Negligence in Nursing, Legal Standards of Negligence against Coral Reef Nursing Facility - Case Study Example

Legal Dilemma Institution Name Introduction Registered nurses are professionally obligated to provide patients with ethical, safe and competent care. In medical care, negligence refers to violation of duty or failure of a medical practitioner to meet standards of care. Failure to apply professional knowledge and skills in practice also amounts to negligent behaviour (Bryden, 2011). In this case, nursing negligence describes the combined actions or non-actions that breach the standards of care leading to damages and nursing malpractice actions. Simply put, it is the failure of a nurse to act in a manner that can be considered to be reasonably prudent, or what a reasonable person holding the same position would act (Pandit & Pandit, 2009). This paper analyses a case study involving improper administration of drugs due to nurses’ negligence and the nursing facilities poor patient safety policies, as a result causing injuries to three patients. The key issue in the case is who should be held liable for the misdeeds. Negligence in Nursing As presented by the facts from the present care study, the central issue of concern is determining whether RN Shark committed malpractice by allowing Mr. Mackerel to assist in medical rounds, and whether RN Swordfish also committed an offence by failing to notify RN Shark that Mrs Ray’s Oxycontin had been delivered. It is also determines whether Coral Reef Nursing Facility engaged in malpractice by allowing the nurses to provide sub-standard care (CRNN, 2007). Overall, negligence has to be established in order to determine existence of nursing malpractice (Croke, 2013). For this to happen, all three elements of negligence – namely duty of care, breach of duty, injury, and causation -- have to exist. The four-test establishes whether the nurses and the nursing facility owed a duty of care to the patient, whether a duty of care was breached and whether the breach caused the patients to suffer harm. All parts of the test have to be satisfied (Pandit and Pandit, 2009). Duty of care The acceptable levels of care consist of reasonable and ordinary care needed to ensure that patients are protected from unnecessary harm. The standards of care also offer criteria needed for determining whether duty owed to the patient has been breached by the nurse (Nursing Law Manual, 2008). Duty of care describes the obligation imposed on the nurse and which requires that they apply reasonable standard of care while providing nursing care. For the duty of care to arise, there has to be a satisfactory relationship between the nurse and the client (Alllaw.com, 2014). According to Bryden (2011), nurse-client relationship occurs when the nurse engage in providing care to the client. When the relationship can be established, then the nurse can be held to a standard of care of a prudent and reasonable nurse with the same experience, qualification and education. In the case, the hospital could be held liable due to the nurse’s breach of standards of care. Duty of care is an important prerequisite in determining whether RN Swordfish and RN Shark were negligent, as it has to exist and must have been breached for negligence to exist (Pandi & Pandit, 2009). Similarly, in the case study, a nurse-client relationship existed between RN Shark and two of the clients who had collapsed on the floor of the Tranquil Seas TV room. He knew two of the clients as he had administered medication to them, earlier that day. However, it cannot be established whether a nurse-client relationship existed between RN Swordfish and the three clients who had collapsed. Indeed, there is no evidence that they had any form of contact. ‘Duty to provide care’ may, however, still exist in RN Swordfish’s situation. CRNN (2007) describes ‘duty to provide care’ as the requirement for a nurse to provide care to clients whom she had been assigned to or agreed to do so. It begins once the nurse has accepted the assignment, and can therefore arise before the nurse interacts with the patient. Once the nurse agrees to provide care, she has the duty to start care, continue, as well as be available for care until another nurse takes charge (CRNN, 2007). Since the nurse-client relationship exists, RN Swordfish and RN Shark owe duty of care to the two patients, RN Shark had treated earlier in the day. The element of duty is easy to prove under such circumstances since once the nurses undertake care of their clients, they have a duty to provide competent and reasonable care to the patients (Alllaw.com, 2014). Failure to communicate or notify RN Shark of the delivery of the drugs falls below the standards of care. On the hand, allowing unqualified person to run the nursing rounds also amounts to negligent behaviour (Nursing Law Manual, 2008). In doing this, RN Shark failed to provide and maintain safe environment for the patients. Coral Reef Nursing Facility also owed the three patients a duty of care. In order for the nurses to provide a duty of care, they have a right to receive accurate and complete information (Cherry & Jacob 2013). In the case, after RN Shark placed an order for Mrs Ray’s Oxycontin at 0800 hours, she was not informed that the medications had been delivered at 1200hrs. These shows poor communication policies were in place at the Coral Reef Nursing Facility. Bryden (2011) also observes that the employers have the ultimate duty to provide adequate staffing and to ensure that the resources and personnel competencies are efficiently used. In the case, allowing Mr Mackerel to have free access to locked rooms and to assist RN Shark implies that Coral Reef Nursing Facility had failed in its duty. Murthy (2007) states that hospitals must provide procedures, policies and guidelines in order to ensure that the nurses make decision that ensure duty to provide care. They also need to provide sufficient staffing for competent, ethical and safe care (Cherry & Jacob 2013). As a result, RN Shark may be subjected to legal liability for breaching duty or care. Similarly, Coral Reef Nursing Facility and RN Swordfish may be subjected to legal liability. Breach of Duty In nursing, a breach of duty occurs when a nurse does what a reasonable nurse should have done under the same circumstance. This would imply that the nursing care has fallen below acceptable standards of care, since the nurses were expected to behave professionally. Nursing malpractices happen when a nurse fails to perform his medical duties competently and the failure causes harm to the patient (Croke, 2013). This implies that since RN Shark and RN Swordfish have been proven to owe duty of care to the two clients, they were expected to conduct themselves with a degree of care, knowledge and competence that reasonable competent nurses would show in a similar situation (Cherry & Jacob 2013). At this stage, it is significant to remember that the standards of care signify minimum level of practice that nurses have to comply with to avoid being negligent. Put differently, rather than use heroic efforts in performing their jobs satisfactorily, RN Nurse and RN Swordfish were expected to exercise their training, education and good judgement to the best of their capability under such circumstance. In the case, RN Shark had ordered more stock of Mrs Ray’s Oxycontin after noticing that it was running low. The order arrived later in the day and RN Swordfish took the medication to RN Shark at Tranquil Seas ward. However, RN Swordfish acted negligently by failing to place the medication in a locked drawer of the medication trolley. RN Swordfish also acted negligently by failing to notify RN Shark of the delivery of the medications (Croke, 2013). RN Shark also acted negligently by allowing Mr Mackerel, who was a retired medical assistant, to help him with the medication round. Under such circumstance, since Mr. Mackerel could be viewed as working under RN Shark’s orders based on his lack of qualifications to administer medication, RN Shark would be held liable for Mr Mackerel’s misdeeds (Cherry & Jacob 2013). Therefore, RN Shark and RN Swordfish are in breach of their duty of care since the nursing care falls below the acceptable standards of care. In both cases, it is perceivable that both nurses were aware of the detriments that could be caused by their actions and failed to deal with the issues reasonably. Hence, their actions fell below the required standards of reasonableness and resulted in foreseeable harm to the clients. These may lead to medical malpractice lawsuit (CRNN, 2007). Harm In the case, it is clear that foreseeable harm was caused by a breach in the standards of care due to actions and omissions by RN Shark, RN Swordfish and Coral Reef Nursing Facility. The three residents at the nursing facility suffered actual harm due to negligence in standards of care. However, they would not be held liable if the harm could not have been reasonably anticipated as capable of happening. According to Nolo (2014), a court may not find negligence if there was no harm, despite the nurse’s omissions or actions breaching the standard of care, or if the harm could still have happened. Therefore, in proving the element of injury, it must be established that the patients experience pain and suffering, actual reduction in quality of life and loss of money. Without injury, there would be no established negligence (Croke, 2013). RN Shark found the three people collapsed on the floor of the Tranquil Seas TV room. The three people were later taken to the local hospital in an unconscious state. They were returned three days later in Coral Reef Nursing Home. Causation Causation or proximate cause covers the scope of the nurses’ responsibility in causing harm or injury to the patient. The nurses and the nursing facility would only be held liable for the injuries that they could have foreseen through their actions (Shives, 2008). In this case, if RN Shark and RN Swordfish caused injuries that are not part of the scope of risks they could have foreseen, then they would not be held liable under the proximate cause. To prove that RN Shark, RN Swordfish and Coral Reef Nursing Facility caused the harm or injury, there has to be proof that the defendant’s omission or act caused the harm (Bryden, 2011). Their actions or omissions must also be substantial factor in causing the harm to the clients. In the present case scenario, RN Shark, RN Swordfish and Coral Reef Nursing Facility by acts of omission and actions caused the harms to the patients. Their breaches of duty materially contributed to the harms and injuries and that the damage was due to their negligent actions (Cherry & Jacob, 2013). In regards to causation, RN Swordfish is negligent by act of omission. RN Swordfish had failed to notify RN Shark that she had delivered Mrs Ray’s Oxycontin at Tranquil Seas Ward. Consequently, RN Shark remained unaware of the delivery and subsequent events. Additionally, she had left them exposed, leading Mr Mackerel to believe they were safe. He then swallowed one tablet himself and gave each of the four residents in the TV room one of the tablets from the box that he found on the medication trolley. These directly exposed the clients to harm (Bryden, 2011). RN Shark also allowed Mr Mackerel to help him with the medication round. Coral Reef Nursing Facility also caused the harms through negligent hiring, negligent supervision, failure to provide satisfactory medical treatment and failure to maintain health and safety policies (CRNN, 2007). Legal standards of negligence against Coral Reef Nursing Facility Overall, since the four elements of negligence have been proved to exist, RN Shark and RN Swordfish could be held liable for negligence. Since both are employees at the Coral Reef Nursing Facility, their employer is likely to be held liable for negligence for four reasons. These include negligent hiring, negligent supervision, failure to provide satisfactory medical treatment, and failure to maintain health and safety policies (Cherry & Jacob, 2013). In terms of negligent hiring, Coral Reef Nursing Facility allowed retired medical assistant Mr Mackerel to work as a resident staff at the nursing home. Murthy (2007) opined that health care provider can be sued for negligent hiring of employees when it hires employees or allows individuals to work within the facility, in which they may end up negligently or intentionally causing harm to the patients. When it comes to negligent supervision, Coral Reef Nursing Facility failed to satisfactorily supervise residents, who end up causing harm to the clients. In the case scenario, Mr. Mackerel, who is a retired medical assistant and a resident at the facility, was allowed to assist in nursing rounds unsupervised. He later administered medication to patients unsupervised, hence causing harm to the patients (Bryden, 2011). Coral Reef Nursing Facility also failed to maintain satisfactory health and safety policies, such as locking non-prescribed medications away from patients, or keeping them away from the common areas (Bryden, 2011). For instance, it could be argued that when RN Swordfish found RN Shark busy with a client and left the medication on the top of the trolley, it was a clear indication that the Coral Reef Nursing Facility had no policies in place to prevent such acts (CRNN, 2007). Additionally, there appears to be a lack of policies that restrict movement of non-medical staff. For instance, Mr Mackerel had free access to locked rooms. In the case, RN Swordfish was unaware that Mr Mackerel, a resident of the facility, had followed her into the locked ward. Coral Reef Nursing Facility also failed to provide professional medical treatment in compliance with the standards of care. Allowing Mr Mackerel to work in the hospital unsupervised implies provision of sub-standard health care on the part of Coral Reef Nursing Facility. According to Murthy (2007), when the provision of sub-standard care results to harm to the clients, a case for medical malpractice against the nursing facility may exist. Coral Reef Nursing Facility should have ensured a safe environment by making sure that residents receive maximal supervision and assistance to prevent accidents, qualified staff are hired to work in the facility, and that adequate patient safety policies are in place (CRNN, 2007). Conclusion The four-part test establishes that RN Shark, RN Swordfish and the nursing facility owed a duty of care to the patient, whether a duty of care was breached, and whether the breach caused the patients to suffer harm. Based on the present case scenario, all parts of the test have been satisfied. Since it can be established that a nurse-client relationship exists between RN Shark, RN Swordfish and the three clients who had collapsed, it is clear that duty of care exists. Therefore, Coral Reef Nursing Facility, RN Swordfish and RN Shark owe duty of care to the two patients, RN Shark had treated earlier in the day. RN Shark and RN Swordfish have been proven to owe duty of care to the two clients, they were expected to conduct themselves with a degree of care, knowledge and competence that reasonable competent nurses would show in a similar situation. It is also evident that foreseeable harm was caused by a breach in the standards of care due to actions and omissions by RN Shark, RN Swordfish and Coral Reef Nursing Facility. Causation also exists, the breaches of duty by RN Shark, RN Swordfish and Coral Reef Nursing Facility materially contributed to the harms and injuries and that the damage was due to their negligent actions Hence, RN Shark and RN Swordfish could be held liable for negligence. However, since both are employees at the Coral Reef Nursing Facility, their employer is likely to be held liable for negligence for four reasons. References Alllaw.com (2014). When Can You Sue a Nursing Home for Negligence? Retrieved: Bryden, D. (2011). Duty of care and medical negligence. Contin Educ Anaesth Crit Care Pain, 11 (4), 124-127 Cherry, B. & Jacob, S. (2013). Contemporary Nursing, Issues, Trends, & Management,6: Contemporary Nursing. New York: Elsevier Health Sciences, CRNN. (2007). Professional Practice Guidelines: Duty to Provide Care. College of Registered Nurses of Nova Scotia. Retrieved: Croke, E. (2013). Nurses, Negligence, and Malpractice. 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