Legally speaking: Care coordination and management

By | 2015-11-17T16:50:02-05:00 November 17th, 2015|0 Comments

If you are a nurse fulfilling the role of care coordinator, you know the position is complex due to changes in the delivery of healthcare, including a looming RN shortage, increasing numbers of high risk and vulnerable healthcare consumers and the high cost of providing quality care to patients.

Although nurses have been at the forefront of coordinating patient care for healthcare consumers and their families for many years, the care coordination role is unique. According to the Agency for Healthcare Research and Quality, it is a team-based model designed to evaluate and meet the clinical needs of patients and their families and, at the same time, help the patient effectively and efficiently navigate the healthcare system.
Members of the team that you work with can vary, depending on your facility, but the nurse manager is an essential member with whom you collaborate.

Regardless of these changes, care coordination is an essential role for RNs. In its 2012 Position Statement, Care Coordination and Registered Nurses’ Essential Role, the American Nurses Association describes the RN’s role as “integral in the care coordination process” to improve the quality of patient care while “stewarding the efficient and effective use of healthcare resources.”

The RN’s unique role also demands the nurse serve as a role model and leader in developing cooperation among and between all those healthcare providers who are involved in the coordination of patient care.

Legal liability

Care coordination brings with it age-old principles of legal liability for all those involved in the care coordination process. One such principle under negligence and professional negligence is that everyone is responsible for their own behavior, including negligent behavior. As a result, it is difficult, if not impossible, to shift the liability for a patient injury or death to another. Liability for a patient injury or death may be shared among several defendants, but a unilateral shift to another is rare.

As a result, the RN coordinator, the physician, the physical therapist and all others working together to coordinate a patient’s care must be responsible for their own practice and judgments by adhering to their respective standards of care and standards of practice.

A second legal principle applicable to the RN specifically is that of negligent coordination. Should the RN care coordinator not perform his duties in this role as other RN care coordinators would in the same or similar circumstances in the same or similar community, the nurse may be found liable for those omissions or commissions if it can be proven they directly contributed to a patient injury or death.

Third, the ANA clearly stated in its Position Statement that care coordination “is not a delegated activity.” Rather, care coordination is part of an RN’s independent scope of practice. Delegation of the responsibilities inherent in care coordination would be inconsistent with the RN’s professional role and quite likely state nurse practice parameters regulating the delegation of care to others.

Care  coordinator skills

Care coordination also requires specific skills and educational preparation. The ANA’s Position Statement lists some of these requirements: timely referrals, communication and counseling expertise, cognitive decision-making and whatever else it takes “to develop and implement an interprofessional plan of care that utilizes each healthcare consumer’s and caregiver’s unique resources, needs and preferences.”

  • If you already are in this role and have the skills and educational preparation to undertake this role in a new form, you know what is expected of you and what you have undertaken. If, however, you are about to assume the role of care coordinator for the first time, some things to remember include:
  • Be educationally and experientially prepared, either through an acceptable and comprehensive certificate program or a formal educational program;
  • Know your state nurse practice act and rules governing delegation, scope of practice and how professional conduct is defined, especially when working with other healthcare providers;
  • Ensure that your professional liability insurance policy provides coverage for your role as care coordinator in your practice setting;
  • Know the strengths and expertise of your team members;
  • Make appropriate decisions to bring in another healthcare provider or service for the patient’s care when needed;
  • Be an advocate for the healthcare consumer and his family;
  • Utilize resources available to you within your practice setting;
  • Know the community in which you work and its resources;
  • Remember that health promotion and teaching of the patient, the family and the community is an ever-present core component of care coordination.

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About the Author:

Nancy J. Brent, MS, JD, RN
Our legal information columnist Nancy J. Brent, MS, JD, RN, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.

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