The nursing profession is a very intricate work by which it is motivated by altruism; it has autonomy that governs its right and ability to make decisions; it has authority which makes nursing practice updated because of its evidenced- based principles;it has accountability for its conducts and responsibilities; it has code of ethics, referring to its professional and social values; and lastly, it has a distinct identity and subculture.
As defined by Virginia Henderson, it is done with the heart, the head and the hand. This means that nursing is not only about educational training and experience but it also refers to dedication and the compassionate hands that give efficient and quality healthcare. However, there are times when nurses face legal issues, commonly negligence in the act of providing nursing care. Delving this topic makes us more knowledgeable of what we are doing in the health care setting and help us reflect on it constructively.
Negligence in the healthcare setting before was recognized as similar with that of the medical practitioners’, but because nursing was realized to have its own autonomy and code of ethics, nursing practice was differentiated from it. It is described as an act of omission or commission of duty. The components of professional negligence include (1) duty to use due care; (2) failure to meet standard of care or breach of duty; (3) foreseeability of harm; (4) injury; and (5) a direct relationship between failure to meet the standard of care and injury can be proved.
Nursing Negligence can be manifested in the following situations:
- Failure to count or incorrectly counting the number of sponges or instruments where a duty exists to account for them.
- Improper exercise of judgement that bed rails should have been used to safeguard clients.
- Lack of supervision of clients at regular and appropriate intervals – referring to inappropriate monitoring of client’s status.
- Failure to recognize an emergency and give emergency treatment to client.
- Lack of judgement in evaluating the physician’s orders.
- Failure to contact the physician of changes in the status of the client.
- Failure to recognize adverse signs and symptoms, to discontinue treatments, and to notify the physician.
- Failure to assist client with ambulation and other ADLs.
- Failure to administer medications properly, following the 10 Rs in giving medication.
- Failure to monitor vital signs and status of client.
- Failure to apply appropriate principles of hot and cold.
- Failure to evaluate client complains and needs.
- Lack of sterile technique.
- Improper identification of client.
There are still many examples of scenarios where negligence is manifested. It could be intentional or unintentional, but all these could harm the client in many ways. Liability held against the profession of nursing because of malpractice is usually required to pay for damages. The impacts of negligence can be held responsible according to different situations, too.
- Personal liability – the nurse is responsible for his/ her actions
- Respondeat superior – liability is expanded to include the employer; he/ she are liable for the act committed by his employee.
- Captain- of- the- ship-doctrine – the head of the team is liable for the actions of his team members, i.e. surgeon in the operating room.
- Corporate liability – the corporation or institution is responsible to ensure the safety of their clients.
- Force Majeure – it is a situation that cannot be foreseen or prevented; act of nature or an act of God that no one is held liable for the act.
The impact of negligence in the nursing profession has grown fervently as the profession also had evolved into a sophisticated, specialized and independent occupation. Many have appreciated the work of a registered nurse in the Philippines but many too are counting the pitfalls of nurse’s malpractice. It is somehow different when a nurse commits mistakes and when a physician commits mistakes, when a client is to compare it. A nurse can sometimes be called; “psst” even without a proper name called, so how much more if nurses commit mistakes?
The dignity of a profession is most likely to be affected if negligence is committed. Great power comes with great responsibility. Being a nurse comes with a set of commitments. Laws and professional values govern its boundaries, as for it to maintain its dignified autonomy among other profession. When a nurse commits an erroneous act, the nursing profession including the innocent ones are as well affected. For instance, a news about an image personality was reported because a nurse was known to extract and vulgar the personality’s whereabouts. It could be then concluded that the client’s vital information was not given appropriate privacy. As a nurse, responsibility of any actions committed should be known by heart and practiced with care.
Respect and dignity both originated from the word, trust. It is the most coveted value that a nurse should treasure. Trust, by any sense is a very sensitive avenue for an open relationship between client and a nurse, a smooth sailing communication and treatment implementation and evaluation, as well as a hasten recovery of client’s health problems and resolution to independence from nursing care. It is an essential tool that it should not be hindered by a certain negligence of duty.
There are many would- be- nurses who aspire to become a registered nurse, today but please understand fully that being a nurse is not just a heroic identity that many people believe. It is more than that, it is becoming and understanding how is it to be on a client’s shoes, too.