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Professional Development Exercises : Read the case study presented at the end of Chapter 11 (Guido, p. 222) A nurse had been working in a critical care unit for more than 25 years, gaining respect for her competence and dedication before suspicions began to gather that she was diverting narcotics for her own use. The acute care hospital had recently installed a “computerized medicine cabinet” for enhanced distribution and better monitoring of narcotics. The cabinet recorded the nurse’s per 222 Part 4 • Impact of the Law on the Professional Practice of Nursing nurses testified that they often deviated from the physician’s order for an IM injection, electing to give the medication by an IV route. Finally, there was testimony that the hospital had no formal policy for which nurse was to document narcotics in the paper record when two nurses, such as a preceptor and a mentee, both had responsibility for the patient. The nurse who was suspended testified that she, too, frequently entered data into the paper record long after she had administered the medication and, in some rare instances, entered the data on the following day. QUESTIONS 1. D id the facility have sufficient evidence to suspend the nurse from their employee? 2. How should the testimony of the other nurses in the unit affect the outcome of this case? 3. What additional questions should the institution address before the court rules in this case? 4. How would you have ruled in this case? sonal keypad code and the patient’s data before it could be unlocked and narcotics dispensed. The nurses were also required to document the narcotic usage by handwriting the patient’s name, medication, time, route, and dosage on a more traditional paper medication administration record (MAR). D iscrepancies were noted between this nurse’s patients’ electronic data for narcotic administration and the handwritten notations made on the paper record. The nurse was first questioned by her supervisors and then she was suspended, as they did not find her explanations credible. Her grievance was upheld by the arbitrator assigned to the case and the hospital appealed. A t trial, other nurses from the same unit testified that they frequently completed their paper record documentation during their breaks or at the end of the shift, often when they could not remember exactly what medications or dosages they had administered to patients. There was additional information that the nurses would electronically sign for narcotics, prepare IV drip bags in advance of when they were needed, and then discard these same IV bags when they were no longer required or the physicians had changed the medication orders. Additionally, these Did the facility have sufficient evidence to suspend the nurse? How should the testimony of the other nurses in the unit affect the outcome of this case? What additional questions should the institution address before the court rules in this case? How would you have ruled in this case? Read the case study presented at the end of Chapter 12 (Guido, p. 238) preschool teacher called child protective services about a child who appeared to have a vaginal infection and the child protective services worker instructed the mother to take her child to the emergency center at the local acute care facility. In the emergency center, the child was examined by an ANP who found a vaginal tear, which the ANP felt could have been caused by digital penetration. The child would not talk about the injury with the ANP. T he ANP then discussed the child’s case with the child protective services worker, and the child was admitted to the facility. The parents were subsequently questioned regarding potential abuse of the child. Charges of child abuse were filed against the father, who is now a registered sex offender in the state. The parents filed suit against the preschool teacher, the case worker and the ANP. A t trial, evidence was presented that the ANP did not share her findings or impressions of possible child abuse with the mother, the child’s primary pediatrician, or other emergency center physicians. She also did not recommend that the mother contact the child’s pediatrician for an evaluation and a second opinion. The ANP also admitted that it was possible that the child had scratched herself as a result of the infection and that the child herself had caused the vaginal tear. Did the ANP have a duty to consult with the child’s physician or another emergency center physician regarding the possibility of child abuse before she reported her findings to the case worker? What questions would you anticipate might be asked regarding the injury itself and the possibility that the child had caused her own injury? Did the ANP have a duty to report the injury, even though the diagnosis was not absolutely conclusive at the point that the child was initially examined? How would you determine liability in this case, assuming that the trial court found liability against any of the three defendants? Read the case study presented at the end of Chapter 16 (Guido, p. 329) licensed practical nurse (LPN) employed by a nursing personnel agency worked one evening shift at the Veterans Administration Hospital in a major city. She cared for a patient who had recently undergone hip replacement surgery. Since his surgery, the patient had consistently spiked significant temperatures, and his temperature generally responded well to oral Tylenol, 500 mg, 2 tablets, every 4 hours as needed. The change nurse explained to the LPN that the patient was to continue on vital signs every 4 hours, including temperatures, and that he was to be medicated if his fever increased, even if only at low-grade levels. During the evening that she worked, the LPN obtained the patient’s temperature at 4 p.m. and again at 8 p.m. He had a lowgrade fever at the 4 p.m. hour and his temperature had risen to 102 degrees orally at 8 p.m. At both intervals, the LPN administered Tylenol as ordered. The charge nurse did not assess the patient during the evening, nor did she inquire about the patient’s condition. The nurse caring for the patient at midnight noted that his temperature was still elevated (102.4 orally). When notified, the attending physician ordered blood cultures, additional treatment for his ever-increasing fever, and a change in antibiotic therapy. D espite this aggressive therapy, the patient developed a fatal septicemia and the patient’s family sued for wrongful death. At trial, the court determined that the charge nurse had been derelict in her duty to supervise this patient and assessed partial liability against the LPN and the charge nurse Did the nurse manager have a responsibility to supervise the care of the patient? Was the care of this patient appropriately assigned to the LPN by the charge nurse, or could the charge nurse have delegated this patient’s care more appropriately? If the charge nurse assigned the care of the patient to the LPN, did she retain any supervisory responsibility that would result in her liability in this case? How do the principles associated with delegation and supervision figure into this case? How would you decide this case? You are not required to adhere to the 500-1000 word count for each of the responses, but please be thorough in your responses so that you adequately address all aspects of each question.
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