Good Samaritan Laws & Acts. Do They Cover Nurses Volunteering Nursing Care When A Citizen Goes Anaphylactic.

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Summary:  "Off-duty" healthcare professionals rendering
Emergency aid are in most cases "covered" by the Good
Samaritan Acts.  These are laws enacted in each state
that provide some degree of immunity from liability for
good faith efforts in giving emergency care.  In this
case, a nurse and physician were sued for providing
assistance in a volunteer function at a "first-aid" station.
Good Samaritan "immunity" was not recognized by the
courts.

A nurse, physician and several others volunteered to help
out with a first-aid station at a food festival being held locally.
 During the festivities one attendee would suffer an anaphylactic
attack.

The man had a known allergy to fish and helped himself to a
"gumbo" mix that contained the allergen.  He proceeded to experience
an anaphylactic allergic reaction.  The event "first aid squad" was
notified only of a "problem" and the person's location.

"Anaphylactic Shock

is the most severe form of allergy which is a medical emergency,
is a type I reaction in Gell And Coombs Classification .An often
severe and sometimes fatal systemic reaction in a susceptible
individual upon exposure to a specific antigen (as wasp venom
or penicillin) after previous sensitization that is characterized
especially by respiratory symptoms, fainting, itching, urticaria,
swelling of the throat or other mucous membranes and a sudden
decline in blood pressure."2

Of those present, all but a nurse remained at the station.  With the
physician and others on the way to assist the victim, clearly someone
had to stay at the station in case there were other emergencies.  The
question would arise of whether or not their actions were covered
under existing Good Samaritan Laws.  A key consideration is whether
or not a legal "duty to assist" the victim was created when the
responsibility to "volunteer" was accepted.

"Flynn v. United States, 681 F. Supp. 1500, 1506 (D. Utah 1988),
modified in part, 902 F.2d 1524 (10th Cir. 1990). Good Samaritan
laws responded to the common law rule that made one liable for
negligently rendering voluntary emergency assistance by extending
immunity from suit, thereby encouraging humanitarian acts by
licensed medical providers."3

Arriving on the scene, not knowing what to expect, they found
the person symptomatic, still conscious and standing on his own.
He indicated that he'd had a reaction and was in need of "a shot."

"Symptoms of anaphylactic shock include dizziness, loss of
consiousness, labored breathing, swelling of the tongue and
breathing tubes, blueness of the skin, low blood pressure, and
death bronchospasm"1

The physician recognizing the anaphylactic nature of the situation
requested one of the others obtain "epinephrine," while she stayed
with the patient.

When the other member of the squad returned with a single "Epi pen."
 The physician administered a dose.  The patient claimed to not have
obtained any relief.  A second shot was requested.  The pen was a
single dose unit only.  Having already used the available dose, the
physician explained it would be nearly empty.  There was no other
immediate source of epinephrine available at the time.  Unable to
offer an alternative, the physician gave the patient a second shot with
the same injector hoping it might still contain "some" medication.

Again the patient did not obtain relief.  With symptoms persisting,
the patient's condition deteriorated.  At this point an ambulance was
on the way, the nurse had been relieved at the station and came up
to assist, still unaware of what the problem had been.

When she came upon the patient, the best she could do was stay
with him until the emergency medical personnel arrived.  The
patient would complain of increasing shortness of breath.  En route
to the hospital, he would slip into a coma.  He would die the next day.

A lawsuit was filed naming both the physician and the nurse alleging
a "wrongful death."  Both the nurse and physician fought this in court.
 In the initial trial, the complaint was dismissed.

They argued for protection under the Good Samaritan Acts of the state.
  This legislation was enacted to encourage health professionals to
render aid at the roadside.  Previously, professionals had and still do
hesitate to assist for fear of being sued by the injured party.

"Because of the pervasive myth of liability in the medical professions,
most states have enacted some form of Good Samaritan law prohibiting
a patient from suing a physician or other health care professional for
injuries from a Good Samaritan act. To trigger the protection of such
an act, two conditions must be satisfied: it must be a volunteer act, and
the actions must be a good-faith effort to help. Displacing a neck fracture
in an effort to do rescue breathing might be malpractice in the Emergency
Room, but it is not bad faith on the roadside."4

While a Good Samaritan Act may protect you in state-specific circumstances
from being found and held liable, it will not protect you (nor will an
employer's malpractice insurance policy) from being sued in the first place.

In most states there is no obligation for a bystander to render aid or
legislation to penalize those that do not decide to get involved.
Minnesota, Vermont and Wisconsin are exceptions to this rule.
Minnesota statutes follow:

"A person at the scene of an emergency who knows that another person
is exposed to or has suffered grave physical harm shall, to the extent
that the person can do so without danger or peril to self or others, give
reasonable assistance to the exposed person. Reasonable assistance
may include obtaining or attempting to obtain aid from law enforcement
or medical personnel. A person who violates this subdivision is guilty
of a petty misdemeanor. "5

A common thread in each of the Good Samaritan laws is that no
immunity will be afforded for specific exceptions.

"The most commonly stated exception to immunity is for conduct that
is willful and wanton. Many jurisdictions also exclude other categories
of conduct, such as conduct that is grossly negligent, reckless, malicious,
in bad faith, fraudulent, or intentionally tortious or that is a knowing
violation of law. A few even included ordinary negligence, which arguably
negates the protection afforded."6

In the state of Rhode Island, in which this event occurred, there are
no specific laws requiring that a bystander give assistance.

Interestingly, immunity by the state laws is granted in the following
which do not specify volunteer medical and first aid activities.

"Rhode Island law also grants immunity from civil damages to:

(1) Persons rendering service as, or assisting, a manager, coach, instructor,
umpire, referee or official in certain interscholastic or intramural
sports programs;

(2) Any uncompensated person voluntarily serving as or assisting a
manager, coach, instructor, umpire, referee or official in a youth
sports program organized and conducted by or under the auspices
of a nonprofit corporation; or

(3) Directors, officers, trustees or employees of any nonprofit
organization, authorized to do business in the state, that organizes,
conducts or sponsors a youth sports program.208"6

It is debatable whether the initial trial led to a dismissal on grounds
of protection under existing Good Samaritan laws, or simply a lack
of evidence to prove negligence.  Of these, the latter is more likely.

With the complaint initially dismissed, the patient's estate appealed.

Questions to be answered.

1. In rendering care to the patient in a state of anaphylaxis, did
both the nurse and physician perform to the best of their abilities
with the resources available to them.

2. In rendering emergency aid to the patient, were they covered by
the state's existing "Good Samaritan" laws.

The plaintiff's attorneys would argue that negligence had been
a factor in the patient's death.  They accused the physician and
nurse of arriving on the scene "unprepared" to deal with the situation.

Interestingly, the plaintiff could offer no expert witness testimony
to support this.

In deciding the second question, the court explicitly stated that
"it assumed the defendants were not covered under Good Samaritan Laws."

This is alarming in that if the plaintiff had been able to produce
sufficient expert testimony to prove negligence, the nurse and
physician may well have been held liable.

In light of these circumstances,  the ruling of the lower court was
affirmed.

It sends a frightening message to nurses, medical and health care
personnel who chose to "volunteer" their expertise in times of need.
Some state laws do require action in specific circumstances:

It is unclear whether this opinion was offered because the assistance
was "organized."  Is an exception made to the Good Samaritan Acts
for First Aid Squads and Organized Emergency Medical Personnel
regardless of whether or not they charge the patient for their services?

Troubling questions for the individual when deciding whether or not
to render aid.  The answers and exceptions are defined in individual
state laws that vary widely.

Many nurses rely on malpractice insurance provided by their
employers to cover them at work.  It is highly unlikely that such
a policy would cover them while performing volunteer duties.

If you accept responsibility to perform expected duties either on
a paid or volunteer basis, for a profit or non-profit organization, you
may not be covered under otherwise applicable Good Samaritan Statutes.
If you chose to protect yourself by carrying malpractice insurance
policy, it would be wise to make sure this coverage is specifically included.

Related link Sections:

Direct Patient Care Links
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Emergency Department Nurses on the Nurse Friendly:
http://www.nursefriendly.com/nursing/directory/spec/ed.html

Good Samaritan Laws & Acts:
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/good.samari...

Ethics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm

Medical Legal Consulting Nurse Entrepreneurs:
http://www.nursefriendly.com/nursing/ymedlegal.htm

Sources:

1. 38 RRNL 4 (September 1997)

2. Health on The Net Foundation. July 2, 1998.  HON Allergy Glossary Anaphylactic Shock. Retrieved July 18, 1999 from the World Wide Web:  http://wolfgang.hcuge.ch/Library/Theme/Allergy/Glossary/shock.html

3. Utah State Courts. Filed November 14, 1997.  Hirpa v. IHC Hospitals, Inc., No. 960180.  Retrieved July 18, 1999 from the World Wide Web:  http://courtlink.utcourts.gov/opinions/supopin/hirpa.htm

4. Law and the Physician Homepage.  No Date Given.  Good Samaritan Laws. Retrieved July 18, 1999 from the World Wide Web:   http://plague.law.umkc.edu/Xfiles/x894.htm

5. LawGuide.  1998.  Minnesota Good Samaritan Law.  Retrieved July 18, 1999 from the World Wide Web:  http://www.lawstreet.com/lawguide/sigsgomn.HTML

6. Carter-Yamauchi, Charlotte A. 1996.  Volunteerism - A Risky Business? Retrieved July 18, 1999 from the World Wide Web:  http://www.hawaii.gov/lrb/vol/volchp3.html
 

The Uniform Resource Locator (URL) or Internet Street Address of this page is
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Send comments and mail to Andrew Lopez, RN

Created on July 14, 1999

Last updated by Andrew Lopez, RN on Monday, February 28, 2011

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#Diabetic Coronary Artery Bypass #Patient, Septic & Noncompliant. #Nursing Duty and Responsibility Questioned.

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Summary:  Patient noncompliance can present serious challenges to
nurses  and physicians providing care.  If aware of the proper measures
to be taken, what happens when the patient does not agree
or comply with the course of treatment?  In this case, a patient after
having a coronary artery bypass grafting developed a sternal infection.
When advised by a nurse to return for treatment, the patient refused.

The patient was known to have Insulin-Dependent Diabetes Mellitus.
She would seek medical attention with a history of Angina (chest
pain).  Following the episode, she was referred for a diagnostic
cardiac catheterization.

"According to latest statistics from the American Heart Association,
roughly 323,000 cardiac catheterizations were performed in the
United States in 1994. The procedure provides doctors with
information about the heart's structure and its ability to function.
Doctors may also use catheterization to perform procedures on the
heart, such as balloon angioplasty.

To perform a cardiac catheterization, a thin catheter is inserted
through a small puncture wound in a blood vessel -- usually the
femoral artery in the leg. Using X-rays for guidance, doctors feed the
catheter through the circulatory system until it reaches the heart."2

Following the catheterization, an emergent multiple bypass surgery
was recommended by the Cardiologist.

"What is coronary artery bypass surgery?

A coronary artery bypass graft operation is a type of heart surgery. It
is sometimes referred to as CABG or "cabbage." The surgery is done
to reroute, or "bypass," blood around clogged arteries and improve the
supply of blood and oxygen to the heart. These arteries are often
clogged by the buildup over time of fat, cholesterol and other
substances.

The narrowing of these arteries is called atherosclerosis. It slows or
stops the flow of blood through the heart's blood vessels and can lead
to a heart attack."3

The patient would refuse and left the hospital Against Medical Advice
(AMA). Three days later the patient would return to the hospital and
provide an Informed Consent to the operation.  It was performed by
the Facility's Cardiac Surgery  Director assisted by a fourth year
resident.

""Revascularization with coronary artery bypass graft surgery
(CABG) and percutaneous transluminal coronary angioplasty (PTCA)
is well accepted as a method of relieving anginal pain and thus
improving quality of life. In addition, CABG has been shown to
improve survival in certain subgroups of patients with coronary
disease, which has led to the widespread use of this procedure in
revascularization. In 1991 407 000 bypasses and 303 000 PTCA
procedures were performed.1 Currently, coronary atherectomy,
various laser techniques, and coronary stents are being evaluated as
additional approaches to revascularization."4

Following the coronary artery bypass grafting, the patient would
remain in the hospital for ten days.

The patient would return for a follow-up visit just under two weeks
later with the surgeon.  Assisted by a cardiac nurse, the midsternal
incision was examined, staples were removed.  A portion was found
to be purulent, draining and healing poorly.

Cultures were obtained and sent, the patient would be scheduled for
another follow up visit a month later.

Four days later, the patient spiked a temperature.  She called the
medical center and spoke to the nurse who had assisted the surgeon.
After listening to the patient's complaints, the nurse instructed her to
return to the medical center for treatment.  She informed the patient
that her test results had come back and multiple infections had been
discovered from the midsternal wound in her chest.

"Approximately 2% to 20% of CABGs are complicated by a surgical-
site infection (SSI).4,5 Much of the literature on SSI following
cardiothoracic surgical procedures focus on deep chest infections,
which, although not frequent (complicating 0.5% to 5% of cardiac
procedures4,5), are important because of the high morbidity,
mortality, and immense costs they add to the healthcare system."5

The patient refused.  She stated that it was almost an hour's drive to go
to the medical facility.   In her "condition" she didn't feel she could
"make" the trip.

She asked the nurse if antibiotics could be "prescribed over the phone"
and started without her being evaluated.  The nurse informed her this
was not an option.

The nurse informed the patient that it would be best for her to return
to the facility where the operation had been performed.  If she
returned her condition could be evaluated and treatment initiated.  The
patient still refused.

Alternatively the nurse stated that the patient should seek immediate
medical assistance and contact her local physician.

The patient was unable to contact a local physician and did not go to
the Emergency Room immediately.  In fact, the patient was not
examined by her physician until almost ten days later.

At that time, ten days after the known Insulin Dependent Diabetic
patient had been informed by the nurse that she had a potentially life
threatening multiple organism infection in her chest, she was
readmitted to a local hospital.

"Surgical-site infection of the sternal wound includes superficial SSI,
deep sternal SSI, sternal osteomyelitis, mediastinitis, and endocarditis.
These often have been pooled together in the analysis of risk factors.
Host intrinsic risk factors that have been linked specifically to SSI of
the sternal wound include obesity,4,9-11 diabetes mellitus,4,9-13
current cigarette smoking,9 and steroid therapy,13 the former two risk
factors being the most frequently reported (Table 1). Kluytmans and
colleagues further demonstrated that the risk of developing SSI was
higher in the diabetic patient using insulin therapy than in the diabetic
patient treated with oral agents.12"5

A sternal infection was verified.  The patient would require
readmission and surgery to debride the wound and bring the infection
under control.  Part of her sternum would be removed in the process.

At the patient's request, the course of events was examined by the
Physician Medical Review Board.  She alleged that standards of care
had not been maintained.  She stated that negligence on the part of the
surgeon and the nurse had led to her infection and subsequent surgery.

The board dismissed the complaint.  They stated there was no clear
evidence of wrongdoing or negligence on the part of the nurse or
physician.

The patient filed a lawsuit regardless against the physician, facility
and the nurse accusing negligence.  The case was dismissed.

The patient appealed.

Questions to be answered:

1. Did the nurse fail to observe the applicable standards of care in her
conversation with the patient?

2. Was the nurse giving the patient "medical advice" when she
advised her to return for treatment?

3. Did the nurse mislead the patient or make any statements that could
have contributed to the patient's complications?

The physicians and the court when reviewing the nurse's performance
agreed it was appropriate.  The nurse was dealing with a known septic
patient with a history of noncompliance.  She instructed and
emphasized to the patient that an infection was present and required
treatment.

The nurse advised the patient of where the best treatment could be
obtained.  The patient was notified that if she could not return
immediately, that treatment should be sought elsewhere on an
emergent basis.

The nurse was giving medical advice.  In this case, the nurse was
telling the patient exactly what a competent surgeon would have told
her as well.

This is a special situation involving a nurse with advanced skills and
experience in a nursing specialty.  Nurses with specialized training are
recognized as competent to advise patients on pre-defined situations
according to their level of expertise.

A midsternal infection is a known complication of coronary artery
bypass grafting.  The nurse being aware of this was appropriate in her
counseling of the patient to seek immediate care.

The nurse in the eyes of the law would be and was held to the same
standards as a physician in the advice that was given.  The nurse did
in fact, maintain the standards of care expected in the situation.

Her responsibility or "duty" to the patient was to advise her of the
medical condition present (a septic infection), make recommendations
for treatment (return to the hospital), inform her of consequences of
not being treated and present alternatives.

This duty was fulfilled and recognized repeatedly by the medical
review panel and the courts.  It is unfortunate that the noncompliant
patient decided to pursue litigation regardless.

It demonstrates clearly how vulnerable even the most prudent nurses
are to being sued.  Often it is the case that nothing has been done
wrong, nor is there negligence likely.  It's a constitutional right for an
individual to initiate a lawsuit for real or perceived losses.

Makes an excellent case for carrying a malpractice insurance policy.
For the cost of a typical day's pay, you can have protection against
lawsuits without having to depend on an employer's policy being
adequate to protect you.

Related Link Sections:

Cardiac Arrhythmias Links on: The Nurse Friendly
http://www.nursefriendly.com/nursing/directpatientcare/symptoms/cardiac.arrhy...

Cardiac Catheterization (Diagnostic) Links on: The Nurse Friendly
http://www.nursefriendly.com/nursing/directpatientcare/tests/cardiac.catheter...

Cardiac Links, Direct Patient Care on: The Nurse Friendly
http://www.nursefriendly.com/nursing/directpatientcare/cardiac.htm

Clinical Charting and Documentation, Nurses Notes:
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Coronary Artery Bypass Grafting (CABG) Links on: The Nurse Friendly
http://www.nursefriendly.com/nursing/directpatientcare/cardiac/coronary.arter...

Direct Patient Care Links on: The Nurse Friendly
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Emergency Department Nurses on the Nurse Friendly:
http://www.nursefriendly.com/nursing/directory/spec/ed.html

Ethics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm

Head Injuries:
http://www.nursefriendly.com/nursing/directpatientcare/head.injuries.htm

Informed Consent:
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/informed.co...

Mechanical & Physical Restraints:
http://www.nursefriendly.com/nursing/directpatientcare/mechanical.physical.re...

Medical Legal Consulting Nurse Entrepreneurs:
http://www.nursefriendly.com/nursing/ymedlegal.htm

Operating Room (Surgical) Links on: The Nurse Friendly
http://www.nursefriendly.com/nursing/directory/spec/operatingroom.htm

Sources:

1. 40 RRNL 1 (June 1999).

2. WTVC NewsChannel 9.  1999.  Cardiac Catheterization: http://www.newschannel9.com/healthwatch/hw594.html

3. The American Heart Association.  1999.  Bypass Surgery, Coronary Artery:  Retrieved July 4, 1999 from the World Wide Web:  http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/bypass.html

4. American Heart Association.  1994.  Optimal Risk Factor Management in the Patient After Coronary Revascularization.  Retrieved July 4, 1999 from the World Wide Web: http://www.amhrt.org/Scientific/statements/1994/129401.html

5. Infection Control & hospital Epidemiology.  April 1988.  Surgical-Site Infections After Coronary Artery Bypass Graft Surgery: Discriminating Site-Specific Risk Factors to Improve Prevention Efforts. Retrieved July 4, 1999 from the World Wide Web: http://www.slackinc.com/general/iche/stor0498/edit.htm
 

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The Uniform Resource Locator (URL) or Internet Street Address of this page is
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Send comments and mail to Andrew Lopez, RN

Created on July 4, 1999

Last updated by Andrew Lopez, RN on Monday, February 28, 2011

via nursefriendly.com

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******************************************************

Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137
856-415-9617, (fax) 415-9618

150,000 + Nurse-Reviewed & Approved Nursing Links

http://www.4nursing.com
http://www.inspirationalnursing.com
http://www.legalnursingconsultant.com
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Emergency Department Nurse Verbally Abused, Physician History Well Documented

See also: Medical, Legal Nurse Consultants, Clinical Nursing Case of the Week, Clinical Charting and Documentation, Nurses Notes, Courtrooms, Disability, Discrimination, Employment, Expert Witnesses, Informed Consent, Medical Malpractice, Nursing Practice Acts, Pensions, Search Engines, Torts and Personal Injury, Unemployment, Workers Compensation, Workplace Safety:

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Summary:  Official tolerance for verbal abuse and sexual harassment is approaching zero.  It is clear that both are still prevalent in healthcare settings today.  Enforcing and reporting instances of abuse are critical to an end being put to the situation.  In this case, a physician had a "history" of verbal abuse in the facility involved.  It was the documentation of previous events that made formal action and administration of a suspension feasible.

The physician berated the nurse for the way in which one of his patients was being handled.  He accused the nurse of "not doing her job" and giving the patient substandard care.

Specifically, he admitted making the statement that the nurse "Should get off her ass and that she was a wrench in the works, she was obstructing patient care."1

"Rothschild says that physical abuse is more publicly recognized than verbal abuse, the latter is just as potent a force in a person's life. Verbal abuse might not inflict the same bruises and scars that physical abuse does, but it does not occur without leaving its own marks."2

This was not the first time this type of verbally abusive statement had been made by the physician.  Complaints had been made and formally documented about his outbursts.

These attacks had been occurring with sufficient frequency to merit formal written warning by the hospital's Credentialing Committee.

This instance represents the exception, rather than the rule regarding abusive behavior on the job.

"The continued low profile of verbal abuse could be attributed to the idea that it is a subtler form of abuse and therefore more likely not to be taken seriously, Kesden says. "If you don't inflict a wound on someone, it is easier to be passed off."

Often, abusive behavior was learned by the abuser in childhood and cannot be overcome without therapy.

"If a person is raised in a house with verbal abuse ... there is a good chance he will bring that into a romantic relationship," Kesden said.

The first step in acknowledging a verbally abusive relationship is to admit that there is a problem. "The abuser has to recognize what he is doing," Rothschild says."2

Regardless of a behavioral pattern's origin, when it occurs on the job, toleration or inaction can set a dangerous precedent.  By not taking action on the spot or when safety allows, the stage may be set for future occurrences.

The physician's abusive and harassing behavior was clearly identified and reported.

"Harassment

Discriminatory harassment includes verbal or physical conduct designed to threaten, intimidate, offend, demean, or coerce; and may impair an employee's ability to do his or her job. Harassment may take on many forms such as:

• gestures, or physical acts
• slurs
• taunting
• verbal abuse or epithets
• comments or jokes
• displaying derogatory objects, cartoons, posters, drawings, or pictures
Harassment may also be any unwelcome or offensive conduct relating to an individual's race, color, religion, ancestry, national origin, sexual orientation, sex, age, disability, veteran status, political ideology, or other protected characteristics."3

Prior to the above outburst, it had been made clear that any further abusive behavior would result in a suspension of privileges at that hospital.

When the incident was reported, a suspension was handed down of no more than 30 days.  The physician appealed the suspension internally.  The decision to suspend was affirmed.

When it was clear that the suspension was going to be upheld, the physician filed suit against the hospital.  The hospital filed for and was granted summary judgement to dismiss.

The physician appealed.

Questions to be answered:

1. With documented evidence of abuse and previous warnings of future consequences, did the physician have grounds to appeal the decision?

2. In light of the history of abuses, did either the Credentialing Committee or the court arbitrarily or without merit decide that a suspension was appropriate?

To initiate filing a suit, typically no legitimate grounds are needed, just an attorney that will take the case.  It can literally be done at will.  It can be called "frivilous." It is a basic and constitutionally guaranteed right.

The physician regardless of his chances of succeeding had a right to appeal a decision that will deprive him of the right to practice.  A suspension would directly affect his ability to earn an income from consulting/treating patients.

The appeal could have been filed to make a point.  This could also have been done to further harass the nurse who would be called in to a deposition and subjected to interrogatories.

It is common for an individual to attempt to delay hearings that will result in a license suspension or revocation.  Whether the physician was looking to "buy time," further harass the nurse or if he actually thought he could "get off," procedures to do so are in place and available.

The likelihood of the decision being overturned, was slim.

It was to the nurse's advantage in this case that previous actions had been taken.  It was not the first time that abusive practices by the physician had been documented.

It is vital, that when a pattern of behavior is emerging that action be taken to document it.  If a nurse or patient or member of the healthcare team is abused, it needs be reported.

Frequently, abusive behavior is not.

This case example occurred in the Emergency Department.  It can happen in any unit or setting.

The Association of Operating Room Nurses offers the following guidelines:

"The best thing to do about a surgeon's abusive behavior is to confront the surgeon at the time the abuse occurs. This does not mean, however, that you should interrupt the surgical procedure. Immediately after the patient is out of the OR, confront the surgeon and let him know that his behavior is unacceptable and that you will not tolerate it. Tell the surgeon how the abusive behavior makes you feel.

Offer a comment, such as

When you berate me as you did during the surgical procedure, I feel very uncomfortable and distracted. This interferes with my ability to provide you the assistance you deserve.

Inform the surgeon that you will confront him immediately should another incidence of abusive behavior occur. Also inform your supervisor of the surgeon's abusive behavior, your confrontation with the surgeon after the surgical procedure, and your plan for continued confrontation. If the surgeon's abusive behavior occurs again, continue to confront this behavior each time it occurs. Consistency is essential. In addition, you should file a formal complaint to the medical staff committee through the appropriate channels in your facility. Finally, if this does not stop the abusive behavior--and as a last resort--you can press charges for slander and/or sexual harassment, if there are sexual tones to the abuse"4

Verbal abuse is both damaging and demeaning and treated similarly to sexual harassment in the workplace.  If you feel you have been the victim of any type of abuse, you need to be aware that rarely will it "just go away."

Whether it is a personal relationship or "on the job," the likelihood of a person changing their ways or stopping an abusive behavior is poor.

"SOLO emphasizes that the quicker a woman decides to get out of an abusive relationship, the better. Verbal abuse only escalates, like physical abuse, and the longer a woman stays in such a relationship, the deeper her self esteem sinks and the harder it is to get out of the relationship."2

It is a difficult situation for both the individual and coworkers that might be hesitant to step in.  It's crucial then for the individual to discuss the situation with a supervisor or someone they feel comfortable with.

A fatal trap to avoid is making excuses for the abuser.  Phrases like  "I deserved it" or "I made him angry" are common responses to abuse and are patently false.  There is never any excuse for abuse in the workplace or at home.

"Women do a lot of convincing to themselves, rationalizing about the relationship," Kesden says. Many women often try to justify the abuser's actions."2

A sad fact is that often abuse is occurring at home as well.  It compounds the problem and can be disabling when the problem is encountered at work.

The sooner action is taken, the sooner formal proceedings can be set in motion.  Taking initial action does not guarantee an immediate solution.  It may cause the abuse to escalate initially

This can deter many from reporting a situation in the first place.   It is this first crucial step that makes corrective action possible when there are recurrences.

Depending on the environment, pressure may be put on the nurse or physician to "make the problem disappear."  An administration may or may not be intimidated by the fact that physicians are sometimes viewed as the "money makers" of the hospital.  In this case, they were not.

Regardless of the cause or abuser, one outcome is inevitable.

If the problem is not dealt with, it will not go away.  It may signal to the abuser that it is "ok" to abuse if it is demonstrated that he can get away with it.  If no resistance is encountered it literally gives free license to pick other "victims."  It opens the door for abuse to get progressively worse.

The question you need to ask is this.  "If I'm getting abused today, how much worse can it get? Who will it be tomorrow?"
  Related Link Sections:

Abuse:
http://www.nursefriendly.com/nursing/directpatientcare/abuse.htm

Emergency Department Nurses on the Nurse Friendly
http://www.nursefriendly.com/nursing/directory/spec/ed.html

Psychiatric Nurses on the Nurse Friendly:
http://www.nursefriendly.com/nursing/directory/spec/psych.html

Sources:

1. RRNL 4 (September 1998)

2. Munoz, Rachel.  No date given.  Student.com.  Verbal Abuse Scars.  Retrieved June 6, 1999 from the World Wide Web: http://www.student.com/article/verbalabuse

3. Francis Hutchinson Cancer Research Center.  1995. Personnel Policy and Procedures Manual, Section 3-2. Harassment/Sexual Harassment.  Retrieved June 6, 1999 from the World Wide Web: http://www.fhcrc.org/admin/hr/pppm/p0302.htm

4. Association of Operating Room Nurses. September 1997, Volume 66, Number 3. Clinical Issues.  Retrieved June 6, 1999 from the World Wide Web:  http://www.aorn.org/JOURNAL/997/Septci.htm
 
 

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Send comments and mail to Andrew Lopez, RN


Created on June 6, 1999

Last updated by Andrew Lopez, RN on Monday, February 28, 2011

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Sample Nursing Care Plans — The Ultimate Internet Guide

Although nursing care plans often seem to follow a formula, each plan — just as each patient who needs that plan — is different. Classification activities of the North American Nursing Diagnosis Association International (NANDA-I) have been instrumental in defining nursing care plans, and the plans and tools offered online through various nursing sites and universities also lend a hand in developing the best nursing plans possible. If you are a nurse or a caregiver who needs help caring for a loved one or patient who suffers from a disease or disorder, these nursing care plans can provide you with unlimited resources.

The plans and tools listed below are not the only tools you can find on the Web. Google Books and other open source resources also carry materials that can help you learn more about care plans for specific diseases and disorders.

Sample Care Plans

1. Care Plans 123: This site has a resource library that contains only graded care plans and graded student nursing-related documents for a fee.
2. Care Plans And More: This forum-based list offers a few care plans categorized by psychological and physical disorders and cardiac disorders.
3. CarePlans: Careplans.com states that it is the #1 online resource for nursing assessment, planning, implementation and evaluation.

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Clinical Nursing Case Studies on: The Nurse Friendly

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See also: Legal Nurse Consultants, Clinical Charting and Documentation, Nurses Notes, Courtrooms, Disability, Elder Law, Expert Witnesses, Informed Consent, Medical Malpractice, Negligence, Nursing Practice Acts, Nursing Research, Personal Injury, Toxic Torts, Unemployment, Workers Compensation, Workplace Safety:

Editors Note: The urls to these cases are Permanent and Will Not Change. Feel free to link to any case you feel is helpful. We've been contacted by several schools who are using them as assignments for their nursing students, feel free to do the same. To host any of our cases on your website or reproduce them in your publications, please contact Andrew Lopez, RN.

Each case will be reviewed and supplemented with clinical and legal resources from the web. Legal Nurse Consultants and Nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material. If you have related materials and would like us to link to or use them as resources, kindly contact us.

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Current Case:

Physician Dismisses Nursing Assessments, Question of Nursing Advocacy.
Rowe v. Sisters of Pallottine Missionary Society, 2001 WL 1585453 S.E.2e – WV
Summary: The patient was involved in a motorcycle accident in which his bike fell onto and injured his left leg. When the nurses assessing the patient could not detect a pulse in that leg, an ominous sign of circulatory failure. The physician when notified chose to dismiss this fact and discharge the patient. The patient would return soon after with worsening symptoms that would require emergency surgery. Should the nurses have initially pressed for further action, treatment?
http://www.nursefriendly.com/041013

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See also:

Legal Eagle Eye Newsletter for the Nursing Profession:"Legal Eagle Eye Newsletter for the Nursing Profession was started in 1992 and has been published monthly ever since. Originally it was called Legal Eagle Eye Newsletter for Nursing Management, then changed to Legal Eagle Eye Newsletter for the Nursing Profession. The readers of Legal Eagle Eye Newsletter for the Nursing Profession are busy professionals in clinical nursing, nursing management, healthcare quality assurance and healthcare risk management. The newsletter focuses on nurses' professional negligence, employment, discrimination and licensing issues."

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Please choose from the following:

• Malpractice Cases By Date Posted (Thirty-one Cases Total)

• Malpractice Cases by Department: Emergency Department, Operating Room, Surgical

• By Type of Facility: Hospital

• By Topic:
  • Child Abuse,
  • Felony Crimes,
  • Informed Consent,
  • Nurse Abuse,
  • Nursing Documentation,
  • Organ Donation,
  • Reportable Crimes,
  • Restraints,
  • Sepsis,
  • Sexual Harrassment,
  • Sponge Counts,
  • Verbal Abuse

See also:
Legal Eagle Eye Newsletter for the Nursing Profession:"Legal Eagle Eye Newsletter for the Nursing Profession was started in 1992 and has been published monthly ever since. Originally it was called Legal Eagle Eye Newsletter for Nursing Management, then changed to Legal Eagle Eye Newsletter for the Nursing Profession. The readers of Legal Eagle Eye Newsletter for the Nursing Profession are busy professionals in clinical nursing, nursing management, healthcare quality assurance and healthcare risk management. The newsletter focuses on nurses' professional negligence, employment, discrimination and licensing issues."

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Using Case Study Methodology in Nursing Research by Donna M. Zucker:"The purpose of this paper is to illustrate a research method that may contribute a unique and valuable method of eliciting phenomena of interest to nursing. Case study method can be used as a creative alternative to traditional approaches to description, emphasizing the patient's perspective as central to the process. This manuscript will define case study method, and discuss various case study designs. Approaches and tactics from a variety of disciplines, and theoretical or philosophical perspectives are discussed with an emphasis on method and analysis. The bulk of the manuscript outlines the stages used in a case study of men with chronic coronary heart disease (CHD), as well as presenting a case study protocol. Implications for its usefulness in nursing research, practice, and theory generation are discussed."
http://www.nova.edu/ssss/QR/QR6-2/zucker.html

A Nursing Primer On The Law: Being Named In A Lawsuit, by Joe A. Flores, JD, FNP, MSN, CCRN, Malenursemagazine:"Being named in a lawsuit can be an extremely stressful event for any nurse. The litigation process can cause devastating damage to a nurse's self-concept and to the nurse's practice. In the past suing the hospital and the doctor were generally the usual manner to obtain relief for someone bringing a lawsuit. However, now more than ever, the new order in the health care arena has made the nurse an integral part of delivering care to patients. The nurse has been delegated more responsibility and is also more accountability for the actions of licensed and unlicensed staff. This role has provided for increased autonomy as well as increased accountability. To make matters more complicated, the nursing shortage and limited resources have been a factor in nurses being increasingly involved in medical malpractice lawsuits."
Jerry R Lucas, RN
MaleNurseMagazine.com
10510 South State Hwy 3
Deputy, IN 47230
Phone: 812-352-1293 cell: 812-701-9014
Jerry.RN@verizon.net
http://www.malenursemagazine.com/lawsuit.html

Nursing Malpractice: Protect Yourself. What to do when you’re the subject of a board of nursing complaint. American Journal of Nursing:"Q. I’ve just learned that a complaint against me has been filed with my state board of nursing. What should I expect? A. Complaints to a state board of nursing (BON) can be initiated by other health care providers, patients and their family members, and health care institutions. Once a complaint is lodged, an investigator—who may or may not be a nurse—is sent to the site to gather information about the incident. BON investigators can obtain and review medical records, drug logs, personnel records, and incident reports, as well as take depositions or call in potential witnesses for questioning. If the case concerns drug abuse or another matter pertaining to one’s physical fitness to practice, most states also have the right to ask you to have a physical examination conducted by your health care provider."
Lippincott, Williams and Wilkins toll-free at 1-800-627-0484
http://www.nursingworld.org/AJN/2001/dec/Wrights.htm

Nursing Malpractice: Implications for Clinical Practice and Nursing Education Janet Pitts Beckmann, Ph.D., R.N., Galen Press:"Protect yourself by reading this book! The increasing number of nursing malpractice cases is affecting clinical practice and nursing education. After describing a typical malpractice suit, the author details sixty actual cases, each categorized by the underlying cause of the malpractice, such as medication administration and equipment use. Also provides recommendations for reducing the occurrence of malpractice and improving nursing education."
Galen Press, Ltd.
P.O. Box 64400-WB Tucson, AZ 85728-4400 USA
Call toll-free: 1-800-442-5369 (1-800-4-GALEN-9) Fax: (520) 529-6459 Tel: (520) 577-8363 sales@galenpress.com
http://www.galenpress.com/00320.html

Nursing Malpractice by Patricia W. Iyer (Editor), Amazon.com:"A reference for attorneys and claims adjustors investigating a nursing malpractice claim. Covers the spectrum of the nursing process, from patient admittance to lawsuit, reveals typical ways in which nurses try to cover up their mistakes, and shows how nurses are caught in difficult positions between insurance company lawyers and hospital procedures. Details the defendant nurse's daily routine, whether as a surgical nurse or nurse-supervisor in a nursing home setting. Material is in sections on nursing practice and documentation; common areas of nursing liability, such as pediatric, emergency, critical care, and psychiatric nursing; and litigation of nursing malpractice claims. Specific topics include trial consulting, the role of the forensic economist in nursing malpractice actions, and today's health care environment. Includes a drug and chemical name index. Iyer is a legal nurse consultant and a medical surgical nurse expert witness.Book News, Inc.®, Portland, OR --This text refers to the Hardcover edition."
http://www.amazon.com/

Nursing Malpractice: What You Should Know, By Jennifer Larson, Nursezone.com:"If you think that the worst thing that could happen in a hospital is the accidental death or injury of a patient, you’re right. But sometimes sentinel events are followed by another dreaded event: a lawsuit. Do you know what you need to know to protect yourself from being sued for malpractice? Are you prepared in the event that you receive a letter from a patient’s attorney? Joe Flores, a nurse practitioner and practicing attorney, recommends that new nurses educate themselves as soon as they start their first nursing job. “I would strongly recommend that a nurse determine what the policies and procedures are at her individual facility and determine what type of preceptor program is in place,” said Flores, who works for a law firm in Corpus Christi, Texas."
NurseZone.com
12400 High Bluff Drive San Diego, CA 92130
Phone: (877) 585-5010 Fax: (866) 732-4535
E-mail: contact@NurseZone.com
http://www.nursezone.com/stories/SpotlightOnNurses.asp?articleID=9901

Nursing Malpractice Liability and Risk Management, By Charles C. Sharpe:"Students and professional nurses at any level of clinical practice will find this book to be a vital resource on the basic legal concepts and principles of malpractice, liability, and risk management, and their implications for the profession. The book also provides detailed strategies for dealing with these issues. The content is also highly relevant to practitioners in all other health care and legal disciplines that collaborate in the delivery of health care. Issues discussed include the expanding and evolving roles for professional nurses and the concomitant legal accountability and risk for liability, the increasing incidence of nurses named as defendants in malpractice lawsuits, anticipated changes in our health care delivery system, and breakthroughs in science and technology that will present new legal questions. The book also includes material on other important facets of today's nursing practice, including the growing phenomenon of tele-nursing, the essentials of malpractice insurance, and the legal significance of documentation and patients' medical records. It helps the reader identify the nurse at risk for a malpractice suit and the characteristics of the patient likely to sue. The appendices provide information on state laws concerned with access to medical records, a list of useful websites, a list of state boards of nursing, and a glossary of important terms."
http://www.goodreads.com/book/show/5673547-nursing-malpractice

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Nurses' Station:"The idea for the Nurses' Station Catalog was conceived in 1989. After searching the marketplace in response to customer inquiries, it became obvious that there were no catalogs of this type serving the nursing profession. To be sure, there were several catalogs offering nurse's uniforms and a smattering of professional items. But there weren't any catalogs at the time offering a range of gifts, clothing, professional items, name badges, shoes and scrubs for nurses. It took two years of hard work to gather samples and put a together a catalog of the most unique and high-quality items for nurses."
Nurses Station P.O. Box 388 Centerbrook, CT 06409-03881
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