In most states a nurse may enter a non-disciplinary alternative to discipline program (National Council of State Boards of Nursing, 2018b). The sooner the substance abuse is identified and treated, the better the chance the nurse will return to work and patients will be protected (National Council of State Boards of Nursing, 2018b). Nursing consideration: Recreational marijuana: As more states legalize recreational use of marijuana, nurses may wonder if there are implications for their practice. The answer is in a grey area but can be yes. A nurse can be subjected to random drug testing at work or before obtaining employment. Marijuana can stay in the blood stream for up to 30 days, thus with recreational use, even if it has been a few days, drug screens can be positive. Current recommendation is not to use any products for recreational use that contain marijuana (Brown, 2018).
nurses show signs of substance abuse at work and many nurses report using substances to cope with stressors (Webster, 2022). Risk factors include family history of substance abuse or past emotional or physical trauma. The vast number of nurses report work stress as the reason for choosing to use drugs or alcohol. The workplace stress includes chronic staff shortages with extra shifts, and excessive workload during shifts (Webster, 2022). Nursing consideration: Signs of unhealthy substance use in nurses: Changes in work habits, conflicts with patients or patients’ families, charting errors or omission, dramatic mood swings, and social/professional isolation. Impaired performance is a clear warning sign; however, symptoms of impairment might be subtle such as being dazed or sleepy (Webster, 2022). Categories of negligence that often lead to malpractice lawsuits Nurses can be sued for some of the following reasons (O’Neil, 2022): 1. Medication errors. 2. Failure to follow orders. 3. Practicing outside of one’s scope of practice. 4. Failure to recognize an order error. 5. Failure to communicate, report, or notify and provide pertinent information about a patient in a timely and proper manner. 6. Wrongful delegation of a nursing function. 7. Lack of, or poor documentation. Nursing consideration: In a court of law, the patient is referred to as the plaintiff. The nurse named in the malpractice lawsuit is referred to as the defendant (Wacko Guido, 2020). Standards of care Failure to follow established standards of care can change as new treatment interventions are discovered and nursing roles and responsibilities evolve. Policies and procedures often change based on advances in treatment and the need to use new or unfamiliar equipment. Examples of failure to follow standards of care can be as simple as failure to adhere to medication administration procedures; failure to institute necessary protocols such as a fall protocol; or failure to use equipment in a responsible manner. In fact, failure to use equipment safely and accurately is identified as a separate category among the six major categories of negligence that can lead to malpractice lawsuits (Wacko Guido, 2020). Communication Failure to communicate is a consideration in most malpractice lawsuits (Wacko Guido, 2020). Because many conversations are not documented, it can be difficult to prove the adequacy of communication between nurses and other healthcare professionals. Here are some suggestions for ensuring adequate communication (Wacko Guido, 2020): ● Clearly communicate all pertinent patient information to the physician and other healthcare professionals as appropriate. ● Provide all relevant discharge information to the patient. ● Document thoroughly. ● Clearly communicate all assessment findings to the nurse from the oncoming shift. ● Participate in continuing education activities that focus on communication. Documentation Failure to document can be summed up in the familiar sentence, “If it isn’t documented, it wasn’t done.” Failure to document can also lead to a specific treatment intervention (e.g., medication
LAWSUITS
administration, dressing change) done more than once. Failure to document can lead to an inadequate plan of care if, for example, new assessment findings are not documented and shared with the appropriate colleagues (Wacko Guido, 2020). A well-documented medical record can provide an accurate reflection of nursing care, improve communication among the interdisciplinary team, demonstrate competency, and may help guard against a lengthy litigation process (NSO, 2020). Assessments and monitoring Failure to assess and monitor indicates that the nurse did not assess and monitor the patient appropriately based on the patient’s clinical presentation or the facility policy. When evaluating, monitoring, and assessing are reviewed in a court of law, nursing expert opinions are crucial. The nurse expert for the plaintiff would describe what a reasonably careful and prudent nurse would do under the same or similar circumstances (Wacko Guido, 2020). Elements of malpractice What evidence must be obtained to prove malpractice? Four elements must be shown before a nurse is said to be liable for malpractice (Wacko Guido, 2020): 1. Duty. 2. Breach of duty. 3. Harm or damages. 4. Causation. Nursing consideration: Remember that once duty is established, the nurse cannot abandon the patient. For example, when a nurse accepts an assignment, the nurse cannot stop caring for the patient without insuring there is another nurse to care for the patient (Wacko, Guido, 2020) In a malpractice action, the plaintiff (the patient) must prove that the nurse’s actions, or failure to act, violated a standard of care, thereby breaching the duty to the patient. Attorneys for the plaintiff will present testimony concerning the nurse’s failure to competently provide safe and appropriate nursing care (Wacko Guido, 2020). What types of evidence will the plaintiff’s attorneys use to show breach of duty? Evidence is gathered to show that there was a violation of the standard of care. Sources of such evidence include the following (Wacko Guido, 2020): ● The patient’s medical record. ● Photographs. ● X-rays. ● Results of diagnostic (including imaging) studies. ● Testimony from witnesses such as other nurses, nurse managers, the patient, the patient’s family members, and other visitors.
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