Legal Corner: Changes and Responsibility in Nursing

Upon completion of law school and successful passage of the Alabama Bar Exam twenty-five years ago, I began taking legal work of a wide variety which I thought would allow me to undertake a general practice of law rather than specialization in any one area. In other work settings, that would have made me a “jack of all trades, but a master of none,” so to speak. I remember speaking to an elder in the profession of law, and he put it another way: He said, “if you do that, you will know enough about the law to get yourself into trouble, but not enough to get you out.” It was good advice. It is probably true for most professions, including nursing.

Specialization has changed nursing a lot through the years. I mentioned in my last report that my daughter is a Nurse Practitioner. I have watched her change practice settings a number of times now and seen how different those settings can be, from floor nurse, to nurse supervisor, to surgery, to neurology and now to wound care. It is daunting. And, with those changes come responsibility – the responsibility to become proficient in each new role. That responsibility is most importantly owed the patient, but also to the employer and to the State in that the State (State and Federal law and regulations, not to mention case law in courts) regulates the profession. This is one of the most important reasons to support your professional organizations because who else would look out for nurses first as changes take place in the profession and as your role changes. So what responsibility do you owe as a practicing nurse regardless of practice setting? From a civil, i.e., non-criminal, standpoint? A nurse must:

1. Assess and monitor
2. Follow standards of care
3. Use equipment in a responsible manner
4. Communicate
5. Document
6. Act as a patient advocate and follow the chain of command

Failure to do any of these could be considered malpractice, according to Deanna Reising, Professor of Nursing, Indiana University. There are books written on medical malpractice and the nuances associated with each of these so do not make the mistake of thinking that if you do all of these generally, you are home safe, but generally speaking these are the practices that keep you out of trouble.

Here are some additional steps that can minimize your risks, also borrowed from Reising:

1. Know and follow your state’s nurse practice act and your facility’s policies and procedures
2. Stay up to date in your field of practice
3. Assess your patients in accordance with policy and their physicians’ orders and more frequently, if indicated by your nursing judgment
4. Promptly report abnormal assessments, including laboratory data, and document what was reported and any follow-up
5. Follow up on assessments or care delegated to others
6. Communicate openly and factually with patients and their families and other health care providers
7. Document all nursing care factually and thoroughly and ensure that the documentation reflects the nursing process and never chart ahead of time
8. Promptly report and file appropriate incident reports for deviations in care

I wish I could say that it just all comes down to common sense, but that would be a vast overstatement. The truth of the matter is that it takes a lot of discipline to know the who, what, when, why and how of professional nursing. The constant change in roles that many of you experience over the course of your career make that even more challenging. Thankfully, there are a lot of organizations, like ASNA, to help you along the way.