Mistakes in your stroke care can lead to lawsuits

Nurses 'ultimately responsible for their education'

As an emergency nurse, you are expected to recognize the symptoms of a stroke and properly intervene in the patient's care and treatment, including planning for possible deterioration in the patient's condition, says Mary Ann Shea, JD, RN, a St. Louis-based nurse attorney and former ED nurse.

For example, if the patient is experiencing life-threatening symptoms, it is the responsibility of the nurse to get physician involvement immediately, says Shea. "The nursing process must be followed at all times," she says. "Most lawsuits against nurses are the result of failing to follow one or more steps of the nursing process."

Any nurse that is not practicing according to the standard of care can be held liable if it causes harm to the patient, says Vickie Halstead, RN, CVNS, CCRN, CEN, CLNC, principal of Circle Pines, MN-based The Critical Difference, a consulting firm specializing in emergency and critical care education and an emergency nurse at North Memorial Medical Center, a Level 1 trauma center in Minneapolis. Nurses are required by law to follow the standard of care developed by the facility that employs them, she explains.

It is the facility that is liable if evidence-based guidelines are not incorporated in their standard of care for a stroke patient, says Halstead. "However, the nurse team that develops the standard of care for that facility could also be held liable if those standards do not follow evidence-based guidelines for stroke," she adds.

To successfully sue an emergency nurse for negligence, the patient would have to prove two things: That the nurse deviated from the standard of care, and that this resulted in an injury to the patient, says Shea. The standard of care is derived from many sources, one of which could be evidence-based guidelines developed for treatment of various disorders, she says. "However, the mere existence of such guidelines would not result in an automatic determination that the nurse deviated from acceptable standards," notes Shea.

Nurses are likely to be sued if they fail to assign the appropriate triage level to the stroke patient, do not gather the needed clinical data, fail to timely carry out orders for treatment, or do not communicate significant changes to the physician, says Patricia Iyer, RN, MSN, LNCC, president of Flemington, NJ-based Med League Support Services, a legal nurse consulting firm specializing in malpractice and personal injury cases. "I think that ED nurses have a high risk of breaching the standards of care for stroke patients by delaying treatment, thereby causing more disability," says Halstead. By not recognizing the signs of stroke or not treating the stroke patient as emergent, delays in care can occur, she adds.

"ED nurses need to be aware that strokes have many signs and symptoms in addition to paralysis, and that many patients who are not paralyzed at presentation to the ED need the same care as those patients with paralysis," says Halstead.

Take responsibility

There is not any universally accepted definition of when evidence-based care becomes the standard of care, says Iyer. "Is it a year later? Five years later? Or when other health care providers in the area start embracing the changes?" she asks. "Attorneys and experts often grapple with this issue."

It is unreasonable to expect ED nurses to immediately integrate new research findings into clinical practice, because there has to be a period of time when the recommendations are disseminated, Iyer explains. "But nurses are expected to keep current," she emphasizes.

Clinical nurse specialists and others with advanced nursing education often act as "change agents" to educate ED nurses on the needed changes in practice, says Iyer. "However, nurses who work in EDs without this level of educational support have to keep current with nursing literature and continually integrate new thinking, based on sound research, into their practices," she advises.

In other words, ED nurses must take individual responsibility for maintaining their skill and knowledge, says Shea. "This includes an awareness of when standards of care change as a result of new research," she says. "Nurses are ultimately responsible for their own education."


For more information on liability risks of stroke care in the ED, contact:

  • Vickie Halstead, RN, CVNS, CCRN, CEN, CLNC, The Critical Difference, Emergency/Critical Care Education, Legal Nurse Consulting, Five Oak Ridge Trail, Circle Pines, MN 55014. Phone and fax: (763) 786-6645. E-mail: victoire2@mac.com.
  • Patricia Iyer, MSN, RN, LNCC, President, Med League Support Services, 260 Route 202-31, Suite 200, Flemington, NJ 08822. Phone: (908) 788-8227. Fax: (908) 806-4511. E-mail: patmedleague@yahoo.com. Web: www.medleague.com.
  • Mary Ann Shea, JD, RN, P.O. Box 220013, St. Louis, MO 63122. Phone: (314) 822-8220. Fax: (314) 966-0722. E-mail: masheajdrn@aol.com.