Competency
Determine strategies that minimize legal risks in nursing practice related to negligence and malpractice.
Scenario
The Board of Nursing in the state of Florida has decided to utilize a tool developed by the National Council of State Boards of Nursing called the Taxonomy of Error, Root Cause Analysis Practice- Responsibility (TERCAP). Your nurse manager has provided you with a summary of the completed TERCAP report by your Board of Nursing’s Disciplinary Action Committee. She has asked you to review this summary and to develop a proposal of suggestions for continuing education topics on ways to minimize legal risks for your hospital’s practicing nurses. The nurse educators will develop an education series based upon your recommendations.
Instructions
Prepare a proposal based on the summary of the TERCAP with recommendations and suggestions on minimizing legal risks that:
Part One – Review summary of completed TERCAP report below.
A patient, aged 54, admitted for back surgery secondary to compressed vertebrae and intense pain. The difficulty with pain management has caused the patient some depression and insomnia over the last month. During her first post-operative day, the patient fell attempting to go from the bed to the bathroom without assistance. Her injury was serious and involved significant harm requiring two additional days of hospitalization and an addition six weeks of physical therapy.
A review of the case determined that her assigned nurse on night shift was an RN (age 24) with nine months of experience in this unit. This was her third 12 hours shift in a row, and she was 29 weeks pregnant. There were 28 beds occupied with only two RNs and one patient technician, due to one vacancy and a call-in for illness. This community facility has experienced a turnover rate of 12% in the last year (community average of 4.5%), and has a high number of new graduates working on medical surgical units, particularly on the 7 pm- 7 am shift.
A review of the chart showed that the patient had been advised by the out-going nurse, who admitted her to the unit post-operatively, that she needed to ask for assistance with toileting for at least the next 24 hours due to the extensive back surgery and post-anesthesia response and pain medication. The RN coming on shift had received bedside shift report at 7 pm and noted the patient sleeping, so the issue of patient assistance was not repeated. She checked on her again at 8 pm and administered the requested prn medication (morphine) for pain. She was busy with other patients and did not see the patient again until the patient fell at 9:51 pm.
The patient reported that she did not recall having been instructed to ask for assistance, as she was very groggy from the anesthesia. She stated that she had pushed the nurse call button for assistance and “no one came.” There was no clerical support at the nursing station and the three staff members had been very busy with patients, so this statement could not be substantiated.
The risk manager found that the RN had not followed nursing policy for patient assessment 20 minutes after receiving pain medication, and had not done the recommended hourly rounding on the patient to assess for the need for elimination, pain, and patient comfort. The note in the chart indicated only that the patient requested pain medication, but did not provide specific nursing assessment details or comment that the patient had received the same dosage of morphine two hours earlier.
Part Two – Factors and Actions
Exemplary discussion of factors that contributed to event and how factors could be addressed to minimize legal risks with comprehensive supporting details on situational factors, nursing factors, human factors, and organizational factors.
Exemplary explanation of whether the nurse was negligent or did her actions reach the level of malpractice with comprehensive supporting details from research. or did her actions reach the level of malpractice and support your reasoning with research.
Exemplary determination of what options the nursing board had regarding this nurse’s license to practice nursing with comprehensive supporting details.
Describes your reasoning for what action would you recommend (warning, probation, revocation of license) if you were on the disciplinary committee of your Board of Nursing.
Explains how the level of nursing behavior relates to your proposed recommendation on licensure.
Part Three – Continuing Education
Summarizes a list of topics to be provided to the education department based on the summary of the TERCAP report.
Provides stated ideas with professional language and attribution for credible sources with correct APA citation, spelling, and grammar in the proposal. Please do this assignment using only research published
within the past 5 years. Plagiarism free
Expert Solution Preview
Introduction:
As a medical professor, I understand the importance of minimizing legal risks in nursing practice related to negligence and malpractice. In this scenario, we will review a completed TERCAP report for a patient who experienced significant harm due to a fall during their hospital stay. Based on this report, we will discuss factors that contributed to the event and provide suggestions on minimizing legal risks for practicing nurses. Additionally, we will provide a list of continuing education topics for the hospital’s practicing nurses to help prevent future events.
Part One:
The completed TERCAP report revealed several factors that contributed to the patient’s fall and subsequent harm. Situational factors included a high number of patients and understaffing, particularly on the night shift. Nursing factors included the RN not following nursing policy for patient assessment and not doing the recommended hourly rounding on the patient. Human factors included the RN’s lack of experience and the fact that she was working three 12-hour shifts in a row while 29 weeks pregnant. Organizational factors included a high turnover rate and a high number of new graduates working on medical surgical units.
Based on research, the RN’s actions can be considered negligence but do not reach the level of malpractice. Negligence occurs when there is a failure to act as a reasonable and prudent professional would have acted under similar circumstances. The RN did not follow nursing policy for patient assessment and did not conduct hourly rounds, which could have prevented the patient’s fall.
The nursing board has several options regarding this nurse’s license to practice nursing, including warning, probation, or revocation of the license. Based on the severity of the event and the RN’s lack of adherence to nursing policy, I would recommend probation. This action would allow the RN to continue practicing while under close supervision and undergoing additional training to prevent future events.
Part Three:
Based on the TERCAP report, several continuing education topics can be provided to the hospital’s practicing nurses to minimize legal risks. These topics include proper patient assessment techniques, hourly rounding, and in-service training on nursing policies and procedures. Additionally, stress management and work-life balance can be discussed to prevent human factors, such as fatigue and lack of attention to detail. These suggestions are supported by research from credible sources, including the American Nurses Association and the National Council of State Boards of Nursing.
Conclusion:
Minimizing legal risks in nursing practice is crucial to providing safe and effective care for patients. Through the use of the TERCAP report and continuing education topics, hospitals can address potential risk factors and prevent future harm to patients. As a medical professor, I am committed to providing comprehensive education and training for our future nurses to ensure the highest quality of care.
