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Chapter 08:
Legal Issues in Critical Care
Nursing
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Five Legal Responsibilities of the
Registered Nurse
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
What Is “Reasonable Care”?
• Expert testimony
• Professional organization’s standards of care
• Agency policy and procedure manuals
• Nursing textbooks and literature
• Job description of the nurse
• Manufacturer’s instructions for equipment, if involved
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Avoiding the Legal Pitfalls of Floating
See Box 8-2.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Case Study 1
A client arrives in the emergency department in full arrest
and resuscitation is started. The family arrives and
produces the client’s living will. The family informs the
health care team to stop resuscitation efforts.
Apply your knowledge of advance directives to this
situation. What steps should the health care team take?
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Case Study 2
A 88-year-old man living in a nursing home has a
documented DNR order. Colon cancer and a stroke have
left the client wheelchair bound. He is totally blind and
has amnesia, short-term memory loss, and difficulty
swallowing. The man is brought to the hospital with a
new-onset stroke. The son states that he has the health
care power of attorney. He wants all medications stopped
and hospice called.
Apply your knowledge of advanced directives to this
situation. What steps should the health care team take?
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Case Study 3
A 22-year-old man has met the criteria for brain death. The
family informs the nurse that they want their son to
continue on life support and to remain a full code.
Apply your knowledge of advanced directives to this
situation. What steps should the health care team take?
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
The critical care nurse performs neurological checks every hour
on a patient at high risk for a stroke and finds new-onset
right-sided paralysis, aphasia, and pupil changes. She does
not report the findings to the neurologist. The nurse is taking
meperidine prn for back pain. This is called which of the
following?
A. Ordinary negligence
B. Gross negligence
C. Criminal assault
D. Criminal battery
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
B. Gross negligence.
Rationale: Ordinary negligence is professional carelessness
and not willful neglect. In this case the nurse is taking
medications that can impair judgment and willfully
ignored the risks of harm to the patient by not reporting
the evolving neurological changes. This constitutes
gross negligence. This is not criminal assault because
the nurse did not willfully threaten to physically harm
the patient. This is not criminal battery because the
nurse did not willfully inflict physical harm on the
patient.
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Question
Which of the following statements about making the
injured patient whole is correct?
A. Pain and suffering would be determined by an actuary.
B. The spouse or children of the patient are never entitled
to a settlement for economic losses.
C. Many states place monetary limits on how much a
patient can receive for loss of consortium services.
D. Lost wages are awarded at the current rate when the
court case is settled.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
C. Many states place monetary limits on how much a
patient can receive for loss of consortium services.
Rationale: Many states place monetary limits on pain and
suffering, which includes loss of consortium services
(loss of marital relations or the ability to perform tasks
around the home). An actuary is an accountant who
determines monetary compensation for lost wages,
medical costs, and other economic damages for the
past, present, and future based on economic formulas.
The spouse or children of the patient may be entitled to
compensation for any economic damages they incurred.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
The ICU is chronically understaffed. There is one critical
care nurse in the ICU and two nurses on the adjacent
step-down unit. A patient arrests in the ICU. The code
button signal does not reach the step-down unit. The
patient dies because of the delay to get help. This is:
A. A case of respondeat superior
B. A case of corporate liability
C. A rule of personal liability
D. A case of negligent supervision
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
B. A case of corporate liability
Rationale: Corporate liability is the unreasonable behavior
of the hospital in staffing the unit with one nurse,
expecting that the nurse can adequately care for patients
by getting the step-down nurses to help. Respondeat
superior states that a hospital is responsible for the
negligence of its employees, and the nurse is not at fault
because the code was called. Negligent supervision
occurs if the supervisor fails to supervise the staff
properly, resulting in injury of the patient. Personal
liability is a result of not exercising proper judgment on a
questionable order.
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