Legal, Ethical and Clinical Issues of Healthcare Practitioners - Case Study Example

Legal, Ethical and Clinical Issues in Relation to the Case Study Name Institution Date Legal, Ethical and Clinical Issues in Relation to the Case Study Introduction Some experienced nurses are presently assuming comprehensive roles and a couple of them are completing medical responsibilities, conventionally assigned to doctors. These healthcare providers ought to remember that extra responsibility invariably implies raised professional risk as well as accountability. Hence, it is imperative that those getting involved in advanced nursing practice completely comprehend the characteristic and reach of their trained duty of care together with the importance of statutory and regular law developments (Cowen & Moorhead, 2011). Transitioning from new graduate nurse to a professional nurse brings about new experiences and exposure that new graduate nurses need to be prepared to handle. This paper will discuss the legal, ethical and clinical practice issues relevant to the case study provided. Legal and Ethical Aspects The law inflicts a responsibility of care on healthcare practitioners, regardless of their status as students, doctors, registered nurses or others, when it is rationally foreseeable that they may bring harm to patients via their actions or failure to take action (Bjarnason & Carter, 2009). Students, graduate registered nurses and healthcare assistants have a responsibility of care and hence a legal liability in reference to the patient. In addition, they must inform their seniors when they are not able to carry out tasks competently. For an individual to be considered accountable they should: have the capacity to execute the task; accept the accountability for carrying out the task; and have the power to carry out the assignment within their job description, as well as the organization’s protocols and policies. Registered nurses (RNs) have a legal liability and a duty of care in reference to the patient (Cowen & Moorhead, 2011). Once they delegate a task they ought to make sure that the delegated task has been properly delegated. This implies that the task is crucial and delegation is in the best interest of the patient. With regards to the case study, the senior nurse delegated a task to John, but John thought that was not within his scope of practice because the medication did not have a written order. The senior nurse went ahead and administered the anti-emetic to the patient, which later caused unwanted effects and this would be considered as a breach of duty. This is also against the ethical principle of nonmaleficence, which means avoidance of hurt or harm and is the core of nursing ethics and medical oath (Sigma Theta Tau International, 2012). Negligence is another legal aspect in the healthcare setting and nursing practice in particular. Malpractice and negligence are applied synonymously in legal action. The difference is that ‘malpractice’ is considered more of a specialized or restricted type of negligence, described as a failure to fulfil a standard of care or an infringement of professional duty or failure to apply the knowledge and skills of other experts in similar situations (Bjarnason & Carter, 2009). Nursing negligence is defined as the non action or action that breeches the principles of care, bringing about damages as well as nursing malpractice acts (Cowen & Moorhead, 2011). Negligence should be determined before having a nursing malpractice situation. Nursing negligence, which is also the failure of nurses to perform as reasonably sensible individuals under similar or same circumstances that result in or cause harm to the patient. The aspects of negligence include duty; infringement of duty; causation; and damages and injury (Bjarnason & Carter, 2009). When all these four elements are not clearly determined there can be no case of claiming malpractice within a law court. Some of the types of negligence include and not limited to: failure to adhere to standards of care, failure to do assessment and monitor, failure to communicate, and failure to document. Standards like hospital policies have advanced to protect healthcare consumers from care that is substandard. In defining up to standard degrees of care, the reasonable and ordinary care needed to make sure that no preventable harm comes to a patient, principles of care offer criteria for establishing whether nurses have breached duty in the care obligated to the patient (Bjarnason & Carter, 2009). Principally, standards of care are originated from sources like professional nursing organization such as Australian Nursing and Midwifery Council; hospital procedures and policies; and nursing state boards. Linking this to the case study, the senior nurse could have breached the duty of care by not following the standards of care through not consulting with the physician to obtain a written order for medication administration (Bjarnason & Carter, 2009). Changes in a patient’s health status can be sudden or gradual and nurses are normally the first people to note the changes and act. The accuracy of a nurse in assessing and monitoring as well as her well-timed reporting of patient’s health status changes to a physician can frequently indicate the distinction between death and life (Stevens, 2013). Essential elements of communication in addition to correctness in reporting the patient’s health status change include diligence in informing the physician of the patient’s status, and accurateness in communicating the characteristic and level of the change (Ard & Valiga, 2009). In accordance with the case study, John reported the patient’s status change to the senior nurse but the senior nurse did not report the patient’s condition to the physician for review of medication. This indicates how failure of communication is an issue in healthcare setting and can result in negative outcome of the patient’s condition. Failure to document is another major issue in effective healthcare delivery. Documentation, the intention of which is basically to convey information of the patient among providers should precisely reveal the nursing process, indicating proof of nursing assessment and diagnosis, nursing intervention’s planning, execution and evaluation of intended interventions, and response of the patient (Stevens, 2013). According to the case study, the senior nurse did not document her interventions in reference to the patient. ANMAC Competencies and Standards The Australian Nursing and Midwifery Council (ANMC) states that the RN exhibits competence in nursing care delivery as specified by requirements of registration, National Board codes and standards, educational preparation, applicable legislation and background of care (Australian Nursing and Midwifery Council, 2006). The RN should practice according to the legislation that affects nursing practice and generally health care. This means that the RN abides by the common law and relevant legislation whereby she or he recognizes legislation that governs the nursing practice; illustrates nursing practice in the common law requirements; depicts and follows official requirements for medications. The RN should also recognize nursing interventions’ legal implications; and his or her actions illustrate awareness of nursing practice legal implications (Australian Nursing and Midwifery Council, 2006). With regards to the case study, the senior RN can be held accountable for her actions in reference to administration of a medication that brought about an allergic reaction to the patient. This is because she did not call the physician to review the medication prior to administration. Yet communication among health care providers is crucial for effective health care delivery (Arnold & Boggs, 2011). The ANMC 1.2 states that the RN should discharge the duty of care by performing nursing interventions according to established principles of practice; explains responsibility for features of care with other health team members (Australian Nursing and Midwifery Council, 2006). The RN should also identify the responsibility of preventing harm, and carries out nursing interventions adhering to comprehensive and correct assessments. The senior nurse did not discharge the duty of care effectively because her actions led to the patient’s unwanted reaction. The ANMC 2.5 contends that the RN should understand and practice within his or her own scope of practice. This can be achieved by seeking clarification when directions, questions and decisions are not understood or are not clear; undertaking decisions concerning care that are contained by scope of competence with no consultation of senior staff. It is also seen when the RN demonstrates responsibility and accountability for own acts within the nursing practice; assesses results of various decision making outcomes (Australian Nursing and Midwifery Council, 2006). It is also demonstrated when the RN consults significant health care team members when needed; and clarifies and questions interventions that seem inappropriate with pertinent health care team members. In accordance with the case study, John demonstrated his understanding of scope of practice by seeking clarification with the senior nurse when he declined to administer a medication that did not have a written order. The senior nurse delegated aspect of care without considering John’s scope of practice and did not consult with the physician. On the other hand, the senior nurse could have thought that his actions were in the patient’s best interest, which on the contrary turned out to be harmful. Transitioning from New Graduate Nurse to a Professional Nurse Transition into the professional nurse role is the basis for great apprehension and excitement for student nurses. Fresh graduate RNs need to understand the qualities they appreciate within their place of work to get a better fit (Chang & Daly, 2012). For instance, they value support, collaboration, and participation as opposed to rivalry. As a fresh graduate RN it is imperative to reflect on major elements of organization culture since it can foretell one’s commitment to the institution. Polifko, (2010) illustrated that the higher the fresh graduate RNs get social support as well as a friendly work atmosphere the less they give an account for psychological stress and experience a higher competency with their own skills. In reference to the case study, John may feel that the senior nurse was not supportive because after he reported the incidence, the senior nurse went ahead and administered the medication independently without considering the correct procedure or policies. From the scenario in the case study, John could consider journaling the experience. Polifko, (2010) describes the journaling process as an opportunity for fresh graduate RNs to learn from what they experience. It offers their clinical mentors and leaders a substantial topic to talk about how they dealt with particular circumstances and what they are able to learn from each other. Journaling has revealed to enhance skills of critical thinking and engage senior nurses with new graduate nurses and nurture professional growth for every fresh graduate RN (Polifko, 2010). The process of reflection can toughen decision-making as well as strategies of coping through practice. Considering that new graduate RNs have full responsibility of their actions, this could be the reason why John felt it was not appropriate for him to execute the task that the senior nurse ordered because it was not approved by the physician. Fresh graduate RNs ought to remember that they are now the future senior nurses for the health care. They carry vast quantity of knowledge together with new learnt experiences (Chang & Daly, 2012). They are certainly not perfect because no one is after all but as they continue their new career and path they will be taking up vast knowledge. Experience comes with time; therefore new graduate RNs should not feel discouraged, confused, and misled believing that they are not good nurses when an incidence happens (Kelly & Jubb, 2012). A good nurse is not only one who can flawlessly read off an electrocardiograph (ECG), easily insert a Foley catheter, insert an IV line following a first try, able to complete their tasks and get medications done promptly, predict a disease before the physician can, and get time to relax. Instead, a good nurse is also a nurse that can make patients smile, laugh and keeping them off any unwanted effect. Conclusion In conclusion, this paper has presented various legal, ethical and clinical issues related to the case study provided. New graduate RN get themselves in scenarios that leave them in dilemma because they believe that nursing practice is bound within a legal legislation that governs their practice. This is why John, the new graduate RN found it difficult to perform a task assigned to him by the senior nurse citing that it was not a written order. In case of a legal pursuit since the medication brought about unwanted effect, the new graduate RN will definitely be out of the hook. Additionally, the directive by the senior nurse was also not within the new graduate RN’s scope of practice because traditionally it is believed that physicians review patients’ medical need so as to order medications. Reference Australian Nursing and Midwifery Council. (2006). National Competency Standards for the Registered Nurse, Australian Nursing and Midwifery Council. Chang, E., & Daly, J. (Ed.) (2012). Transitions in nursing: Preparing for professional practice. (3rd ed.).  Chatswood, NSW: Elsevier, Churchill Livingstone. Cowen, P. S., & Moorhead, S. (2011). Current issues in nursing. St. Louis, Mo: Mosby Elsevier. Sigma Theta Tau International. (2012). Nursing ethics in everyday practice. Indianapolis, IN: Sigma Theta Tau International. Ard, N., & Valiga, T. M. (2009). Clinical nursing education: Current reflections. New York: National League for Nursing. Stevens, K. (2013). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas OJIN: The Online Journal of Issues in Nursing, 18(2), Manuscript 4. 25(32), 35-37. Polifko, K. A. (2010). The practice environment of nursing: Issues & trends. Clifton Park, NY: Delmar Cengage Learning. Bjarnason, D., & Carter, M. A. (2009). Legal and ethical issues: To know, to reason, to act. Philadelphia, Pa: Saunders. Kelly, L., & Jubb, B. (2012). Nurses professional development register. Salisbury, Qld: Boolarang Press. Arnold, E. & Boggs, K. U. (2011). Interpersonal relationships: Professional communication skills for nurses. St. Louis, Mo: Elsevier/Saunders. Read More