Nursing Accountability and Professional Regulation Flashcards
Professional Competence
When examining the disciplinary and professional competence, responsibilities, and obligations of nursing regulatory bodies, nurses must understand the distinction between professional misconduct and malpractice.
The term is misconduct is not synonymous with malpractice.
It is important for nurses to know their own provincial or territorial statues.
Malpractice
Malpractice does not necessarily involve any such misconduct.
Malpractice involves performing lawful acts in a careless manner or in a manner that does not conform with generally recognized practice standard or standard of care in the nursing profession.
Offences are generally dealt with in civil courts.
Duty of Care and the Standard of Care
To be liable in tort, a defendant must owe a duty of care to the plaintiff.
Duty of care can involve situations in which the patient is receiving services but it can also include personal situations where the nurse is required to place their competencies in their actions.
This requires a responsibility for the nurse to keep current in developments and techniques within the profession and to undertake retraining as necessary.
The Elements of Negligence
- Duty of care owed to the plaintiff (e.g. a patient or client).
- Breach of duty of care by the defendant (e.g. nurse or physician) by failure to administer treatment or provide health care in accordance with a particular standard of care.
- Patient suffers damage as a direct result of the breach of the duty of care.
Latin v. Hospital for Sick Children et al. (2007)
A febrile 14-month-old girl was admitted to a paediatric hospital in January 1998. The triage nurse assessed her as an urgent patient using the triage classification system.
One hour after her arrival, she began a generalized tonic-clonic seizure in the waiting room. She was immediately taken into the treatment room where medical staff attempted to bring her convulsions under control.
She suffered brain damage and extreme permanent disabilities. The child’s family brought a lawsuit against the hospital and the triage and charge nurse on duty as well as against several other on-duty nurses.
Nurse was not found liable.
Duty of Care and the Standard of Care
A breach of a duty to care will be found to exist when one person has placed others in peril as a result of their conduct.
A person who creates hazard, even unwittingly and through negligence of their own, may still be held liable if they fail to warn others of the hazard and they are injured.
Gaudreau v. Drapeau (1987)
There is no general duty to aid a person in need of assistance. What may be clearly moral or ethical imperative may not necessarily be a legal requirement.
Exception: failing to provide the necessities of life to a child, abandoning a child, using skills and knowledge in a legal duty and omission of skills would result in saving a life.
Kolesar v. Jeffries (1974)
The Supreme Court of Canada made the judgment in absence of contemporary documentation of events in Kolesar v. Jefferies. A patient who had a spinal fusion was, post-operatively, returned to a surgical unit and the next morning he was found dead. The chart was important in establishing liability because there were no nursing entries from 2200 hours until 0500 hours, when the death was discovered. The absence of nursing documentation allowed the court to infer that “nothing was charted because nothing was done.”
Criminal Law Standard of Care
In rare circumstances, a person who represents herself or himself as a duly qualified health care practitioner will, if serious injury or bodily harm ensues, be held to the standard of the reasonably qualified practitioner.
R. Sullivan and Lemay (1986)
The case involved two midwives assisting a home birth and the infant died as a result of negligence during the delivery. Both were charged with negligence causing death and negligence causing bodily harm.
Professional Liability Insurance
Many health care professionals who practice independently carry professional liability insurance.
Most nurses are employed by publicly funded health facilities, which carry negligence insurance.
A nurse who performs acts outside the normal scope of nursing would not have liability protection from the employer. The nurse would remain fully liable for their own negligence.
The Coroner’s Inquest
Is primarily a fact-finding and investigatory endeavour. In earlier times, it could find criminal or civil responsibility; however, the modern coroner’s inquest is not a criminal trial.
Nursing Documentation
Inadequate or missing documentation can have serious consequences in negligence actions.
Trials can occur years after the event.
Meticulous, clear, and well-organized records help the court determine how events took place (sequence and circumstances).
Testimony is therefore strengthened by records.
Legal Requirement to Keep Records: In Ontario medical records are kept for 10 years.
Meyer v. Gordon (1981)
A case in which the newborn suffered severe brain damage ensuing cerebral palsy following a fast delivery. There was a failure to determine the nursing history. Progress of labour was not documented accurately.
Documentation: the nurses altered the records rather than inputting a late entry, the documentation lacked accuracy (quantity/quality of meconium, of the cervical dilation, fetal positioning, fetal heart rate) and use of words such as “normal”, “regular”, “good”.
Standard of Care for Documentation
Reliable timely recording
Documentation of your own actions
Chronological order
Clear and concise recording
Regular entries
Record corrections clearly
Record accurately
