What is a significant action a nurse can take to prevent being named in malpractice suits

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Written By: Darby Faubion BSN, RN

The very nature of a nurse's job means being held to a high standard of professional conduct. Nurses are expected to act with great regard for patient safety and well-being and promote favorable outcomes for the patient, healthcare team, and organizations for whom they work. Unfortunately, even the best nurses make mistakes. When those mistakes result in injury or harm to a patient, it is called negligence. Perhaps you have heard of nursing negligence but do not have a clear understanding of what it is. Maybe you have wondered, "What constitutes negligence and what are the most common examples of negligence in nursing?” In this article, you will learn what nursing negligence is, find out the 20 most common examples of negligence in nursing + how to prevent them.

What Is Negligence In Nursing?

Nursing negligence occurs when a nurse fails to perform minimum nursing care within designated standards of conduct, resulting in harm or loss. Negligence can result from failure to perform a nursing duty or may result when a nursing task is done incorrectly.

What Is The Difference Between Incompetence And Negligence In Nursing?

Although some people use the words incompetence and negligence interchangeably, they are not the same thing. Incompetence is a lack of knowledge, judgment, or skill. Examples of incompetence in nursing practice include a nurse not knowing how to administer a particular type of medication or to perform a nursing-related procedure or task incorrectly. On the other hand, negligence occurs when a competent nurse does something or fails to do something that a reasonably competent and prudent nurse would or would not do in the same situation. Negligence in nursing includes the elements of causation of injury and damages.

What Is The Difference Between Malpractice And Negligence In Nursing?

While malpractice and negligence in nursing have some similarities, there are also some key differences. Nursing negligence occurs when a patient experiences unintended harm due to a nurse’s unintentional mistake or omission in care. Nursing malpractice, on the other hand, occurs when a nurse knowingly and willfully does not follow the proper standard of care and the patient experiences harm. While both malpractice and nursing negligence can have dire consequences, malpractice is typically a more serious charge.

What Every Nurse Needs To Know About The 4 Elements Required To Prove Negligence In Nursing?

Negligence in nursing is very serious, and accusations should never be taken lightly. There are four basic elements required to prove nursing negligence. Those elements are duty, breach of duty, causation, and damages. Let’s take a closer look at each element.

1. Duty of Care:

Nurses have a duty to behave in a responsible matter and within their scope of practice. A few examples of nursing duties include administering correct medications, monitoring patients for changes, and alerting physicians when there is a change in the patient’s status.

2. Breach of Duty:

To prove negligence in nursing, it is necessary to articulate the nurse’s duty and demonstrate how the nurse deviated from that duty. There must be a clear expectation of duty before a breach of duty can occur. For instance, if a nurse observes a decline in a patient’s status and does not report the change to the attending physician, the nurse has committed a breach of duty to report.

3. Causation:

The third element of negligence in nursing is causation. Causation requires a complainant to show proof that the nurse's breach of duty was the cause of the patient's injury or loss. To prove causation, the damages must be foreseeable. For example, a nurse failed to document a previous dose of an opioid pain medication and administered a second dose.

4. Damages:

Complainants must prove that injuries or other damages occurred as a result of the breach of duty by the nurse. Considering the example in #3 above, the damage could be that the patient suffers respiratory arrest due to the respiratory depressant properties of the medication.

WHAT ARE THE MOST COMMON EXAMPLES OF NEGLIGENCE IN NURSING?

(There are many situations that can result in claims of nursing negligence. The 20 examples below are some of the most common examples of how negligence in nursing may occur and ways to avoid committing negligence.)

EXAMPLE #1: Not responding to a patient in a timely manner

About the Negligence:

Understandably, nurses can't be everywhere at once. That is why prioritizing patient care is essential. If the response to a patient's call for help or delivery of care is delayed, resulting in injury or harm, the nurse can be guilty of negligence in nursing.

How to Prevent this Negligence:

It is crucial to respond to patient needs as quickly as possible. If a nurse is unable to answer a patient's call or provide care immediately, she should notify the charge nurse and ask for help. When documenting about the patient, the nurse should include whether she had to ask for assistance, who she reported the need to, and follow-up promptly.

EXAMPLE #2: Failure to administer medication

About the Negligence:

In some cases, the nurse may need to withhold medication. For example, if a patient has an order for Digoxin, the nurse must assess the patient's pulse before giving the medication. If the patient's pulse rate is less than sixty, the medication is withheld. In this case, the nurse should document the patient's pulse rate and that the medication was not given. Nursing negligence occurs when a nurse fails to administer medication without just cause, a physician's order, and properly documenting it.

How to Prevent this Negligence:

Nurses can prevent this type of negligence by reviewing patient charts and medication orders and administering medications at the appropriate time. If the nurse feels there is reason to withhold a medication, the charge nurse and/or physician should be notified, and it should be documented.

EXAMPLE #3: Not reporting a change in patient status

About the Negligence:

A patient's status can change in a matter of minutes. Nurses must monitor and report changes as they occur. Failure to report a change in a patient's status can have dire consequences. For example, if a patient has a diagnosis of chronic renal failure and the nurse observes 3+ pitting edema, but since the patient is taking a diuretic, the nurse chooses to postpone notifying the doctor. If the edema is not resolved and fluid accumulation continues, the patient could experience a respiratory crisis due to fluid buildup.

How to Prevent this Negligence:

The best way to avoid nursing negligence like the one in this example is to report always any abnormality in a patient's status. The physician may or may not alter the treatment plan. However, by reporting concerns and creating supporting documentation, nurses protect themselves from accusations of negligence. Also, keep in mind that if you report a concern and the person you reported to does not respond or if your concerns are not alleviated, it is appropriate to go up the chain of command. It is, after all, the nurse's job to advocate for the patient.

EXAMPLE #4: Administering the wrong medication

About the Negligence:

One of the nurse's primary responsibilities is medication administration. Although physicians prescribe medication, it is the nurse's job to verify the order for accuracy and administer the medication according to the order, if it is appropriate.

How to Prevent this Negligence:

Medication errors are one of the most common and easily preventable sources of negligence in nursing, resulting in patient injury and legal ramifications for nurses and the organizations for whom they work. To prevent medication errors, the nurse should check written orders and read the medication label to ensure the right medication and dose are on hand. The doctor may write an order using a medicine's brand name, and the pharmacy may supply the generic brand. The nurse should verify if the physician has okayed generic substitutions and ensure the correct medication is delivered before administering it.

EXAMPLE #5: Injuring a Patient with Medical Equipment

About the Negligence:

It is understandable that accidents sometimes happen. Negligence in nursing may occur as a result of something that is genuinely accidental. However, it is every nurse's responsibility to put forth reasonable efforts to prevent injury.

How to Prevent this Negligence:

A few ways nurses can prevent patient injuries associated with medical equipment are by making sure equipment is secured in proper places and placing call lights within the patient's reach but secured, so the patient does not become entangled in the cord. Medical equipment should be calibrated and verified to be in working order before using them in patient care.

EXAMPLE #6: Not Speaking Up when Action is Required

About the Negligence:

Patient advocacy is one of the most powerful tools nurses use to improve nurse-patient relationships and promote positive patient outcomes. Being a patient advocate means speaking up or acting on behalf of the patient. When nurses fail to act on a patient’s behalf, it could result in injury and claims of nursing negligence.

How to Prevent this Negligence:

Although it takes a deliberate effort to be proactive on a patient's behalf to prevent negligence in nursing, that does not mean it has to be a difficult feat. Preventing nursing negligence can be as simple as monitoring a patient for signs and symptoms of a disease, side effects of a medication, administering a medication or treatment, or calling for help. You may be one of the most well-educated nurses. Still, if you do not use your knowledge, skills, and experience to enhance and promote high-quality patient care and protect your patients, you set yourself up to risk committing nursing negligence.

EXAMPLE #7: Administering Medication Using the Wrong Route

About the Negligence:

All medication orders should include the patient’s name, dose, frequency, and route of administration. The nurse is obliged to verify medication orders and follow proper protocol for their administration, including knowing and following the proper route of administration. A nurse commits nursing negligence if she administers the right medication but uses the wrong route of administration. For example, if a patient is to receive an injection intramuscularly and the nurse administers the medication subcutaneously, this is considered an act of negligence.

How to Prevent this Negligence:

If the orders are not clear, or if the nurse suspects the route of administration is not appropriate, she must verify the order with the physician and the pharmacy. While following doctor’s orders is important, following orders is outweighed by the nurse’s obligation to act responsibly and with the patient’s best interests in mind.

EXAMPLE #8: Failure to Monitor the Patient

About the Negligence:

Nurses are often the first to notice changes in a patient's status. However, if nurses fail to monitor their patients properly, they can miss vital signs that indicate patient complications or decline.

How to Prevent this Negligence:

Proper patient monitoring is an essential component of good nursing care. Nurses can prevent a breach of duty resulting in nursing negligence by carefully monitoring patients.

EXAMPLE #9: Failure to Document

About the Negligence:

Documentation is the means by which a record of patient care is established and maintained. As a nursing instructor, I felt I could never stress to my students enough, "If you did not document it, you did not do it." If nurses fail to document properly, it can lead to serious trouble. For example: Suppose Mr. Grayson has an order for Lortab every six hours for pain as needed. Nurse Amy administers the medication at 2:30 p.m. and does not document she gave the medication. At 4 p.m., Mr. Grayson asks the evening nurse for something for pain. When she checks his chart, there is no record of the 2:30 p.m. dose; so she gives him another pain pill." The patient can experience side effects of being overmedicated, and the nurse is responsible for committing an act of nursing negligence.

How to Prevent this Negligence:

The best way to prevent this act of negligence in nursing is to document as soon as possible after a treatment, medication administration, or when there is any change in a patient’s condition.

EXAMPLE #10: Not Implementing Patient-Appropriate Safety Measures

About the Negligence:

It is the nurse's responsibility to safeguard patients from harm, including the harm that can occur due to the absence of appropriate safety measures. Even in cases when a patient is the source of injury to himself, if the nurse did not implement measures to prevent patient-inflicted, preventable injuries, this could result in a case of negligence in nursing.

For example, suppose the nurse leaves a patient's bed in an elevated position, and the patient falls while trying to get out of bed. The nurse may be held responsible for the injury because the nurse did not ensure the bed was in its lowest position before leaving the patient alone.

How to Prevent this Negligence:

Nurses can prevent this act of nursing negligence by implementing safety measures and educating patients about their importance. Safety protocols in hospitals include measures such as placing the bed in a low position, placing cushioned mats on the floor beside the bed of patients who are at risk for falls, and ensuring the call light is always within the patient's reach.

EXAMPLE #11: Abandonment of Patient Care

About the Negligence:

The American Nurses Association defines patient abandonment as "a unilateral severance of the established nurse-patient relationship without giving reasonable notice to the appropriate person so that arrangements can be made for the continuation of nursing care by others...." If a nurse accepts a patient assignment, then abandons the task of patient care without notifying appropriate leaders, leaving the patient without nursing care and an injury occurs, the nurse has committed an act of negligence.

How to Prevent this Negligence:

Once a nurse-patient relationship is established, the nurse is obligated to continue care within the guidelines established for his role. If continued care is not possible, for any reason, the nurse must report to a nurse leader or supervisor and ensure there is a proper hand-off of patient care.

EXAMPLE #12: Not Monitoring the Effects of Restraints

About the Negligence:

Restraints are intended to prevent harm, but if they are misused or their use is not monitored, they can cause harm. Compromised circulation, respiratory status, and skin integrity can occur if a restraint is applied wrong or if it is not removed within the appropriate time.

How to Prevent this Negligence:

Every healthcare facility has protocols in place for using restraints based on law. Nurses should know their facility's restraint protocol and follow it carefully. Restraint policies should include guidelines for how often restraints should be checked and released, when a patient can refuse restraints, who may order restraints and the conditions that justify the use.

EXAMPLE #13: Failure to Provide Discharge Instructions/Education

About the Negligence:

Patient education may not be the first thing you think of when it comes to an example of negligence in nursing. However, patient education is a vital part of nursing care and relevant to promoting positive patient outcomes even after discharge.

How to Prevent this Negligence:

Nurses should review discharge orders and instructions with patients, including providing guidance about medications to take at home, signs and symptoms to report, and when to follow up with the doctor. Failure to provide adequate discharge instructions and verify the patient's understanding can lead to a case of nursing negligence if the patient suffers injury as a result.

EXAMPLE #14: Documenting Incorrect or Incomplete Information

About the Negligence:

All documentation is not "good" documentation. Nurses are busy people. At times, it can feel as if there are not enough hours in the day to do all the work that needs to be done. Unfortunately, when nurses get sidetracked or feel overwhelmed, errors in documentation may occur. Documenting incorrect patient information or only recording partial information can put the patient at risk for harm, especially if the documentation is related to medication administration or treatments.

How to Prevent this Negligence:

It is the nurse's responsibility to record information in the patient's chart or medical record precisely as it happens and with enough information that anyone else who reads the patient's chart can get a clear picture of what is going on. When documentation is performed correctly and completely, patient risks decrease, and outcomes improve.

EXAMPLE #15: Not Verifying Patient Allergies

About the Negligence:

Part of the nursing assessment includes asking the patient if he has any allergies to foods or medications. If the nurse does not verify a patient's allergies and the patient reacts to a medication because of the oversight, the nurse is responsible.

How to Prevent this Negligence:

If the initial nursing assessment was done properly and documentation is correct, the patient’s chart should state whether he has any allergies. However, the nurse is still responsible for asking the patient about allergies before administering any medications. To avoid an act of negligence in nursing related to allergies, the nurse should ask what type of reaction occurs when the patient takes the medication and, if necessary, verify with the pharmacy if any of the medications ordered are contraindicated with the allergy.

EXAMPLE #16: Nurse Preceptor Fails to Supervise Nursing Student

About the Negligence:

Although nursing students do not practice under a preceptor’s nursing license, the preceptor is responsible for patient outcomes when a task has been delegated to a student in their charge.

How to Prevent this Negligence:

The risk of being held accountable for the actions of a student nurse is enough to make some licensed nurses decline opportunities to precept. However, actions against student nurses for negligence are not common. It is possible to precept nursing students and have successful outcomes for the patient, student, preceptor, and the organization. As a preceptor, it is crucial to communicate with the nursing student and nursing school faculty to determine the level of responsibility the student may assume.

EXAMPLE #17: Failure to get Informed Consent

About the Negligence:

Patients have a right to be informed about any proposed treatment plan and decide if they want the plan implemented. Nurses must inform patients about medications or treatments ordered and verify their understanding. If a nurse initiates any treatment plan without the patient being properly informed and giving consent, this is considered an act of negligence in nursing.

How to Prevent this Negligence:

To prevent this act of negligence, nurses must take the time to explain procedures and treatments to patients and/or their loved ones and give them the opportunity to make an informed decision about the care. Nurses need to document who they educated (patient/spouse) and their response to the teaching.

EXAMPLE #18: Not Performing a Follow-Up Assessment

About the Negligence:

Quality patient care requires continued monitoring and reassessment of the patient's status. From the time a patient is admitted to care, the nurse begins a nursing assessment. A nursing care plan is developed and implemented with the data gathered from the assessment. The patient's response should be assessed frequently to determine if the care plan is effective or if changes need to be made. Failure to evaluate patient responses to treatment by performing follow-up assessments is another example of negligence in nursing.

How to Prevent this Negligence:

To prevent nursing negligence, as described in this example, nurses should perform frequent assessments on clients. Nursing care plans and physicians' orders should indicate how often vital signs are measured and any other pertinent information necessary for an assessment. Competent nurses understand it is acceptable to reassess a patient anytime the nurse feels there is a change in the patient's status, even if it is not a scheduled assessment.

EXAMPLE #19: Failure to Act as a Patient Advocate

About the Negligence:

Nurses typically spend much more time with patients than physicians or other healthcare team members, which leaves them in a perfect position to understand the patient's concerns and needs. It is every nurse's responsibility to advocate for patients. Failure to act as a patient advocate could lead to unintentional injury or adverse health consequences, resulting in a claim of nursing negligence.

How to Prevent this Negligence:

To prevent this act of negligence in nursing, the nurse should strive to develop strong nurse-patient relationships and speak up for the patient when necessary. Whether it's notifying the doctor that the patient does not understand information about a diagnosis or test, or has concerns about medication orders or treatment plans, the nurse can be a voice for patients who may not speak up for themselves.

EXAMPLE #20: Using Damaged Equipment to Assess or Care for a Patient

About the Negligence:

Any equipment used in patient care must be kept in good working order. Medical equipment that is in disrepair can result in patient injury. For example, a blood pressure cuff that is not correctly working can give an inaccurate reading, resulting in an abnormal blood pressure being overlooked. If the situation is not remedied, the patient could experience complications caused by the abnormal blood pressure. The nurse's failure to maintain equipment in good condition or replace damaged equipment is another example of nursing negligence.

How to Prevent this Negligence:

Most healthcare facilities have a protocol for how often medical equipment is calibrated and checked for accuracy and proper functioning. The nurse should be aware of these protocols and help ensure quality equipment is used in patient care.

7 Possible Consequences Of Negligence In Nursing

Nursing negligence can result in severe consequences. The following are the 7 possible consequences of negligence in nursing.

1. Injury to or Death of a Patient:

The most devasting consequence of negligence in nursing is an injury to or death of a patient.

2. Loss of Job:

The risk associated with nursing negligence is not something employers want to be associated with their organizations. Therefore, nurses who commit acts of negligence are likely to find themselves out of a job.

3. Loss of Nursing License:

Although negligence in nursing may be unintentional, the circumstances of the situation could lead to action against the nurse’s license. Depending on the situation and the degree of injury, the state board of nursing may suspend a nurse’s license or revoke her license.

4. Legal Action Against the Nurse:

In some cases, nursing negligence may lead to legal action against the nurse.

5. Financial Loss:

Negligence in nursing can lead to significant hardship. Whether the nurse loses her job, is sued for damages, or both, the loss can be devastating.

6. Tarnished Professional Reputation:

Even if a nurse escapes an allegation of nursing negligence and maintains her license, the impact of such an allegation on her professional reputation may be severe.

7. Compromised Professional and Nurse-Patient Relationships:

Although acts of nursing negligence may be unintentional, it is not uncommon for them to affect relationships between nurses or between nurses and the patients they serve.

7 Steps You Can Take If You Have Committed An Act Of Negligence In Nursing

Realizing you committed an act of negligence in nursing can leave you feeling frightened, disheartened, and embarrassed. If you find yourself in a situation that you think may constitute a negligent nursing act, there are a few things to keep in mind and do.

1. Do not try to cover up your mistake!

The worst thing you can do when an act of negligence in nursing occurs is try to hide it.

2. Report to your supervisor right away.

Before you talk to any other healthcare member, you should address the issue with your supervisor and ask for their assistance and guidance in moving forward with reporting and handling the situation.

3. Make sure an incident report is filled out and that YOU write your version of what happened exactly as you remember it.

No one should fill out an incident report for you.

4. Talk to your facility’s safety committee or safety officer.

Safety personnel designated to handle these issues can help you navigate the complications associated with claims of negligence. Your nursing supervisor may speak to the safety committee, but it is advisable for you to ask to join your supervisor or make an appointment with them yourself. Remember, it’s your license on the line.

5. Notify the patient and/or caregiver.

Many nurses fear that notifying patients of an error increase the chance of legal pursuits. However, some studies show that patients and families who are notified of errors are less likely to reactively seek legal damages. Because the issue of negligence in nursing has both ethical and legal aspects, you should ask your nursing supervisor to accompany you to notify the patient and family members.

6. Document everything you say and who you say it to.

If a patient or family member decides to pursue legal action, your best defense is honest documentation.

7. Consider speaking with an attorney.

While cases of nursing negligence may not be pursued legally, it is appropriate to talk with an attorney if you feel so inclined. Remember, whatever you discuss with an attorney is confidential. So, if you choose to speak with one, be completely transparent. Attorneys can provide a better defense for you if they know all of the facts.

BONUS! Things Nurse Leaders Can Do To Help Prevent Negligence In Nursing Practice

Negligence in nursing is a challenge in healthcare settings worldwide. The impact of acts of negligence in nursing is far-reaching, affecting patients, individual nurses, the nursing profession, and healthcare organizations. Therefore, reducing the risk of negligence among nurses should be a priority for all nursing leaders. The following are some examples of things nurse leaders can do to help prevent negligence in nursing practice.

1. Establish clear standards to guide nursing practice:

Once standards of practice are established, nurse leaders must ensure nursing staff know their roles and responsibilities. This is especially important because nurse leaders can be held responsible for nursing negligence if they do not educate and supervise the nurses in their charge.

2. Create an atmosphere where nurses are comfortable asking for help and guidance:

Many times, nurses avoid asking for help for fear of being rejected by leaders. Strong nurse leaders understand the importance of being available as a source of guidance and assistance, which can help reduce the risk of negligent nursing acts.

3. Use experienced, competent nurses as preceptors:

Nurse leaders can utilize the knowledge, skills, and clinical experiences of seasoned nurses to help build strong teams of nurses who work together and rely upon one another.

4. Be a safe person for patients and nurses to talk to:

If a nurse leader becomes aware of a potential act of negligence, it is vital for them to be available for both the patient and the nurse suspected of the negligent act. The nurse leader can gather all information related to the situation and address the issue with the appropriate management.

5. Create opportunities for continued learning:

Nurse leaders can support staff nurses and reduce the risk of incidents of negligence by offering ongoing opportunities for learning and skills development and improvement. The more educated a nurse is, the more competent she becomes and (hopefully) less likely to commit an act of negligence in nursing.

My Final Thoughts

The first step in avoiding acts of nursing negligence is to understand what it is. In this article, we have answered the question, "What are the most common examples of negligence in nursing?” By familiarizing yourself with the 20 most common examples of negligence in nursing + how to prevent them, you can help reduce the risk of committing nursing negligence.

FREQUENTLY ASKED QUESTIONS ANSWERED BY OUR EXPERT

1. What Is Criminal Negligence In Nursing?

Criminal negligence refers to a person’s conduct that involves ignoring obvious risk or disregard for the safety or life of others. Criminal negligence in nursing requires serious harm, such as death of the patient or significant bodily injury as the result of ignoring obvious risks.

2. Is Nursing Negligence An Ethical OR Legal Issue?

Negligence in nursing has both ethical and legal aspects. Nurses have an ethical obligation to promote patient safety and perform with high standards of care. When breaches of nursing conduct occur, there is a chance of legal ramifications.

3. What Is Gross Negligence In Nursing?

Gross negligence in nursing is a severe form of negligent nursing behavior. It is characterized by a lack of care that involves willful disregard for the safety of human life.

4. Does A Medical Error Always Mean Negligence?

A medical error does not always mean negligence in nursing. Some errors occur during medical management. For instance, suppose Mr. Smith has pneumonia and is prescribed a specific antibiotic. Mr. Smith develops an allergic reaction to the medication, which causes acute renal failure. This injury/error is considered an adverse event and is not the result of negligence.

5. Can A Nurse Be Sued For Negligence?

Yes, nurses can be sued for acts of negligence in nursing. There are four elements that constitute a claim of nursing negligence: duty of care, breach of duty, causation, and damages.

6. How Often Do Nurses Get Sued For Negligence?

Although medical negligence and malpractice are more common than legal cases for nursing negligence, statistics indicate the incidence of nurses being sued for negligence is higher now than in years past. Despite the rise in cases, most sources estimate only five to thirty percent of negligence incidents ever make it to litigation.

7. Can A Student Nurse Be Held Liable For Negligence?

Student nurses are held to the same standards of practice as a licensed nurse when performing nursing duties and can be held liable for negligence.

8. How Can A Nurse Become Negligent With Medication Administration?

A few ways nurses can commit an act of negligence with medication administration include administering the wrong dose of a medication, administering the wrong medication to a patient, using a mislabeled prescription medication, and failing to advise the patient about potential side effects or adverse reactions.

9. Can A Nurse Go To Jail For Negligence?

Although some nurses are not criminally charged for negligence, depending on the circumstances and the degree of injury or loss, nurses can be jailed for acts of nursing negligence.

10. Can An Act Of Negligence In Nursing Become Malpractice?

Although nursing negligence and nursing malpractice are different, it is possible for negligence to result in malpractice. If a nurse commits an act of nursing negligence, which is a mistake that results in unintended harm but continues the same behavior after realizing the mistake and its impact, the act can then be deemed nursing malpractice.

What is the nurse best protection against a malpractice suit?

What action can the nurse take to uphold the ethical principle of fidelity?

What are the most common allegations of nursing malpractice?

What type of nurse is most likely to get sued?