A nursing error that contributes to the death or serious harm of a patient

The nurse need not be reported unless the conduct indicates that the nurse (A) ignored a substantial risk that exposed a patient or other person to significant physical, emotional or financial harm or the potential for such harm;

A Peer Review Committee is not required to report a nurse to the Board unless the nurse has engaged in conduct subject to reporting and the conduct subject to reporting means that a nurse(A) violates this chapter or a board rule and contributed to the death or serious injury of a patient;

The very nature of a nurse's job means being held to a high standard of professional conduct. Nurses are expected to act with great regard for patient safety and well-being and promote favorable outcomes for the patient, healthcare team, and organizations for whom they work. Unfortunately, even the best nurses make mistakes. When those mistakes result in injury or harm to a patient, it is called negligence. Perhaps you have heard of nursing negligence but do not have a clear understanding of what it is. Maybe you have wondered, "What constitutes negligence and what are the most common examples of negligence in nursing?” In this article, you will learn what nursing negligence is, find out the 20 most common examples of negligence in nursing + how to prevent them.

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What Is Negligence In Nursing?

Nursing negligence occurs when a nurse fails to perform minimum nursing care within designated standards of conduct, resulting in harm or loss. Negligence can result from failure to perform a nursing duty or may result when a nursing task is done incorrectly.

What Is The Difference Between Incompetence And Negligence In Nursing?

Although some people use the words incompetence and negligence interchangeably, they are not the same thing. Incompetence is a lack of knowledge, judgment, or skill. Examples of incompetence in nursing practice include a nurse not knowing how to administer a particular type of medication or to perform a nursing-related procedure or task incorrectly. On the other hand, negligence occurs when a competent nurse does something or fails to do something that a reasonably competent and prudent nurse would or would not do in the same situation. Negligence in nursing includes the elements of causation of injury and damages.

What Is The Difference Between Malpractice And Negligence In Nursing?

While malpractice and negligence in nursing have some similarities, there are also some key differences. Nursing negligence occurs when a patient experiences unintended harm due to a nurse’s unintentional mistake or omission in care. Nursing malpractice, on the other hand, occurs when a nurse knowingly and willfully does not follow the proper standard of care and the patient experiences harm. While both malpractice and nursing negligence can have dire consequences, malpractice is typically a more serious charge.

What Every Nurse Needs To Know About The 4 Elements Required To Prove Negligence In Nursing?

Negligence in nursing is very serious, and accusations should never be taken lightly. There are four basic elements required to prove nursing negligence. Those elements are duty, breach of duty, causation, and damages. Let’s take a closer look at each element.

1. Duty of Care:

Nurses have a duty to behave in a responsible matter and within their scope of practice. A few examples of nursing duties include administering correct medications, monitoring patients for changes, and alerting physicians when there is a change in the patient’s status.

2. Breach of Duty:

To prove negligence in nursing, it is necessary to articulate the nurse’s duty and demonstrate how the nurse deviated from that duty. There must be a clear expectation of duty before a breach of duty can occur. For instance, if a nurse observes a decline in a patient’s status and does not report the change to the attending physician, the nurse has committed a breach of duty to report.

3. Causation:

The third element of negligence in nursing is causation. Causation requires a complainant to show proof that the nurse's breach of duty was the cause of the patient's injury or loss. To prove causation, the damages must be foreseeable. For example, a nurse failed to document a previous dose of an opioid pain medication and administered a second dose.

4. Damages:

Complainants must prove that injuries or other damages occurred as a result of the breach of duty by the nurse. Considering the example in #3 above, the damage could be that the patient suffers respiratory arrest due to the respiratory depressant properties of the medication.

WHAT ARE THE MOST COMMON EXAMPLES OF NEGLIGENCE IN NURSING?

(There are many situations that can result in claims of nursing negligence. The 20 examples below are some of the most common examples of how negligence in nursing may occur and ways to avoid committing negligence.)

EXAMPLE #1: Not responding to a patient in a timely manner

About the Negligence:

Understandably, nurses can't be everywhere at once. That is why prioritizing patient care is essential. If the response to a patient's call for help or delivery of care is delayed, resulting in injury or harm, the nurse can be guilty of negligence in nursing.

How to Prevent this Negligence:

It is crucial to respond to patient needs as quickly as possible. If a nurse is unable to answer a patient's call or provide care immediately, she should notify the charge nurse and ask for help. When documenting about the patient, the nurse should include whether she had to ask for assistance, who she reported the need to, and follow-up promptly.

EXAMPLE #2: Failure to administer medication

About the Negligence:

In some cases, the nurse may need to withhold medication. For example, if a patient has an order for Digoxin, the nurse must assess the patient's pulse before giving the medication. If the patient's pulse rate is less than sixty, the medication is withheld. In this case, the nurse should document the patient's pulse rate and that the medication was not given. Nursing negligence occurs when a nurse fails to administer medication without just cause, a physician's order, and properly documenting it.

How to Prevent this Negligence:

Nurses can prevent this type of negligence by reviewing patient charts and medication orders and administering medications at the appropriate time. If the nurse feels there is reason to withhold a medication, the charge nurse and/or physician should be notified, and it should be documented.

EXAMPLE #3: Not reporting a change in patient status

About the Negligence:

A patient's status can change in a matter of minutes. Nurses must monitor and report changes as they occur. Failure to report a change in a patient's status can have dire consequences. For example, if a patient has a diagnosis of chronic renal failure and the nurse observes 3+ pitting edema, but since the patient is taking a diuretic, the nurse chooses to postpone notifying the doctor. If the edema is not resolved and fluid accumulation continues, the patient could experience a respiratory crisis due to fluid buildup.

How to Prevent this Negligence:

The best way to avoid nursing negligence like the one in this example is to report always any abnormality in a patient's status. The physician may or may not alter the treatment plan. However, by reporting concerns and creating supporting documentation, nurses protect themselves from accusations of negligence. Also, keep in mind that if you report a concern and the person you reported to does not respond or if your concerns are not alleviated, it is appropriate to go up the chain of command. It is, after all, the nurse's job to advocate for the patient.

EXAMPLE #4: Administering the wrong medication

About the Negligence:

One of the nurse's primary responsibilities is medication administration. Although physicians prescribe medication, it is the nurse's job to verify the order for accuracy and administer the medication according to the order, if it is appropriate.

How to Prevent this Negligence:

Medication errors are one of the most common and easily preventable sources of negligence in nursing, resulting in patient injury and legal ramifications for nurses and the organizations for whom they work. To prevent medication errors, the nurse should check written orders and read the medication label to ensure the right medication and dose are on hand. The doctor may write an order using a medicine's brand name, and the pharmacy may supply the generic brand. The nurse should verify if the physician has okayed generic substitutions and ensure the correct medication is delivered before administering it.

EXAMPLE #5: Injuring a Patient with Medical Equipment

About the Negligence:

It is understandable that accidents sometimes happen. Negligence in nursing may occur as a result of something that is genuinely accidental. However, it is every nurse's responsibility to put forth reasonable efforts to prevent injury.

How to Prevent this Negligence:

A few ways nurses can prevent patient injuries associated with medical equipment are by making sure equipment is secured in proper places and placing call lights within the patient's reach but secured, so the patient does not become entangled in the cord. Medical equipment should be calibrated and verified to be in working order before using them in patient care.

EXAMPLE #6: Not Speaking Up when Action is Required

About the Negligence:

Patient advocacy is one of the most powerful tools nurses use to improve nurse-patient relationships and promote positive patient outcomes. Being a patient advocate means speaking up or acting on behalf of the patient. When nurses fail to act on a patient’s behalf, it could result in injury and claims of nursing negligence.

How to Prevent this Negligence:

Although it takes a deliberate effort to be proactive on a patient's behalf to prevent negligence in nursing, that does not mean it has to be a difficult feat. Preventing nursing negligence can be as simple as monitoring a patient for signs and symptoms of a disease, side effects of a medication, administering a medication or treatment, or calling for help. You may be one of the most well-educated nurses. Still, if you do not use your knowledge, skills, and experience to enhance and promote high-quality patient care and protect your patients, you set yourself up to risk committing nursing negligence.

EXAMPLE #7: Administering Medication Using the Wrong Route

About the Negligence:

All medication orders should include the patient’s name, dose, frequency, and route of administration. The nurse is obliged to verify medication orders and follow proper protocol for their administration, including knowing and following the proper route of administration. A nurse commits nursing negligence if she administers the right medication but uses the wrong route of administration. For example, if a patient is to receive an injection intramuscularly and the nurse administers the medication subcutaneously, this is considered an act of negligence.

How to Prevent this Negligence:

If the orders are not clear, or if the nurse suspects the route of administration is not appropriate, she must verify the order with the physician and the pharmacy. While following doctor’s orders is important, following orders is outweighed by the nurse’s obligation to act responsibly and with the patient’s best interests in mind.

EXAMPLE #8: Failure to Monitor the Patient

About the Negligence:

Nurses are often the first to notice changes in a patient's status. However, if nurses fail to monitor their patients properly, they can miss vital signs that indicate patient complications or decline.

How to Prevent this Negligence:

Proper patient monitoring is an essential component of good nursing care. Nurses can prevent a breach of duty resulting in nursing negligence by carefully monitoring patients.

EXAMPLE #9: Failure to Document

About the Negligence:

Documentation is the means by which a record of patient care is established and maintained. As a nursing instructor, I felt I could never stress to my students enough, "If you did not document it, you did not do it." If nurses fail to document properly, it can lead to serious trouble. For example: Suppose Mr. Grayson has an order for Lortab every six hours for pain as needed. Nurse Amy administers the medication at 2:30 p.m. and does not document she gave the medication. At 4 p.m., Mr. Grayson asks the evening nurse for something for pain. When she checks his chart, there is no record of the 2:30 p.m. dose; so she gives him another pain pill." The patient can experience side effects of being overmedicated, and the nurse is responsible for committing an act of nursing negligence.

How to Prevent this Negligence:

The best way to prevent this act of negligence in nursing is to document as soon as possible after a treatment, medication administration, or when there is any change in a patient’s condition.

EXAMPLE #10: Not Implementing Patient-Appropriate Safety Measures

About the Negligence:

It is the nurse's responsibility to safeguard patients from harm, including the harm that can occur due to the absence of appropriate safety measures. Even in cases when a patient is the source of injury to himself, if the nurse did not implement measures to prevent patient-inflicted, preventable injuries, this could result in a case of negligence in nursing.

For example, suppose the nurse leaves a patient's bed in an elevated position, and the patient falls while trying to get out of bed. The nurse may be held responsible for the injury because the nurse did not ensure the bed was in its lowest position before leaving the patient alone.

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