Archive for the ‘legal issues’ Category
September 10, 2010
By Peggy McDaniel, BSN, RN. Peggy is an infusion practice manager and an occasional contributor to this blog.
by Lars Plougmann/via Flickr
The headline for a recent article in the New York Times caught my attention: U.S. Inaction Lets Look-Alike Tubes Kill Patients. For me, this conjured up pictures of giant tubes with teeth, wrapping around weak patients in their hospital beds and squeezing them. Although I knew exactly what the article was going to discuss, it bothered me that the tubes were given the reputation of being “killers.” Can tubes kill? I think not. Can they contribute to errors? Certainly.
The article explains that numerous patients have been harmed and some have died because clinicians have connected tubing that should not have been connected. These errors run the gamut from enteral feedings being given intravenously and blood pressure inflation devices being attached to IV lines, to administration of intravenous medications into epidural lines.
However, it remains the clinician’s responsibility to provide safe care. Read the rest of this entry ?
Posted in legal issues, nursing perspective, patient safety | Tagged Intravenous therapy, ISMP, patient safety, tubing | 4 Comments »
April 16, 2010
By Shawn Kennedy, MA, RN, AJN interim editor-in-chief
Tough Decision/by love4loaded, via Flickr
Nurses at Temple University Hospital in Philadelphia have been on strike since March 31st over a number of issues including wages, health benefits, and a “gag order” that could prohibit nurses from speaking out against the hospital. Nurses walking picket lines is not a new phenomenon. What is new is research showing that patients suffer harm when nurses strike.
In March, a paper (subscription only) published by the National Bureau of Economic Research provided some evidence that nurses’ strikes have harmful effects on patients. The authors analyzed strikes (in all, 50 strikes in 43 hospitals) in New York State over a 20-year period and looked at what happens to inpatient mortality rates and 30-day readmission rates for patients admitted during a strike. They found that inpatient hospital mortality increased by 19.4% and that readmission within 30 days increased by 6.5%. The researchers asked, “Is this because [patients] receive less care, or because they receive worse care?” And, in an analysis to see if the results were different in strikes where management hired replacement workers, it showed they were not—outcomes were still worse.
These findings really shouldn’t come as a surprise. How can care be safe when there are fewer nurses than the normal levels (which often are already less than adequate for providing optimum care)? How can care be safe when replacement nurses—whether newly hired or shifted from other positions—are plopped onto units with little time to get to know the patient or families? (This is the “nurse-is-a-nurse-is-a-nurse” concept—also known as the “just send me a warm body” approach.)
So now I wonder: will employers at hospitals where nurses strike try to make nurses the “bad guys,” claiming striking nurses have no regard for patients or are failing to follow the professional code? This has been the argument that has stopped nurses from striking for years and is still the reason many nurses will cross a picket line or not join a union.
But the alternative question is this: is it better to take a stand now to change the status quo so that, ultimately, patient care and working conditions and staffing improve—and thus, in the long run, more patients get better care? It’s a question I’ve always struggled with. I have been fortunate in that I’ve not worked in a facility during a labor dispute—but that’s perhaps because the state nurses’ association that negotiated our contracts did a good job and I was a recipient of others’ hard work and hard choices.
What about you? Would you strike now for better conditions in the future, or would you cross the line to provide care for the patients already there?
Posted in advocacy/political action, ethical issues, legal issues, nursing perspective, patient safety, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged ethics, mortality, NEBR, nurses strike, Temple University Hospital | 5 Comments »
April 14, 2010
With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor’s watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called “Doctor.”
That’s the start of an MSNBC story called “Doc Deficit? Nurses Role May Grow in 28 States.” Much of the article is about nurse practitioners (NPs)–and the different ways they are (or are not) allowed to practice in different states, as well as the ongoing efforts of physician groups to limit their practice (even as the health care overhaul increases the demand for primary care physicians and invests in nurse-managed clinics). We’ve posted on scope of practice issues here more than once—what’s your take as nurses, or patients?
HAIs persist. Also today, as described from a number of perspectives in a collection of articles on Kaiser Health News, the Department of Health and Human Services (HHS) released a report stating that the rate of hospital-acquired infections did not improve in 2009, despite ongoing attention to this issue in studies, IHI initiatives, nursing journals, and nearly everywhere else. What gives?
Does getting sick make you an expert? Elsewhere, at Covering Health (the blog of the Association of Health Care Journalists), Andrew Van Dam is critical of tennis star Martina Navratilova’s public advocacy for yearly mammograms for women over 40.
In February, Martina Navratilova was diagnosed with ductal carcinoma in situ, the most common form of breast cancer. She has since had a lumpectomy and says she’s doing well and doesn’t expect the cancer to return. But in an interview with Good Morning America during which she announced her diagnosis and surgery, the tennis star stepped beyond the world of sport and into the world of medicine. And there she made the sort of missteps she’s known for avoiding on the court.
Tort reform, redux. Lastly, today the Wall Street Journal Health Blog reported on a new study that takes a fresh look at the question of whether tort reform–making it harder to sue health care providers for mistakes or perceived mistakes in your care–is really that important or not. During the health care reform debate, Republicans often held it out as the single most important solution to our health care system’s ills, arguing that doctors ordered so many unnecessary tests because they were praciticing “defensive medicine.” Democrats, on the other hand, were less enthusiastic about tort reform, which was predicted to only save about .05% of total U.S. spending.
The new study found that nearly 24% of cardiologists surveyed said that fear of malpractice lawsuits influenced their decision to order catheterization. As health care reform is implemented, the cost issue is not about to go away; tort reform may not be as important as comparative effectiveness research, but many people think it deserves another look. Nurses, doctors, how many of your decisions are influenced by “non-clinical factors” such as fear of litigation?
Posted in health care reform, legal issues, nurse practitioners, patient safety | Tagged defensive medicine, HAIs, hospital-acquired infections, mammogram recommendations, nurse practitioners, primary care, tort reform | Leave a Comment »
February 16, 2010
By Shawn Kennedy, interim editor-in-chief
By now you’ve probably heard that last Thursday Anne Mitchell, the Texas nurse who found herself fired from her job and on trial after reporting a physician for what she felt was poor medical practice (see our report in the October 2009 issue) was found not guilty (her colleague, Vicki Galle, had her case dismissed prior to trial). It only took the jury about an hour to exonerate Mitchell of criminal charges and uphold her right to advocate for patients. (Day-by-day reports from the trial were made available on the Texas Nurses Association (TNA) Web site.)
The case garnered national attention—at its core was a nurse’s right (duty, really) to safeguard patients in her or his care. It seemed a no-brainer, and almost incredible that the case even came to trial. Last Friday, I spoke with TNA president Susan Sportsman, PhD, RN, who agreed, saying she was surprised the case went forward, especially after the state medical board agreed that what the nurses did was appropriate. Sportsman said, “This is the role of nurses—it’s required that we report what we see to safeguard patients. This nurse was just doing her job, what she was supposed to do.”
Like nurses everywhere, Sportsman was “delighted and ecstatic” about the verdict. Sportsman noted a guilty verdict would have discouraged nurses and others from coming forward about poor care out of fear of losing their jobs and facing prosecution. Perhaps more chilling would be the result that nurses would be powerless and without support to protect patients from unsafe care. (See JParadisi’s excellent piece on this on her blog.)
Nurses seem to be coming under fire lately—witness the lawsuit California anesthesiologists have filed against their governor. According to the petition (available on the American Association of Nurse Anesthetists’ Web site), the anesthesiologists charge that, in following Medicare policy allowing a state to “opt out” of the physician supervision requirement, the governor is acting outside of California law in allowing nurse anesthetists to practice without physician supervision. It’s another case that bears watching (and rallying!) by all nurses, not just CRNAs. Nurses have a right to practice within the scope allowed under the law and for which they are qualified; a challenge to one nursing group should be a challenge to all of us.
What’s your take on these issues? Will the Mitchell case (despite the verdict in her favor) discourage potential whistle-blowers among nurses? And should physician groups really be attempting to restrict nurses’ scope of practice?
Posted in ethical issues, legal issues, Shawn Kennedy, AJN editor-in-chief | Tagged nurse anesthetist, scope of practice, Texas nurse, whistle-blower, whistleblower | 4 Comments »
February 7, 2010
KERMIT, Tex. — It occurred to Anne Mitchell as she was writing the letter that she might lose her job, which is why she chose not to sign it. But it was beyond her conception that she would be indicted and threatened with 10 years in prison for doing what she knew a nurse must: inform state regulators that a doctor at her rural hospital was practicing bad medicine.
That’s from an article in today’s New York Times about a Texas nurse who’s being prosecuted for blowing the whistle on what she asserts were inappropriate medical practices by a doctor she worked with. We’ve posted on this as the case has developed and also written about it in the journal. Ultimately, the judgment is up to the court. But the concern we’ve expressed and which others have also voiced is that this will have the effect of silencing others who should be speaking out. In the process it may well reinforce old nurse–physician dynamics that profit no one. What do you think?
UPDATE: She was acquitted today (February 11)!
Posted in ethical issues, legal issues, nursing perspective | Tagged ethics, nurse, prosecution, Texas, whistle-blower, whistleblower | 5 Comments »
January 14, 2010
Shawn Kennedy, MA, RN, AJN interim editor-in-chief
I spend a lot of time checking various web sites for news or new information nurses need to know, for interesting items for blog posts or articles, or for trends that may be coming down the pike. Here’s some “food-for-thought” items I found in my recent web crawls:
On nursingworld.org, the American Nurses Association, in a recent poll, asked site visitors if they had been “a target of unprofessional behavior” in the workplace. A startling 82% of respondents said yes. While “unprofessional behavior” was not defined (when you think about it, it could be any number of things, ranging from gossip and practical jokes to bullying and unwanted sexual advances), the fact that so many people feel this way deserves further exploration. What about you? What have you seen on your unit that might fit this category of “unprofessional behavior”?
Vindy.com, an Ohio news outlet, reports that advanced practice nurses (APNs) in the state want more recognition and freedom to practice. According to the article, the Ohio Association of Advanced Practice Nurses (OAAPN) is seeking legislators to remove restrictions that prevent them from heading the medical home models of primary care. Currently, physicians must be the designated head of the medical home. (See our article on this.) Jacalyn Golden of OAAPN said APNs “have proved themselves since they began providing primary care in 1965.” Amen.
Remember the “Sentosa Nurses,” the nurses from the Philippines who became embroiled in prosecution after they quit en masse from New York nursing homes in 2007? (We reported on it then and in a follow-up last April when the criminal charges against them were dropped, as well as here on the blog.) A Filipino Web site reports that the nurses have filed a civil suit against the nursing home company (which still has a civil suit against the nurses) and the Suffolk County, New York, district attorneys.
The Texas nurses who filed charges against a physician for unsafe practice weren’t as lucky – they face a criminal trial in February. Go to the Texas Nurses Association Web site for updates and to contribute to their defense fund.
Posted in legal issues, Shawn Kennedy, AJN editor-in-chief | Tagged advanced practice nurses, nurses, unprofessional behavior, whistleblowers | 5 Comments »
October 26, 2009
By Shawn Kennedy, MA, RN, AJN interim editor-in-chief
bv alvi2047/via flickr
There’ve been articles, blog posts, a court ruling in New York State halting mandatory H1N1 vaccinations for health care workers, and last week a suspension of the mandatory vaccinations by Governor Paterson (who explained the decision in terms of the vaccine shortage). Earlier this month, we ran a poll on this site related to whether or not nurses and other health care workers who work as direct caregivers should be mandated to receive the flu vaccine. In reading the poll results, I notice that many of the arguments against mandatory vaccination focus on the right to decide about one’s own body—a powerful argument, indeed.
It did make me wonder: do those who stand by this reason for not getting an H1N1 vaccination shot (or nasal mist) recognize that this argument—that one has a right to determine what happens to one’s body—is the same argument used by women who want to choose whether to have a baby or not? At the very least there’s an interesting parallel, even if some people I’ve pointed this out to don’t seem to agree. I’d like to know if others feel there is a difference—and if so, what?
Posted in children's health, ethical issues, H1N1 virus (swine flu), legal issues, Shawn Kennedy, AJN editor-in-chief | Tagged abortion, ethics, feminism, freedom to decide, keep your hands off my body, mandatory vaccination, nurses, Paterson | 8 Comments »
October 13, 2009
Update: Oct. 21: Thanks to everyone who took part in the vaccination poll (interestingly, only a fraction of those who visited the poll actually answered the simple yes/no question). The poll is now closed. The results: approximately 170 respondents (nurses?) answered the question “should the H1N1 vaccine be mandated for nurses?” Of these, 77% answered “no” and 23% answered “yes.”
Judging from comments we’ve received in response to other posts (here, here, and here) about the H1N1 vaccine, we surmise that not every nurse who answered no is actually opposed to getting the vaccine. They just don’t want to be told they have to get it. Others, of course (as some of the strongly worded comments left in response to this poll show) are entirely against it, whether it’s mandated or not. And others are wholeheartedly for it, firm believers that decisions made by experts using available evidence usually, if not always, lead to benefits for us all.
But there’s obviously a lot more to say on this topic, and we’ll be posting about it soon.
Posted in ethical issues, H1N1 virus (swine flu), legal issues, nursing perspective | Tagged mandated vaccinations, nurses, poll, swine flu vaccine, vaccination | 5 Comments »
September 30, 2009
By Diana J. Mason, RN, PhD, editor-in-chief emeritus
Yesterday, nurses and other health care workers from New York State went to the state capitol in Albany to protest a regulation issued by the New York State Department of Health mandating that all health care workers get vaccinated for both the seasonal flu and for the pandemic H1N1 2009 influenza by November 30th or lose their jobs. Deborah Gerhardt, RN, who was interviewed by USA Today, says she may have to lose her job because she doesn’t have confidence in the safety of the new H1N1 vaccine: “Just because the FDA approved the H1N1 vaccine ‘doesn’t mean it’s safe in my book.’”
New York State Commissioner of Health Richard Daines, MD, disagrees, and followed up an open letter to health care workers released on September 24th with a press conference to defend the new policy. The New York State Nurses Association, which urges nurses to get vaccinated but is against mandatory vaccinations, wrote their own open letter in response.
Citing one study of health care workers during a mild flu season that showed that 23% of the workers showed evidence of having had the flu that season but that 59% of these said they didn’t have the flu that year, Daines said that his concern is that workers are carrying the virus and exposing at-risk patients without realizing it. When challenged on whether family members and other visitors represent an equally great threat to patient safety, Daines noted that some hospitals would close their doors to visitors if an infectious disease were spreading.
Should we have a choice? Does our health and safety come before that of our patients?
For more on the ethics and safety of getting vaccinated, see these recent blog posts as well:
Nurses Express Safety Concerns About H1N1 Vaccine
Is It Ethical for a Nurse to Decline the H1N1 Vaccine?
Posted in ethical issues, H1N1 virus (swine flu), legal issues, nursing perspective | Tagged flu pandemic, flu pandemic preparedness, influenza vaccine, mandated vaccinations, New York State, patient safety, regulation, swine flu vaccine, vaccination policy, vaccine safety | 8 Comments »
September 22, 2009
A few weeks ago I came across an article in a Virginia newspaper in which reporter Mike Owens wrote about the arrest of James Wright, who was indicted on four counts of aggravated sexual battery against different patients in a nursing home where he worked as a nurse’s aide from 2000 until 2007. The nursing facility, NHC HealthCare – Bristol, is one of 76 facilities owned by National HealthCare Corporation. According to the story, staff members—from peers to administrators—had known about Wright’s abuse of patients for years, but nothing was done to stop it until Patty Davenport, another nurse’s aide, frustrated and appalled that no action was being taken, lodged a complaint with the Office of the Attorney General of Virginia.
To me, Davenport is a hero. But why did this take so long to come to light? A more recent article by Owens reports that several staff have accused the then director of nursing, Anne Franklin, of “trashing” their written complaints about Wright.
Through her attorney, Franklin denies this. I hope it’s not true. I’d like to think that any nurse who learned of such egregious acts would immediately take action to protect patients and blow the whistle long and hard. Read the rest of this entry ?
Posted in ethical issues, human rights, legal issues, media depictions of nursing, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged National HealthCare Corporation, nurse's aide, nursing home, responsibility to report, sexual abuse | Leave a Comment »
