Malpractice in Advanced Nursing Practice Essay

Pages: 10 (3418 words)  ·  Bibliography Sources: 8  ·  Level: Master's  ·  Topic: Health - Nursing

SAMPLE EXCERPT:

[. . .] If a nurse specialist, her conduct should be compared with the reasonable practice of a similar or equivalent specialist. In addition, the courts recognized the extent of her role in patient care. While she may not modify the course of treatment set by the physician, she may consult nurse supervisors or other physicians to discuss her difference in view from the physician on the treatment. She may also communicate changes in the patient's condition to the physician and may do more if she is not appropriately or sufficiently advised. Acts or omissions, which constitute a breach of the nursing standard of care, can make her liable for malpractice. An example is failure to observe a post-operative patient at least every 15 minutes for the first hour. Other less serious examples of nursing malpractice are the failure to take the vital signs of a post-operative patients, failure to delay a patient's discharge while having high fever; the failure to delay a patient's discharge when he has high fever, the failure to recognize signs of neonatal hypoglycemia, the failure to correctly monitor a patient's blood sugar level, and the failure to call for additional help in bringing a post-operative patient from the bathroom back to bed (Abramson & Dugan).

Regulatory Body and Complaints Procedure: a Solution

Regulatory boards of the professions whose members are of good standing are set up to monitor professional activities primarily to insure and protect public safety and welfare ((Hudspeth, 2009). The regulatory body that monitors nurse practice is the Board of Nursing of 47 jurisdictions. Boards of Nursing or BON aim at regulating the activities of nurses, including nurse practitioners, for the protection of the public and not to promote the nurses' needs. The Boards monitor educational programs that prepare nurses for licensure; evaluate applicants for licensure through appropriate procedures; monitor clinical practice standards to keep them within accepted practice; and they apply the disciplinary process to assure that problems are appropriately addressed for the protection of the public (Hudspeth).

Types of Complaint

Complaints fall into four broad categories, namely exceeding or breeching SOPs, drug or substance diversion or use, ethical and moral issues, and criminal activity (Hudspeth, 2009). They are also categorized into 7, namely, practice-related, drug-related, boundary motivations, sexual misconduct, abuse, fraud and positive criminal background checks (NSCBN, 2012). A common SOP for the registered nurse applies to all regulatory jurisdictions but not to the SOP for the Nurse Practitioner or NP. NP education and certification are more uniform than the SOP in separate jurisdictions. Thus, the variability in SOP can confuse the NP in what she can or cannot do. Drug diversion ia often the issue that comes up when discipline is discussed. This complaint rate has been growing proportionately to the increases in the overall profession. Complaints in this category include violations of State and federal narcotics or controlled substance laws. Inappropriate or excessive alcohol use is closely linked to drug diversion. It is a violation when alcohol use puts the patient at risk or when it affects clinical judgment. Ethical, moral, and boundary violations raise the chances of harm for patients. These violations include moral turpitude, abuses under the Medicare or Medicaid programs and court findings of the NP's mental illness or mental incompetence. Criminal violations, such as felony convictions, are handled by the judicial system and can affect the NP's license. These violations include discipline in another jurisdiction, license fraud or imposter, court conviction, being on court-ordered probation, and failure to comply with license or certification requirements (Hudspeth, NSCBN).

The Complaint Process

The process begins with complaint reporting (Hudspeth, 2009). Complaints filed with the BON come from different sources. Physicians are the most common source of complaints about exceeding the scope of practice. Colleagues or supervisors are the most common complainants about the use of sample medications; the pharmacy, about prescriptions of controlled substances; and colleagues or supervisors, about inappropriate or excessive alcohol use (Hudspeth).

When the complaint is filed, it goes through a review on whether there is a violation of existing laws or regulations in nursing practice (NCSBN, 2012). There should also be sufficient information on the identity of the nurse or if she is actually a nurse over whom the Board has jurisdiction. If the issue is within the Board's authority, evidence is gathered and interviewed conducted. The investigation process varies according to the seriousness of the allegation and the timeliness of the complaint. This process may include obtaining additional documents or information from the complainant, the nurse's written response to the complaint, and full investigation. This last phase can include site visits and interviews with witnesses ((NCSBN).

When sufficient information has been obtained, the proceedings start. These consist of giving the nurse the chance to respond to the complaint against her and to give her side (NCSBN, 2012; Hudspeth, 2009). If the Board decides that disciplinary action is warranted, it decides on what type of action to take. Aspects often considered are the level of risk, suspension of the nurse and mitigating or aggravating factors. Every jurisdiction has its own process. In many jurisdictions, the case is assigned to a BON investigator. The investigation takes an average of 1 year or sometimes longer in jurisdictions with larger volumes of complaints to deal with. Other factors are the complexity of the investigation, the level of public risk, the availability of witnesses, and if the NP has a legal counsel. No public disclosure of the complaint is made during the investigation to protect the nurse's rights (Hudspeth, NCSBN).

During the investigation, the Board is guided by two considerations (Hudspeth, 2009). The NP's standard of practice is compared with the accepted standard. And the Board must protect the NP's rights under the U.S. Constitution to due process and assure that she is not wrongly or unjustly deprived of her license and the public of care. The level of evidence and the standard of proof are the criteria. The lowest level of burden is the preponderance of evidence, which requires a 51% likelihood of the violation as having occurred. The intermediate level burden requires it to be clear and convincing to justify the removal of one's professional license. And the highest level of evidence is the "beyond reasonable doubt" concept, which requires a 90% likelihood of the violation occurring. Most NP violations are tackled at the lower or intermediate level where the resolution does not have monetary value but requires less than a life-and-death consideration (Hudspeth).

Complaint Resolution

A complaint can be dismissed on certain grounds (Hudspeth, 2009). It may be for lack of merit, insufficiency of evidence, legal technicality or breach of due process. When BON decides it has merit, it is transmitted to a disciplinary review body or the BON attorney. There are a number of ways of resolving the complaint. The attorney and the BON staff may negotiate a settlement with the defendant nurse. If it is acceptable to her, it is endorsed or rejected by the BON and then made final. A second option is bringing the complaint to a disciplinary body or a judicial hearing officer endorsed or rejected by the BON. The third option is common in smaller and rural jurisdictions, which have fewer cases of this kind (Hudspeth).

Disciplinary Action

The disciplinary action may be a letter of caution, a letter of reprimand, restriction, probation, suspension of license, revoking of license and fines (Hudspeth, 2009). A letter of caution is the lowest level of discipline. It does not restrict practice and not even considered formal discipline. This is not transmitted to the national databases but informs the nurse that she has been investigated for a complaint. A letter of reprimand is issued when the situation complained of is considered serious but has already been resolved and remedied. It becomes part of permanent records with or without conditions imposed. Restriction does not always imply discipline. An NP, for example is returning after a prolonged absence or into practice evaluations until her competency is established. Restrictions on NPs often involve access to drugs or limitation on prescriptive authority. These are usually time-limited and may be lifted when their conditions are eventually met. Boards can place restrictions on licenses of NPs serving court-appointed probation. The restrictions may or may not be lifted when probation is complete. Suspension of a license may be for a specified time or indefinite. It may or may not remain. Most Boards apply specific and uniformly applied criteria for suspension. Revoking a license is the most severe form of discipline. When this happens, a time interval is required before an application for reconsideration or reinstatement is considered. Some licenses are revoked permanently. And Boards in some States have the authority to impose fines and reclaim the costs incurred by the investigations and hearings (Hudspeth).

Conclusion

The nurse is as subject to error as everyone else. Thousands of medical errors are made every year and result in patient injury, which must be compensated (Sohn, 2013). The ideal and the… [END OF PREVIEW]

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