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In legal terms who is ultimately accountable if patient harm or death occurs if respiratory therapy regularly overrides RN judgment?



Dear Nancy,

I am a charge nurse/shift supervisor of a rural hospital. We have respiratory therapy in-house 24/7. The RT department feels it can override nursing judgment in ordering meds and oxygen delivery. In legal terms who is ultimately accountable if patient harm occurs due to their error in judgment?


Dear Nancy replies:

Dear Helga,

Although the respiratory therapist is the expert in relation to respiratory therapy, you are the expert in the practice of nursing. You did not specify how your rural hospital is organized. For example, to whom do the RTs report? Do they report to the same administrative person you do as the nursing supervisor? (It is hoped, by the way, that you report to the director of nursing). However the facility is structured, it might shed some light on why your judgments get overridden.

Another legal issue is the state regulatory statute that defines respiratory therapy and what the scope of practice of RT is. It may say, for example, that only a licensed respiratory therapist determines medication for respiratory problems, including oxygen administration and rates.

It seems as though this situation needs immediate intervention with the director of nursing, the director of RT and risk management or legal counsel. If nursing and RT are in competition for who does what for a patient, and in the meantime a patient is injured or dies due to the direct inability to receive RT therapy as the patient should, all involved may be sitting in a courtroom to determine liability.

This situation needs clarification with a clear policy about RT roles and nursing roles in relation to RT therapy. You might also want to contact your state board of nursing, either on-line or by phone, to determine if they have issued a position statement or have other guidance about this issue.

One of the other factors to be clarified, of course, is how does a physician’s or advanced practice nurse’s order to administer RT, with specific medications and/or specific oxygen rates, fit into this contest between the two departments?



About Author

Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.

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