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
email@example.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:
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.
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.
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?
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
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
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
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
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