Chapter 11 Case Study

The nurse presented in this case has been working at the said critical care unit for a period of 25 years. The nurse has gained respect for her dedication and competence in her work. However, when the hospital installed an automated medicine cabinet, suspicions began to arise that the nurse is diverting narcotics to personal use. The computerized system records the personal code of the nurse as well as patient’s data.  The nurse is expected to fill a manual form indicating the patient’s name, route, time, and dosage (Guido, 2014). When discrepancies appeared in the nurse’s electronics and manuals records, she was suspended. There was no adequate evidence to trigger the suspension of the nurse. First, testimonies from other nurses confirmed that recording in paper records occurred at the end of shifts giving room for errors. None of the nurses in the unit recorded immediately after administering a dosage meaning it was the policy of the nurses to record at their free time. The nurse was suspended on mere suspicions, which the arbitrator did not agree with. Had the facility determined that the nurse was breaking a policy or was caught using the narcotics for personal use, then, this would have been enough evidence to suspend her.

The testimony of the other nurses should have great weight in determining the case. They upheld the defendant’s claim that she frequently recorded data after administering medication and could not always remember the exact dose. This proves that there is room for errors. It is upon the facility to come up policies to close the error gap (Ruel & Motyka, 2009). The fact that all the nurses entered data at their free time shows that there is no policy to minimize errors. The facility allows the nurses to record data after administering the dosages knowing very well that this could lead to errors. The testimony of the nurses should affect the outcome for the defendant.

Before the courts deliver a ruling, the institution should address other questions. If the nurses have been recording dosages way after administering for the last 25 years, then there should have been discrepancies between the total dosages and the total narcotics utilized in a certain period. Since no discrepancies appeared for the last 25 years, is it that the nurses have been very accurate or the facility had no strict procedures to detect such errors. Why did the facility only discover discrepancies immediately the computerized system came to use? Does the facility have effective policies that ensure that nurse is competent and ethical? The fact that nurses even deviated from the orders of the physicians raises serious ethical and procedural issues. If I were the judge, in this case, I would have ruled for the nurse. It is clear that the facility management have not incorporated effective policies to prevent such discrepancies from occurring. The facility cannot prove that the nurse was using the narcotics for her benefit, but there is proof that the discrepancy could have been a result of recording errors.

Chapter 12 case study

The ANP should have consulted other emergency center physicians or the child’s physicians before reporting her findings. The ANP felt that the vagina tear could be because of digital penetration. However, later she admitted that the child after scratching herself could cause the tear (Guido, 2014). The ANP was not certain that the cause of the injury was abuse and thus should have consulted the second party to determine the exact cause of the injury. Her diagnosis of the injury was not certain, and thus, she should have consulted other physicians to make the diagnosis certain. The Nursing ethics provisions for human rights protection calls for collaboration for health and human rights. The nurse owed a duty of care to the child by accurately diagnosing the injury. This could only occur through consulting other emergency physicians.

The cause of the injury raises several questions. One of the questions could be the cause of the infection. The ANP admits that the child could have scratched herself due to the infection. This shows there was another infection apart from the vagina tear. What was the cause of the infection? Does the infection commonly cause itching, which could have prompted the child to scratch herself? Did the infection itself lead to the vagina tear?  Were there any indications of abuse?

The ANP had a duty to report the injury since the initial observation had determined that it was a vaginal tear. However, since at this point the diagnosis was not conclusive regarding the cause of the injury, the ANP did not have a duty to report the cause of the injury. Ethics dictate that a nurse should not make assumptions about diagnosis rather; the nurse should carry out appropriate tests to determine the accurate diagnosis. The ANP assumed that the cause of the injury is digital penetration with no prove or second opinion.

Assuming the court found liability against any of the three defendants, I would determine the liability as follows. The preschool teacher who first discovered the injury contacted the child protective services. She followed the guidelines regarding the protection of children and thus not liable. The Child Protection Service worker after assessing the situation directed the mother to take the child to the emergency center for treatment. The worker could not take the child to the center without consulting the parents who are the primary caretakers of the child. The worker thus followed the right procedures and gave the mother the right advice and thus not liable. At the emergency center, the ANP after initial examination found a vaginal tear and then concluded that there is likelihood that the cause was digital penetration. The cause of the injury diagnosis had its basis on what the ANP felt and not on any tests or other opinions. The ANP later admitted that the child could have scratched herself leading to the injury. It is clear that her initial diagnosis regarding the cause of the injury, which led to the father facing child abuse charges, was not conclusive. I would have placed the liability on the ANP.

Chapter 16 Case Study

It was the responsibility of the nurse manager to supervise the LPN.  According to the American Nursing Association principles of delegation, a registered nurse has the power to delegate some components of duty of care but cannot delegate the nursing process itself (National Council of State Boards of Nursing, 2005).The functions, planning, assessment, evaluation, and nursing judgment cannot be delegated. The nurse manager should have supervised the LPN regarding consulting on the condition of the patient.

When the charge nurse was leaving, she directed the LPN on what to do in caring for the patient. She was clear and concise on the procedures the LPN has to follow (Guido, 2014). The LPN followed the orders as directed by the nurse manager. However, the nurse manager failed to inquire about the condition of the patient meaning she assumed the LPN would assess the patient. She should have directed the LPN to report regularly on the condition of the patient.

The nurse manager assigned the duty of care to the LPN. However, some components of duty of care are not open to delegation. The nurse manager still had the duty of care to assess, plan and evaluate the patient. The LPN received directions to administer Tylenol but received no instructions on the appropriate action if the medicine failed to lower the temperature. It was the duty of the nurse manager to assess if the patient was responding well to the drugs. Had she assessed the patient at night, she would have noticed the high temperature and take appropriate action (Bittner & Gravlin, 2009). Any delegation should be supervised appropriately to ensure there the patient receives quality health care.

In this case, the principles of delegation and supervision figure prominently in this case. The nurse manager was negligent in supervising the patient. The case itself is primarily an issue of delegation and supervision. Most of the states allow the registered nurses to delegate some components of care. The assistive personals are very significant in the delivery of quality and affordable health care. Though registered nurses are allowed to delegate, appropriate supervision is to ensure quality health care. Supervision can be a physical, onsite or offsite (National Council of State Boards of Nursing, 2005). In the case presented, the registered nurse was right to delegate the care to the patient but failed to supervise the LPN either physically or through other communication channels. This is a case questioning the principles of delegation and supervision.

The nurse manager delegated the duty of care to the LPN with clear and concise instructions. The LPN followed the instructions as directed. However, the nurse manager failed to assess the patient at night. The midnight caring nurse noted a problem with the patient and notified the attending physician. If the manager nurse had assessed the patient at night, she would have noticed that the patient was not responding to the medicine. The manager nurse failed in her delivery of duty of care. The LPN, on the other hand, ought to have notified the manager nurse about the condition of the patient. As a licensed nurse, the LPN owed a duty of quality care to the patient (American Nurses Association, 2010). Both the manager nurse and the LPN failed in their duty of care to the patient. In deciding this case, I would hold the nurse manager and the LPN liable for the death.

References

American Nurses Association. (2010). Nursing: Scope and standards of practice. Nursesbooks. org.

Bittner, N. P., & Gravlin, G. (2009). Critical thinking, delegation, and missed care in nursing practice. Journal of Nursing Administration, 39(3), 142-146.

Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Upper Saddle River, NJ: Pearson/Prentice Hall.

National Council of State Boards of Nursing. (2005). Joint statement on delegation: American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN).

Ruel, J., & Motyka, C. (2009). Advanced practice nursing: A principle‐based concept analysis. Journal of the American academy of nurse practitioners, 21(7), 384-392.

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