The enactment of various legal provisions like Consumer Protection Act, Right to Information Act and standardization of procedures and practices have brought nursing care under legal ambit. Needless to say, the level of legal awareness amidst nursing staff in India is abysmally low. Present study was undertaken to assess the level of legal awareness and responsibilities of nursing staff in administration of patient care at a trust hospital.
Concomitant with the development of a theoretical base, the role of nurses has undergone a paradigm shift, leading to the expansion and extension of their clinical roles in a number of specialized areas. Commercialization of the medical profession has resulted in large scale mushrooming of hospitals, nursing homes and clinics on one hand and the patients developing an attitude of “shopping” with his/her disease on the other. Nursing colleges and institutes have grown in manifold ways, to exploit this lucrative business. The number of Auxiliary Nurse Midwife (ANM) colleges has grown from 271 in Mar 2006 to 1113, while the number of General Nursing and Midwifery (GNM) colleges has increased from 1321 to 1961 by August 2013 [1,2].
The nurses in India are generally basking under the impression that the onus of all omissions and commissions rests with the doctor and the hospital administration, and that they are not accountable for anything. The enactment of various legal provisions like Consumer Protection Act, India, 1986 (CPA), Right to Information Act, 2005 (RTI) and standardization of procedures and practices has brought nursing care under the legal ambit and focus, more than ever before. Needless to say, the level of legal awareness amidst nursing staff in India is abysmally low. Even in developed countries like USA, the number of adverse actions reported to NPDB, related to nurses in 2011, was nearly double of that which was seen in 2002 (21,586 vs. 11,029 respectively) .
However, of late, nurses in India have been in the limelight for negligence and cases of criminal medical negligence against nurses are also being registered in courts . The growing awareness on literate and net savvy consumers, the prying eyes of the media and the race for breaking news will ensure that such cases will be hard to put under the carpet in the future. It is time for nurses to understand that doctors will no longer be party to negligent acts attributable to nursing care.
There are not too many cases of legal suits filed against nurses in India, as our patients and their relatives still feel that the responsibility of any criminal negligence in patient care lies with the doctors. However, there have been criminal suites of medical negligence against nurses and the notable ones among these are:
Unskilled treatment of a high risk pregnancy at Jeevan Hospital at Tanjore Road near Tiruchirapallli in Tamil Nadu (1994), resulting in death of the foetus .
Partial disability of leg, caused due to administration of injection by an unqualified nurse in 1995 at Karuna Hospital in Thiruvanthapuram .
Permanent brain damage caused by negligence of nurse in administration of drug at Spring Meadows Hospital in 1993 .
Death of an Infant caused by negligence of nurse on duty on 22 February 2010 at Government Medical College, Nagpur .
A very recent case of a mismatched blood transfusion carried out by a nurse in Bangalore at KC General Hospital, resulting in death of patient .
All nurses should be familiar with nursing laws and ethics and they should understand as to how nursing legal issues can affect them. Basic nursing laws which all nurses should know are:-
Signatures are Golden: When a physician or another health care provider orders that a procedure be done on a patient, it is the nurse’s responsibility to obtain the patient’s informed consent and signature. If the nurse does not obtain his/her signature, both the nurse and the health care provider can be held liable for damages.
Documentation: It is the nurse’s responsibility to make sure that everything that is done with regards to a patient’s care (vital signs, specimen collections, medication administration, etc.) is documented in his/her chart/case sheet. If they are not documented within the proper time frame, the nurse can be held liable for negative outcomes. A note of caution: if an error is made on the chart, it should be crossed out with one line (so that it remains legible) and the correction and the cause of the error should be noted.
Report it or Tort it: Allegations of abuse are serious matters. It is the duty of the nurse to report to the proper authority when any allegations are made (emotional, sexual, physical, and mental) towards a vulnerable population (children, elderly, or domestic). If no report is made, the nurse has to be heldliable for negligence or wrongdoing towards the victimized patient. Rights to Privacy: The nurse is responsible for keeping all patient records and personal information private and only accessible to the immediate care providers. If records get out or a patient’s privacy is breached, the liability lies on the nurse, because the nurse has immediate access to the records.