Nursing Standards of Practice – Care Example

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"Nursing Standards of Practice" is a brilliant example of a paper on care.   Did the facility have sufficient evidence to suspend the nurse from employment? No. This nurse was suspended based on felony charges for diverting narcotics for personal usage. However, she was not caught in action and there is no evidence that she actually used narcotics for any purpose other than nursing care. Hospital management did not investigate the alternatives such as inaccuracies in data entering which could be causing discrepancies between the handwritten documentation and the computerized version. Inaccurate data entering is not considered a felony charge (TAANA, 2013).

  How should the testimony of the other nurses in the unit affect the outcome of this case? Other nurses testified that the methodology of the drug monitoring system had many flaws. The medication documentation system of this hospital had been inefficient and data entering had been inaccurate. Hospital management had fired a nurse based on unreliable evidence. Testimony of other nurses indicates a different side of the issue and it may strongly affect the final court decision of this case. What additional questions should the institution address before the court rules in the case? Firstly the hospital needs to make a policy entry and demand a proper investigation on this case.

The institution has to collect evidence that the accused nurse had used the particular narcotics outside the hospital. Unexplained income in her bank account or personal health records may support the felony charges against the nurse. Furthermore, the hospital documentation policy does not specify which nurse’ s responsibility is to document medication. If this was the root cause of information discrepancies there could be errors in other nurses’ records as well.

Thus hospital management should investigate all the data entry records of nurses’ who are in similar working settings. Hospital should also consider the maximum possible penalty for inaccurate data entering by a nurse. How would you have ruled in this case? I would have first questioned the nurse and then handed over the case to the legal department. I would have also considered the history records and other causes that could create information discrepancies in medication documentation. After conducting a proper investigation by the legal department only, the necessary disciplinary actions would be taken against the said nurse or nurses.

In case of a felony charge, I would have temporarily terminated the accused nurse and handed over the case to the police for further investigation. Furthermore, I would have taken the necessary actions at the hospital policy level to prevent information discrepancies in the medication documentation system before indicting felony charges against a nurse. Additional questions. What principles of protecting patient safety are involved in this case? Other nurses testified of using IV drip bags prepared in advance and deviating from the physician’ s order for IM injection often.

Patients rely on physicians for prescribing medication and nurses for adhering to the guidelines of excellent nursing care. On the one hand, this case reveals significant flaws in contemporary nursing care. On the other hand hospital’ s decision can induce other nurses to prioritize administration supportive duties such as medication documentation over caring for patients. Such duties take a considerable amount of time allocated for nursing care. This can challenge the safety of patients by deteriorating the standards of nursing care (American Academy of Pediatrics, 2001). Are the nurses that work in this unit negligent for delaying their medication documentation? Yes.

The hospital administration expected nurses to document the patient’ s name, medication, time, route, and dosage at the time of taking out drugs from the medicine cabinet. However, nurses have admitted to delaying the documentation till the break or end of shift. And also nurses admitted taking out medicines based on assumptions and/or experience rather than physician’ s prescription and wasting IV drip bags. Therefore nurses were negligent of the hospital’ s drug enforcement procedure. This case reveals that delaying or neglecting medication documentation can result in termination and/or jeopardizing nursing license. Was it below the standard care for these nurses to delay their medication documentation? Yes.

Medical records are legal documents. Negligence of nursing documentation can create serious problems for the nurses despite their level of skills or years of professional experience. For example: in case of lawsuit experts investigate nursing documentation for evidence on Standards Of Care (SOC’ s) rendered by the defendant nurse to the patient (Austin, 2011). Thus if the nursing records were incomplete or had discrepancies accused nurse could be convicted guilty for not rendering appropriate nursing care. When the organization looks at the root causes of this situation what ethical principles must be considered? Firstly, hospital administration expected nurses to carry out two documentation procedures.

Nursing involves frequent emergences and hectic schedules. The administration had not specified a time period or specific nurse to carry out the documentation. Thus hospital administration has to be ethical in investigating discrepancies in medication documentation. Secondly, nurses used prepared IV drip bags and often deviated from the physician’ s order for IM injection.

In this case, nurses’ actions might not be determinant of a patient’ s health but it is unethical. Therefore ethics of both administration and nursing care have flaws. If this case did go to trial, what do you think the chargers would be and what kind of court would hear this case, and why? Chargers would be against the hospital for suspending a nurse without conducting a proper inquiry. This case would be taken to labor courts because it involves labor rights. If this case did go to trial, who are the defendants in this case?

Which defendants could potentially hold liable? Why? Defendants would be administration officer/manager, drug enforcement agents, and supervisors who are responsible for taking the suspension decision. Supervisors would be liable because they held the initial inquiry and decided that the accused nurse was guilty. How do you think the court would rule in such a case? Why? This case was taken to courts by the accused nurse. Thus the court would hear this case as violating labor rights. They would call for any evidence of investigations which were held by the supervisors prior to suspending the nurse. Do you think the State Board Of Nursing should be notified or involved in this?

why or why not? Yes. This case revealed serious issues affecting the standards of nursing care. Therefore the State Board Of Nursing should be informed. Do you think that organization’ s policy and procedures manual should be changed? Why or why not? Who should be involved in the process if any changes are made? Yes. This case revealed that hospital policy on medication documentation had many deficiencies. Nurses were not clear whose responsibility it is to document medication and how to allocate time for this task.

Therefore hospitals can remove one type of documentation procedure and revise the approach in such a way that it does not interfere with the priority responsibilities associated with nursing care. Nurses, physicians, drug enforcement agents, and supervisors should be involved in making policy decisions.

References

American Academy of Pediatrics. (1 June 2001). Principles of Patient Safety in Pediatrics. Retrieved on 11 Feb 2013 from http://pediatrics.aappublications.org/content/107/6/1473.full

McMahon D. (1995). Nursing Standards of Practice. Retrieved on 11 Feb 2013 from http://www.hgexperts.com/article.asp?id=6237

The American Association of Nurse Attorneys (TAANA), Retrieved on 11 Feb 2013 from http://www.taana.org/

Austin S. (2011). Stay out of court with proper documentation. Retrieved on 11 Feb 2013 from

http://www.nursingcenter.com/prodev/ce_article.asp?tid=1150680

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