Medication Management For Nurses
A lot of lawsuits are happening in many parts of Australia, and many nurses are being sued every year. With a legal knowledge, a nurse is able to evaluate a healthcare outcome and understand responsibility as a way to improve health care of patients.
Nurses in their line of study, duty and care of patients are governed by a Code of Professional Conduct for Nurses. This is a generally accepted manner in which a person is meant to behave, while conducting his/her duties in a professional capacity. A patient is normally at the core of professional nursing practice. The current paper discusses legal and ethical issues in relation to administration of medication.
Nurses face ethical dilemmas daily, while performing their duties, and they are expected to make wise decisions. Some of the principles that frequently arise include:
- Autonomy and self-determination, which includes respect for all persons
- Positive attitude
- Remaining faithful to one’s commitment
- Fairness, equitability and truthfulness
- Avoiding harm to other persons and oneself
All nurses must find a good balance between displaying concern and empathy, while recognizing and maintaining safe advantageous boundaries.
In the early 1990s, the Australian Nursing and Midwifery Council adopted national competence standards for registered nurses, in order to guide and manage them in their line of duty. There may have been a lot of changes but this has helped to make sure that the competency standards remained contemporary and congruent with the new legislative requirements. They provide a framework for assessing competence of a nurse, and it is also used as a part of the annual renewal registration of nurses.
Legal issues are made up by acquiring a license, application of state and federal laws that govern practice in the field of nursing. A nurse will be exposed to litigation, once his or her code of conduct and core practice falls short of the acceptable standards of care and competence.
Litigation of nurses solely falls on negligence and failing to put into practice a reasonable level of care. Professional negligence is an act of neglect, committed in a nurse’s professional role. Litigation cases due to negligence and failed reasonable level of care may lead to a reprimand of a nurse’s licence or complete loss of license for a person involved.
Nurses are also bound by standards to administer medications according to the orders given by the medical doctor in charge or medical consultant, unless there is a reason as to why the orders are questionable. Furthermore, in a state where the orders are questionable, a physician should be contacted and an explanation of the objection made. It is important to allow him or her to put into better perspective the rationale behind the order. Prior to medical administration, a nurse should:
- Have a good knowledge of medication - its purpose and intent in managing that particular medical condition
- Have a good background knowledge of a patient and any drug allergy he or she might have. Some patients do have allergies to sulphur drugs and penicillin-based drugs.
- Understand the route by which medication is to be administered to a patient - whether it is oral, sublingual, per rectal, intramuscular, subcutaneous or intravenous.
A nurse is, therefore, expected to comply with practices in accordance with legislation affecting nursing practice and health care. He or she should identify legislations that govern nursing practice, describe nursing practice within requirements of the law and also, identify with legal implications of interventions done by nurses. This shows that nursing interventions should only be done following comprehensive and accurate assessments done by a nurse beforehand.
A nurse should also identify unprofessional practice, as it relates to confidentiality and privacy legislation. Consequently, this means that a nurse identifies behaviour that may be detrimental to achieving optimal care and also, follow up incidents of unsafe practice to prevent recurrence.
Assessing Scenarios, Patients Prior to Medication and Prior Medical Knowledge
According to Kelly and Joel (1995), caution that nurses who may assume that they may be of little risk just because they do not work in a very high pressure area, for example, the emergency room make a mistake in thinking that way. They found out that in many instances where nurses were sued the main reason was the everyday situations where nurses failed to use good nursing judgement, something that may otherwise be referred to as common sense.
Among the most frequent contributors to nurses’ malpractices include medication errors. Medication errors will mostly arise due to lack of proper knowledge on medication from nurses, also poor judgements made by nurses and an outright inattention to orders.
Pepper (1995) reported an actual occurrence where a staff nurse administered 40 meq of potassium chloride injection to a very elderly man, where in actual sense the patient was to get 40mg of Lasix, IV push. As a result, the man passed away and the family sued for the damages. The board of nursing investigated the nurse and, at the end, the employer had to terminate the employment of nurse from advice made by the hospital’s risk manager.
In some of the notable suits, the verdicts were passed following some of the poor nursing practices noted:
- There was a jury verdict that revolved around trauma that had been suffered by an infant that was mishandled by a nursing staff.
- Another verdict had been made as a result of an injury caused to a patient due to incorrect sponge count done by a circulating and scrub nurse.
- Another verdict came as a result of failure of some nurses to recognise an emergency and delayed failure of the same nurses to notify physicians in charge, in a timely manner and an inadequate medical record.
Protection against Suits
It is important for nurses to keep up to date on new treatment modalities, medications and new technologies in order to be on the safe side of the law. Being familiar with reasons for litigations meant that nurses are also very relevant in managing the risk.
Nurses should also take a professional liability insurance policy as another risk management tool. This policy will protect nurses against financial consequences that may be a result of the verdicts meted on them in the legal suits. Nurses ought not to assume that a hospital will protect them in time of legal suits. Lastly, the main aim of a hospital attorney is to protect the best interest of a hospital; concern of a nurse will, therefore, be secondary.
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Koniak-Griffin, D 1999, ‘Strategies for reducing the risk of malpractice litigation in perinatal nursing’, Journal of Obstetrics, Gynaecology and Neonatal Nursing, vol. 28, no. 3, pp. 291-299.
Kelly, LY & Joel, L 1995, Dimensions of professional nursing, McGraw Hill Inc, New York.
Marianne, A 1994, Nurses’ medication errors: an interpretive study of experience, Peter Lang International Publishers, New York.
Pepper, GA 1995, ‘Errors in drug administration by nurses’, American Journal of Health-System Pharmacy, vol. 52, no. 15, pp. 391-392.
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