Labor & Delivery: Nurse As Patient Advocate, Chain Of Command.
Legal Eagle Eye Newsletter for the Nursing Profession
May 2018
The nurse was aware of the hospital’s policy that a nurse must invoke the nursing chain of command when a physician continues on a path that threatens the patient’s welfare.
It is a violation of the legal standard of care for a nurse to fail to invoke the nursing chain of command when that is called for. Grounds may exist for a civil lawsuit against a nurse and the nurse’s employer if a patient is harmed after a nurse has failed to invoke the chain of command, if invoking the chain of command would have changed the outcome for the better.
In this case the jury was not instructed to consider whether the nurse should have invoked the chain of command to obtain a physician’s order for a nitrazine test for the presence of amniotic fluid. APPELLATE COURT OF ILLINOIS March 30, 2018
The mother’s obstetrician told her to go to the hospital for a workup on the labor and delivery unit for preterm labor. The mother was seen and evaluated by a labor and delivery nurse and examined by a physician and went back hours later to be seen by the same nurse and a physician.
About fourteen hours after the second visit a discharge of fluid from her body made her go to an emergency room, this time at a different hospital. Spontaneous rupture of her membranes was diagnosed at the second hospital. Antibiotics were started, but the baby was born with a Group B strep infection which has caused profound brain damage.
The nursing expert for the baby testified the labor and delivery nurse at the first hospital was expected to know that a nitrazine test for amniotic fluid is indicated when spontaneous rupture of the membranes is suspected.
A nitrazine test at that hospital required a physician’s order. If the test was indicated by the nurse’s assessment, and the physician neglected or refused to order it, the nurse had a legal responsibility to invoke the nursing chain of command to get someone to get a physician to order it. However, the Appellate Court of Illinois was satisfied from the hospital’s nursing expert’s chart review that the nurse had correctly determined that spontaneous rupture had not occurred. Thus the chain of command issue was a moot point. Watson v. Med. Ctr., __ N.E. 3d __, 2018 WL 1567665 (Ill. App., March 30, 2018).
More references from nursinglaw.com
http://www.nursinglaw.com/labor&delivery12.pdf
http://www.nursinglaw.com/labor&delivery2.pdf
http://www.nursinglaw.com/labor&delivery12.htm
http://www.nursinglaw.com/labor-delivery-EMTALA.htm
http://www.nursinglaw.com/labor-delivery-breech-presentation.htm
http://www.nursinglaw.com/labor-delivery-nursing-negligence.htm