Improper observation accusations are legal minefield for nurses

Florence Nightingale, the founder of modern nursing, said, “The most important practical lesson that can be given to nurses is to teach them what to observe.”

These words still ring true today. The observation, assessment and monitoring of a patient is a fundamental part of nursing practice but it is often not done by nurses, with sometimes fatal results.

When patients are not carefully observed and an injury or death occurs, potential liability for the nurse exists in the form of professional negligence. The nurse also can be subject to professional disciplinary actions by the state board of nursing.

Examples of legal cases involving improper observation by nurses

  1. A board of nursing suspended a psychiatric mental health nurse practitioner’s certificate for 14 days, followed by a one-year probation of certificate and RN license for, among other allegations, failure to properly assess a client and document assessment when prescribing drugs.
  2. A hospital and one of its nurses, a named defendant, filed a motion to dismiss a case filed by the family of an ICU patient who died allegedly because of three nurses’ alleged failures. The alleged failures included failing to monitor the patient’s anticoagulant therapy, failing to observe and monitor the patient at least 30 minutes prior to his arrest (which, if done, would have revealed the removal of the patient’s IJ catheter) and failing to be in audible or visual proximity to the patient to respond to any “clinical or physiological alarm conditions.” The appeals court upheld the lower court decision to deny the motion, so the case could proceed to trial or settlement.
  3. A board of nursing reprimanded a nurse for, among other allegations, failing to properly assess and document client assessment when prescribing medications.
  4. A motion for summary judgment filed by a nursing and rehabilitation center stated there was no professional negligence on the part of nursing staff as alleged by the patient’s executrix of her estate. The case against the nursing home included the following failures of the nursing staff: failing to monitor the patient’s high fever, failing to assess and maintain proper hydration of the patient and failing to properly assess the patient’s throat infection. The court denied the motion by the nursing home so the case could proceed to trial or settlement.

These examples do not involve complicated or unusual patient care situations. The RNs, APRNs and LPNs involved all had experience in the areas in which they worked and should have been aware of what their respective state nurse practice acts required of them.

Even so, they did not conform to standards of practice or their overall legal standard of care. One would think observation of a patient’s condition, whether termed observation or assessment, monitoring or all three, would be a basic principle of nursing practice.

Avoid placing yourself in these types of situations with these guidelines:

  1. Remember assessment is not a one-time duty; it is a continual duty for all your patients.
  2. Documentation of any observations, assessment and or monitoring results is essential.
  3. When you determine a patient’s condition has changed during your observations, assessment and/or monitoring, notify those who need to be notified and document that notification in the patient’s medical record.
  4. When notifying the health team members of any changes in the patient’s condition, do so with specific clinical signs and symptoms.
  5. Use your clinical judgment and observe, monitor and/or assess a patient more frequently if you think it’s necessary.
  6. Never fail to observe any patient for his or her current status and any changes that might have taken place since your last assessment.
  7. Stay clinically up to date in your area of practice and in patient manifestations, signs and symptoms that may occur because of the patient’s diagnosis.
  8. A physician or an advanced practice nurse may order how frequently a patient is to be observed but you are not bound to limit your observation of the patient should the need arise.
  9. If you are a faculty member in any nursing education program, remember to continue to teach your students what to observe as they provide nursing care to patients.

Courses related to ‘everyday patient care and communication’

CE711: No Way Around It: Rounding Means Satisfied Patients and Nurses
(1 contact hr)
Hourly rounding is a systematic, nurse-driven evidence-based process designed to anticipate and address the needs of hospital patients. Hospital patients often need assistance with basic tasks, such as using the bathroom, eating, bathing, and ambulating. Nurses’ responsiveness to patients’ needs is a key factor patients often consider when making judgments about the quality of their care. This module provides nurses and nurse leaders with an understanding of hourly rounding’s purpose and process, and tips for implementation and success. It discusses the types of rounding: introductory rounds, initial rounds, and hourly rounds, and the key behaviors in each.

CE666: Effective Communication With Patients
(1 contact hr)
A growing body of research has shown a variety of patient populations experience decreased patient safety, poorer health outcomes, and lower quality of care based on race, ethnicity, language, disability, and sexual orientation. Effective communication with all patients is crucial to providing safe care. The healthcare team should aspire to meet the unique communication, cultural, and familial needs of all patients.

CE195-60: Improving Patient Education for Poor Readers
(1 contact hr)
Many patients don’t understand the information that healthcare providers give them. Inadequate health literacy can put patient lives at risk, and it’s a major driver of healthcare costs due to preventable complications. Health literacy is not limited to the ability to read letters and numbers; it requires a complex group of reading, listening, analytical and decision-making skills, and the proficiency to apply these skills to health situations. This updated continuing education module provides information to help nurses ensure their patients understand vital healthcare instructions.

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