Case Study Review
An LVN named Maggie was seen to suture a deep laceration in the presence of a physician (Marquis & Huston, 2009). The incident simultaneously raises several ethical, procedural, legal, and other issues. As an Emergency Department evening charge nurse and the one who witnessed Maggie suture a wound, I need to consider possible legal ramifications of the situation and assess the responsibilities of the involved parties. This will help me develop recommendations on what should be done in the case.
It should be acknowledged that the case could have had serious legal ramifications. If the patient had been hurt during suturing or if complications had occurred (such as hemorrhage), the patient would have been entitled to start legal proceedings. It would have caused negligence accusations that could have affected not Maggie alone but also her supervisor, the physician who let her suture, and the entire medical facility at the end of the day. Technically, since rules have been violated, legal ramifications can occur anyway if the case is duly reported.
Case analysis requires examining the responsibilities of each party involved in the incident. As a supervisor, I am responsible for communicating the boundaries of authority and responsibilities to the members of my nursing team and explaining the ramifications of violating the boundaries (Eggenberger, 2012). Since I had heard that Maggie could occasionally exceed her job description before the incident, I should have approached her and explained that such excesses were unacceptable. The physician who let her suture should have understood that he or she could let down the entire facility. Despite claiming to take the responsibility for Maggie’s actions, the physician let the nurse perform a task outside of her licensure, which is too serious and goes beyond the area of things that a doctor can take the responsibility for. Finally, Maggie herself deliberately committed a violation, which brought about risks not only for her license but also the reputation of the physician she was working with, for me as her supervisor, for her team, and the entire hospital. Her responsibility was either to refrain from exceeding her job responsibilities or pursue a different license.
However, despite possible adverse effects, this incident showed something positive, too. First of all, the relationship between Maggie and the physician who defended her was trustful and respectful. Such relationships between different members of the medical staff should be encouraged and facilitated (Tang, Chan, Zhou, & Liaw, 2013). It is necessary to prevent a development where the incident would cause a conflict between nurses and physicians. Nonetheless, it does not mean that the incident should be simply ignored. As a supervising nurse, I will need to immediately communicate to the incident’s participants that they committed a violation and may be penalized for it. I want to make it clear that such behaviors are unacceptable and will be inevitably reported to the hospital’s management if repeated. Yet, I do think that the incident does not have to be reported now because it was the first time such a violation was observed.
Everyone should stay within their responsibilities and authority. No-one should question this rule. However, it should be recognized that sometimes in healthcare, such as in emergency cases, providers are forced to and have to go beyond formal entitlements to provide optimal care. It is a positive thing that a hospital has competent and dedicated nurses. It is a positive thing that physicians appreciate them, support them, willingly delegate some tasks, and take the responsibility for their actions. While encouraging all this, it is still necessary to set and protect boundaries. Maggie and the physician who let her suture should not be reported the first time they got caught, but they should be forbidden to do it again.
References
Eggenberger, T. (2012). Exploring the charge nurse role: Holding the frontline. Journal of Nursing Administration, 42(11), 502-506.
Marquis, B. L., & Huston, C. J. (2009). Leadership roles and management functions in nursing: Theory and application. Philadelphia, PA: Lippincott Williams & Wilkins.
Tang, C. J., Chan, S. W., Zhou, W. T., & Liaw, S. Y. (2013). Collaboration between hospital physicians and nurses: An integrated literature review. International Nursing Review, 60(3), 291-302.