The Pinella Case

Duty owed patient – As a nurse we have a duty to provide the best possible care to all of our patients within our scope of practice. Providing best care requires assessing our patients and reporting any abnormalities to the health care team so further action can be taken. It is not within the nurses scope of practice to make medical diagnosis or to initiate interventions in which they do not have physician orders for. For this reason it is essential for the nurses to communicate to the doctor when further evaluation and interventions are needed for the patient. The two nurses failed to do so.

Standards of care can be seen as the level of competence expected from a “reasonably prudent nurse” when carrying out duties with the expectation of yielding positive outcomes (Westrick, 2014). Westrick also explains that nurses can face legal charges when there are breaches in the expected standards of care. Nursing malpractice occurs when the actions or inactions of a nurse—breaches in the expected standards of care—results in harm to the patient.

Over the last 15 years or so a number of cases concerning patient care and safety have come to light prompting investigations and inquiries that have led to changes in the way care is delivered. These include inquiries at Winterbourne View hospital, Mid-Staffordshire hospital(Mid staffs) and Harold shipman to name a few.

Standards of care can be seen as the level of competence expected from a "reasonably prudent nurse" when carrying out duties with the expectation of yielding positive outcomes (Westrick, 2014). Westrick also explains that nurses can face legal charges when there are breaches in the expected standards of care. Nursing malpractice occurs when the actions or inactions of a nurse—breaches in the expected standards of care—results in harm to the patient.

Every health professional has a legal obligation to patients. Nurses as part of the health care team share an important role in the quality and safe delivery of patient care. They have the major responsibility for the development, implementation and continuous practice of policies and procedures of an organisation. It is therefore essential that every organization offer unwavering encouragement and resources to support their staff to perform their duty of care in every patient. On the other hand, high incidences of risk in the health care settings have created great concerns for healthcare organizations. Not only they have effects on patients, but also they project threat to the socioeconomic status. For this reason, it is expected that all health care professionals will engage with all elements of risk management to ensure quality and safe patient delivery. This paper will critically discuss three (3) episodes of care from the case study Health Care Complaints Commission [HCCC] v Jarrett [2013] Nursing and Midwifery Professional Standards Committee of New South Wales [NSWNMPSC] 3 in relation to Registered Nurse’s [RN] role as a leader in the health care team, application of clinical risk management [CRM] in health care domains, accountability in relation to clinical governance [CG], quality improvement and change management practices and the importance of continuing professional development in preparation for transition to the role of RN.

It was claimed that the nurses, even though they picked up signs/symptoms of a medical emergency in their assessments, did not do enough to see that those concerns were addressed by the physician on duty. They would argue that had the matter been pursued further, the patient’s true injuries could have been diagnosed and treated earlier. Earlier treatment could have prevented the permanent damage and injuries the patient would sustain due to a delay in treatment.

The CNO outlined professional standards for nurses to comply with. The seven that are outlined are accountability, continuing competence, ethics, knowledge, knowledge application, leadership, and relationships. “A standard is an authoritative statement that sets out the legal and professional basis of nursing practice” (College of Nurses of Ontario, 2009, p. 3). Although each standard has different meaning, they all work together in order to provide the best possible patient care.

In examination of the issues that contributed to the healthcare team’s failure to comply with the standardized plan, it became evident that the issue was complex. The causative factors were interdependent, and each failure created a cascade of future failures that contributed to a more negative patient outcome. Nursing care is the fulcrum from which all other healthcare is coordinated. In this particular situation, the initial failures were attributed to nursing care; failing to administer antibiotics and obtaining blood cultures within the stipulated timeframe. There were also failures within numerous other healthcare disciplines; however, standardized care plans affect nurses in particular because initiation of care plan protocols, especially for

Standard of care -ascertained by asking what a reasonably prudent person would have been expected to do in the same or similar circumstances reasonably prudent person- objective legal standard to which defendant is held

1.Practices in accordance with legislation affecting nursing practice and healthcare 1.2 Fulfills the duty of care The respondent failed to perform any nursing interventions following comprehensive and accurate assessments. For example, during the assessment of patients, she failed to touch the patient physically to check pulse pressure and perfusions like skin warmth and capillary refill. She didn’t perform a formal physical assessment of the patient and respiratory assessment as well. Due to lack of skills in assessing patients correctly, she couldn’t execute the right nursing interventions in a particular problem that arises.

Under this standard, an obstetrical attendant with tremendous experience or potentially preparing will be dared to perceive potential issues doctor who repeats the request or if the medical attendant depends on the doctor's declaration that the doctor will assume full liability utilized by individuals from the nursing calling. A medical attendant will be at risk in tort if hurt follows because he or she doesn't have or utilize such learning, aptitude, care, or perseverance. A nurse that works for a hospital is legally obligated to be aware of these policies and procedures and to comply with the institution’s rules and regulations. Procedures, rules, regulations, and by-laws of various health care institutions can be used to define the nursing standard of care. For example, a hospital ‘s procedure manual for nurses or a nurse’s job description may set forth in detail specific rules of conduct for nurses.

Facilities should have a specific set of guidelines of how to approach situations where an error was made that could harm the patient. Nurses should remember that justice is one of the key principles of nursing; it is one of the core ethical guidelines that guide nursing practice. Nurses should go to the charge nurse and fill out the appropriate paperwork in order to properly document an incident. Nurses should also remind their coworkers of the importance of reporting medication errors and near misses. Nurses should set the standard for their peers to value and promote honesty in the workplace without having to fear negative retribution from supervisors and other higher-ups.

When I first looked at this case and read, “The defendant nurse stated that she understood her assignment at the time of the plaintiff’s admission to this unit was to provide oversight of the patient care on the entire floor for that shift” my first thoughts were, how many patients was this nurse caring for and how many hours did she work? Therefore, I decided to do my third article on nurse staffing in regards to patient outcomes.

Although the worker failed to identify with some of the issues the resident of the long-term care facility was having to be a potentially harmful situation moving forward it is evident that they used a lack of professionalism to report the matter due to future risks. “Patricia Stone, Arlene Smaldone, and Robert Lucero (2011) reports nurses are in the position of being “at the sharp end” of health care interventions by being the patient's advocate, providing care that may result in an error, or witnessing the error(s) of other clinicians. Accidents, errors, and adverse outcomes result from a chain of events involving human decisions and actions associated with active failures and latent failures. Many of these failures are associated with individual

It was found that the nurses had insufficient recording of wound care and the staff were not monitoring the wounds consistently or keeping Mr Selir’s GP up to date on his condition. After this incident, the nursing home introduced new staff, systems and processes to improve the quality of care to residents. I felt frustrated and disturbed as coming from overseas, my family background has always taught us to respect and look after our elderly therefore back in our country we don’t believe in nursing homes. According to Nursing and Midwifery Board of Australia [NMBA] 2016, health professionals ought to provide safe, appropriate and responsive quality nursing practice.