Legal And Ethical Concepts In Nursing

Legal And Ethical Concepts In Nursing: A Case Study

Ethical Issues in Nursing
Case Study
You graduated from Loyola after receiving your MSN and after your excitement about Nursing 709 you decided to remain at Loyola to study Law. You have now graduated from Loyola School of Law. Congratulations! In addition, you passed the Bar exam in your home state with an excellent score! You have been recruited by a top notch law firm and are expected to be a health care law expert by the owning partners. Your good luck continues as you are just arriving for your first day and the senior partner walks into your office with 3 large boxes of legal files. She advises that you have been assigned a new case and she expects a legal analysis on her desk by 8 am the next morning. Your head is swimming but as a Loyola School of Nursing graduate you know you can handle this task. After drinking a cup of coffee and listening to a motivational speech from Justice Sonia Sotomayor, you attack the legal files. The case you must analyze is as follows. Thankfully, the partner was kind enough to provide an outline for you to follow for submitting your legal analysis, opinion and best strategy for the defense of your client.

The case:
The client, Nurse Willy Wonka RN, MSN, CPHN, CNE, CCCN, CDE, has been terminated from his position at a large health care system, based upon the following scenario. Additionally Nurse Wonka has been personally sued for negligence by the family. Nurse Wonka has retained your firm for the legal defense of negligence in this case and for his counter-suit against the hospital for wrongful termination. The facts are as follows:

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Nurse Wonka has been the nurse manager of the palliative care unit at Candy Land Health System for 25 years. On December 24th of 2015 the unit was full to capacity and 4 RNs called in sick. Nurses were pulled from pediatrics, an area with low census, to staff the palliative unit. These nurses had completed the competency for patients aged 2 months to 18 years and the annual evaluations were in their personnel files. Nurse Wonka was called at 1930 hours that evening by one of the pediatric nurses, nurse Nestle Crunch- Bar, who advised him that she was not capable of handling dying patients, did not know the unit protocols and had no adult care experience. Nurse Wonka had worked 7 days straight and was exhausted and referred nurse Crunch-Bar to the house supervisor (nurse Reese Cup). Two hours later (2130), nurse Crunch-Bar again called nurse Wonka and advised that nurse Cup refused to respond to her. She also advised nurse Wonka of the charge nurse’s (nurse Hershey Kiss) advice to her: “just do your job or you are fired!” Nurse Crunch-Bar further advised nurse Wonka that the only other nurses on the unit were staffing agency contract nurses, including nurse Kiss, who had minimal knowledge of the unit and no palliative experience. Nurse Wonka called the house supervisor, nurse Cup, and left a message for a return call. While waiting for the return of his call, nurse Wonka fell into an exhausted sleep. At 1am (0100 hours) nurse Crunch-Bar again called nurse Wonka who advised nurse Crunch-Bar that he was waiting for a return call from the supervisor for assistance and he would return to the unit at 5am (0500) to help her. Nurse Wonka actually arrived on the unit at 6:30am (0630), after sleeping a bit more and enjoying mugs of hot chocolate on Christmas morning with his family. Nurse Wonka saw a code in progress. Inside the room the patient’s family were watching the code and screaming in horror that their father did not want this treatment. The Resident and staff were ignoring them and actively providing aggressive means of life support. Nurse Wonka recalls the DNR order for this patient suffering with terminal lung cancer and the living will, as well as a healthcare power of attorney for the son. Nurse Wonka also recalls the patient’s wishes to die in peace and comfort, surrounded by his family and loved ones. Nurse Wonka was horror stricken and thought of the patient’s self-determination being violated, as well as his dignity. The end result was the patient’s death during the aggressive code. The patient sustained 6 broken ribs, extreme trauma due to failed intubation and a crushed larynx. As the group dispersed, one nurse stood frozen over the patient: Nurse Crunch-Bar. Nurse Crunch-Bar saw nurse Wonka and screamed: “I have killed this patient and you are guilty too!” Nurse Crunch-Bar had followed the order for morphine 40mg IV q 4 hours. However, nurse Crunch-Bar had misread the order, which was actually morphine 4 mg IV q 4 hours. During the push at 6am (0600) the patient drifted off to sleep and then stopped breathing. Nurse Crunch- Bar then called the code. Nurse Kiss, the contract nurse who was in charge, advised nurse Wonka that he certainly had no liability, as he is only a contracted employee. However, the contract was never executed and still sits in Administration awaiting final agreement, payment terms and signature. The house supervisor (nurse Cup) never responded to nurse Wonka’s call.

Nurse Wonka was called to Administration at 0930 and terminated for failure to properly train and supervise the nurses, delayed response to a request for assistance and for failure to monitor medication dosages and narcotic dosing regimens on the unit. Since this event, the family has sued the hospital and nurse Wonka for negligence and wrongful death.

– Identify the legal concepts and explain the expected legal progression (trial process) for this case
– Outline four major elements of Negligence and state if each is present or absent in this case. Provide your rationale.
– Discuss the ethical principles of this case-be specific and provide your rationale. Contrast the ethical principles to the legal issues. Do they conflict?
– Discuss the issue of informed consent, patient self-determination, vicarious liability and the manager’s duty to evaluate and supervise in this case.
– Analyze the contractual relationship in this case. Include a discussion of the elements of a contract and a legal analysis as to any missing or required elements.
– Based upon your complete analysis of the case, provide the best legal opinion to your client based upon the answers to the above noted rubric sections and your research in this course.

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