Essay On Negligence And Malpractice

Negligence and Malpractice What Nurses to Know
Negligence and malpractice are terms that many use interchangeably, but the meanings are very different. Healthcare is one practice that has been in existence for centuries whether informally or formally. Since the first birth of any kind, the nurturing and caring of each other man or beast utilized the methods available to restore or maintain life. Since the 19th century, instructional school for nursing was established, streamlining the institution of health care today. In the previous centuries, caring for the sick was not the industry we know today. One did not worry about negligence and malpractice lawsuits, but today one has to be knowledgeable and aware of the implications of both negligence and malpractice in the 20th century practice of healthcare. This paper will explore the difference between negligence, and malpractice, and what one can do as humanly possible, to avoid being the subject of either. It will explore the importance of accurate and adequate documentation and how important it is for nurses to maintain Professional

Liability Insurance.
Negligence
Negligence is a term used to express lacking of care due and the care was rendered below the standard of practice or reasonableness. This expected standard of reasonable care is below the standard delivered by others providing the same type of care.
Who can be charged with negligence?

If a person commits a “tort a civil wrong committed to another person or their property and the person is a nonprofessional this is negligence.” (Guido, 2014) In the case of Thomas v. Sheridan (2008) a sheriffs’ deputy not trained in handling a prisoner properly, allowed the unrestrained prisoner to take possession of his weapon, fire a shot and take a nurse hostage, no harm ensued, but the courts found the Sheriff’s department was negligent in favor of the nurse. (Guido, 2014) Anyone including nonmedical personal can be negligent. Tort law violations based on “fault” is the most common violation seen in the health care setting. Even if you are not the negligent individual, if you are overseeing staff and you are the licensed personal you could be named in ones’ negligent suit and be in violation of malpractice because of your professional

status.
Malpractice
Malpractice is a negligence by a professional who failed to provide standard of care. This person is termed a tortfeasor a profession such as a “physician, nurse, accountant or lawyer commits a civil wrong.” (Guido, 2014) In the eyes of the court this skilled professional has provided below standard care deemed unreasonable, lacking of the implied skill and professional conduct. This lack of standard of care would include the allowance of others you supervise to provide improper care or conduct in a nonprofessional manner resulting in negligence and you the professional facing malpractice allegations.
Ethics and Lawsuits
Nursing homes have been and increasing target for negligence and malpractice lawsuits with an increase noted in the past decade. In an article entitled “Nursing Home Quality, Staffing, and Malpractice Paid-losses” by Zhao, & Haley (2011) a study from 2001-2005 using Medicare Cost Report data and Online Survey, Certification, and Reporting (OSCAR) tool found that nursing homes that have increased their register nurse staff ratio in reference to the nursing assistance ratio are less likely to experience malpractice losses. The issue of staffing in relation to increase lawsuits has long been a strong indicator for change, but continues to be a work in progress.
Ethics are a strong force behind nursing standards of practice, in an article entitled “Force-feeding of Detainees at Guantanamo Bay” on the American Nurses Association (ANA) (2015) website, one nurse took a stand. The prisoners refusing to eat at Guantanamo Bay had been force fed via tube for some six years and this registered nurse took a stand and refused to continue to participate in what was considered a violation of human rights. The Navy’s stand on the matter was originally to discharge the nurse, but with the support of the ANA sending a letter to the Navy’s Chief and then the Secretary of Defense this work place retaliation has been rescinded. Nurses are placed in difficult decision making circumstances many times in their career, but if it is ethically and legally wrong to carry out orders of higher command or medical personnel, the wise nurse will adhere to standard of practice and ethics. This adherence could possibly help the nurse avoid a malpractice lawsuit or have a legal defense of refusal to participate.
Communication and documentation
Communication is the exchange of information between two or more persons. This is something we do without thought, but the way we communicate has great implication in the world of health care. Communication needs to be in a way that both parties obtain a clear and concise exchange of information to be deemed effective communication. Documentation is official or written material that provides a record of information or evidence of occurrences. Communication and documentation go “hand and hand” in most arenas, but in the health care setting this is critical. Nurses must be diligent in their communication with their patients, the physician and other health care staff and documentation is the written proof of such. As nurses we often focus on the caring aspect of the profession, but when all is said and done, documentation provides the picture of the appropriate standard of care that was given. Nurses are multitaskers and must perform many task throughout a given day and recalling all necessary details without putting it in writing is impossible. Great care could have been rendered in a day, however if it’s not documented “it didn’t happen” by law.
Health care documents serve many important functions in the care provided to our patients. Forrester (2011) notes that documentation gives an account of the events of care to our patients, if serves as communication between healthcare professionals, it can provide data for research and a source of evidence in the case of legal action being filed.
Communication is also essential when dealing with ‘suit-prone” patients. Suit prone patients are those that are more than likely to file a lawsuit regardless of the care received. However, the way one communicates can make a difference, it has been stated that, "some people are going to get sued a lot more than others because of the way they communicate." (Suit-prone EP? consider communication style, 2012) Nurses must be keen to recognizing suit-prone patients and must exercise good communication skills when dealing with this population, it just might be the deciding factor in avoiding a lawsuit. This patient will display immature behaviors, not taking responsibility for their actions that have resulted in their life circumstances due to non-compliant with health care instructions given. The nurse needs to apply her good communication skills by showing by showing “empathy, attentiveness, praise and patience to prevent future lawsuits.” (Guido, 2014)
Nurses often wonder how much information is enough information. Forrester (2011) relates that documentation should be clear and concise, in correct chronological order, stating the events witness or performed by the documenter using terms medically acceptable, legible and understandable by others. The information should not contain derogatory statements, like “he appears sloppy drunk,” (Forrester, 2011) but should contain what the nurse observes or is told by the patient, “patient’s speech was slurred,” or the direct reference to a blood alcohol level as documented is acceptable. It is also acceptable to write patient states, “he drank a liter of vodka just two hours ago,” this is an objective acceptable entry. Nurses must be very mindful not to change documented information, but can amend entries that were performed by the documenter, without altering what has been previously stated, especially once a lawsuit has ensued. What is entered into a patient’s record could be the deciding factor if malpractice has occurred or not and could prevent the nurse and the institution from a long financial and stressful nightmare of trial and possible loss of licensure.
The prudent nurse will follow her institutions policy of documentation and procedure when providing care. In a case noted by Masoorli (2009) nurses infused total parental nutrition into a malfunctioning centrally inserted line even after repeated complaints by the patient and he died. Their negligent actions resulted in a multimillion dollar settlement, awarded to the patient’s family (as cited in Eisenberg, 2010). It is impossible to be one hundred percent perfect on all matters of health care and documentation, but if standards of practice and policy are in place and adhered to, patients will have a better chance of positive outcomes and nurses and facilities will have fewer losses related to negligence and malpractice.
Protecting yourself and License
Nurses must be proactive in protecting themselves against negligence and malpractice lawsuits. Reliance on your employers’ insurance for protection is a nurses lack of critical thinking applied to her practice. It has been passed around that nurses with insurance are more apt to be sued when issues of negligence or malpractice are made, but this is not the case. Nurses need the protection that having their own insurance provides. The institution’s lawyers have the interest of the facility they represent first place and the nurse may not be represented to her best defense. Your “inherent accountability means you, the responsible nurse must not stand by the notion that the facility that you are employed for provides you with exemption it is important to realize that this notion has changed and exemption is a fleeting law of protection. Employment by a “government, religious or charitable organization” (Guido, 2014) does not provide you immunity from being sued.
There are different types of insurance available to nurses with varying cost depending on which area of nursing you practice and the state. However, regardless of the cost it is still considered an affordable expense in respects to the practice you have chosen just for the piece-of mind if you are sued, and the thought of losing everything you have worked for including your career and personal possessions.
Nurses can obtain professional liability insurance that can provide protection if a suit of negligence is brought against them while guilt or innocence is being proven. Insurance policies contain many clauses and nurses must be prudent and have a clear understanding of the coverage they have. There are two primary ways of classification of insurance policies, claims-based, and occurrence-based. Claim-based is good only if a suit is filed by the courts while an individual has active insurance and there has been no lapse of coverage. Occurrence-based covers claims that are brought forth during the policy period and does provide coverage even if the policy has expired, but the claim period was during the coverage period. Occurrence-based coverage is the type of coverage that most nurses obtain and is most affordable, nurses can also obtain license protection insurance that is useful for claims brought forth by the board of nursing. These polices can be further defined as individual or employer based policies. Even if your employer does provide coverage, nurses need individual professional liability insurance of their own equivalent to their practice.

Nurses must be aware of what constitutes standard of care for their profession and be knowledgeable of the laws of the state, which they practice. The fact that no practice is feasibly at one-hundred percent at all times due to imperfection, our goal has to be at or above the standards of care. Having knowledge of negligence and malpractice, avoiding the dangers that lead to them with evidence based practice, good communication and documentation we can do what is humanly possible to be prepared when faced with dilemmas of ethical and legal proportion. We as nurses must be prepared, not leaving our financial well-being and career in the hands of others we must be proactive when in obtaining professional liability insurance for protection in the event of legal cases brought against us. Professional Liability Insurance is not an option, but a must for the critical thinking, practicing professional nurse.