What is the legal implication for a nurse practitioner who is educated and trained in adult primary care but whose background (as a staff nurse) is in the ED working in an acute care setting such as a hospital? I also had lots of clinical training in the hospital during the nurse practitioner clinical rotation.
Nancy Brent replies:
Your question is unclear about the exact legal implication(s) you are asking about. However, I can make some general comments about nurse practitioners who work in a hospital setting. As you probably know, their practice is governed by the hospitals staff bylaws, which include required qualifications and experience for the position (e.g., specialty certification) and policies about the patients with whom the nurse practitioner will work and with which physicians the nurse practitioner will collaborate.
The state nurse practice act and other applicable state laws also impact a nurse practitioners practice. Staff bylaws are normally in conformity with these regulations. Additionally, standards of practice as set forth by professional nursing associations also must be addressed.
Insofar as legal liability goes, this topic is beyond the scope of this column. However, one case can be reviewed for an idea about how one Florida appellate court handled a nurse practitioners care of a patient in a physicians office.
In Seigel v. Husak (2006), a nurse practitioner and the physician with whom she worked were sued over the care the nurse practitioner provided in the physicians office. The patient was seen in the office for injuries sustained at work. The nurse practitioner examined the patient, made a nursing diagnosis, ordered treatment, and documented her care, including the fact that there were popping sounds in each shoulder. The nurse practitioner saw the patient several more times, and the patients condition improved.
The physician did not regularly review the nurse practitioners documentation and care of the patient, as required by Florida law and their practice agreement. At one point, however, he did document that he agreed with the nurse practitioners diagnosis and treatment.
But when the patient consulted with an orthopedic surgeon, it was determined he needed reconstructive surgery on the biceps of both shoulders. The surgery did not yield 100% results. It was the surgeons opinion that if the patient had seen him within 1 1/2 weeks of his injury, his chances for a full recovery would have been better.
The patient sued both the nurse practitioner and the physician, and the trial court awarded damages of $1,848,068 against both defendants. The nurse practitioner asked the court to grant her a verdict in her favor despite the judgment. Her motion was denied. She appealed that decision.
The appellate court sent the case back to the trial court and ordered it to enter a judgment in favor of the nurse practitioner. It opined that a physician is responsible for directing the specific course of medical treatment when working with an advanced practice nurse. In this case, he failed to do so. This failure resulted in the patients worsened condition for surgery. The physician, then, bore full responsibility for the worsening condition and for the monetary verdict for the patient.
* Siegel v. Husak, No. 3D042310, as reported in 47 NLRR 6 (2006).