The Legal issues

Negligence is the area of the civil law where the plaintiff brings action against the defendant. As defined by Staunton and Chiarella (2004, p.36), “The cardinal principle of negligence is that the party complained of should owe to the party complaining a duty to take care, and that the party complaining should be able to prove that he has suffered damage as a consequence of a breach of duty.”. In order for a patient or the family members to be successful in a negligence action against a doctor, nurse or respective employer, there are specific elements or facts that must be established by evidence. These are: a duty of care owed to the patient, that the defendant has breached that duty, and harm or injury to the patient was caused by the breach of duty (Tingle & Cribb, 2002).

Duty of Care

A nurse owes a duty to a patient, where there is a nurse-patient relationship that creates that duty (Corcoran, 2000). Duty of care protects individuals from the risks and foreseeable injury resulting from factors within the organisation’s control. (Nurses Board of Western Australia, 2004). The existence of duty of care has already been established in this case study, and a nurse owes the client a special duty of care based on the establishment of a nurse-patient relationship (Mahlmeister, 1999). When Nurse Z accepted an assignment to care for Baby X, a legal duty is usually established (Ganschow, 2002). Doctor Y, by her profession, also owed a duty of care to her client.

Breach in duty of care

Breach in duty of care occurred when both Nurse Z, Nurse E, and the doctor owed the duty of care to Baby X. When suspecting that the prescription might be wrong, Nurse Z needed to fulfill the duty of care by performing nursing intervention in accordance with recognized standards of practice and within own scope of practice, consulting and clarifying any interventions that appear inappropriate with the relevant members of the health care team (ANMC, 2006). Nurse Z did not follow the protocols to check thoroughly with other health care professionals such as the pharmacist, other more experienced Doctors. When Nurse E was approached by Nurse Z to countercheck the dose of medicine, she did so by physically checking the medicine with the written order from Doctor Y. This was not the expected standard of care. When Nurse Z expressed that the treatment will endanger the patient’s life, a reasonable and prudent nurse should exercise due diligence to ensure that the order by Doctor Y was appropriate. There is a clear standard established in all health care settings to deal with disagreements with physicians’ orders, and it was not exercised. Thus, all the parties involved in this case had breached the duty of care.

Harm caused

In this case study, Baby X suffered from brain damage as a result of the infusion of Dextrose 50%. Here, there is a direct or causal relationship between the breach of duty that is claimed, and the injury that is alleged to have resulted from the breach (Ganschow, 2002). Compensation will be awarded in this case (Staunton & Chiarella, 2004). This may take into account the loss of quality of life and loss of bodily functions. According to civil law, Baby X’s parents can sue up to six years after Baby X has turned eighteen.

Q 2. Duty of care from the two nurses’ perspective

Responsibility and Accountability

Every nurse should have the knowledge and skill expected of them, to practice according to the nursing standard of care (Mahlmeister, 1999). They are legally accountable for patients in their care, and have an absolute duty to take positive action to prevent any harm to them.

In this case, there are two possible reasons that resulted in the mistake of Nurse Z giving an infusion of Dextrose 50% to baby X instead of Dextrose 5%. Firstly, it could be due to a lack of knowledge: she did not know that the dosage ordered by Doctor Y could cause fetal damage to a baby. The other reason is due to the professional hierarchy within the modern health care system. Nurses have no authority to change doctors’ orders, yet they have no legal right to refuse to carry out the medical instructions, even if they object to them (Thompson, Melia, & Boyd, 1994 as cited in Nolan & Hazelton, 1995). However, for the benefit of the patients, a nurse has a right, and a professional and legal obligation to question a doctor’s orders, if he or she believes that the treatment ordered is medically inappropriate or incorrect (Staunton & Chiarella, 2003). Any objections must be documented.

The nurse is always accountable for the outcomes of his or her actions in carrying out nursing duties (Mahlmeister, 1999). Thus both Nurse Z and Nurse E have the ultimate responsibility to ensure Baby X’s safety. By merely ensuring that the right patient was given the right drug, according to the right dose ordered by the Doctor, at the right time as to when the drug was to be given, and via the correct route, does not mean that both nurses were doing what a nurse should do. Both nurses must remember that the basis of the duty of care was to ensure that the nursing care patients received were given with autonomy, beneficence, non-maleficence and justice (Nolan & Hazelton, 1995).

Nurse Z and Nurse E must also be able to recognise the signs and symptoms in the baby that signaled that something was wrong when Dextrose 50% was infused. There should be regular monitoring of Baby X’s condition and the Doctor must be alerted when the baby’s condition was deteriorating. In this case study, no one realized that anything was wrong until Baby X had a cardiac arrest and subsequently suffered brain damage from the incorrect infusion of Dextrose 50%.

Principle of Beneficence

Nurse Z should be assertive when clarifying the dosage, and in obtaining additional medical advice. Doctor Y told her that she has checked with Doctors A, B, and C. To avoid being negligent, and to check if Doctor Y was lying, Nurse Z could check again with Doctors A, B, or C whether Doctor Y had consulted with them about administering Dextrose 50% to a baby. She could also escalate the matter to more experienced doctors. Alternatively, Nurse Z could consult the pharmacist to clarify and resolve the conflict over the drug dosage. If the conflict is still unresolved, her supervisor or senior nurses could be the best people to help Nurse Z.

Nurse E had re-checked the dose of Dextrose 50% with Nurse Z. She should not just look at the order form, and check against the medicine ordered. Nurse E should not countersign without understanding the patient’s condition. Although there may have been a lack of communication between Nurse E and Nurse Z, the question was whether Nurse E was accountable for her colleague’s actions. According to Gray and Pratt, (1989), as cited in Nolan & Hazelton, (1995), nurses are accountable for exercising their power in the interests of nursing. Their actions will affect the profession’s destiny.

Reference

ANMC (2006). ANMC national competency standards for the registered nurse. Canberra: ANMC.

Corcoran, M. (2000). What is negligence? BJU International, 86(3),280-285.

Ganschow, J. R. (2002). Introduction to the law. Seminars in Oncology Nursing, 18(2), 99-104.
Mahlmeister, L. (1999). Legal issues in nursing and health care. In B. Cherry, and S, Jacob. Contemporary nursing: issues, trends and management. St Louis: Mosby.

Nolan, A., & Hazelton, L. (1995). Responsibility and accountability. The practicing nurse. Sydney: WB Saunders.

Nurses Board of Western Australia. (2004). Scope of Nursing Practice Decision-Making Framework Learning Guide. Retrieved March 28, 2007, from http://www.nbwa.org.au.
Staunton, P., & Chiarella, M. (2003). Nursing and the Law. (5th ed.) Sydney: Churchill Livingston.

Tingle, J. & Cribb, A. (2002). Nursing law and ethics (2nd ed.). Oxford: Blackwell Publishing Company