ED Nurses Face Increased Risk of Malpractice Suits

Have you ever made an honest mistake that a family member caught before you did, or given the wrong dose of a medication? "These scenarios, unfortunately, can make the news, and they make us look careless," says Michelle Myers Glower, RN, MSN, LNC, a health care consultant based in Grand Rapids, MI. "But how we handle them can make or break us."

As ED nurses assume an ever-widening list of patient-care responsibilities, many are concerned about possibly facing a lawsuit one day, according to Glower.

Fortunately, says Glower, only a small percentage of the mistakes made by emergency nurses actually produce injury to patients. "Of this small number of injured patients, even smaller percentages go on to seek compensation for damages through legal action," says Glower. "Nevertheless, the numbers of lawsuits filed against nurses continue to increase."

These four conditions must be present for nurses to be considered guilty of malpractice, says Glower. The plaintiff must prove that:

• The nurse owes the patient a duty;

• The nurse has breached that duty or standard of care;

• Harm or damage has resulted and can be linked to the duty owed;

• The breached duty is the proximate cause of the harm or damage.

Since situations involving a dissatisfied patient and/or family member are common in today's health care environment, adds Glower, "this is all the more reason to practice safe medicine. Patients complain when there is a mismatch between expectations and reality."

For this reason, says Glower, it is important to be honest and transparent with your patients. "Tell your patients, 'If you are happy with us, please tell the world! If you are not happy with us, please tell us, so we can fix the problem,'" she says. "Knowing how to address patient relations issues is key." Glower gives these recommendations for emergency nurses to reduce legal risks:

• Review your "chain of command" policy.

"Know this inside and out. This will jump start you on how issues are processed," says Glower. "This will at least give direction as to the process in your institution on how critical information is communicated, regardless of the topic, to the right people."

• Chart factual information.

When an emergency physician was unable to remove a chicken bone stuck in the throat of a 60-year-old woman, he contacted the on-call ear, nose, and throat physician, who also wasn't able to remove it, then called the on-call gastrointestinal physician. "He refused to come in, stated he was watching the basketball playoffs, and instructed the ED to transfer the patient," says Glower.

"The daughter became hysterical, pointed at the physicians and nurses, and yelled, 'If my mother dies, I will sue you!'" says Glower. "The patient was transferred to a Level I Trauma Center and died en-route. The family did sue." In a situation like this one, says Glower, emergency nurses should chart factual information, including the times calls were made, the time the call was returned, and the time a specialist arrived in the ED.

• Stay on your patient's good side.

"Trial attorneys have a saying: 'If you don't want to be sued, don't be rude.' Always remain calm when a patient or his family gets upset," says Glower. Glower says guaranteeing unrealistic outcomes, a condescending attitude, lack of openness, failing to inform patients, and lack of empathy are all characteristics of what she calls "the litigious clinician profile."

"Litigious-prone profiles are not just limited to nursing," says Glower. "They include all health care providers — physicians, physician's assistants, emergency medical technicians, and nurse practitioners."

• Enlist help from risk management when appropriate.

Patients need to know the truth about mistakes, says Glower, but this information should be communicated with discretion. "It is not our place in the ED to give out every detail of a bad outcome," she says. "We have experienced professionals that know how to manage these very types of situations."


For more information, contact:

• Michelle Myers Glower, RN, MSN, LNC, Healthcare Consultant, Grand Rapids, MI. E-mail: mmyersglower@aol.com. Web: www.nursingexpert.info