November 8, 2016

Legal Tips For Graduate Nurses

The legal ramifications of nursing care are a common concern among graduate nurses. To play the game, you must first know the rules. Therefore, understanding your legal obligations, professional responsibilities, and institutional goals are a must. You can obtain this information from your state nurse practice act, your organization's employee handbook, your organization's nursing scope of practice, and departmental protocols and regulations. Here are some tips for new nurses who are worried about the legal aspects of nursing care.

1. Documentation

Sometimes, veteran nurses make fun of graduate nurses because new nurses are often found "documenting and not actually being a nurse." A common complaint is that new nurses are on computers more than they are in their patients' rooms. Yes, documentation is a necessary element of nursing. But, when you start off, it can be seen as obsessive. In my opinion, it SHOULD be obsessive. Until you have the foundations of nursing cemented into your brain, document everything and ask the charge nurse or provider to confirm the decisions you've made. When I started out as a graduate nurse, I asked my educator for sample forms of documentation. What was approved? What format was best? Do I chart nursing interventions only or just when something goes wrong? I wanted to know what was expected of me and how to protect myself. When I chart, I assume nothing and explain things in great detail. If I'm being subpoenaed about a patient from three years ago, do you honestly think I'm going to remember if I gave them a bath? As nurses, we do 100 things in our 12-hour shift. Document every nursing intervention you perform and document all forms of communication. I don't support people who ignore patients, nor do I support individuals who ignore the social aspects of healthcare. What I'm saying is, until the rules are familiar to you, don't wing it and chart the minimal. That type of thinking will get you into trouble.

Common things I document:

a. Patient refusing something
- Notification is given to the charge nurse and provider.
Example: Patient refused metoprolol 21:00 dose - 50MG. BP 150/45, HR 85.
CCM called, awaiting return phone call. Will continue to monitor.

b. Communication initiation
- Notification is given to the charge nurse and provider.
Example: CCM called regarding sustained HR 140s.
Charge nurse aware and provider notified. Will continue to monitor.
Awaiting return phone call at this time.

c. Communication follow-up
- Notification is given to the charge nurse.
Example: CCM returned call regarding sustained HR 140s.
No orders given. Will continue to monitor.

d. Nursing interventions 
- No leadership notification necessary, required care activity.
Example: Bath given, foley care completed (CHG/peri-care).
Patient in no distress following interventions. Will continue to monitor.

e. Abnormal vital signs and findings
- Notification is given to the charge nurse and provider.
Example: Upon initial assessment, found pitting edema at BLE.
CCM called, awaiting return phone call. Will continue to monitor.

* NOTE: Ask your educator/manager for the documentation practices, as each institution is different.

2. Nursing Insurance

Now, some institutions require nurses to carry professional liability insurance, and some don't. Mine didn't, but I purchased a policy voluntarily. It's just something that makes me feel better as a nursing professional providing care in critical situations. Now, that doesn't give you carte blanche to do absurd things. But, it does protect you in certain situations, where your employer might not provide assistance. Hospitals will support and defend you as long as you have followed policy (in its entirety, not up to a point) and you have done nothing wrong (100% of the protocol was performed and can be verified). I'm realistic, and I know that policies are oftentimes left open to interpretation. Nurses are sadly left without representation if the hospital finds out you omitted a task or document. It is in the hospital's best interest to find fault in what you do, so they can leave you with all the legal or criminal responsibility. It's nothing personal, just business, and businesses will protect themselves and their investment at the cost of your professional reputation. Understand your role and protect yourself. You're the primary caregiver, you had the syringe, you signed the employee handbook... this is ALL on you! Protect your family, protect yourself.

3. Don't Lie, Ever!

Assessments should be the standard, but often people chart them and don't perform them. You'd be surprised by how many nurses chart something, and it never happened. It could be due to carelessness, time constraints, or an honest miscommunication. Whatever the reason, it's a lie. A half lie is still a lie. You might chart that you did anterior and posterior lung auscultation and document that all the sounds heard were diminished, when in reality you only did anterior lung auscultation. There are patients out there who are confused, fragile, and need help. You're their nurse, and you are responsible for their safety. Charting Morse Fall and Braden Scores are excellent tools in healthcare (and mandatory at some institutions). Good documentation, five points for you. But are you performing the necessary interventions post score determination? Proper follow-up is key to keeping your name out of the headlines. When you're a nurse, you're expected to do what is needed. Cutting corners or lying will always come back to bite you in the ass. We all start out overwhelmed, and with time, we perfect our craft and find things that work. Laziness or carelessness, won't help you. It might work for a short period, but all things come to light in the end. Don't lose your license over a rushed decision made when you were panicking. Nursing isn't a solo gig. It's a team effort. Ask for help, even if you think it makes you look weak. I'd rather be a weak nurse than a nurse who killed someone's child. Respect the power you hold and seek help when it's needed.

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