Can a nursing supervisor be held responsible for the action of nursing staff?
Nancy Brent replies:
Explaining which healthcare provider can be held liable for his or her actions, and possibly those of others, is beyond the scope of this column. It would be helpful for you to review some of the responses concerning a nurse supervisors responsibilities and liability that have been posted in this column in the past.
Sometimes reviewing a decided case can help illustrate some of those issues. For example, in Hohenleitner v. Quorum Health Resources, Inc., 435 Mass 424 (Massachusetts Supreme Court 2001), Ms. Hohenleitner experienced severe angina pain at home shortly after midnight and dialed 911. She was taken by ambulance to the ED of Quincy City Hospital. Upon her arrival at about 12:35 AM, she was taken into a treatment room and triaged by an RN. The RN administered oxygen, placed the patient on a cardiac monitor, and left the patient in the treatment room alone. Although the ECG later indicated the patient was suffering an MI, the patient did not see a doctor until 1:17 AM. While being interviewed by the physician, the patient went into cardiac arrest and experienced a second arrest later that morning. Although the patient survived the arrests, her heart was irreversibly damaged.
Ms. Hohenleitner filed a suit against Quorum Health Services, Inc., alleging that the triage nurse, who was employed by the city of Quincy and working in the ER, was negligent, and her negligence caused the injuries to the patient/plaintiff. At the time of the injury, Quorum operated the hospital under a written contract with the city. Briefly, Quorum was to act as the manager of the hospital, which included supervising and managing the day-to-day operations of the hospital. Quorum had specific authority for the supervision and management of all employees in the hospital, which included determining the number and qualifications of the employees need in the hospital departments, employee in-service training, and employee staffing. Therefore, the theory went, Quorum was vicariously (indirectly) liable for the plaintiffs injuries due to the triage RNs negligence.
The trial court returned a verdict in favor of the plaintiff against Quorum due to its obligations and duties to control the manner in which the triage RN provided treatment to patients in the ED. Quorum filed a motion for a judgment (in its favor) notwithstanding the verdict against it, which the trial judge granted. Ms. Hohenleitner appealed that determination to the Massachusetts Supreme Court.
In granting Quorums motion and thus granting a judgment in its favor, the Court discusses many issues of agency law, vicarious liability, and of course, the contract between the hospital and Quorum. During the trial, one of Quorums employees, who acted as the director of the hospital, testified that she had no authority to change the clinical efficacy of what was being done for a patient. In short, Quorum had no responsibility for patient care decisions.
In fact, the director testified concerning the hierarchy of supervision of the ED. A staff nurse was to report to a charge nurse (which was the position the ED nurse held who cared for the patient/plaintiff in this case). The charge nurse was responsible for a specific shifts coverage activities. The charge nurse, in turn, reported to a nurse manager (responsible department head for the ED regardless of shift). The nurse manager reported to the associate director of nursing who then reported to the director of nursing. The director of nursing was to report to the associate director for patient care who was a Quorum employee. That person reported directly to the director of the hospital, also a Quorum employee.
In short, Quorum had no liability for the injury sustained by the patient/plaintiff. Rather, because the nurse was an employee of the hospital, the hospital (and the triage RN) would have been the appropriate defendants. Had the triage RN consulted with any member in the nursing hierarchy concerning the patients care, and had that member or members also been negligent in their respective supervisory duties concerning this patient, they, too, may have been named in the suit.
Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.