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Brent's Law

Nancy J. Brent, RN, MS, JD received her Juris Doctor from Loyola University Chicago School of Law and concentrates her own solo law practice in health law and legal representation, consultation, and education for health care professionals, school of nursing faculty, and health care delivery facilities.

Brent has conducted many seminars on legal issues in nursing and health care delivery across the country and has published extensively in the area of law and nursing practice.


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I’m concerned that patients are being assigned to a nurse who is unqualified to handle them. What can I do?
Wednesday October 22, 2008
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Questions:

Dear Nancy,

I am working in a SICU. Recently, I was in charge of the unit and the previous charge nurse assigned a post open heart patient with IABP to a nurse who has no formal orientation to IABP and never attended a class. I told that nurse that I would take over the case for patient safety. The nurse hesitated but eventually gave me the patient. I told my manager not to assign the same nurse a patient with IABP because he needed to be oriented and to take a class. I was recently off. When I got back to work (less than a week), the same nurse was working with a post open heart with IABP. No class was taken and no orientation was given. I think this is ethically and legally wrong. Am I wrong? Should I follow the chain of command and talk to administration about this.

Brad



Nancy Brent replies:

Dear Brad,

The situation described in the question submitted is something faced by nurses in many settings. As a patient advocate, it is necessary to protect patients from unsafe and unskilled practitioners, including fellow nurses. This necessity is based on several foundations.

The first is based on the ethical mandates of the nursing profession. Because the nurse is the last line of defense against risk of harm, the nurse must be proactive in protecting the patient. Reviewing nursing codes of ethics (American Nurses Association-ANA) and specialty association codes underscore this requirement. For your information, you can review information about the ANA’s new publication, Guide to the Code of Ethics for Nurses: Interpretation and Application, at www.nursingworld.org.

A second basis upon which the protection of the patient is necessary, not only for the patient, but for the nurse, is the liability that can occur if a nurse knew or should have known of a risk to a patient and did nothing to try to eliminate that risk. In this situation, then, if an injury to a patient occurred, you might be brought into the suit because you had a duty to intervene, knew of the risk to the patient, but did nothing about it.

A third foundation upon which intervention rests is one’s obligations under the state nurse practice act and its rules. Often, reporting unsafe conditions to the appropriate persons or authorities is a requirement of the nurse licensee. If one were to ignore a risk, and an injury to the patient took place, the nurse who knew of the risk but did nothing about it could face disciplinary proceedings.

It would be important for you to consult with a nurse attorney or attorney in your state in order to obtain specific directions on how to handle this situation, especially since your nurse manager has elected to ignore your concerns. Taking any employer policies or procedures on reporting unsafe patient care in the facility would be helpful. Strategizing how best to prevent this kind of situation from happening in the future, plus protecting your potential liability, would be the best of both worlds.

Cordially,
Nancy



Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.



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