I work on a rehab unit in a small hospital. Often I am the only nurse with as many as four patients. There are alarms on the beds, but a confused patient can and does get out of bed before I have time to reach the patient when I am in another room. Am I legally responsible if a patient is injured while I am rendering care to another patient? Would the hospital be responsible for the staffing pattern? Would I also be responsible for accepting the assignment?
Nancy Brent replies:
You are correct in stating that the responsibility for staffing a facility, including a rehab unit, rests with the hospital under the theory of corporate liability. One of the duties the facility has under an negligence analysis is to adequately staff its units. If that is not done, and a patient is injured or a death occurs, the facility is named in the suit under this theory. If you recall, the elements of negligence are duty, breach of duty, proximate cause and damages or injuries.
Likewise, the nursing staff have their own duties of care. If a patient care assignment is such that the care required by each patient in a particular circumstance like the one you describe is not what you would consider to be safe, both for the nurse and the patient, the nurse must make his or her concerns known to the immediate supervisor so additional nursing staff can be assigned. Although you cannot hire nursing staff yourself, voicing your concerns about the inadequate staffing may help mitigate against any liability you may be exposed to because you tried to rectify the situation within the limits of your power as a staff nurse.
Remember, too, that inadequate staffing does not just contribute to a patient fall. Short staffing has been shown to increase medicine and medical treatment errors, patient complications and nurse fatigue.
There are many ways to deal with an unsafe assignment, including attempting to negotiate a more acceptable one, asking to be re-assigned to another unit, and refusing the assignment.
Some references that might be helpful to you include: American Nurses Association (2009), “Patient Safety: Rights of Registered Nurses When Considering A Patient Assignment”; American Nurses Association (2001), Code For Nurses; and American Nurses Association (2012) ANA’s Principles for Nurse Staffing, 2nd Edition. All are available on the association’s website at www.nursingworld.org.