Nursing Assistants Leave Client Alone, Patient Receives Second Degree Burns During Bath.
Molden v. Miss. State Dept. of Health, 730 S.2d 29 -MS (1998)
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Summary: Registered and Licensed Practical Nurses frequently delegate responsibilities and tasks to Certified Nursing Assistants and Unlicensed Assistive Personnel. It is clearly recognized that they are responsible for the actions/inactions of those they supervise. In this case, two nursing assistants recognized injuries to a patient while giving a bath. When they failed to notify the nurse of the injuries, they would be reported and lose their certifications.
The patient was a long resident in a nursing home facility, admitted for long term care treatment. As part of her routine the resident on the day in question was to receive a whirlpool bath from a Certified Nursing Assistant. The patient was transported by an assistant to the bathing room. Once the patient was in the whirlpool the second assistant left. The two nursing assistants working under the "supervision" of an LPN.
"Licensed nurses (Registered Nurse/Practical Nurse) within the scope of their practice are responsible for all nursing care that a client receives under their direction. Assessment of the nursing needs of a client, the plan of nursing actions, implementation of the plan, and evaluation of the plan are essential components of nursing practice. Unlicensed personnel may be used to complement the licensed nurse in the performance of nursing functions, but such personnel cannot be used as a substitute for the licensed nurse."2
While preparing the bath, the nursing assistant "tested" the water with a double-gloved hand. Assuming it was the correct temperature the patient was placed in the bath. The CNA realized at that point that some supplies were missing that were needed to bathe the patient. The lone CNA stepped out of the room to obtain more supplies leaving the patient alone for several minutes.
During the bath the patient did not complain of pain or give any obvious signs of distress. The assistant continued with the bath. When the other assistant returned they took the patient out of the bath and prepared to take her back to her room. At that point the "transporting" nursing assistant noted that the patient's foot was "bleeding." It would turn out that patient's legs were in fact peeling from scalding second degree burned received during the bath.
Both of the CNAs noted and agreed that the patient had been burned. They also discussed that it should be reported to the nurses on duty. The nurse who had given the bath stated a report would be given to the nurse. This was never done.
The other CNA that transported the patient back to the room simply reported to the nurse that the "patient was ready" for the day's dressings/treatments.
When the nurse went in to do the treatments, she noted the patients scalded extremities and immediately reported both the aides. As a result the Department of Health (which issued certifications) was contacted and revoked the licenses of both CNAs.
Their conduct, it stated, was grossly negligent and resulted in serious injury to the patient.
The aides would appeal.
Questions to be answered:
1. Was the accepted standard of care expected of a Certified Nursing Assistant observed by the two persons in their handling of the patient?
2. Was the patient placed in unnecessary jeopardy from the time the injury was noted to the time the nurse discovered the incident.
3. Could the nurses on duty have also been held liable for the actions/inactions of the nursing assistants?
It could be reasonably expected that a nursing assistant would recognize obvious signs of injury such as "bleeding" and "peeling skin." In this case it was noted by the assistant when the patient was taken out of the bath.
The standards of practice would clearly dictate that "any change in condition" be reported to the nurse. In this case, an injury such as a burn where there was clear evidence of tissue damage was should have immediately been reported.
By not reporting the incident at all, the certified nursing assistants delayed treatment the patient's burned extremities. In a patient that already has skin damage, this inaction increased the risk of additional pain, tissue destruction and infection.
Had the incident been reported to the nurse on duty, the burns could have been assessed and treated promptly. Instead, the patient was allowed to "suffer" until discovered by the licensed practical nurse coming in to perform treatments.
The actions of the Certified Nursing Assistants put both the patient and the nurses supervising them in jeopardy.
It is ultimately the responsibility of the nurse, to monitor the safety of the patient. This includes when care is being given by a nursing assistant or other unlicensed assistive personnel under their supervision.
The family of the patient when/if initiating a lawsuit, would be well within their rights to ask:
1. Where was the nurse when the bath was being given.
2. Why wasn't the patient observed or checked on following the bath.
3. What training did the certified nursing assistants have?
It is the responsibility of the Nurse to be sure the assistants working with her patients are competent in their duties. When this is not the case, as soon as it comes to light, a duty is owed to the patient to correct the situation.
Even though the nursing assistants were working with the patient at the time, both they, the nursing staff and the facility could be held accountable to the patient's injuries.
Regardless of corrective actions that are taken, the nurse is still held responsible for any incidents that can occur.
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Sources:
1. 40 RRNL 2 (July 1999)
2. Oklahoma Board of Nursing Guidelines. 1993. "Delegation of Nursing Functions to Unlicensed Persons." Retrieved September 26, 1999 from the World Wide Web:
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Send comments and mail to Andrew Lopez, RN Created on September 20, 1999
Last updated by Andrew Lopez, RN on Wednesday, December 28, 2011
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