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Examine the implications of health law for nurses, ethical principles, and decision making when faced with the potential for medical error is part of the nurse’s daily activity when caring for patients. Each state has a Board of Nursing governing the practice of nurses. The board of nursing specifies through codes, titles, articles, and definitions how the licensed registered nurses can legally practice. The case study “Where Did This Patient’s Intravenous (IV) Therapy Go Awry? ” is the study being addressed in the paper.

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Error The nurse in this case chose to perform a nursing procedure without a physician’s order. The nurse felt she had no other options and chose to place an IV in the right foot of a patient with poor access in the upper extermities. The nurse was unaware of the guidelines from the Center of Disease Control and Prevention (CDC) and the Infusion Nurses Society (INS). The INS states “Cannulation of the lower extremities in adults should be avoided because of the increased risk of phlebitis” (Intravenous Nursing Society,2000).

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The nurses admitted she was “vaguely aware of the hospital’s policy” (Rosenthall, et al). By performing a procedure without an physicians order, the nurse is acting outside her scope of practice. Additional errors followed involving other nurses. It is the nurse’s responsibility of report to the next shift the patient’s overall patient condition, including signs and symptoms, past history, and findings on assessments. The nurses caring for this patient failure to do a complete nursing assessment, report findings to the next shift nurse or the physician in charge is the patient’s care.

Everyone caring for the patient is liable for the patient’s care. The ethical standards violated by this nurse involves 3. 5 Acting of Questionable practice. The questionable practice involves the nurse placing an IV in the patient’s lower extremity, the violation of hospital policy, INS guidelines, and the CDC guidelines, and doing so without an order. Then forgetting to pass along the information to the physician and the staff. Standard 4. 2 requires nurses to take responsibility for their actions. The case study does not state how the nurse reacted to her actions.

Nurses are to take responsibility for their action every shift. The taking of responsibility for starting an IV in the foot without an order and then forgot to pass along the incident in report is a not taking responsibility for her actions. The other nurses caring for Mrs, Smoltz did not do a complete assessment and was not responsible in their nursing practice as well. If the nurses caring for Mrs. Smotlz had done a complete assessment, they would have seen the injection site, redness, and swelling in the patient’s right leg only. Ethical standard 4. states “individual nurses are responsible for assessing their own competence”. If a nurse is over worked, short staffed, and uneducated to the nursing guidelines and policies of the hospital, the nurse is not stopping to assessing their abilities and they are liable for their performance. The nurse’s failure to adhere to the ethical standards placed the patient in danger. Had the nurse not performed the IV insertion into the patient’s right foot, the patient’s probability of surviving pulmonary embolisms related to the deep vein thrombosis in the right popliteal and femoral veins would be high.

The nurse practice act is to protect and assist nurses in their daily practice. This incident makes the case for continued education. As evidence based practice in so many areas of nursing becomes guidelines, it is importance for nurses to continue learning through their specialty association and through the difference societies of nursing. The pros of providing an apology for mistakes or errors can result in a positive outcome or a negative outcome. The legal or financial outcome depends on the severity of the error and the values of the patient and family members.

All families want to know what happened or why it happened. Some people value the honestly and they may not take legal action. The cons of providing an apology is it can be a costly error and the nurse could be in jeopardy of losing their professional license. To prevent such an error from occurring nurses need to know their options. Nurses should be encouraged to report potentially negative nursing actions and complete incident reports. Nurses must be educated to the chain of command, so they are not making decisions on their own and they know who to contact for support.

When questionable nursing practices occur, nurses should be educated as to what is expected of them to minimize the risk of error. Education should be an ongoing event as evidence based practice becomes available. Staff should be encourage and reimbursed for attending educational meetings, conferences, and for joining their specialty organization. Staff should be encouraged to obtain their specialty certification. Errors happen and they should be reported in staff meeting and in hospital wide committees to prevent their reoccurrence.

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Kylie Garcia

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