This article covers a sample Case Study on Legal Issues Facing Nursing as part of a solution to a nursing class assignment.
Instruction
Research common legal issues in health care in one of the legal case studies from the Nurses Service Organization.
Select a legal case study of interest or area in which you have experience from the website Nurses Service Organization.
Analyze the legal case study. Ensure you include the following:
- Summarize the legal issues present in the case.
- Brainstorm risk-mitigation techniques that the hospital could have employed to prevent the situation.
- Determine actions the nurse could have taken to improve the outcome.
Cite at least 3 evidence-based, peer-reviewed sources published within the last 5 years to support your positions.
Format your assignment as one of the following:
875-word paper using Level 1 headings for key points
The legal issues are in the report mentioned in the assignment. This is the link Nurses Service Organization. The examples of legal issues are easy to find and read with this link.
https://www.nso.com/risk-management/individuals?SelectedTabID=3722%20
You\’ll find a lot of legal claims and some scenarios there. Find one that\’s interesting to you and follow the instructions for the assignment and the grading rubric.
On the grading rubric, please note that a summary/explanation of the case is not the same as “summarizing the legal issues.\”
Solution
Case Study on Legal Issues Facing Nursing
Introduction
Healthcare has become a complex entity resulting from phenomenal changes over the years. The transformations have brought significant challenges as healthcare professionals of all cadres face complex situations because of their patients. To address the resulting challenges, health professionals have to make legal and ethical decisions concerning their patients, questioning their expertise and morals sometimes. The pertinent practice question that emerges is whether the practitioners have the mental and professional capacity to handle these matters as some unscrupulous medical and healthcare experts endeavor to get quick riches by setting illegal healthcare facilities.
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The illegal facilities lead to a decline in treatment quality as the professionals substitute money with patient’s health due to greed. Some are known to demand payment before attending to the patient, regardless of the medical urgency leading to the patient’s death in context. Therefore, there is a cognizant need to identify the legal issues and educate both the healthcare professionals and the public on their legal-ethical duties to improve the health care industry. It is imperative to explore some common legal issues in health care using a case study approach. To achieve this goal, the author explores the legal issues arising from a typical nurse case study on wrongful delegation of patient care to unlicensed assistive personnel.
Case Background
The facility’s insured was a registered nurse (RN) employed under a home healthcare agency attending a patient when she received a telephone call from a certified nursing assistant (CNA) employed at the same agency. The CNA was at the home of a mutual patient and reported that the patient’s gastrointestinal (GI) tube had come out sometime during the night. The RNA informed the CNA that the patient would need to go to the emergency department to have the tube reinserted, as it would be several hours before she could see the patient. The patient’s family did not want to take the patient to the ED but would instead wait for the RN to see the patient.
The CNA informed the RN that she had reinserted several GI tubes when employed at a nursing home, so she felt comfortable reinserting this patient’s tube. The RN agreed to let the CNA insert the tube but advised her not to restart the feedings. Approximately 45 minutes later, the CNA contacted the RN and affirmed that the tube was reinserted without difficulty, and proper placement was confirmed. When the nurse arrived at the patient’s home several hours later, she noticed that the patient was receiving tube feeding. When questioned, the daughter confirmed that she resumed the tube feedings shortly after the CNA left and denied being told to wait. The RN noted that the patient complained of abdominal pain and reported feeling nauseous.
On physical assessment, the patient’s abdomen was distended and positive for abdominal palpation pain. After stopping the feeding, the nurse called 911. The patient was transferred to the nearest hospital, where she was diagnosed with peritonitis due to the GI tube being accidentally placed in the peritoneal space. The family filed a lawsuit against the RN and the home healthcare agency.
Summary of the Legal Issues Present In the Case
The Kentucky Nursing laws KRS Chapter 314.011(2) defines delegation as the act of directing a competent person to perform a selected nursing activity or task in a selected situation under the nurse’s supervision and according to administrative regulations promulgated by the board. (KBN, 2019). The legal issues arising in this scenario were the patient’s wrongful delegation to unlicensed and assistive personnel like the CNA. Failure to follow the agency’s policies and procedures on proper delegation, GI tube insertion, and supervision of UAPs, failure to contact the referring provider and obtain an order to reinsert the GI tube, and failure to assure that the patient and family had received appropriate communication related to reinserting the GI tube and holding the GI feedings. Following KRS 314.021(2), nurses bear responsibility and accountability for making decisions based upon their educational preparation and current clinical competence in nursing and require licensees to practice with reasonable skill and safety.
Risk-Mitigation Techniques That the Hospital Could Have Employed To Prevent the Situation
Wagner (2018) notes that over the last 20 years, healthcare organizations have initiated processes that improve communication and team effectiveness. Suffice it to say that the hospital in this context should have focused on nurse-physician and nurse-patient communication strategies. The use of evidence-based products like the situation, background, assessment, and recommendation (SBAR) guidelines could have significantly improved communication. The hospital management should also have to it that nurses are sufficiently trained on the delegation aspects and role responsibilities of UAPs. Doing so would ensure that nurses do not struggle with which tasks to delegate to the many different levels of UAPs that include patient care assistants, nursing assistants, technicians, and aides. Some of the commonly delegated tasks to UAPs that significantly impact patient outcomes include turning, bathing, feeding, ambulating, and personal care.
Actions the Nurse Could Have Taken To Improve the Outcome
Barrow & Sharma(2020) opine that the delegation’s five rights are the right task under the right circumstance delegated to the right person under the right supervision and the right direction and communication. In making the delegation decisions, the RN should have asked him/herself which tasks are legally appropriate to delegate and whether the RN could delegate the task based on the hospital’s policies and procedures. This in and of itself would have ensured that the right task is delegated to the CNA.
To determine the right circumstances, the RN should have established if there were appropriate equipment and resources for the CNA to perform the task, if the delegate had the right supervision to accomplish the task and whether the environment was favorable for delegation in this situation. To ascertain the right person for delegation, the RN should have asked the CNA whether they had received training to perform the GI re-insertion, whether they had ever performed the task with a patient, whether they had completed a similar task without supervision.
The RN could have enquired what problems the CNA had encountered in performing this task in the past. The same line of appropriate context questioning would have let the RN ensure the proper supervision and right direction and communication if the nurse had utilized the KBN decision tree for delegation to UAPs. Step 2 of communication is a two-way process, then step three on surveillance and supervision, and lastly, step four on evaluation and feedback (KBN, n.d).
Additionally, the nurse could have taken other risk control measures to know the employer’s policies and procedures connected to the delegation and clinical practices. Next, before delegating the task, the RN should know the delegatee’s knowledge and skills, training, experience, and diversity awareness besides monitoring how the CNA implemented the delegated task. Furthermore, the RN could have evaluated the healthcare consumer’s overall condition and the CNA’s skills and performance of the task. Despite the lawsuit, a settlement was reached before it could go to trial since the nurse was reported to the National Practitioner Data Bank (NPDB) as mandated by the respective state law. The total cost incurred to defend and settle the case on behalf of the insured nurse was more than $ 255 000.
Conclusion
The case study has established that using the American Nurses Association and the National Council of State Boards of Nursing would have helped avoid the family lawsuit filed against the RN and the home healthcare agency. Adhering to the five rights of nurse delegation and effective utilization of the KBN decision tree for delegation to UAPs can help healthcare organizations to avoid such legal issues and eventual costs while improving patient outcomes.
References
Barrow, J. M., & Sharma, S. (2020). Five Rights of Nursing Delegation. In StatPearls [Internet]. StatPearls Publishing.
KBN (n.d) KBN Decision Tree for Delegation to Unlicensed Assistive Personnel (UAP) URL: https://kbn.ky.gov/practice/Documents/DecisionTreeforDelegationtoUAP.pdf
Kentucky Board of Nursing(2019) Advisory Opinion Statement#15 Supervision and Delegation URL: https://kbn.ky.gov/practice/Documents/aos15.pdf
Wagner, E. A. (2018). Improving patient care outcomes through better delegation-communication between nurses and assistive personnel. Journal of nursing care quality, 33(2), 187-193.
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