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chapter 3 | Nursing Practice and the Law 31 CikguOnline
and telephone conversations about the case. Do not responsibility for their own safety (Young v.
withhold any information from your attorneys, GastroIntestinal Center, Inc., 2005). In this case,
even if that information can be harmful to you. A the nurses acted appropriately. They adhered to the
pending or ongoing legal case should not be dis- standard of practice, documented that the client
cussed with coworkers or friends. stated that someone would be available to transport
Let the attorneys and the insurance company him home, and filled the duty to warn.
help decide how to handle the difficult situation.
They are in charge of damage control. Concealing Professional Liability Insurance
information usually causes more damage than dis-
closing it. We live in a litigious society. Although there are a
Sometimes, nurses believe they are not being variety of opinions on the issue, in today’s world
adequately protected or represented by the attor- nurses need to consider obtaining professional lia-
neys from their employing institution. If this hap- bility insurance (Aiken, 2004). Various forms of
pens, consider hiring a personal attorney who is professional liability insurance are available. These
experienced in malpractice. This information can policies have been developed to protect nurses
be obtained through either the state bar association against personal financial losses if they are involved
or the local trial lawyers association. in a medical malpractice suit. If a nurse is charged
Anyone has the right to sue; however, that does with malpractice and found guilty, the employing
not mean that there is a case. Many negligence and institution has the right to sue the nurse to reclaim
malpractice courses find in favor of the health-care damages. Professional malpractice insurance pro-
providers, not the client or the client’s family. The tects the nurse in these situations.
following case demonstrates this situation:
End-of-Life Decisions and the Law
The Supreme Court of Arkansas heard a case that
originated from the Court of Appeals in Arkansas. When a heart ceases to beat, a client is in a state of
A client died in a single car motor vehicle accident cardiac arrest. In health-care institutions and in the
shortly after undergoing an outpatient colonoscopy community, it is common to begin cardiopul-
performed under conscious sedation.The family sued monary resuscitation (CPR) when cardiac arrest
the center for performing the procedure and permit- occurs. In health-care institutions, an elaborate
ting the client to drive home. The court agreed that mechanism is put into action when a client “codes.”
sedation should not be admininstered without the Much controversy exists concerning when these
confirmation of a designated driver for later. It also mechanisms should be used and whether individu-
agreed that an outpatient facility needs to have als who have no chance of regaining full viability
directives stating that nurses and physicians may should be resuscitated.
not admininster sedation unless transportation is
available for later. However, the court ruled physi- Do Not Resuscitate Orders
cians and nurses may rely on information from the
A do not resuscitate (DNR) order is a specific direc-
client. If the client states that someone will be avail-
tive to health-care personnel not to initiate CPR
able for transportation after the procedure, sedation
measures. Only a physician can write a DNR order,
may be administered. The second aspect of the case
usually after consulting with the client or family.
revolved around the client’s insistence on leaving
Other members of the health-care team are expected
the facility and driving himself. When a client
to comply with the order. Clients have the right
leaves against medical advice, the health-care per-
to request a DNR order. However, they may make
sonnel have a legal duty to warn and strongly
this request without a full understanding of what it
advise the client against the highly dangerous
really means. Consider the following example:
action. However, nurses and physicians do not have
a legal right to restrain the client physically, keep his When Mrs. Vincent, 58 years old, was admitted to
clothes, or take away car keys. Nurses are not obli- the hospital for a hysterectomy, she stated, “I want to
gated to call a taxi, call the police, admit the client to be made a DNR.”The nurse, concerned by the state-
the hospital, or personally escort the client home if ment, questioned Mrs. Vincent’s understanding of a
the client insists on leaving. Clients have some DNR order.The nurse asked her,“Do you mean that