her recommendation that the family reconsider their choice of physicians. Further, the nurse has an obligation to provide counseling and guidance to patients and their families when faced with a deteriorating medical condition and the inaction of the attending physician.
Related Links:
Care Givers, Nursing Homes & Long Term Care
http://www.nursefriendly.com/nursing/directpatientcare/care.givers.htm
Certified Nursing Assistants, CNA, Nursing & Healthcare Jobs on: The Nurse
Friendly
http://www.nursefriendly.com/nursing/jobs/certified.nursing.assistants.cnas.htm
Clinical Charting and Documentation, Nurses Notes:
http://www.nursefriendly.com/nursing/directpatientcare/clinical.documentation.nurses.notes.htm
Courtroom Directory (National):
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/courtrooms.online.htm
Direct Patient Care Links :
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm
Ethics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm
Medical Legal Consulting Nurse Entrepreneurs:
http://www.nursefriendly.com/nursing/ymedlegal.htm
Related Malpractice Cases:
September 19, 1999: Abusive Psychiatric Patient Restrained, Placed In
Seclusion For Angering Nursing & Medical Staff?
Summary: In dealing with violent, abusive or angry psychiatric patients,
the safety of the patient and staff are the priority concerns. When
restraints or seclusion are deemed necessary, justification for the
measures must be documented concisely. In this case, an unruly patient
angered the nurse caring for him. When leather restraints were applied and
maintained for a prolonged period of time, the patient would object and
later sue for damages.
Alt v. John Umstead hospital 479 S.E. 2d 800
http://www.nursefriendly.com/nursing/clinical.cases/091999.htm
August 1, 1999: Nursing Duty To Patient, "Does Not Guarantee" Safety Or
Quality Of Care.
Summary: When a nurse accepts report and responsibility for the care of a
patient a duty to the patient is also accepted. This duty is to provide a
reasonable standard of care as defined by the Nurse Practice Act of the
individual state and the facility Policy & Procedures. In this case, a
post-op abdominal aneurysm repair patient was injured after falling from
his bed to the floor. When a lawsuit was filed the court initially mistook
expert testimony to imply the role of the nurse includes a guarantee of
safety.
Downey v. Mobile Infirmary Med. Ctr. - 662 So. 2d 1152 (1995).
http://www.nursefriendly.com/nursing/clinical.cases/080199.htm
July 25, 1999: Premature Child of Cocaine Addicted Mother Survives
Abortion. Physician Order: Leave To Die?
The premature birth of a child under normal circumstances requires highly
skilled nursing and medical care if the child is to survive. The birth of
a premature child to a known Cocaine addicted mother greatly increased the
risks of mortality. In this case, a child intended to be aborted is born
alive. When the physician orders that the child be to left to die, it
miraculously survives on its own. Were the nurses liable for "following
orders?"
Hartsell v. Fort Sanders Reg. Med. Ctr. 905 S.W. 2d 944 - TN (1995).
http://www.nursefriendly.com/nursing/clinical.cases/072599.htm
June 13, 1999: Felony Child Abuse Conviction, Made Possible Thanks to
Nurse's Documentation.
Child abuse is a "reportable" crime. This means when a healthcare worker
suspects in the course of their duties that a child has been abused, it
must be reported. Procedures are in place in hospitals and other
facilities for the reporting of abused children. In this case, it was the
expert documentation of a child's statements by a nurse, physician and
field agent that made the conviction of an abuser possible.
State v. Gillard, 936 S.W. 2d 194 - MO (1999).
http://www.nursefriendly.com/nursing/clinical.cases/061399.htm
June 6, 1999: Emergency Department Nurse Verbally Abused, Physician
History Well Documented
Official tolerance for verbal abuse and sexual harassment is approaching
zero. It is clear that both are still prevalent in healthcare settings
today. Enforcing and reporting instances of abuse are critical to an end
being put to the situation. In this case, a physician had a "history" of
verbal abuse in the facility involved. It was the documentation of
previous events that made formal action and administration of a suspension
feasible.
Gordon v. Lewiston Hospital, 714 A.2d 539 - PA (1998)
http://www.nursefriendly.com/nursing/clinical.cases/060699.htm
May 23, 1999: Sponge Count Off, Patient Develops Sepsis, Surgeon Blames
Nurse.
Sponge Counts are a basic and critical safety measure during a surgical
operation. In this case, the standard three counts were not performed. A
sponge was left in the patient that would later lead to infection. When
the issue went to court, the surgeon claimed "it was not his
responsibility" to keep track of the sponges.
Johnston v. Southwest Louisiana Assn. 693 So. 2d 1195 -LA (1997)
http://www.nursefriendly.com/nursing/clinical.cases/052399.htm
Related Resources in Print
1. Buckley-Womack C, et al., A new dimension in documentation: the PIE method. J Neurosci Nurs. 1987 Oct;19(5):256-60.
2. Ehrenberg A, Ehnfors M. Patient records in nursing homes. Effects of training on content and comprehensiveness. Scand J Caring Sci. 1999;13(2):72-82.
3. Martin A, Hinds C, Felix M. Documentation practices of nurses in long-term care. J Clin Nurs. 1999 Jul;8(4):345-52.
4. Boroughs DS. Documentation in the long-term care setting. J Nurs Adm. 1999 Dec;29(12):46-9.
5. [No authors listed] Nursing practice guideline documentation. Nurs BC. 1998 Nov-Dec;30(5):suppl 1-2.
6. Ehnfors M, et al., Nursing care as documented in patient records. Scand J Caring Sci. 1993;7(4):209-20.
7. Weber M., Documentation: short, simple, and meaningful. Neonatal Netw. 1991 Aug;10(1):53-62.
8. Sinha L, et al., "Patient focused charting". Can J Nurs Adm. 1988 Jun;1(2):20-2.
9. Kerr SD., A comparison of four nursing documentation systems. J Nurs Staff Dev. 1992 Jan-Feb;8(1):27-31.
10. Nordstrom G, et al., Nursing documentation in patient records. Scand J Caring Sci. 1996;10(1):27-33.
References
1. Deerman v. Beverly California Corp., 518 S.E.2d 804 - NC (1999)
2. [No authors listed] Nursing Law Case of the Month - Nurse Advises "Reconsider Choice of Physicians". Regan Rep Nurs Law. 1999 Dec; 40(7):2.
http://www.nursefriendly.com/nursing/clinical.cases/2000/021600.htm
Created on January 30, 2000
Last updated by Andrew Lopez, RN on Monday, January 25, 2010