Legal Issues Facing Nurses
The author will discuss the case study of an 80-year-old male with a medical history of osteoporosis and severe dementia. The patient was, admitted to the emergency department from a nursing home for an assessment after falling. After proper evaluation and medication, the insured nurse noted that the patient was confused and uncooperative, meaning the patient needed close monitoring. However, the patient was placed in a bed that could not be monitored closely from the nursing station. Consequently, the patient fell and fractured his hip, leading to surgery. As a result of the operation, the patient suffered limited morbidity as he was restricted to a wheelchair.
Summary of legal issues
The hospital and the nurse in charge of the patient received a letter of intent to file a lawsuit from an attorney representing the 80-year old male. Both parties received a letter because of neglecting the needs of the patient and prolonging his stay in the hospital.
The assessment by the nurse concluded that the patient was an elderly male at risk for falls. Also, the patient was confused, uncooperative, and incontinent. Thus, the patient required close supervision and monitoring from the nurses to prevent further falls during hospitalization.
One of the standard fall prevention interventions includes placing a patient close to the nursing station to ensure close monitoring. However, despite the patient being at risk of falls, he was placed at a bed that was not in direct view of the nursing station. Due to the negligence, the patient fell and fractured his hip. The fractured hip and surgery are as a result of neglect since the nurse did not closely monitor the patient.
The patient also suffered from pneumonia, which required antibiotic therapy, lengthening his stay at the hospital. Also, before hospitalization, the patient could move around, but after hospitalization, he got restricted to a wheelchair. The hip fracture and surgery would have been prevented if the patient had been closely monitored.
The nursing supervisor assigned the nurse with three patients who needed close monitoring. Ideally, when patients require close monitoring, they should be placed in beds close to nursing stations or get assigned to nurses. The patient in question was assigned to a nurse, but the nurse was also tasked with monitoring two other patients. Thus, the nurse was not in a position to closely monitor all patients at once. Besides, the nurse had expressed her concerns to the nursing supervisor about the quality of monitoring offered to the patients. However, the nursing supervisor brushed off her concerns, citing a shortage of nursing staff. Thus, the hospital is also legally liable for malpractice because of compromising the quality of monitoring rendered to patients by overworking nurses.
Risk mitigation techniques
The malpractice lawsuit would have been avoided had the hospital and the nurse implemented essential fall prevention interventions. According to Kadivar et al. (2017), ensuring the safety of patients and preventing any injury or damage is a top priority for healthcare providers. In cases of special conditions such as patients at risk of falls, healthcare providers should take extra care to prevent the patients from falling and getting injuries.
The patient should have been placed at a bed in a direct view of the nursing station. The nurse had assessed the patient and concluded that the patient was uncooperative, confused, and incontinent. Such a patient requires close monitoring. The most common cause of injury in hospitals is either medication errors or falling (Kadivar et al., 2017). Hospitals should cultivate an organizational safety culture whereby patients who are at risk of falling receive undivided attention to prevent injuries resulting from falling.
The nursing supervisor should have assigned lesser high-risk patients to the nurse. In line with Haddad et al. (2019), when overworking nurses declines the quality of care offered to patients. In the case, the nurse was assigned three patients who needed close supervision. The nurse was unable to monitor all patients at once, which put all the three patients in danger. The hospital should increase the number of nurses to avoid overworking nurses.
The nursing supervisor should have listened to the concerns of the nurse. Nurses are supposed to advocate for the rights of the patient (Haddad et al., 2019). The nurse raised a concern about the welfare of the three high-risk patients assigned to her. However, her concerns got dismissed by the nursing supervisor. If the nursing supervisor had assigned the other patients to other nurses, the nurse would have monitored the patient carefully and prevented the fall.
The hospital should cultivate a clear line of communication between nurses and their supervisors. The nursing supervisors should understand that nurses understand the needs of the patients better. Thus, when nurses express concerns about the welfare of patients, the supervisors should take action to address the concerns. Clear and effective communication goes a long way in improving the quality of care offered to patients.
Actions to improve the outcome
The nurse could have taken several precautions to improve the outcome in the case scenario. Since the nurse was well aware that the patient was susceptible to falls, she should have implemented falls prevention intervention techniques to avert the situation.
The nurse should have placed the patient at a bed in a direct view of the nursing station. The nurse had assessed the patient, and she was aware that the patient needed monitoring. Nevertheless, the nurse placed the patient at a bed that was not in direct view of the nursing station. According to Kadivar et al. (2017), a nurse should make decisions that are purposefully meant to ensure the welfare of patients. Thus, the nurse had an obligation to place the patient at a bed where he could have been easily monitored.
The nurse should have stood her ground with the nursing supervisor. The nursing supervisor assigned the nurse to three patients who needed close monitoring. The nurse was concerned about the quality of services rendered to the patients because she could not monitor all the three patients single-handedly. However, the nursing supervisor dismissed the concerns. According to Digby et al. (2017), nurses not only provide care but also advocate for the rights of their patients. The nurse knew that she could not single-handedly offer quality care for three patients who needed close monitoring. Therefore, when the supervising nurse dismissed her concerns, the nurse should have explained to the supervising nurse the risk of leaving high-risk patients unmonitored.
Conclusion
The case of the 80-year old male who suffered a fall in the hospital could have been avoided. The hospital should have increased the number of nurses assigned to high-risk patients to ensure all patients received close monitoring. The hospital should also cultivate a proper communication channel between staff to improve the quality of care offered to patients. Also, nurses handling patients who face risks of falls should implement all fall prevention interventions, including close monitoring of the patient.
References
Digby, R., Lee, S., & Williams, A. (2017). The experience of people with dementia and nurses in hospital: an integrative review. Journal of clinical nursing, 26(9-10), 1152-1171.
Haddad LM, Geiger RA. (2019) Nursing Ethical Considerations. StatPearls . Treasure Island (FL): StatPearls Publishing
Kadivar, M., Manookian, A., Asghari, F., Niknafs, N., Okazi, A., & Zarvani, A. (2017). Ethical and legal aspects of patient’s safety: a clinical case report. Journal of Medical Ethics and History of Medicine, 10.