The Issues of Professional Governance in Health Care - Case Study Example

Supplementary Assessment NURS12144 Legal Issues in Health Care   Delegation is a process of entrusting work to someone or the assignment of responsibility (Hansten and Washburn, 1999). It is a legal and management oriented concept, there are those that define it as being an art and a skill, a decision-making process; as a process delegation can never be absolute; the one delegating a task maintains ultimate answerability for the delegation and the decision-making process, and for the results of the task being delegated (Hansten et al., 1999). Efficient nursing delegation in a clinical setting is important for the proper management and implementation of the patient care process. In fact its importance cannot be stressed enough because it is the efficiency of the nursing delegation process that decides ultimately, the level of comfort that is provided to the patient and ensures faster recovery for all intents and purposes.  In this analysis we shall explore the issues of professional governance as far the medical setting is concerned in general and the delegation of nursing tasks by doctors and registered nurses are concerned in particular. For this purpose we shall establish the role played by the regulatory bodies like the Australian Nursing and Midwifery Council (ANMC). This analysis will also focus on the laws that could be applicable in cases of patient health deterioration due to the incorrect nursing administration that has resulted from incorrect delegation practices (George, Burke and Rogers, 1997).. In order to do those the paper will look at the existing correct practices in delegation and will end with a conclusion about how the hospital, the responsible doctor and the nurse need to go about dealing with the problem. It must be stated at the beginning of the discussion that nursing delegation should for all aims and purposes meet the five rules of delegation that are a part of the RN delegation task pane but would apply to other task delegation as well. The five variables to be considered while delegation of responsibility by RN: The Right Task: One that is delegable for a specific patient, it needs to be based on desired outcome, within the scope of practice and according to the job description of the one to whom the task is being delegated. The basic consideration under this principles being the task that is correct to perform for each specific patient needs to be based on outcomes planned in partnership with the patient. Right Circumstances: This needs to be in line with the appropriate patient setting, available resources, and other relevant factors under consideration. This is based on setting, patient situation, degree of supervision and predictability of results Right Person: Right person is delegating the right task to the right person to be performed on the right person. The factors under consideration are certification/licensure, job description, skill checklist, demonstrated skill Right Direction/Communication: Clear, concise description of the task, including its objective, limits and expectations; The Four Cs of Initial Direction i.e. ‘Clear- Concise- Correct- Complete’ need to be answered (Marx and Miceli, 2008). Right Supervision: This includes appropriate monitoring, evaluation, intervention, as needed, and feedback. This means that Giving and receiving feedback, while supporting each team member’s accountability, can improve performance by up to 60% if goals are also clear. The law in this regard is clear: RCW 18.79.270 LPNs “. . . administer drugs, medications, treatments, tests, injections, and inoculations, whether or not the piercing of tissues is involved and whether or not a degree of independent judgment and skill is required, when selected to do so by one of the licensed practitioners designated in this section, or by a registered nurse who need not be physically present; if the order given is reduced to writing within a reasonable time and made a part of the patient's record. Such direction must be for acts within the scope of licensed practical nurse practice”. The case would have two essential argument points: The legal and the regulatory. The cases that would be applicable in this case would be first and foremost, the High Court ruling Paton v Parker and Another (1941) 65 C L R. 187. The ruling of the case found the surgeon free of responsibility for damage rendered. The idea was that an accident does not ordinarily occur if those in control of the anesthetic use pro[per care. Unexplained these facts constitute some evidence of want of care on the part of the anesthetist fit for submission to the jury. The idea therefore was that a surgeon could and would work under the assumption that the one operating in their given field would know the right course of action. In this case therefore, there could be an argument put forward that the surgeon did tell the nurse what to do under the assumption that the nurse would make it a point to accept within the scope of his duty and backed by training to have checked the patient’s charts and doubled checked with the registered nurse before administering the medication the manner in which he did. The fact of the matter also remains that the nurse in question was not authorized to administer the drugs in the first place having had no experience of narcotics administration before. The first thing that ANMC would have to do is to refer the surgeon responsible for the instructions to the relevant doctors and surgeons regulatory body in Australia (Doherty and Hope, 2006). This is a necessity given the fact that there was a large aspect of the blame that needs to be placed at the surgeon’s end given the fact that he passed instructions without assessing the competencies of the nurse that he was instructing for the task for which the instructions were being given. The fact that the nurse was not competent enough for the administration of narcotics should have been assessed (Healy J and Braithwaite J, 2006). The second thing that ANMC would have to do is find out why the registered nurse did not make a plan or the administration of medication for the patient given the fact that the patient was due for surgery. In any ideal or well managed situation, there should have been a chart with a competent nurse posted on the management of the patient the morning that the surgery was supposed to take place. The fact that an incompetent nurse with no experience in the administration of narcotics was allowed to administer the drug in the first place is an occurrence that needs questioning and thorough investigation (Badovinac, Wilson, and Woodhouse, 1999). The nurse in question would therefore be legible for a training and competence building process wherein the specifications of narcotics administration would have to be clarified. On the more legal side of it, the hospital as an establishment, the doctor and the nurse herself would be liable to pay the damages to the patient’s health due to the careless behavior demonstrated by the surgeon. The hospital and the surgeon could be sued based on the tort of negligence that exists to serve two basic purposes: first to compensate injured persons whose injuries have resulted from the fault of others with the limits stated in law and secondly, to inhibit socially undesirable activities of the type that are likely to inflict injury. What we have here is a clear cut case of negligence. There was no planning and no manner in which the patient was at fault despite her having received some serious injuries due to the incorrect administration of narcotics. Negligence, called malpractice on occasions poses a particular problem for most health workers given the fact that the nature to torts such as assault and false imprisonment. Negligence is in essence defined as the omission to do something that a reasonable man, guided upon those considerations which ordinarily regulate the conduct of human affairs would do, or doing something that a prudent or reasonable man would not do (Bamberger, 2006). Going by this particular definition therefore one would have to indict the nurse for having administered the drug despite a knowledge that he was not competent enough in the correct capacity to do so and the doctor as well for having instructed a nurse not competent to administer a critical narcotics dose. Having said all this one would have to consider in final conclusion the fact that predominant model of work as far as regulatory bodies in Australia medical system are concerned has been the work of reconciliation (Bogosian, 1998). The primary focus has been on the bodies seeking to identify whether complaints could be resolved directly using some form of conciliation or mediation turning to investigation only if these other avenues are not successful. The registration board would be responsible for the investigation and prosecution if the patient were determined to in fact carry the prosecution out. There are a number of complaints that are never handled in the correct manner and one might not be wrong in assuming the fact that a lapse as serious as this one might not get the justice that it deserves but will be, in all probabilities dusted under the mat like a number of previous cases. Reference: Hansten, R.I. and Washburn, M J, 1999, Individual and organizational accountability for development of critical thinking, pub, Journal of Nursing Administration, Vol.29 No.11, pp39–45  Hansten R I, Washburn M, Jackson M, Kenyon V, 1999, Home Care Nursing and Delegation Skills, pub, Jones and Barlett Publications, pp73-76  Bogossian, F H, 1998, A review of midwifery legislation in Australia — History, current state & future directions, pub, Australian College of Midwives Incorporated Journal, Vol.11 No.1, pp24-31 Marx E S and Micle  D G, 2008, Leadership and Management Skills for Long-Term Care, pub, Amazon Books, pp53-55  Badovinac, C.C., Wilson, S., and Woodhouse, D, 1999, The use of unlicensed assistive personnel and selected outcome indicators, pub, Nursing Economics, Vol.17 No. 4, pp194–200  RN liability exposure for delegated acts AORN, Volume 69, Issue 1, Pages 277-279 E. Murphy Healy J and Braithwaite J, 2006, Can better governance produce better health care?, pub, Medical Journal of Australia, Vol.184 No.10, ppS56-S59 Doherty C., Hope W, 2000, Shared governance - Nurses making a difference, pub, Journal of Nursing Management, Vol.8 No.2, pp77-81 George V, Burke L J, and Rodgers B l, 1997, Assessing nurses' attitudes toward governance and professional practice autonomy after hospital acquisition, pub, Journal of Nursing Administration, Vol. 27 No.5, pp53-61 Read More