Britney is a nurse on the orthopedic unit at a local hospital. She agrees to cover for Paul, another nurse on the unit, during his lunch break. The nursing assistant tells Britney that one of Paul’s patients, a 62-year-old female 2 days postoperative for a hip replacement, is complaining of pain in the hip.

QUESTION

Britney is a nurse on the orthopedic unit at a local hospital. She agrees to cover for Paul, another nurse on the unit, during his lunch break. The nursing assistant tells Britney that one of Paul’s patients, a 62-year-old female 2 days postoperative for a hip replacement, is complaining of pain in the hip. Britney reviews the medication sheets, finding an order for 50 mg of Demerol every 4 to 6 hours IM or IV push. She notes that the patient received Vicodin 10 mg 3 hours ago, with no pain relief. Britney decides to give the Demerol intravenously for better control of the pain. She administers the medication, and 15 minutes later the patient is unable to breathe because of swelling of her throat. The patient is transferred to the intensive care unit and makes a full recovery. Britney reviews the chart, which documents the patient’s allergy to Demerol. The patient had not received the medication during the hospital stay until it was given by Britney.

1. Who has the duty to provide reasonable care in this scenario? Does Paul retain accountability? Did Britney assume accountability? When Britney took over for Paul, she assumed responsibility for the patient. Therefore, she is accountable for the care provided to the patient.

2. Was there a process problem leading to the problem? There was a process problem leading to the problem. The physician should never have written an order for Demerol since it stated a Demerol allergy on the patient’s medication chart. Also, if the pharmacist had to give the floor the medication, he/she should also have caught the Demerol allergy, which was on the patient’s chart.

3. How does professional duty apply in this scenario? Professional duty means that the nurse will act as a reasonable nurse would under the same or similar circumstances. In order to have a breach of professional duty, one must be able to prove that the standard of care was not met, and demonstrate that the nurse did not act as a reasonable and prudent nurse would have acted under the same circumstances. A competent nurse should have done the three ‘checks’, which would have shown that the patient had an allergy to Demerol when compared to the physicians order.

4. How would a breach of professional duty be proved in this scenario? Explore intentional versus unintentional breaches. In order to have a breach of professional duty, one must be able to prove that the standard of care was not met, and demonstrate that the nurse did not act as a reasonable and prudent nurse would have acted under the same circumstances. In this case, there is no sign of intentional breach or intentional tort, which are most commonly encountered as assault, battery, false imprisonment, invasion of privacy, and fraud. Non-intentional breach involves negligence or malpractice. Negligence is the failure to use ordinary or reasonable care or the failure to act in a reasonable and prudent (careful) manner. Malpractice has a similar definition and applies only to professionals, such as physicians and nurses. It is defined as the failure of a professional person to act in a reasonable and prudent manner. A malpractice lawsuit may occur when such actions cause injury or death to the patient.

5. What damages might the plaintiff claim as a result of the action? In civil cases, the remedy for the harm the patient suffered is money. The judge or jury will award the plaintiff money to compensate her for pain and suffering, lost wages, additional medical bills, and other losses. In some cases, the plaintiff may be awarded punitive damages for grossly negligent or wrongful behavior by the healthcare provider.

6. Which type of liability might apply in this scenario? Malpractice is defined as the failure of a professional person to act in a reasonable and prudent manner. A malpractice lawsuit may occur in this scenario because the nurse’s actions caused injury to the patient. Under malpractice, there is a subcategory of breach of duty. A breach of duty occurs when the nurse fails to meet standards of care. Attorneys look to several sources of information to identify the standards of care and to determine what a reasonable and prudent (careful) nurse would have done in the situation. These sources include the NPA, job descriptions, hospital policies and procedures, textbooks, professional organizations, and the nursing code of ethics. The attorney will usually hire an expert witness who is a nurse with advanced education or experience. The purpose of an expert witness is to educate the judge and jury on the local practice of nursing and how the nurse’s actions or omissions failed to meet acceptable practice for nurses.

7. The hospital did not pursue any punitive measures against Britney nor Paul. What is the rationale for this action? The rationale for this action would be that the negative outcome was not solely tied to Britney, even though she took accountability for the patient. There was a process problem leading to the problem. The physician should never have written an order for Demerol since it stated a Demerol allergy on the patient’s medication chart. Also, if the pharmacist had to give the floor the medication, he/she should also have caught the Demerol allergy, which was on the patient’s chart. Paul was not involved with the medication administration and was not accountable for the patient during the time of care.

8. When Paul returned from his break, he noticed a change in Britney’s attitude. A normally quiet and reserved person, Britney was exuberant, talkative, and laughing loudly. When Paul removed the pain medication, Vicodin 10 mg, for another patient, he noticed that the count of the number of pills in the drawer was two less than what the computer system showed should be available. Paul remembered that Britney had participated in a drug treatment program 2 years ago. What legal obligations does Paul have in this situation?

9. What might happen if Britney fails a drug test considering her participation in a drug treatment program 2 years ago?

ANSWER

Legal Obligations and Potential Consequences of Britney Failing a Drug Test After Participating in a Drug Treatment Program 2 Years Ago

Introduction

In the given scenario, Paul, a nurse on the orthopedic unit, notices a change in Britney’s attitude and discovers a discrepancy in the count of pain medication in the drawer. He also recalls that Britney had participated in a drug treatment program two years ago. This raises concerns about Britney’s potential drug use and its implications for patient safety. In this essay, we will explore the legal obligations Paul has in this situation and discuss the potential consequences if Britney were to fail a drug test considering her past participation in a drug treatment program.

Legal Obligations of Paul

Reporting suspicions: Paul has a legal and ethical obligation to report his concerns about Britney’s behavior and the medication discrepancy to the appropriate authorities in the hospital (Barkhordari-Sharifabad & Mirjalili, 2020). This may include informing the nursing supervisor, nurse manager, or the hospital’s designated reporting system for such incidents.

Collaboration: Paul should collaborate with the hospital’s administration and follow any established protocols or policies regarding suspected drug diversion or impairment among healthcare professionals. This may involve providing factual information, participating in investigations, and cooperating with any legal or disciplinary proceedings that may ensue.

Patient safety: Paul’s primary responsibility is ensuring patient safety (Toney-Butler, 2022). If he has reasonable grounds to believe that Britney’s behavior or potential drug use compromises patient care, he should take appropriate steps to mitigate any risks, such as notifying the relevant healthcare providers or supervisory personnel.

Confidentiality: While Paul may have suspicions based on the medication discrepancy and Britney’s past participation in a drug treatment program, he should adhere to the principles of confidentiality and not disclose sensitive information without proper authorization or in violation of applicable privacy laws.

Consequences of Failing a Drug Test

If Britney were to fail a drug test, considering her prior participation in a drug treatment program, several consequences could occur. It is important to note that the specific outcomes may vary depending on jurisdiction, hospital policies, and other contextual factors. However, the following possibilities highlight potential scenarios:

Termination of employment: Failing a drug test could lead to termination of Britney’s employment, especially if the hospital has a zero-tolerance policy for drug use or diversion. Employers have a duty to maintain a safe work environment and may take swift action to address potential substance abuse among healthcare professionals.

Professional licensure implications: Britney’s failure of a drug test might trigger a mandatory reporting requirement to the licensing board or regulatory authority overseeing nursing practice in the jurisdiction. This could result in disciplinary actions, including suspension, revocation, or restrictions on her nursing license.

Legal and civil liability: If Britney’s drug use is found to have compromised patient care, legal and civil liability may arise. The hospital and potentially Britney herself could face lawsuits from affected patients or their families, alleging negligence, malpractice, or other related claims. The severity of the consequences would depend on the harm caused and the extent to which Britney’s actions contributed to it.

Rehabilitation and monitoring: In some cases, healthcare professionals who fail drug tests may be given the opportunity to enter rehabilitation programs, especially if they have a history of substance abuse (Treatment, 1997). Following successful completion of a treatment program, they might be subject to continued monitoring and periodic drug testing to ensure compliance and ongoing recovery.

Conclusion

In the given scenario, Paul has legal obligations to report his concerns about Britney’s behavior and the medication discrepancy. If Britney were to fail a drug test considering her past participation in a drug treatment program, the consequences could be severe, potentially resulting in termination of employment, professional licensure implications, legal and civil liability, and the need for rehabilitation and monitoring. It is essential for healthcare professionals to prioritize patient safety, comply with legal and ethical obligations, and maintain their own well-being to ensure the highest standards of care and professionalism.

References

Barkhordari-Sharifabad, M., & Mirjalili, N. (2020). Ethical leadership, nursing error and error reporting from the nurses’ perspective. Nursing Ethics, 27(2), 609–620. https://doi.org/10.1177/0969733019858706 

Toney-Butler, T. J. (2022, December 9). Recognizing Alcohol and Drug Impairment in the Workplace in Florida. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK507774/ 

Treatment, C. F. S. A. (1997). Chapter 5—Specialized Substance Abuse Treatment Programs. A Guide to Substance Abuse Services for Primary Care Clinicians – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK64815/