Can you share the main basis of Standard of Care to adhere to in the nursing profession?
The basis of the Nursing’s Scope & Standards of Practice describes the national standards of practice and performance that define the who, what, where, when, why and how of the nursing practice, as well as the key aspects of nursing’s professional role and practice for any level, setting, population focus, or specialty.
From this, can you expand on the common deviations from these standards, and how this can impact patients?
These professional nursing standards provide a framework for developing clinical competency standards and a means to evaluate the nurse's care. Organisations use evidenced-based established standards to set the organisational policies/guidelines, inclusive of state and federal laws. Nurses are held accountable to these standards by regulatory and legal bodies. Deviations from these standards create patient safety issues and poor outcomes. Legally, a deviation is defined as “that of what a reasonable and prudent nurse would do when caring for a same or similar patient in the same or similar circumstances.” Hence, guidelines and policies/procedures are specific, but may change from year to year. As a result, the nursing care provided to a same or similar patient under the same or similar circumstance in one year is likely to be different from care in previous or later years; deviations from the prudent and reasonable care is what is problematic.
When would patients seek legal help in such matters, i.e., when is the deviation from Standard of Care a legal issue?
A registered nurse (RN) is a qualified health professional deemed competent to perform care. When the RN deviates from the normal practice (when caring for the same patient, or similar circumstances), this is when negative outcomes occur and the patient has a right to seek assistance.
How has regulatory compliance changed over your years of practice? How has this impacted legal disputes in your line of work?
Over time, the scope of nursing practice has expanded, technologies have changed, and nurses have elected higher levels of education. With the growing body of nursing knowledge comes more responsibility, not just in the use of advanced technology, but also in the manner in which nursing care is delivered.
The legal notion of the standard of care for nurses is a living concept: it is broad and allows room for interpretation and expansion as the practice of nursing and the environment of nursing practice evolves and changes. Guidelines and policies, on the other hand, are static and provide more specific information regarding the delivery of certain aspects of nursing care, as interpreted by individual institutions or organisations about the standard of care for nurses. The compliance to these policies has been a significant source in the determination of the compliance and achievement of the standard of care for the nurse, as well as accountability for the organisation.
Moreover, how do you expect it to change in the future? Is there anything professionals should look out for, in order to avoid legal disputes?
Only a nurse is considered to have the special body of knowledge, education/training, and experience to provide testimony regarding what the average nurse would do, under the same or similar circumstances, for a patient presenting in the same or similar manner, and, are protected by laws allowing only nurses to testify regarding what a nurse would do in a similar situation with a similar patient.
Health care is one of the most regulated sectors of commerce, and much of the regulation of the industry comes from federal and state laws, which directly impacts the manner in which nursing is practised. Due to the potential for civil and criminal liabilities and sanctions in regard to health care, nurses should be familiar with key statutes and regulations, their state's nurse practice act, regarding the delivery of patient care in total.
Jeanine Frumenti, DNP, MPA, BSN, RN, CLNC
Legal Nurse & Expert Consulting
347-417-4658
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Dr. Frumenti has over 4 decades of clinical and administrative experience and as a consultant, she provides an evaluation of breaches in the standard of care, provides an opinion on the case with references, as well as Expert witness services.
