Lesson 1, Topic 1
In Progress

Legal Relationships

July 10, 2022

Legal liability for alleged harm may be solely held or shared between multiple parties. The patient or family may choose to pursue charges against the facility, nursing personnel, medical staff, or ancillary departments. Each may be charged separately or in a group. In the past, nurses did not hold legal liability for alleged harm suffered by a patient while receiving medical care, but rather the physician or the hospital did, and sometimes both. As nurses gained recognition for their expertise and gained more autonomy, dissatisfied patients (and their attorneys) began to look at nurses as potential defendants and to seek to hold nurses accountable under the law. Accountability (being responsible for one’s own actions) is a concept that gives rise to a legal duty, and thus, liability (legal responsibility), in nursing. Indeed, the nurse today is not immune from liability in the practice of nursing. An analysis of statistics shows sharp increases in the amount of litigation against nurses by patients. A variety of reasons is at the root for the increases (see Figure 2-2). Nurses are facing increased responsibilities in the health care arena. The technological advances require more knowledge and competence. Staffing shortages and budgetary constraints may also play a role. High levels of patient acuity and an emphasis on early discharge may result in the need for more comprehensive referrals and improved disĀ­charge teaching. Flaws in either may result in litigation. Finally, insurance experts believe that some responsibility may rest with the large payout to litigants. Legal findings against nurses can be categorized. The most common areas of litigation against nurses involve performance failures in the following areas: standards of care, use of equipment, documentation, and patient advocacy (Reising and Allen, 2007).

When a nurse accepts a patient care assignment, the nurse-patient relationship is initiated. This relationship, beyond its more personal human component, has a legal basis: the duty to provide professional care. A failure to provide care to the expected level of expertise gives rise to legal liability (see the discussion on standards of care in the next section). In the nurse-patient relationship, the nurse accepts the role of advocate for the patient. An advocate is one who defends or pleads a cause or issue on behalf of another. A nurse advocate has a legal and ethical obligation to safeguard the patient’s interests.

A landmark case that addressed nursing liability was Darling v Charleston Community Memorial Hospital. In this case, an 18-year-old man fractured his leg and had a cast applied in the hospital. He was admitted to a room, and the nurses caring for the patient noticed that the toes on his casted leg were edematous and discolored. The patient reported decreased feeling in his toes to the nursing staff. Over the next few days, gangrene developed, and the man’s leg had to be amputated. The Illinois Supreme Court heard the case and held that the nurses were liable, along with the physician, because the nursing staff had failed to adhere to the standards of care. This case established a precedent that almost every state has adopted.