9 Ways to Protect Yourself, Your Nursing License, and Nursing Staff
In this new nursing environment, when nursing mistakes like RaDonda Vaught's can lead to criminal liability and loss of a nursing license, nurses must protect themselves and their license to help patients and themselves. Knowing that you followed the law, thoroughly charted, and took all safety precautions can give you peace of mind and a solid defense if something does go wrong.
Supervisors play a big role in ensuring their nursing staff's physical and mental safety. This article describes how supervisors can protect and support their nurses to reduce burnout and increase retention. You can also discover ways nurses can protect themselves and their license.
The Vaught case and the Christiann Gainey case have increased awareness about how unsafe nurses feel in their working environments, whether understaffed, overworked, or put in unsafe situations as frontline workers.
Donna Schisler, RN, BSN, points out that nurses often feel physically unsafe, noting that she has repeatedly experienced violence in the nursing workplace. Healthcare workers are four times more likely to be assaulted than workers in private workplaces, and half of all workplace violence occurs in healthcare settings.
Nurse practitioner Rebecca Morrison shares the same sense of lack of safety as a nurse, especially after seeing how medical mistakes are tried and convicted. Additionally, the nursing shortage and increasingly complex medical needs stretch nurses thin.
"We are required to provide care to more clients that are more complex than they ever have been with less support and the same amount of time," Morrison says. "This is a recipe for disaster and not sustainable."
4 Ways Supervisors Can Protect Nurses
Supervisors like charge nurses need to be not just administrators but leaders. This means deep involvement and constant efforts to improve work conditions for nurses, such as better safety and patient outcomes.
These four aspects are key to ensuring safety and preventing outcomes like Vaught's.
Morrison emphasizes the role of communication about daily work and demands.
"Supervisors can have weekly team meetings to discuss how nurses are coping with their daily demands and bring those concerns to the decision-makers to effect change," she says.
Schisler recommends informal and unscheduled meetings as well, when needed. At Schisler's workplace, this looks like a "vent chair." This chair offers nurses the opportunity to spend time one-on-one with the manager to express concerns, frustrations, unit matters, patient issues, coworker issues, and more.
"The nurses feel listened to, supported, protected, and safer knowing that someone is actually listening," Schisler says.
Schisler's workplace found that dedicating time to a nurse who is choosing to sit in that chair improves morale and brings to light problems within the unit that management would otherwise not be aware of.
2. Review Safety
Floor huddles on a regular cadence provide a space to review medical errors or safety issues and discuss ways to prevent reoccurring issues through unit-wide education and brainstorms.
"A once a week, or month, safety huddle is also a great tool," Schisler says. "Nurses then have the opportunity to voice areas of weakness which could result in sentinel events, and then discuss ways to fix them as a group."
When nurses work together and express the same concerns, management is more likely to act.
Supervisors must also advocate for their teams as well as listen.
"[This] means advocating for more staff, more overtime, [or] approving more vacation and personal time to prevent burnout," Morrison says. "This is part of the role of the supervisor and manager."
Nursing and healthcare leaders at all levels must advocate for nurses outside their organizations and inside. Schisler stresses that there is a need to investigate each state's Nurse Practice Act (NPA) and state boards of nursing. There are responsibilities listed in these acts which are antiquated and should no longer be included, Schisler says.
"There is a fear to practice among nurses because we are expected to know everything within each NPA and abide by it, whether it is relevant or plausible or not," she explains.
When nursing leaders act to reform nurse practice acts and state boards of nursing, it also encourages nurses that leaders are working at the macro level to support them.
Face-to-face time as a supervisor is essential to your staff feeling supported. Supervisors can dedicate time throughout each day to make rounds and check in on staff to see if anyone is feeling underwater or needs help.
"Great supervisors spend more time on the floor with their nurses than they do in their office," Schisler says.
During these rounds, supervisors can offer to watch patients to ensure that staff is getting at least 30 minutes out of a 12-hour day to leave the floor, sit, and eat.
"If the unit is understaffed, they step in to help instead of overburdening the staff by continuing to pile patients onto each nurse's assignment," she says.
Nobody feels inspired working for a leader who demands things that they'd be unwilling to perform. Staff tend to feel loyal to supervisors who step up to support nurses and take on a share of the stress and burdens.
5 Things Nurses Can Do to Protect Themselves and Their Licenses
Nurses must also protect themselves and their licenses by knowing the law, their legal responsibilities, getting malpractice insurance, and by thoroughly charting.
Nurses must also inform supervisors and leadership of risks to patients and create a paper trail. They should take necessary safety precautions, even if it takes longer.
The Vaught case demonstrates what can happen when a nurse rushes through warnings, is overworked, or is distracted.
1. Invest in Personal Liability or Malpractice Insurance
One of the best ways to protect your license is to invest in personal liability insurance for nurses. Personal liability insurance can also be referred to as:
- Medical malpractice insurance
- Nursing malpractice insurance
- Errors and omissions insurance
It's a good idea to carry personal liability insurance, even if you're covered through your facility. This ensures you're protected in the event that you or your facility get sued.
Malpractice insurance, however, does not cover criminal charges, which is why it's important to advocate for nurses being tried in civil court rather than criminal court, when appropriate.
2. Thorough Charting
"Charting is one of the biggest ways to protect yourself as a nurse," Schisler says. "In the healthcare world, there is a saying, 'If it isn't charted, then it wasn't done.'"
When hospital management or a legal team is searching through a patient's file to discover how an injury or death occurred, they will look at everything charted. If pieces are missing, then the nurse could be held liable.
Nurses will generally be safe from repercussions if it's clearly recorded that nurses:
- Followed orders
- Caught mistakes
- Expressed concerns
- Fought for their patients
- Were attentive
3. Verify and Double-Check Medications
The Vaught trial hinged on her failure to heed warnings and confirm the correct medication. Many hospitals have policies on medications such as narcotics or blood products requiring another nurse to double-check them. Be sure not to skip this double-checking process to ensure you have the right medication.
Schisler recommends multiple verifications when administering medications:
- Use the medication administration record to verify that a medication should be given to your patient.
- Ensure that the pharmacy has approved the medication.
- Use the dispensing device correctly; search using both generic and brand names. If that is unsuccessful, ask another nurse, charge nurse, or pharmacy how to find the correct medication.
- Use the scanner to verify the right medication is being given to the right patient.
- Look at the medication you are giving. Make sure there are no errors or warnings that were missed. Ensure instructions for administration are followed.
- Verify the patient's name and date of birth. Explain to the patient what you are giving them.
Keep in mind that all of this does take time. Taking the time you need to verify what is in front of you is crucial to preventing medical errors.
Supervisors also need to ensure that staff feels agency to take the time they need to verify medications.
4. When in Doubt, Ask
Don't go it alone if you're uncertain. If you have questions, are unable to find a medication, or are given something unfamiliar, reach out to another nurse, a charge nurse, or the pharmacy.
"This act alone could save a life," Schisler says.
5. Speak Up
Nurses need to advocate for themselves and a safe work environment.
"If the work environment is not safe for the nurse, it is definitely not safe for the client," Morrison says.
If a nurse does not feel safe with the work being asked of them, they have a right to say "no," and an organization must address this, Morrison stresses.
Additionally, as often as needed, nurses need to complete a safety report to be brought to their manager and other decision-makers.
Meet Our Contributors
Rebecca Morrison, NP
Rebecca Morrison is a seasoned master's-prepared nurse practitioner who specializes in addiction and mental health. She is a member of a number of committees including the creation of provincial acute pain modules.
Donna Schisler, RN, BSN
Donna Schisler is a clinical manager with over nine years of experience as a critical care travel nurse, legal nurse, and clinical manager. She was invited to the Sigma Theta Tau International Honor Society of Nursing after graduating from the Methodist College of Nursing. Today, she is a legal consultant and the clinical manager at Advantis Medical Staffing, providing assistance to nurses and helping to educate people about the world of nursing.
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