I am working in SICU. Recently, I was in charge of the unit and the previous charge nurse assigned a post open heart patient with IABP to a nurse who has no formal orientation to IABP and never attended a class. I told that nurse that I would take over the case for patient safety. The nurse hesitated but eventually gave me the patient. I told my manager not to assign the same nurse a patient with IABP because he needed to be oriented and to take a class. I was recently off. When I got back to work (less than a week later) the same nurse was working with a post open heart patient with IABP. No class was taken and no orientation was given. Am I being paranoid, or is my belief that a patient should only be taken care of by qualified personnel correct?
Nancy Brent replies:
One of the cardinal rules in professional liability avoidance is that a nurse who cares for any patient must be competent, skilled, and experienced in the care of the patient. If the nurse undertakes the care of a patient and is inexperienced, not skilled, and/or not competent to provide the care needed and an injury occurs, the nurse can be held liable for the injury.
This same analysis would apply to a charge nurse who assigns a nurse not capable of caring for a patient non-negligently when it is clear the assigned nurse is not competent to care for the patient. Likewise, if a nursing staff member is aware that a fellow nurse is not capable of caring for a patient and does nothing to try and rectify the problem, he or she may face liability as well.
Whether one has had orientation or not, when a patients condition requires a nursing assessment and the intervention required does not occur, liability can ensue as illustrated in the recent case, John Doe v. Anonymous Hospital (2002-NC Superior Court) (reported at nso.com/case-studies/article/146.jsp).
In 1992, Doe underwent a laminectormy with a bone graft, and metal instruments were installed. In 1997, Doe had surgery for decompression and the removal of the metal instruments. The surgery went well, and the patient could move both of his arms and both of his legs in the recovery room. He was then transferred to an orthopedic unit of the hospital.
A nursing assessment was done, and the patient told the nurse doing the assessment that he had pain and numbness in both feet. Nursing notes recorded later indicated that the patient had weakness in his legs. During the afternoon and evening, the patient complained to several nursing and hospital staff members about severe numbness, burning and tingling, and an inability to move his legs. Nursing staff did not contact the physician regarding these changes.
When the physician examined the patient, he confirmed the patient could not move his legs. An MRI was done, and surgery was immediately performed. The patients diagnosis was cauda equina syndrome secondary to spinal cord compression due to a hematoma. The surgery alleviated the pressure but permanent nerve damage had occurred. Subsequent, intensive OT and PT did not change Mr. Does functional status.
As a result of the permanent nerve damage, the patient was unable to walk independently, had no voluntary control of his bladder or bowels, and suffered from intractable pain. These are but a few of the results suffered by Doe due to the nurses failure to promptly notify the physician of the serious changes in his condition after surgery. Had the nursing staff done so, Doe would not have suffered any permanent neurological injuries.
The case settled for $1,360,000.
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.