NURSES, NURSING AND MALPRACTICE LITIGATION: 1967-197

A search for and analysis of law cases, found in law reporters for appellate courts, involving nurses and the practice of nursing for a ten-year period was undertaken to determine if there were trends in the number of malpractice cases, to provide information regarding the nature of claims and to present legal viewpoints of the independent and dependent functions of the nurse. A total of 1696 cases in the health care field for the decade 1967 to 1977 was read in the primary source known as law reports. From those cases, 390 were selected according to established criteria for analysis and reporting.;There were no apparent trends in the number of malpractice cases involving nurses and the practice of nursing during the decade studied. There was a slight increase in the number of cases during the last five years of the study over the first five years.;To show the nature of claims, the 390 cases were classified into nine categories of nursing practice which evolved from analysis of the cases--seventy-four cases involving the administration of treatments; seventy-one communications; sixty-six supervision of patients; fifty-seven the administration of medications; thirty-five foreign objects left in patients during surgery; thirty-five postoperative injuries and infections; seventeen anesthesia given by nurse-anesthetists; fifteen assisting with ambulation or movement; twenty miscellaneous.;The degree of legal involvement of persons engaged in the practice of nursing in the reported litigations was reported in five groups--five cases with someone engaged in the practice of nursing first-named defendent; forty-one co-defendants, not first-named; 174 cases with someone in nursing service the party directly responsible for the alleged negligence, but third parties charged with the legal responsibility; ninety-eight acknowledged that someone in nursing participated in the incident; seventy-two implied that someone engaged in the practice of nursing participated in causing the alleged damages.;To summarize judicial opinions of the nurse in independent and dependent functions, the courts stressed, for the most part, the nurse in a dependent role subject to the orders of a physician. Over half the cases in the study were within three classifications of nursing practice which the nursing profession believes to be independent functions of nursing practice--communications: observing, charting, reporting; administration of treatments; supervision of patients. This pointed to a marked contrast between how the nursing profession views itself and how the courts viewed it. The courts freely acknowledged independent judgment was required on the part of those engaged in the practice of nursing during the supervision of patients. There was a high degree of ambivalence among the courts in deciding just how to assign the responsibilities of nursing as they pertained to independent and dependent functions in the area of legal responsibilities as well as in the discharge of professional and administrative responsibilities.;The 390 reports in this study mentioned 464 persons engaged in the practice of nursing by (1) specific title, (2) general term, or (3) only by implication. Of the 464 persons mentioned, in 188 instances, specific titles were used, representing a total of twenty-five specific titles. Only thirty-five references were to a registered nurse and fourteen to a licensed vocational or practical nurse. In the group using general terms, someone engaged in the practice of nursing was cited 206 times, and 178 cases mentioned a nurse without further explanation of who the nurse was in terms of qualifications, experience or position in practice.;The findings of the study were discussed, and several areas which seem to need careful consideration and scrutiny by those concerned with nursing education and nursing service were identified. Recommendations for further study were made.