Minimizing Legal Risks in Nursing Practice
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Minimizing Legal Risks in Nursing Practice
Part One: Review summary of completed TERCAP report
The Taxonomy of Error, Root Cause Analysis Practice- Responsibility (TERCAP) report narrates the factors that contributed to negative health outcomes for a 54-year-old patient who has been hospitalized for back surgery secondary to compressed vertebrae and intense pain. The patient suffered a serious injury after falling when she attempted to move from the bed to the bathroom just the first day after an operation. From the TERCAP report, the issues that led to the reported problem are related to nurses being overworked/burnout, inexperienced nurses, improper documentation of patient charts, and the lack of adherence to clinical practice guidelines. According to Russel (2017), issues that touch directly on nursing practice are associated with negative health impacts on patients, pose legal risks for the nurses, and can lead to suspension, fines, or revocation of license.
Part Two: Factors and Actions
Factors
Situational Factors
Situational factors are the elements within the environment where a particular issue is taking place. For example, the situational factors that contributed to the events described in the scenario include; the lack of walking aids or nurses nearby to support the patient with movement to prevent falls. Again, the ward does not have bed alarms to alert the nurses whenever a patient is trying to get out of bed. To minimize legal risks, nurses in the facility should always remain alert to respond to patients’ calls for assistance (LeLaurin & Shorr, 2019). The organization should also provide patients with walking aids and install bed alarms that can help to prevent patient falls.
Nursing Factors
Nursing factors are issues related to nursing development. For example, the specific nursing factors evident in the scenario include; limited work experience, low level of educational achievement, failure to address specific needs of the patient, and the lack of adherence to professionalism. Nurses can avoid legal risks attributed to these factors by performing roles that are aligned with their levels of work experience and educational achievement (Vaismoradi et al., 2020). Additionally, they should effectively identify patients’ needs and utilize appropriate interventions to address them adequately. Adherence to practice policies that define professionalism such as proper documentation of patient charts can help nurses to minimize legal risks (Conroy, 2018).
Human Factors
Some situational and nursing factors can also be classified as human factors. For example, workload and burnout affect the cognitive abilities of the nurses thereby increasing their chances of committing medical errors. Additionally, nurses who are not adequately trained are highly likely to make errors when administering medications and when filling patient charts (Escrivá et al., 2019). To address these factors, there is a need for proper staffing, proper distribution of tasks, and comprehensive nurse training (Conroy, 2018).
Organizational Factors
Poor leadership is the organizational factor that contributed to the event described in the scenario. For example, there is evidence of understaffing, hiring unqualified nurses, an increased workload that leads to high turnover rates, and the lack of proper guidance to the nurses regarding the clinical practice guidelines and policies that they should use during the healthcare delivery process (Conroy, 2018). To minimize legal risks for nurses, the organization’s leadership should be strengthened in areas related to hiring policy, staffing, staff training, and the provision of well-documented clinical practice guidelines and health policies to direct the healthcare delivery process (Escrivá et al., 2019).
Negligence versus Malpractice
The nurse described in the scenario was negligent. Her actions did not reach the level of malpractice. Medical negligence refers to the omission of a procedure or committing an act that would not be omitted or committed by another healthcare professional under similar circumstances and patient injury occurring due to such omission or commission (Dahlawi et al., 2021). On the other hand, medical malpractice occurs when a healthcare provider violates a standard of care, causes a significant injury or damage, and there is evidence to prove that a particular injury or damage occurred due to negligence (Dahlawi et al., 2021). In the current scenario, the patient cannot recall having been instructed to ask for assistance. Besides, her statement that she pushed the nurse call button without a response cannot be substantiated. This qualifies the nurse’s behavior to be negligence but not malpractice.
Available Options and Personal Reasoning
The nursing board has two options regarding the nurse’s license to practice nursing. Since the nurse’s actions did not reach the level of malpractice, the nursing board should warn the nurse and put her on probation but it should not revoke her license (Dahlawi et al., 2021). If I were on the disciplinary committee of your Board of Nursing, I would apply the same reasoning to recommend warning the nurse and putting her on probation for about three months but not to revoke her license (Dahlawi et al., 2021).
The Level of Nursing Behavior
The level of nursing behavior relates to the proposed recommendation on licensure. Essentially, the warning and probation will allow more time for monitoring the nurse’s actions and evaluating them against professional standards (Dahlawi et al., 2021). The board should be able to comment regarding the nurse’s level of competence at the end of the probation period.
Part Three: Continuing Education
The education department should organize training to capture the issues that contributed to the event which increased legal risk for the nurse. The specific areas of education include; proper staffing and patient safety, strategies to minimize the risk of falls in healthcare settings, enhancing hiring, the need for staff training, and the importance of adhering to clinical practice guidelines and policy (LeLaurin et al., 2019). Training in these areas will help to prevent similar incidents from happening again in the future.
References
Conroy, T. (2018). Factors influencing the delivery of the fundamentals of care: Perceptions of nurses, nursing leaders and healthcare consumers. Journal of Clinical Nursing, 27(11-12), 2373-2386. doi: 10.1111/jocn.14183.
Dahlawi, S., Menezes, R. G., Khan, M. A. Waris, A., Saifullah, M., & Naseer, N. M. (2021). Medical negligence in healthcare organizations and its impact on patient safety and public health: a bibliometric study. F1000Research, 10, 174. https://doi.org/10.12688/f1000research.37448.1
Escrivá, J., Brage, R. & Fernández, J. (2019). Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC Health Services Research, 19, 640. https://doi.org/10.1186/s12913-019-4481-7
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: State of the science. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007
Russel, K. (2017). Nurse Practice Acts Guide and Govern: Update 2017. https://www.ncsbn.org/2017_NPA_Guide_and_govern.pdf
Vaismoradi, M., Tella, S., A Logan, P., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ adherence to patient safety principles: a systematic review. International Journal of Environmental Research and Public Health, 17(6), 2028. https://doi.org/10.3390/ijerph17062028