Chapter 07: The Nurse’s Legal Accountabilities: Professional Competence, Misconduct, Malpractice, and Nursing Documentation

Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition

Multiple Choice

1. Which of the following describes an employer’s responsibility in relation to the standard of care?

a. To address the effects of nurse absenteeism on patient care b. To evaluate all nurses on an annual basis to ensure that they are meeting standards c. To implement an improvement plan for nurses who do not meet standards d. To follow collective agreements regarding scheduling practices

ANS: C

Feedback

A Incorrect This does not relate to the employer’s responsibility regarding the standard of care.

B Incorrect Annual evaluation is not only the responsibility of the employer, but nurses are also accountable and have the responsibility to regularly self-evaluate.

C Correct! Employers have a common law duty to take active steps to ensure that nurses falling short of a standard receive the appropriate improvement plan. Otherwise, the employer may be liable.

D Incorrect This relates to meeting the provision of union contracts; it does not relate to the employer’s responsibility regarding the standard of care.

DIF: Cognitive level: Synthesis a. A nurse assaults a patient. b. A nurse makes a medication error, which results in the patient having an adverse reaction. c. A nurse is abusing substances while at work. d. A nurse accidentally runs a commode over a patient’s foot and bruises it.

2. Which of the following is the best example of an intentional tort?

ANS: A

Feedback

A Correct! An intentional tort is a civil wrong committed against one person by another who intends the action that causes injury or damage to either the victim or the victim’s property. A nurse who assaults a patient is committing an intentional tort.

B Incorrect This is a nonintentional tort and may constitute negligence.

C Incorrect This could be related to a medical issue or possibly an illness on the part of the nurse. If, for example, the substance is alcohol and if the nurse is impaired and as a result the patient is harmed, then this would constitute criminal negligence.

D Incorrect This event was unintentional and did not cause serious damage; it is not a tort.

DIF: Cognitive level: Analysis a. Duty of care is owed, duty of care is breached, and damage is a direct result. b. Duty of care is breached, indirect damage is present, and duty of care is owed. c. Duty of care is breached, damage is a direct result, and damage is permanent. d. Duty of care is breached, indirect damage results, and damage is permanent.

3. To prove negligence, which three elements must be present?

ANS: A Feedback

A Correct! First, the defendant must owe a duty of care in law toward the plaintiff. Second, the defendant must have breached that duty and failed to discharge the standard of care required by law in the particular situation. Third, the plaintiff must have suffered damage or harm caused by the defendant’s breach of the duty of care.

B Incorrect The damage must be a direct result of breaching a duty of care.

C Incorrect The damage does not need to be permanent.

D Incorrect A duty of care must be owed, the damage mist by a result of breaching the duty of care and the damage does not need to be permanent.

DIF: Cognitive level: Analysis a. Criminal incompetence b. Statutory negligence c. Professional malpractice d. Criminal negligence

4. A nurse whose lack of actions demonstrates disregard for the lives or safety of others is liable for which of the following?

ANS: D Feedback

A Incorrect “Criminal incompetence” is not a recognized term.

B Incorrect “Statutory negligence” is not a recognized term.

C Incorrect Malpractice (negligence by a professional) is not necessarily criminal; it involves performing lawful acts in a careless manner, which may not involve misconduct.

D Correct! This nurse is liable for criminal negligence. If a nurse knowingly fails to perform a nursing act that is critical to a patient’s safety and well-being and it results in death or serious bodily harm, the omission in care may constitute a criminal offense.

DIF: Cognitive level: Analysis a. To interpret the health care record b. To interpret the educational qualifications of the nurse in question c. To comment on the nurse’s guilt or innocence d. To describe previous malpractice incidents regarding the nurse in question

5. Which of the following may an expert nursing witness be asked to do at a trial?

A Correct! Nursing experts are called as witnesses to interpret the health care record and assist the court in reconstructing the events and drawing inferences.

B Incorrect If a nurse is registered, he or she is presumed competent, so educational qualifications are not the issue.

C Incorrect This would be inappropriate; however, the witness may describe what a reasonable and prudent nurse would do in a similar situation.

D Incorrect This is not applicable.

DIF: Cognitive level: Synthesis a. The standard of care is used as an objective measure. b. Professional standards are used as a subjective measure. c. Only an appellate court can determine this. d. This would go before a disciplinary review board, not the courts.

6. How do the courts determine if a nurse’s conduct has been negligent?

ANS: A

A Correct! The standard of care is what a reasonably competent professional would do in a similar situation. If a defendant’s conduct is seen as having fallen below this standard, a court may find that defendant’s conduct to be negligent.

B Incorrect Professional standards may be used to support a case but are not used to determine negligence.

C Incorrect This does not answer the question. The type of court is irrelevant in this situation.

D Incorrect Cases of misconduct, incompetence, and negligence may all be heard by a review board; however, negligence would also be judged by the courts if the nurse was involved in a lawsuit.

DIF: Cognitive level: Comprehension a. They investigate unexplained or suspicious deaths. b. Health care professionals and the police are accountable for reporting unexplained deaths to them. c. All recommendations made as a result of an inquest are mandatory. d. An inquest’s finding of homicide results in an immediate criminal investigation.

7. Which of the following best explains the coroner, or medical examiner, system?

ANS: A Feedback

A Correct! An unexplained or suspicious death must be investigated to determining cause and possible prevention strategies. If there is cause for concern and the circumstances are unclear an inquest may be ordered.

B Incorrect Although there are mandatory requirements for health care professionals and the police to report, anyone can bring a concern forward.

C Incorrect Recommendations are not mandatory but are encouraged for patient safety and quality reasons. Also, responding to recommendations assist in meeting professional and accreditation standards.

D Incorrect A finding of homicide by an inquest means that the death of a person was caused by the actions of another person or persons. It may not be criminal in nature.

DIF: Cognitive level: Analysis a. Seek out more information about leukemia. b. Accept the charge nurse’s advice, and continue to monitor the patient. c. Express concerns regarding this plan, and document this concern in the patient’s record. d. Express concern to the charge nurse regarding this plan, and page the on-call physician or nurse practitioner.

8. During a night shift, a nurse caring for a patient with leukemia is concerned that the patient’s heart rate has increased and that her temperature has risen from 37.5°C to 38°C. She informs the in-charge nurse, who suggests that rather than disturbing the physician on call, she monitor the patient over the next few hours. What immediate steps should the nurse take?

ANS: D

Feedback

A Incorrect Although it is important to seek out more information, a nurse caring for a patient with leukemia receiving chemotherapy should already be aware of the high risk of infection.

B Incorrect Physicians on call are expected to respond to patient concerns.

C Incorrect Disagreeing with the charge nurse and documenting this does not absolve this nurse of her accountability to the patient.

D Correct! It is appropriate to do what is right for the patient and not be intimidated by hierarchy. This is the appropriate standard of care.

DIF: Cognitive level: Analysis a. Unless nurses engage in independent practice, it is not necessary. b. It is not necessary if nurses are covered by the insurance policies of their employers. c. No, the regulatory body does not require this. d. Yes, because the doctrine of vicarious liability does not apply in all circumstances.

9. Should nurses obtain professional liability insurance?

ANS: D

Feedback

A Incorrect An employer’s insurance covers the nurse in most circumstances, but not all.

B Incorrect An employer’s insurance covers the nurse in most circumstances, but not all.

C Incorrect Regulatory bodies require this.

D Correct! The doctrine of vicarious liability means that an employer is responsible for the negligence of nurses in their employ. However, this would not be the case if the nurse acted criminally or outside of the authority of their role.

DIF: Cognitive level: Knowledge

TRUE/FALSE

1. Failing to meet a standard of practice of the nursing profession would be considered malpractice.

ANS: F Feedback

Correct Failing to meet a standard of practice of the nursing profession would be considered professional misconduct. Malpractice involves performing lawful acts in a careless manner or in a manner that does not conform to a generally recognized practice standard or standard of care in the nursing profession.

Incorrect This is not a true statement.

DIF: Cognitive level: Synthesis

2. A nurse who performs a procedure beyond his or her level of skill and ability would be considered incompetent.

ANS: F Feedback

Correct In this situation, the nurse is not competent to perform the procedure; therefore, with performance of this action, the nurse would be considered negligent.

Incorrect This is not a true statement.

DIF: Cognitive level: Synthesis

3. An assault occurs when a person intentionally threatens another person with imminent harm.

ANS: T Feedback

Correct Assault is the intentional threat of imminent harm. Actual physical contact is not necessary to prove assault.

Incorrect This statement is true.

DIF: Cognitive level: Knowledge

4. The nurse’s duty of care to patients and clients is based on professional standards of care.

ANS: T

Correct Nurses owe a duty of care to patients and clients to act in a competent and diligent manner according to the standard of a reasonably competent nurse.

Incorrect This statement is true.

DIF: Cognitive level: Knowledge

5. In a case where a nurse’s conduct is in question, the standard of care used in courts would be the actions of a reasonably competent nurse in similar circumstances.

ANS: T

Correct The standard of care is what a reasonably competent professional would do in a similar situation. The nurse is legally required to operate and act at a level that meets or exceeds the standard of care of a reasonably prudent caregiver or health care professional.

Incorrect This statement is true.

DIF: Cognitive level: Knowledge

6. Contributory negligence means that the patient, as the plaintiff, is partly responsible for the harm suffered.

ANS: T

Correct Contributory negligence means that the patient, as the plaintiff, is found to be partly at fault for the harm suffered. In all common law provinces and territories, the patient may still recover damages from the defendant even if the patient is, in some way, at fault.

Incorrect This statement is true.

DIF: Cognitive level: Knowledge