Liability Issues In Nursing
October 26, 2020
As professionals, it is important and not an option that when providing care to any one person or persons that we take time to document and record to the best of our ability and above all what is mandated, of the care given. Understanding the importance and legal obligatory along with the recording of the care given, being as detailed and truthful as possible, helps a nurse to be as proficient as possible in the healthcare setting. In this paper I will attempt to provide a visual of instances where this was not followed and the results thereof.
Whether the lack of documentation in the admitting nurse’s assessment and notes affect the ultimate outcome of this case.
If no mention has been made of a condition or a change in a patient’s condition, the jury can conclude that no observation and/or assessment of the patient was conducted. If no mention is made of a fact or intervention in the medical record, then it did not happen (Guido 2020). Similarly, lack of documentation can be a stumbling block to a favorable legal ruling. We know that our documentation is very important when it comes to clinical practice. It tells a story or paints a picture and captures all aspects of patient care from the time the patient is admitted, to the time that they are discharged. It is utilized to identify the medical condition of the person being treated and what care was given as a response. It records the treatment(s), therapy given and the resources used during care (RoBICHAUx, et al 2017). When the documentation is done well and complete, and it is accurate, it is going to prevent levels of ambiguity which means that it is also going to improve communication between the different healthcare providers (Guido, 2020). Therefore when documentation is omitted, is incomplete and/or inaccurate it displays a lack of quality of patients care. In this case, unfortunately, there was evidence that there was a lack of documentation, which meant a lack of care, that matched the condition of the patient based on the medical emergency. The documentation should have been clear documentation of the nurse’s assessment and details documenting the problems identified and care planning and goals to work towards achieving good patient outcomes. This information provided, regarding the patient’s conditions, the treatments/actions taken would have hopefully relinquished the nurse, other professional staff and the hospital as a whole, from liability or case of negligence (Guido, 2020).
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Whether there was negligence on the part of the nursing staff in the care of this patient.
Negligence amongst the nursing staff and care provided may apply here being that this patient experienced a medical emergency, that was not reflected in the patient’s medical record. Negligence shows a deterioration in overall health when care is withheld and/or insufficient and can result in death or serious bodily harm. In any healthcare facility, patients and patient families entrust their health and care to the staff and team of professionals. There are more instances of negligence in long term care facilities where there often is a lack of training and/or lack of quality of training and the workloads are complex, making it more likely to encounter situations where negligence is in question. Industry representatives reports that more instances of negligence or abuse, have been discovered within these types of facilities, amongst the elder population (RoBICHAUx, et al 2017). Robichaux reports that there have been an increase in instances where facilities have been cited as providing unnecessary care or a lack thereof of the care that should be provided and are common within the walls of these facilities. Nursing home litigation within these facilities are new terms and services are becoming more common within the industry.
What the nurse could have done differently to facilitate a different outcome in…..
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this case.
The nurse should have ensured that there was accurate documentation with which would have or should have reflected the entire nursing process. In this manner, the nurse was supposed to make use of critical thinking and good nursing judgement, all the time, with the care being provided. In her documentation, the nurse should have proved that she underwent the whole critical thinking process, included any other professional team allies in collaborating the best plan of care to have been provided (Ejaz, et al 2020). Her documentation failed to show that she identified the patient with a wound. With this, one could have assumed that she did not do a complete assessment of the patient or her conditions. The documentation process is very important in the nursing practice as it also provides for the best practices and help with the interdisciplinary communication while establishing a risk management tool whose value is not underestimated (Guido, 2020). In the event that the nurse would have appropriately documented her assessments of the patient conditions, then there would have been reports where the patient underwent a change in condition or there was an unusual occurrence. In this case, when the change of conditions, was identified, the documentation would have outlined the nurses steps she took and involvement of the other interdisciplinary team of professionals. It makes you wonder what the others who took care of her documented and why did this nurse leave it off? Was it one where she forgot and/or was overly busy and was going to come back to it? The nurse should have also included her informing the physician of the patient’s condition and any orders given for appropriate intervention. The clinical record would show proof that the best appropriate level of care was provided. In this case, the nurse as well as the facility would be held responsible for negligence since she failed to document the complete patient condition and interventions as proof that complete care was taken to ensure the patient well cared for. She was not the only one caring for the patient and she had supervision. Ethical challenges can be observed more than ever. Therefore, the growing and dynamic system of nursing requires nurses with professional and ethical competence who can provide optimal care (Zafarnia, et al 2017).
Provisions for professional liability insurance policy
Professional liability insurance is coverage that protects an person and/or entity and its employees against claims alleging negligent acts, errors, or omissions in the performance of a particular service or services. professional liability policies are as specialized and diverse as the variety of professional practices that exist (Pealer 2007). Although some mistakes can be mitigated much easily, others require substantial finances to minimize the damage caused. Despite the drawbacks of individual professional liability insurance, entrepreneurs who choose coverage tend to ensure that their businesses are secure and intact (Guido, 2020). Here I breakdown the different areas that make up a policy identifying each of the areas that are important to the details of a policy. With the policy being referenced within this assignment, the section that refers to Limits of liability, which detail the amounts of coverage that are usually in two different dollar figures. The amounts of this policy are $1,000.000 per claim/$3,000,000 aggregate. The Declarations, entails the details of the person being covered, identity, location and occupation. This policy is covering Judy Doe, who is a registered nurse on staff with Acute care institution or community health/home health. Her deductibles, which is the amount that the insurance carrier abstracts from the total that could include monies paid out in legas defense. It is taken from the amount the policy pays. I did not see any information of actual deductible(s) reflected in the policy. Exclusions are considered items or areas that the insurance will not provide coverage for. When reviewing her policy, her exclusions were more so depending on if she held a position, within her organization, as superintendent, or executive officer of any hospital, sanitarium, clinic with bed and board facilities, laboratory or business enterprise other than as stated in the above declarations, was a sole proprietor, nurse anesthetist or midwife (Guido 2019). Reservation of rights is usually found in the policy under the general title reservation of rights, it details any info the company has outlined that it reserves the right to deny coverage once all facts are known. Covered injuries outlines the types of injuries and areas that the insurance will cover such as death, undocumented injuries at which her policy makes mention of paying of injury arising out of the rendering of or failure to render of service or provide care during the period in which the policy is effective (Guido 2019). Defense costs have to do with the costs incurred with investigating, defending, any negotiating, also covering if the nurse has to go before the board of nursing or other legal board/governmental regulatory entity. This nurse is also covered for having to have a legal defense team and requests for hearing and board reviews. Coverage conditions and supplementary payments this involves the responsibilities of the nurse to the insurance carrier in the event of lawsuit or legal filing, including provisions to cancellation of the policy, also the nurse the responsibility to contact the insurance carrier immediately upon knowing of any possibility legal action. This policy also has a clause that covers this section and is found under the section of Conditions. Based on knowing about the different areas that should be included in a policy and/or are standards of coverage, I did not find it difficult to navigate the policy and identify the different areas for this section of the assignment. I wouldn’t consider a policy with these provisions of coverage, in being that I would need provisions that cover me as an independent contractor and assist with ensuring representation for a nurse who is works in the capacity as a community health nurse. Guido reports that one of the things to make sure of, with coverage, is that there is representation for protection when a nurse is board review and possible revoke and/or suspension of nursing licensure (Guido 2019). After reading the section on provisions of coverage that are important to ensure, included for coverage and seeing that this policy did not lack basic provisions, I found it to be a basic policy and to provide sufficient protection for those who were operating outside of the capacity listed in the exclusions of coverage, such as proprietor, hospital admin, nurse anesthetist and such.
Chapter 11 case study
There is no specialty in nursing that is immune to legal issues or lawsuits (Guido 2019). In the case of “You be the judge” where the personnel made a decision that cost 4 individuals their lives, one would have to look at their policy under the provisions that outlines and explains the coverage agreements and details the coverage that is provided for the individual and provisions of that coverage. The limits of the policy is individualized to each policy as to what was purchased and would outline the amounts of the each claim. Based on the details surrounding the incident, there should be legal representation for the sake of the investigation into the incident and individuals involved, whose lives were lost, as a result. There is recent documentation that indicates that most malpractice cases involving nurses occur in acute care facilities and involve non-specialized RNs (Guido, 2019). In this scenario, it is noted if the nurse, involved in this lawsuit, has professional liability insurance, of her own. The fact that the Administrator, made a decision, independent of what the facility would have allowed, makes her to be held responsible. What made her think to not turn the air on and make the temperature appropriate for all involved, is not a professional decision of rationale. The insurance agency withholding payment just makes matters worse in this situation. The fact that the nursing home felt that it needed to seek legal action against the insurance agency, says a lot about the organization, in which, they were paying to provide coverage and protection against what was stated in this situation. In this case, based on the information given, I would have to decide this to be negligent on behalf of the administrator in making the decision that was made. It appeared to be one of not in the best interest of the organization. There would need to be a legal review to determine if the insurance company was legally within its limits and right to withhold payment and forego paying and claiming that it was not responsible for paying. It is important for nurses and other professional team members to know that liability is not just for the entity or establishment that you work for and knowing that if you are a part of an organization, knowing if you are protected and if so to what extent is important to your livelihood.
Reference
Brous, E. (2017). Professional liability insurance: What all nurses should know. Journal of Radiology Nursing, 36(4), 236-237.
Ejaz, F. K., Rose, M., Reynolds, C., Bingle, C., Billa, D., & Kirsch, R. (2020). A Novel Intervention to Identify and Report Suspected Abuse in Older, Primary Care Patients. Journal of the American Geriatrics Society.
Pealer, C. (2007). Practice Matters. Architectural Record, 195(12), 59–60.
RoBICHAUx IV, L. E., & PERRY, R. (2017). What’s Happening with Long-Term Skilled Nursing Care Providers?. American Bankruptcy Institute Journal, 36(7), 30-31
RN, G.W.G.J. M. (2019). Legal & Ethical Issues in Nursing (Subscription). [VitalSource Bookshelf]. Retrieved from https://bookshelf.vitalsource.com/#/books/9780134714028/
Zafarnia, N., Abbaszadeh, A., Borhani, F., Ebadi, A., & Nakhaee, N. (2017). Moral competency: meta-competence of nursing care. Electronic physician, 9(6), 4553.