If you haven’t read Brent’s Law in the Ask the Experts section of Nursing Spectrum online, you don’t know what you’re missing. Actually, you can see some of what you’ve been missing in the questions below. Nancy J. Brent, RN, MS, JD, tackles your toughest legal dilemmas and offers guidance for your next step. Log on today at www.nursingspectrum.com and ask your question!

Dear Nancy,

What is the appropriate action to take when a new nurse continually and openly criticizes other nurses and staff in front of patients and family?

Sick of Being Criticized

Dear Sick of Being Criticized,

When a disgruntled staff nurse openly criticizes his/her follow workers, and in doing so, directly or indirectly affects the facility in which the nurse works, the behavior must be dealt with professionally and quickly. Ignoring such conduct by any staff member may be a formula for disaster. Intervention by management is essential. If the nurse manager and/or nurse executive are not aware of the problem, they need to be informed confidentially and in a manner consistent with the employer’s established procedures for dealing with unacceptable conduct. The policy may include filing an incident report, disciplining the employee for a violation of the employee conduct code, and/or requiring the employee to see the employee assistance counselor or a counselor of the nurse’s choice.

What this type of behavior can result in legally can not be overlooked. Is the nurse, for example, having difficulty controlling his or her anger? Could further displays of criticism result in a loss of control and therefore risk injury to patients and staff? Second, the nurse displaying this type of behavior creates the potential for a suit for defamation by staff members if the information spoken about them individually is untrue and damages their respective reputations and good names. Third, if there is a patient injury or death on the unit and a family member (or a patient in the case of an injury) witnessed a nurse’s open criticism of staff, the criticizing nurse may give the patient or family potential fuel to use in a professional negligence suit against the nurse, members of the nursing staff, and/or the facility. For example, was the injury caused by a nurse’s incompetence that the criticizing nurse accused the staff of? Were the staff members feuding and therefore could not provide care to a family member because of the bickering among them?

Despite the fact that the behavior of the criticizing nurse is not acceptable, it would also seem prudent to listen to the voiced concerns of any nurse who is raising such issues. Are any of the criticisms, however badly delivered, based on accurate lapses in patient care? Are some of the staff not helpful or clearly provide less than acceptable care? These, and other, messages raised by a critical staff nurse may be worth evaluating to identify and implement any necessary changes seen to hinder the smooth operation of the unit in the provision of quality patient care.

Cordially,
Nancy

Dear Nancy,

If I provide family, friends, and neighbors with healthcare information and advice, do I need malpractice insurance?

Signed,
Worried

Dear Worried,

Any time a professional provides advice to another, there is the potential that if an injury or death occurs because of the advice not being accurate and it proximately causes the injury or death, liability may occur. Moreover, when you give healthcare advice and information to others, that consultation must be within the scope of your practice. If the advice given is not within the practitioner’s authority granted through the state nurse practice act, there could be a disciplinary action against the nurse for, among other possibilities, unprofessional conduct of a nature likely to deceive or harm the public.

Professional liability insurance is a contract whereby the insurance company agrees to provide a policy of insurance with the nurse for specific professional activities. Examples of such activities include the practice of med/surg nursing, practice as an advanced practice nurse (APN), or functioning as a diabetes educator. It is doubtful that you could purchase professional liability insurance for the informal provision of healthcare information and advice to others. If you were hired as an educator, had a consultation business for this purpose, or were a patient care case manager, then it is possible to purchase professional liability insurance for those practices.

Exploring the issue of coverage with an established professional liability insurance company would be a wise move. You could also do so with an insurance company with whom the insured has done business. It may be that the company is willing to write a special policy for a long-standing customer.

Keep in mind that curb-side consultation by any professional, including a nurse, is risky business legally. It is probably better not to do so at all and tell the neighbor to call their nurse practitioner or physician for advice. One could also establish a formal business in which, consistent with the nurse practice act, health teaching is provided to identified, formal clients.

Sincerely,
Nancy

Dear Nancy,

What is the accepted standard of practice regarding the RN’s responsibility to check lab values prior to the administration of medications or supplements?

Needs Standard of Practice

Dear Needs Standard of Practice,

First and foremost, it is always the accepted standard of practice in whichever nursing specialty you practice in to check lab values and other patient indicators before the administration of any medications, especially when their administration may result in an adverse outcome.

The administration of medications is not a linear, simple process whereby the nurse simply gives the patient his or her medications. Rather, it is a multi-step process. One of the first steps, sometimes even prior to the “pouring” or preparation of the medications, is to do an assessment of the patient’s status to evaluate whether a drug or medication should be given. Likewise, once given, an assessment of the effect(s) of the medication must also be conducted. Moreover, the five rights of medication administration — right dose, right drug, right patient, right time, and right route - must be consistently followed in order for the nurse to meet standards of practice for medication administration.

You must also adhere to the overall legal standard of care when doing so. That standard is what other ordinary, reasonable, and prudent nurses would do in similar circumstances (in the same or similar community). There is no doubt that the standard would require that you assess any patient indicators relevent to the administration of a particular medication prior to its administration.

Sincerely,
Nancy