The Nurse Professional Liability Exposures: 2015 Claim Report Update reveals that malpractice claims against nurses are on the rise. According to the report, more than $90 million was paid in nurses’ malpractice claims over a five-year period.
Nursing malpractice occurs when a nurse fails to perform his or her medical duties competently and that failure harms the patient. It is true that negligence on part of a nurse can cause serious harm to a patient, but the nurse may not always be at fault.
A number of factors contribute to the quality of care that is provided to patients. For instance, the type of facilities available at the hospital or nursing home, the diagnosis made by the treating doctor, the medical information provided by patients or their families, and so on determine the kind of care to be provided to patients.
However, there may be instances when the nurse might be blamed for someone else’s error. If you’re a nurse and something similar has happened to you, you must proactively try to defend yourself with the help of an experienced attorney.
How Negligence and Malpractice Claims Affect a Nurse’s Career
A nurse is required to adhere to the ‘standards of care’ in nursing. By adhering to the standards of care, the nurse ensures best-quality care for patients and stays away from facing the legal hassles of negligence and malpractice. However, a nurse can be sued even if he/she has complied with the standards of care. If this happens, then the nurse’s career will be in jeopardy. The nurse’s license can also be revoked. A lawsuit brought against a nurse can also wreak emotional havoc and strike a fatal blow to his/her self-confidence and self-esteem.
Moreover, other patients under the care of the same nurse may also be affected severely. Therefore, if you believe that you are wrongfully sued or you were only partly responsible for the harm, then you must work with an experienced lawyer and defend yourself.
Remember, medical malpractice laws are enacted and regulated by individual states, so you must appoint an attorney who is well-versed with the laws in your state. For instance, if you are a nurse in Savannah, then you must work with a Savannah personal injury attorney, who can defend you in court.
Defending Nursing Malpractice Claims
After a lawsuit has been filed against a nurse, various defenses can be raised that can absolve the defendant completely or limit the plaintiff’s claims. Some of the most common defenses used to protect nurses in nursing malpractice cases are:
1. Failure to Prove the Elements of Negligence
Just as in any personal injury case, the plaintiff in a nursing malpractice case is required to prove the four elements of a successful claim. These include:
- Duty to the plaintiff
- Breach of duty
- Damage or injury caused due to the breach of duty and
- Proximate causation
If the defendant is able to prove that any one or more of the above elements is not established by the plaintiff, the case may be absolved.
2. Contributory Negligence
If you can prove that the patient was also partly or fully responsible for his injuries/harm, then you can get the case absolved or at least lower your penalty. Contributory negligence involves not communicating the medical history adequately, not following instructions, and not following up. The attorney will study the case and analyze the various factors involved to determine the factor that led to the injury/harm. It is for this reason that you are required to provide in-depth information about whatever happened. However, some states have adopted the comparative negligence approach. So, it is important that you work with an experienced attorney, who can help you understand the laws in your state.
3. Violation of Statute of Limitations
Most states have enacted statutes of limitations, which determine the time frame within which a plaintiff is required to file a personal injury case. If the plaintiff fails to file the case within this predetermined time limit, then it can be used as a defense by the defending party. However, several exceptions have been made to the statute of limitations and these vary from state to state. Therefore, only a seasoned attorney can help you understand whether or not you can use this defense.
There can be several other defenses depending upon your specific case. A skilled attorney will look into the case and decide which recourse will be most suitable for you. Remember, you need to provide enough evidence to prove your innocence. Thus, professional assistance is important.
With nursing malpractice claims rising each year, nurses need to become more cautious about their work and the quality of care they provide to the patient. However, in case you are sued by a patient, you have the choice to get legal help and prove your innocence. If you believe you aren’t at fault, then work with an experienced lawyer and get your name cleared.
Despite a nurse’s best efforts, some patients aren’t willing to follow instructions, but the impacts of patient noncompliance are too serious to ignore.
Prescription drugs provide an excellent example of the importance of adherence. It’s estimated that up to 30% of prescriptions go unfilled and as much as 50% of medications for chronic disease are not taken as directed according to a study published in Annals of Internal Medicine. The study’s authors go on to say that failure to follow prescriptions causes about 125,000 deaths per year and up to 10% of hospitalizations.
Nurses can enhance patient understanding of and adherence to their overall treatment plans by strengthening communication, rapport, and education.
It Starts with Communication
Asking the right questions and opening the lines of communication between patient and nurse can uncover critical barriers to treatment compliance.
- Pose questions in a constructive, problem-solving manner. For example, “I see that you have not been completing your daily exercises. I wonder if they are causing you too much pain, or if there is some other reason?”
- Try to relate personally to the patient to build a stronger therapeutic partnership. Get the patient to express what the nurse and care team can be doing to help them better meet their personal health goals.
- Set and adhere to a discussion agenda for every encounter. Begin with a discussion of the patient’s personal goals and issues before moving on, such as “First, tell me what concerns you most, and then we’ll discuss test results.”
Encouraging Cooperation and Participation
Explain to patients that they must take some responsibility for the outcome of their care and treatment. Let them know that everyone caring for them wants them to be successful in regaining their health. If barriers to compliance persist, try asking the patient what he or she believes would be more effective. The goal should be to achieve a mutually acceptable care plan.
- Clearly and explicitly convey the severity of the problem and the risks of not properly carrying out instructions. Give the patient an opportunity to ask questions and clarify the instructions.
- Find out if there are any underlying factors affecting compliance. For example, “It sounds as though you may be concerned about the medication’s possible side effects. Is that why you have not taken it as prescribed?”
- Identify any practical or logistical difficulties that may hinder compliance.
- End each encounter by having the patient verbalize at least one self-management goal.
Enhancing Patient Education and Understanding
Key barriers to communication – such as low health literacy, cognitive impairment, or limited English – need to be assessed early on to help uncover the best solution for successful communication.
- Have access to qualified and credentialed interpreters for use when necessary.
- Ask patients if they have any questions about their medications and ask that they describe in their own words how to take them.
- Consider involving a health coach, health navigator, and/or case manager for the patient.
- Ask patients to repeat critical instructions and paraphrase in everyday words the medical information they have been given.
Helping Patients Manage Logistics
Sometimes a patient’s noncompliance issue is out of their hands due to a lack of personal support at home or financial restraints. Uncover where those patients are struggling:
- Do health care information records note who can help your patient when they’re outside of the health care setting? Do they have the consistent help of a spouse, relative, friend, or paid caregiver to aid with their care?
- Are patients asked whether they can get to appointments via car or public transportation, and are responses documented in the patient care record?
- If a patient lacks the physical or mental capacity to perform such essential tasks as changing dressings or picking up prescriptions, has a relative or friend been asked to assist, with the permission of the patient or legal guardian?
- Does the patient lack the financial resources to comply with their current care plan? Are they concerned about the out of pocket costs for treatment, or having to take time off of work?
- Document these concerns in the patient care record, and work with the patient and their primary care provider (with the patient’s permission) to find solutions.
Supporting the Effort with Documentation
To help staff deal with hostile, manipulative, or uncooperative patients, written protocols should be in place to help all staff respond to and deal with difficult patients. This should include ways to document and procedures for such common concerns as:
- Repeated prescription refill requests of questionable nature
- Narcotic use and general pain management in drug-seeking patients
- Appointment or procedure cancellations
- Unacceptable behavior, such as belligerent voicemail messages or yelling or cursing at staff
- After-hours patient calls
- Refusal to consent to recommended treatment
- Neglecting to take medications, do exercises, or make necessary lifestyle changes
- Terminating the patient-provider relationship
Driving patient compliance often means health care teams need to repeat themselves again, and again, and again. Different tools and strategies can help nurses drive compliance.
- Remind patients of upcoming appointments, including referrals and laboratory visits, via telephone and/or email.
- Try electronic alerts to remind patients with a history of noncompliance about screening and monitoring requirements.
- Inform blind or visually impaired patients of subscription services that use wireless devices to deliver reminders to take medications or perform vital self-care activities.
- Schedule follow up and referral appointments before patients leave the facility.
- Document no-shows and conduct telephone follow-up within 24 hours.
Know if there is a written policy for terminating the patient-provider relationship if the patient is chronically noncompliant and fails to respond to reminders and other messages.
Keep at It
Patient noncompliance is a deep issue with no easy answers or simple solutions. Nurses in almost any setting will encounter noncompliant patients, but with consistent communication and a persistent, but cooperative, spirit nurses can work to overcome the risk of noncompliance one patient at a time. Nurses also can explore Nurses Service Organization’s patient self-assessment checklist to help facilitate open communications.
Disclaimer: This article is provided for general informational purposes only and is not intended to provide individualized business, risk management or legal advice. It is not intended to be a substitute for any professional standards, guidelines or workplace policies related to the subject matter.
Prostate cancer is the second most common form of cancer in men (skin cancer is first), with the American Cancer Society estimating 161,360 new cases in 2017. A nurse’s role in prostate cancer awareness, prevention, diagnosis, and treatment is essential. As a professional nurse, a loved one, friend, or peer, nurses are on the front lines. They have the knowledge to help people identify what’s going on and have the resources and expertise to help them with treatment options and cutting-edge developments.
Leanne Schimke, MSN, FNP-C, CRNP, CUNP, works with urology patients in private practice and also with the Lancaster Rehab Hospital, and uses Prostate Cancer Awareness Month as a great opportunity to inform people about the disease. Of all things a patient might hear, getting any kind of life changing diagnosis like a cancer diagnosis is overwhelming. A nurse can help educate patients and also offer support. “Nurses need to understand it will take multiple discussions for the patient to retain the information,” says Schimke. “It is helpful to include family members and correct any misconceptions.”
Involving the patient and their loved ones in discussions helps ensure that the information will be understood and retained. Nurses can help patients by answering their questions, of which they probably have many, and making sure they know where to find additional reliable and accurate information. Surfing the internet for information about prostate cancer treatment and prognosis isn’t going to give them the information a nurse can. “I help provide context on information they obtain through the Internet, friends and family,” says Schimke, “such as helping them understand if a certain treatment is an option for them, especially at later stages of disease progression.”
And she also acts as a reference. She encourages patients and their loved ones to write down questions and to understand that while they can’t delay treatment decisions, they should not rush into them. They can take the time to choose the best option for them, and they have time to get a second opinion. “I help them have realistic expectations – some assume when they are diagnosed with prostate cancer they are going to die soon when that is not the case – and in others I need to help them understand that their time is limited. I am a contact for patients to answer their questions and help with their symptoms.”
Schimke also helps dispel the many myths about prostate cancer. Prostate cancer may not be the leading cause of cancer deaths in men, but it is a killer. “I would like to discuss the statement ‘no one dies from prostate cancer,’” she says. “Approximately 14 to 20 percent of men diagnosed with prostate cancer will progress and die from advanced prostate cancer and not another cause. This statement trivializes prostate cancer and may lead men to make decisions that are not in their best interest.”
As a nurse working closely with patients, Schimke is able to work with men and notice signs of the disease’s progression. “When left untreated in an advanced stage, prostate cancer can spread to other bones in the body, which is difficult to treat and can impact survival,” she says. But there are new options for patients. “There are many treatments for prostate cancer depending on the stage of the prostate cancer when diagnosed,” Schimke says. “Our goal is to hopefully cure the cancer if at an early stage, but if it is metastatic at diagnosis, we want to maintain their quality of life and prolong their life through the various treatment options that are available.” One new option is a short-range radioactive treatment that kills cancer cells in men whose cancer has been resistant to medical and surgical treatments. They may have metastasized cancer that has spread but the spread is limited to the bones. Called Xofigo, the option can help extend the life of metastatic castration-resistant prostate cancer (mCRPC) patients.
What can men who do not have prostate cancer do to protect their health? Schimke says getting a PSA test is important. While some men think the test isn’t useful, Schimke says the test is a screening tool, not a diagnostic tool, that can spot potential red flags in men who are at high risk of prostate cancer or those in the 55- to 70-year-old age range who feel they would like the test and understand it. “PSA testing should be done in men with a high risk for prostate cancer, such as men who have a father or brother that has had prostate cancer,” she says. “The American Urological Association has guidelines for which men should be tested.” And while the test results might lead to a biopsy to rule out cancer, the biopsy isn’t always going to come back positive.
And if men do get a cancer diagnosis, each case is very different and finding a reliable and knowledgeable healthcare team with expert urology and oncology teams working together is essential. “Not all prostate cancer needs to be treated,” says Schimke. “Many men can be followed and treated only if their prostate cancer progresses.”
Neonatal nurses sum up their work very succinctly. As the theme of 2017’s Neonatal Nurses Day, celebrated every September 15, states “We Save Babies!”
Sponsored by the National Association of Neonatal Nurses (NANN), the “We Save Babies!” theme resonates with this clinical specialty of nurses who work with the tiniest patients.
Neonatal nurses care for babies who are born so early or with conditions or infections that just a mere decade ago they might not have survived. In fact, according to NANN, survival rates for these patients are 10 times better than they were 15 years ago. Preemies born months too early who barely fit in a hand are now able to survive, but the journey is often treacherous. These nurses might also care for newborns who have birth defects or who were born with life-threatening health problems. Some babies become ill or develop an infection shortly after birth and neonatal nurses care for these babies, too.
This specialty of nursing is very specialized and neonatal nurses are trained to watch for the smallest challenges that can face these newborns. Preemies are faced with a range of potential problems because they didn’t have enough time to fully develop in the womb. They might have breathing problems from underdeveloped lungs, difficulties taking and digesting food, and are often unable to regulate their body temperature. Neonatal nurses’ training prepares them to monitor all the smallest fluctuations in a baby’s health and vital signs.
For families of these babies, neonatal nurses are a lifeline to their babies. Nurses and families often become close as the nurses care for the babies and also help inform the families of how to care for their infants as well. Nurses help families cope with the emotional toll of having a sick newborn and have an impact on families that is often life-long.
Nurses who are interested in this field need experience with infants and children and that should include work in a level lll neonatal intensive care unit, according to NANN. With a current RN designation and work in the field that includes at least 2000 hours in the specialty in a 24-month period, you can obtain RNC Neonatal Intensive Care Nursing certification (RNC-NIC) through the National Certification Corporation.
As neonatal nurses are celebrated today, you can check out videos on NANN’s Facebook page from the people who have been touched by the life-saving skill and care given to their babies when they were in their most fragile state. Take photos of your unit to post on social media and tag them with #NeonatalNursesDay. Let people know of this challenging career choice and the incredible rewards it offers.
The compassionate work and care of all nurses deserves to be celebrated, and throughout the year, different branches of the nursing profession get the chance to spotlight their unique duties.
This week, September 10 to 17, is National Nephrology Nurses Week, sponsored by the American Nephrology Nurses Association (ANNA), and honors the work nurses do with patients who have kidney disease or are at risk for impaired kidney function.
The need in this area is great. According to the National Kidney Foundation, one in seven adults has chronic kidney disease. Many people don’t realize they have a current disease and many of those who are at risk are also unaware.
Many sub-specialties exist within nephrology nursing, so nurses in this area have many choices. To advance their careers and gain more knowledge, nurses can become certified through the Nephrology Nursing Certification Commission in becoming a nephrology nurse nurse practitioner, a certified nephrology nurse, or a certified dialysis nurse (several technical certifications exist as well).
With a varied and diverse population, nephrology nurses work with all ages of patients from the youngest patients to the oldest. They can work in healthcare settings ranging from hospitals to home care, but may also choose to pursue research, policy work in government, or a position in academia.
Renal disease can impact anyone, so nurses become comfortable helping patients with prevention, with deciding on treatment options, and guiding them to administer self care and monitoring. And while many patients are relieved to know their kidney disease can be managed, sometimes the care options (like needing dialysis) are a daunting prospect when patients first hear it. They rely on the compassionate, professional, and expert nursing care to help understand and adapt to their diagnosis. Nephrology nurses must have broad knowledge and care for the whole body as kidney function impacts so many physical systems.
Many kidney patients have additional conditions making their care especially complex, so a nurse who wants to get into the nephrology field needs to be able to work comfortably on a team to understand the complexities of care.
In a public letter celebrating National Nephrology Nurses Week, Alice Hellebrand, MSN, RN, CNN, and 2017-2018 ANNA president, said, “Nephrology nurses use their vision, knowledge, and skills to take action and improve patient outcomes. They make a positive difference in the lives of patients and their families every day. Individuals with kidney failure rely on the skills, knowledge, and expertise of nephrology nurses to ensure the safety and effectiveness of their life-saving care.”
Thanks to all the nephrology nurses out there!
With September designated as Childhood Cancer Awareness Month, it’s especially fitting to recognize the nurses who care for these young patients with a day to honor their compassionate work.
September 8 marks Pediatric Hematology/Oncology Nurse Day, the fifth such celebration of its kind. Spearheaded by the Association of Pediatric Hematology/Oncology Nurses (APHON), the day recognizes the work of caring for children, teens, and young adults who have cancer or blood disorders. In addition, the nurses are also supports and sources of knowledge for the families and loved ones of these children who have been diagnosed with life-threatening and life-changing diseases and disorders.
APHON is working steadily to have states recognize and celebrate September 8 as an officially dedicated day. Organizations and the health care teams within them can help these efforts by notifying legislators of the importance of honoring the work in this challenging and rewarding field.
If you are interested in taking action to support these efforts or just honoring a pediatric hematology/ oncology nurse in your life, there’s lots you can do.
- Write to your legislators to inform them about the day and propose legislation to have the day officially recognized in your state. You can also invite legislators to a presentation to tell them about this important role in the lives of children and families and health care organizations. Teach them about what you do—in short order they will be amazed.
- Use social media for one of its best purposes –spreading good news far and wide. Post on Facebook, chat on Twitter, and post pics on Instagram of you and your fellow nursing team. Use #pediatrichematologyoncologynursesday to bring it all together.
- Say thank you to your team or to the pediatric hematology/oncology nurses in your life. Working with children who are fighting these diseases is uplifting, emotional, and essential for the children. Let these nurses know how crucial their work is by spreading a little joy throughout the day and making them feel appreciated.
If you’re a nurse and are interested in exploring this field, contact APHON to learn about some of the requirements and skills you’ll need. A BSN is recommended for pediatric hematology/oncology nurses, and you’ll probably want to work in a general pediatric unit so you can get a feeling for what it’s like working with kids. After gaining some on-the-job experience, getting certification as a Certified Pediatric Hematology Oncology Nurse (CPHON) with the Oncology Nursing Certification Corporation will boost your confidence, your skill set, and your professional credentials.
Happy Pediatric Hematology/Oncology Nurses Day!