As you probably know, allegations of professional negligence are possible against any nurse. As a nurse, you must conform your conduct to the overall standard of care; that is, what other ordinary, reasonable and prudent nurses would do in the same or similar circumstances in the same or similar community. If you work in med/surg nursing, then the standard of care becomes that of ordinary, reasonable and prudent nurses in med/surg nursing in the same or similar community. If you practice in the pediatric setting, your conduct is compared with other nurses in pediatrics. And the theory of personal liability holds everyone responsible for their own behavior, including negligent behavior. When you undertake a charge position, you have responsibilities to provide care to any patients you directly care for in a non-negligent manner. You also have responsibilities to ensure those nurses you manage are also providing non-negligent care to their patients. If professional negligence is alleged against you in the latter role, your overall standard of care would be compared with other nurse managers/charge nurses. The duty to manage your staff nurses does not require you to be aware of each and every possible injury that a patient may be exposed to because of staff nurses' negligence. Rather, the duty requires you to be aware of those foreseeable and unreasonable risks of harm that the patient might be exposed to if the staff nurse does not provide care as required (an act of omission) or provides care negligently (an act of commission). The duty to manage your staff also requires you to supervise nursing staff in a non-negligent manner. Negligent supervision might occur when, for example, you do not check on whether a nurse assigned to a patient that requires positioning on a regular basis is fulfilling that obligation and the patient develops several decubiti. The patient can file a suit alleging the nurse assigned to him to provide care was professionally negligent in not turning him as ordered and also can include you as the charge nurse for not properly supervising the staff nurse. Or, the same patient may allege, if he can prove it, that you delegated his care to this nurse and she was not competent to provide the care he needed. A nurse manager may also face a negligent supervision allegation for not adhering to a policy governing patient care that results in an injury to the patient. Remember, then, that your duty as a charge nurse is not a higher duty of care in comparison with the staff nurses you manage. Rather it is a different form of liability, with different duties. As a nurse manager, one of the best ways you can avoid potential liability for your role is to underscore the importance of preventing foreseeable and unreasonable risks to patients. Following a sound risk-management approach can do wonders to avoid such risks. Open lines of communication with your staff, as well as with patients and their families, is essential. Foster trust and respect for and with your nursing colleagues. Respond to patient and family concerns promptly and sincerely. Know the strength and weaknesses of your nursing staff and assign and delegate patient care based on the staff's strengths. Provide additional orientation and supervised patient experiences for those who need to improve their patient care skills. Last, but by no means least, don't shy away from the charge nurse/nurse manager role. Yes, the liability is different, but the role is a challenging and interesting one that can bring satisfaction in ensuring non-negligent care is being given to the patients on your unit. Editor's note: Nancy Brent's posts are designed for educational purposes and are not to be taken as specific legal or other advice.
