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Nursing Law
 This page was last updated on 15-Jun-02

Professional Practice:
  Nursing Law
urse Practice Acts (NPAs) are laws in each state that are instrumental in defining the scope of nursing practice.  State boards of nursing oversee this statutory law. They have the responsibility and authority to protect the public by determining who is competent to practice nursing.  Common Law is derived from principles or social mores rather than from rules and regulations.  It consists of broad, interpretive principles based on reason, traditional justice and common sense.  Together, the NPAs and Common Law define nursing practice.  

It is a nurse's responsibility to be informed on both the NPA and Common Law for the state(s) in which they are licensed to practice.  It is critical for students and nurses need to be aware of the legal issues pertaining to the profession.  Familiarity with the law and relevant court rulings helps in understanding the scope of practice and responsibilities that come with being a licensed caregiver, as well as providing insight on how to prevent legal problems before they happen.

Read up on the NPA for your state - know your responsibilities and limitations.  You may also want to subscribe to professional nursing journals to stay abreast of the latest court rulings.  Here are a couple of case studies provided by Legal Eagle Eye Newsletter for the Nursing Profession, a monthly journal covering court cases, rulings and legislation pertaining to the nursing profession:

Healthcare Facility Liable for Student Nurse Error
Nurses Negligent for Giving Nursing Functions to Aides

QUICK SUMMARY: A nursing student's negligence resulted in the fall and injury of patient during transfer.  A nursing student at this studentís level had the training and should have been able to care for this patient. The student nurse testified she had received training to assist patients with ambulation and transfer. The nursing studentís preceptor testified the patient needed someone close with her at a safe distance at all times to ambulate. The healthcare facility was held to the same legal standard of care for a student nurseís error or omission as for the same error or omission by a licensed professional nurse.

The patientís chart indicated that she had serious difficulty with her balance which made it necessary for her to have assistance when standing or walking with a walker and when transferring. She had fallen backward six days earlier, but was caught and lowered to the floor without being injured. She was afraid of falling and needed not only physical assistance, but also encouragement to take steps forward with her walker.

According to the Court of Appeals of Ohio, the student nurse had read the patientís chart and knew the patient had weakness and an unsteady gait. Nonetheless, the student nurse helped her up from the commode, then walked away and left the patient standing with her walker in the bathroom, while the student nurse propped the door hinge open and adjusted her wheelchair, expecting the patient to walk to the wheelchair on her own to transfer with assistance. The patient took a step forward, fell backward and was injured.

The court ruled a healthcare facility will be held to the same legal standard of care for a student nurseís error or omission as for the same error or omission by a licensed professional nurse. There was also testimony from a nursing instructor, that a nursing student at this studentís level should have known, the same as a graduate nurse, to stay close by this patient when standing or walking with a walker. Failing to give proper close attention to a patientís need for assistance while ambulating is negligence, for which a healthcare facility can be held liable.

Dimora vs. Cleveland Clinic Foundation,
683 N.E. 2d 1175 (Ohio App., 1996).

QUICK SUMMARY:  The physician wanted his patient to receive skilled nursing care.  He wrote an order for the home health nurses to re-pack her hip decubitus wound with antiseptic gauze.  Instead, the nurses showed home health aides how to re-pack the wound and left them on their own to do wound care.  Wound healing was delayed more than a year, and the nurses were ruled negligent.

A home health client sued her home health agency because a hip decubitus wound site she sustained in the hospital took a year longer to heal than it should have.  Healing apparently was delayed by old gauze embedded in the wound, found there by a surgeon who operated on the wound when it failed to heal and instead worsened.  The judge believed the home health aides had been changing the outer dressing, but they did not understand the rationale for sterile packing and re-packing of a deep wound and had left the original gauze in the wound the entire time.

The nursing agency tried to defend the lawsuit by claiming its nurses had shown the aides how to re-pack the wound with sterile gauze and replace the outer bandages, and had taught the patient how to do it herself.  The jury sided with the home health nursing agency and found no nursing negligence.  The patient, however, insisted her physician had a reason for ordering skilled nursing care and insisted she was entitled to skilled nursing care.  The judge agreed with her and threw out the jury's verdict, awarding the patient more than $100,000 from the nursing agency.  The Court of Appeals of Louisiana upheld the judge's decision to disregard the jury and award the patient damages against the nursing agency notwithstanding the jury's verdict.

A nurse testified as an expert witness for the patient that nurses do not have the option to change the physician's orders on their own.  The court accepted the nurse as an expert on the nursing standard of care.  The court ruled if the physician orders specific skilled nursing care, it means those specific nursing functions are to be performed by skilled nurses with their own hands, or by non-licensed persons with direct supervision by licensed professional nurses.

There was no documentation that licensed nurses ever performed the re-packing procedure or witnessed non-licensed persons doing it.  The aides signed off that they had performed wound care, but there was no documentation of what exactly they did.  The judge interpreted it to mean they only changed the outer dressing, which would be wholly inappropriate care.  
Singleton vs. AAA Home Health, Inc.,
772 So. 2d 346 (La. App., 2000).

Emergency Room Assessment:  Hospital Liable for
Nurse's False Assurances that Infant Would Be Okay

QUICK SUMMARY: A nurse cannot reassure parents their infant will be all right without fully assessing the childís condition and obtaining a physicianís examination. Based on the nurseís reassurances, the parents did not wait to see the physician, and the child died. The hospital was ordered to pay nearly two million dollars for negligence.

The child had been discharged from the hospitalís neonatal intensive care unit the day before his parents brought him back to the emergency room. The parents told the emergency room triage nurse the baby had turned blue at home, had not had a bowel movement all day, appeared limp and that his eyes had rolled back in his head. The parents had been told to bring the child back to the hospital at once if the baby had even a slight fever, if there was a change in his eating habits or if there was a change in his color.

From the court record in the Court of Appeals of Georgia, it appeared that a struggle developed in the emergency room between the parents, who were highly agitated and insistent that their child be seen by a physician immediately, and the triage nurse on duty, who was intent on insisting that the parents fill out certain forms.

According to the court, the triage nurse made a cursory examination of the baby. She then repeatedly reassured the parents the baby
was fine, apparently to calm the parents and

stop their demanding behaviors. The nurse then classified the baby as semi-urgent under the hospitalís classification scheme, which meant the baby would require medical intervention within eight hours, but did not have an immediately life-threatening problem. The nurse told the parents to wait, and the physician would be with them shortly.

The parents, however, based on the nurseís reassurances concerning their childís condition, within a few minutes elected to get up and leave, without waiting for the child to be seen by the emergency room physician. The baby died several hours later.

The court faulted the triage nurse in several respects. She did not take a complete history and did not correctly assess the gravity and immediacy of the babyís condition. The nurse did not bring the baby to the physicianís immediate attention, as she should have.  Most importantly, the nurse, in an apparent effort to control and defuse the parentís demanding behaviors, had falsely reassured the parents the baby was all right and was not in need of immediate medical attention. The court blamed the parentsí leaving the hospital on the nurseís false reassurances and held the hospital liable for payment of substantial legal damages for the nurseís actions. The parents were not to blame for leaving against medical advice.
 South Fulton Medical Center, Inc. vs. Poe, 480 S.E. 2d 40 (Ga. App, 1996.)

About Legal Eagle Eye Newsletter for the Nursing Profession
Legal Eagle Eye Newsletter for the Nursing Profession was started in 1992 and has been published monthly ever since. Each month, the newsletter spotlights the latest U.S. court decisions and new Federal regulations affecting hospitals, skilled nursing facilities, extended care nursing centers and home health agencies.The goal of the Legal Eagle Eye Newsletter for the Nursing Profession is to reduce nursesí fear of the law and litigation.  By highlighting the law that pertains directly to nursing, it gives nurses confidence to act appropriately. The editor and publisher of Legal Eagle Eye Newsletter for the Nursing Profession is nurse/attorney Kenneth Snyder. He has a Bachelor of Science in Nursing from the University of Washington School of Nursing and a Juris Doctor from the University of Michigan School of Law. He is currently licensed as a Registered Nurse and as an Attorney at Law in Seattle, Washington.

Legal Eagle Eye Newsletter for the Nursing Profession
P.O. Box 4592, Seattle WA 98104-0592
Phone (206) 440-5860 Toll free fax 1-877-985-0977 e mail
Indexed in Cumulative Index to Nursing & Allied Health LiteratureTM

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