Scope and Standards

1. Obtain a standard(s) or policies and procedures) of the agency where you work. If you are not working at present, obtain standards of your specialty or another specialty) or an agency where you would be interested in working.

2. Randomly select a standard, policy or procedure and discuss how the language used makes it a standard?

3. What happens if a policy in your institution is stricter than the Nurse Practice Act (NPA)? What happens if a policy is lesser than the NPA?

4. After you have reviewed the JC Standard on education, discuss how this standard is being executed in your facility? Is it adequate? How do you explain the many patients that are discharged without basic knowledge on how to care for themselves at home?

5. Review the Tenets of Nursing in the ANA document. How has nursing gotten away from Tenet #3? How can we get back to caring?

6. Use Tenet # 5 and discuss how an unhealthy work environment can contribute to less than quality health care?

7. Read page 14 along with the Tenets. Have you been in an unhealthy work environment? Were you a contributor? Or were you proactive in developing ways to reduce toxicity in the workplace? (Tell the truth). What have you learned since you were in a bad environment?

A nurse is caring for a patient with urinary retention. You observe the nurse performing a urinary catheterization. The nurse proceeds with the sterile draping but throws the fenestrated drape on the side saying “We don’t use that”. Has the nurse violated a standard? If yes why. If no why. How would you handle this situation?

Case Two

A nurse administering Morphine Sulfate IVP to a patient in ICU. The doctors’ orders read: 15 mg morphine IVP. Dilute in 1 ml and give over 1 minute every 2-4 hours for pain.

The Nursing IV Drug Book says: • Dilute with at least 5 mL of sterile water or 0.9% NaCl for injection. • Concentration: 0.5–5 mg/mL.

• High Alert: Administer 2.5–15 mg over 5 min The nurse reads the IV drug book but says well the doctor must know better so she gives it as ordered.

1. Has the nurse violated a standard? Explain

2. If the patient has untoward effects of the medication, what malpractice element has the nurse violated?

3. If the patient has severe untoward effects, who is legally liable? Explain

Case Three

A patient in a psychiatric facility was admitted after taking a handful of Xanax. After he was deemed medically stable, he was admitted to psychiatric services. He was placed on every 30 minute – 1 hour check. The check involves status check, and to verify there were no dangerous objects in the room. The nurse checked the patient at 3:30 pm. She went back 10 minutes later at 3:40 and the patient was dead from hanging himself with the bed sheet. (You may want to research how patients are monitored in facilities who are on suicide watch).

1. Has the nurse violated a standard? Explain.

2. Is there any liability in this case? If so, who is liable? If not, explain.

3. Are there grounds for legal action?

Case Four

A patient entered the hospital with complaints of severe headaches. The patient was diagnosed with cerebral aneurysm and was taken to surgery. A stent was placed in the dilated artery via a wire threaded through the groin. The patient was placed on a heparin drip as preventative measure to keep clots from forming around the stent. The patient later complained of weakness on the left side of the body and speech was slurred. The nurse immediately called the resident on duty. The resident believed the weakness was due to a blood clot and ordered the heparin to be continued. The patient dies later from a cerebral bleed.

1. Has a standard been violated?

2. Is the nurse culpable in this instance?

3. The patient’s attorney sued both the doctor and the nurse. How to do you think the ruling on this case was determined?

Case Five

A patient was admitted to the ICU in a general acute care hospital after attempting suicide with pills. The attending doctor wanted to stabilize the patient while the family made arrangements for transfer to a psychiatric facility. There was a delay due to the lack of insurance. The facility agreed to the patient’s hospitalization even though they did not have a mental health unit. After admission, the patient became paranoid, combative and delusional. A nurse sat by his bedside and tried to calm him. The staff contemplated restraints but decided this would only escalate the patient’s paranoia and delusions. The patient got out of bed knocked the nurse down and fought his way past two other nurses and ran away from the unit. He kicked out a third story window and jumped, fracturing his arm and had other minor injuries.

  1. Has the nurse violated a standard? Explain.
  2. Is there any liability in this case? If so, who is liable? If not, explain.
  3. Are there grounds for legal action?
  4. What do you think happened in this case

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