Psychiatric nurses have a duty to protect patients by preventing self-harm and harm by others. They do this by closely monitoring behavior and stepping in when needed, all while following legal and policy guidelines.
In the case below, a patient sued a hospital and a psychiatric RN, alleging she was improperly restrained during admission. The question in this case is whether the RN overstepped while acting in the patient’s best interests.
What happened
A female patient was admitted to a psychiatric unit after walking into traffic, which was deemed a suicide attempt. Upon admission:
- She refused to remove her necklace for a skin check.
- She became agitated and belligerent toward staff.
- She kicked and attempted to bite staff members.
- She refused to follow the nursing staff’s directions.
- She refused oral medication (Ativan).
A male psychiatric RN physically subdued her for about two minutes. Staff administered an injection of Ativan, and the patient's necklace was removed. The RN filed a “significant event” incident report.
Patient files lawsuit
The patient sued the hospital and the RN. In her complaint, she alleged:
- When admitted, she wasn't an immediate danger to herself or others.
- The RN used excessive and unreasonable force, which caused significant injuries and damages.
Her legal claims included:
- Negligence
- Gross negligence
- Wanton and willful misconduct (due to the RN’s alleged improper training and hiring)
- Assault and battery
The patient didn't provide an expert witness to support her allegations.
The defense’s response
The RN and hospital filed a Motion for Summary Judgment, arguing:
- The incident stemmed from a professional nurse-patient relationship.
- The nurse’s actions involved medical and nursing judgment.
- The case required expert testimony to establish the standard of care.
They included in their filing:
- The RN’s incident report
- A doctor’s report related to the patient’s care
- A Department of Health and Human Services (DHHS) policy on restraints and seclusion, which supports restraint if a patient is behaving violently or destructively or is refusing treatment
The patient argued her case was based on ordinary negligence, claiming any lay juror could determine that the RN used unreasonable and excessive force. She also noted the surveillance video hadn’t been released and believed it would show she wasn’t a risk to herself or others.
The courts weigh in
The trial court granted the defendants’ summary judgment, ruling:
- The surveillance video would not be relevant to her claim, which she based on ordinary negligence, because the incident was part of a professional relationship.
- How the patient was restrained involved medical judgment.
- An expert witness was needed to assess the nurse’s conduct.
The appellate court upheld the trial court's ruling and affirmed that the video would not change the classification of the claim to ordinary negligence.
What to learn from this case
1. Know the legal definitions
- Ordinary negligence measures the conduct of an ordinary person. Example: A driver runs a stop sign and causes an accident.
- Professional negligence involves the actions of a licensed professional — such as a nurse. When a patient alleges an injury or damages, a nurse’s conduct is measured against what another reasonable nurse would do in similar circumstances.
2. Lawsuits can lead to board action
- In a lawsuit, patients may allege both types of negligence; the court decides which standard applies.
- A judgment against you for ordinary or professional negligence can trigger disciplinary action by your board of nursing.
3. Proper documentation helps everyone
- Incident reports are a critical part of risk management. They help your facility assess patient care and your role in an incident.
- Document adverse patient care incidents accurately and per your facility’s policies.
- Know your restraint policy, use sound judgment, and stay up to date on current standards.
Courts often treat restraint decisions as professional judgments, but a misstep can result in a lawsuit and other consequences. Be consistent, follow policy, and document clearly because your actions will be scrutinized in a lawsuit.
