HA400 Unit 3 Agency Nurse Liability Analysis Example

Ten Times the Ordered Strength on a Second Shift: A Legal Analysis of a Composite Pain Pump Error by an Agency Nurse, Testing the Nurse, the Staffing Agency and the Hospital Through Negligence, Vicarious Liability and Corporate Negligence

[Student Name]

Purdue University Global

HA400: Health Care Ethics, Law, and Governance

Unit 3 Legal Analysis

[Instructor Name]

[Date]

The hospital, the agency, the nurse and the patient are composite; the analysis demonstrates legal reasoning for a course and is not legal advice, and outcomes would depend on the law of the state.

Facts

1. Day 1: The staffing agency places a registered nurse on a composite hospital's surgical unit. She receives [four] hours of orientation, which covers the electronic record but not the unit's infusion pumps.

2. Day 2, 2100: A patient of [68], on his second day after a hip replacement, has an order for hydromorphone patient-controlled analgesia at 0.2 milligrams per milliliter. The pharmacy sends a syringe labeled 2 milligrams per milliliter, a stronger product stocked for intensive care.

3. 2115: The nurse programs the pump. The pump's drug library flags the concentration; she overrides the alert and starts the infusion. No second nurse checks the setup.

4. 0130: The patient is found with a respiratory rate of [six] and an oxygen saturation of [82] percent. Naloxone is given, and he is transferred to intensive care, where he stays two days. He recovers without lasting injury but stays [three] days longer than planned.

Issues

1. Is the nurse liable for negligence?

2. Is the staffing agency liable for the nurse's negligence?

3. Is the hospital liable, either for the nurse's negligence or for its own?

Issue 1: The Nurse

Rule: A negligence claim has four elements: the nurse owed a duty, fell below the expected standard, caused the injury, and the patient suffered harm. Application: The nurse owed the patient a duty when she accepted the assignment. The standard of care would be shown by expert testimony and by the hospital's own policies, which required checking the concentration against the order and an independent double check for patient-controlled analgesia. Overriding a drug library alert without verifying the concentration is likely a breach. The overdose caused respiratory depression, an intensive care stay and extra hospital days, which are damages. Errors in programming and concentration are among the most common and serious errors with patient-controlled analgesia, which supports the view that the risk was foreseeable (Hicks et al., 2008). Conclusion: The nurse is likely liable, though the extent may be shared with others. The nurse's override is the last step in the chain, but a court will ask how the wrong syringe and an unchecked pump reached her in the first place.

Issue 2: The Staffing Agency

Rule: Under respondeat superior, an employer answers for an employee's negligence committed while doing the job. When a worker is lent to another organization, courts ask which organization controlled the work, sometimes called the borrowed servant question. Application: The agency employed the nurse and paid her. The hospital directed her work, set her assignment and controlled the unit's procedures. Courts differ on whether the agency, the hospital or both are liable in this situation. The contract between the agency and the hospital commonly addresses responsibility, for example through indemnification and insurance terms, and the agency's own duties in screening and verifying the nurse's competence. If the agency placed a nurse without verifying her experience with infusion pumps when the hospital requested it, it may also face a claim for negligent placement. Conclusion: The agency may share liability; the contract will matter.

Issue 3: The Hospital

Rule, vicarious liability: A hospital may be liable for the negligence of a borrowed nurse it controlled, or where the patient reasonably believed the nurse was the hospital's. Rule, corporate negligence: Apart from any staff member's fault, a hospital carries direct duties to its patients, including a duty to oversee the care given within its walls (Darling v. Charleston Community Memorial Hospital, 1965). Some courts describe these duties as including safe facilities and equipment, competent staff, oversight of all who practice there and adequate rules and policies (Thompson v. Nason Hospital, 1991). Application: The hospital's possible failures are its own. It oriented the nurse for four hours without covering the pumps. Its pharmacy dispensed a concentration stocked for intensive care to a surgical floor. It required a double check by policy but had no process to ensure one happened at night. Each failure is a system issue independent of the nurse's override. The patient also had no way of knowing the nurse was not a hospital employee; she wore the hospital's badge. Conclusion: The hospital faces significant exposure, both vicarious and direct.

How Liability Might Be Shared

In many states, damages may be divided among defendants by fault. A jury could find the nurse responsible for the override, the hospital for the dispensing and orientation failures and the agency for any failure in screening. The final split would depend on the evidence, state law and the contract.

Records Each Party Would Need to Produce

The nurse: her license, her account of the shift and any training records she holds. The agency: the placement file, skills checklist, competency verification and the contract with the hospital. The hospital: the orientation record, the pharmacy dispensing record, the pump's event log showing the override, unit policies on double checks, staffing records for the night and the incident report and any root cause analysis, subject to state rules protecting quality review documents.

Risk Management Lessons

Agency staff should not use infusion pumps until competency is verified. Pharmacy should restrict high-concentration opioids to units that need them. Drug library overrides for high-alert drugs should require a second nurse to sign in the pump. Each change would reduce both risk to patients and the hospital's liability.

Damages

The patient's damages include the extra days in hospital, the intensive care stay and pain and fear during the event. Because he recovered without lasting injury, damages would be smaller than in a case of permanent harm, but the costs of the stay and the case could still be significant.

Disclosure and Early Resolution

The hospital should disclose the error to the patient and family, explain what is being done to prevent a repeat and consider an early offer to cover the extra costs. Early, honest disclosure is both an ethical duty and, in many settings, a way to reduce the cost and length of disputes.

Limits of This Analysis

State law differs on borrowed servant rules, corporate negligence and the division of fault. The facts may change with discovery; for example, if the nurse had completed pump training elsewhere, the agency's exposure would fall.

Conclusion

The nurse is likely negligent, the agency's liability turns on control and the contract, and the hospital faces direct exposure for its own system failures as well as vicarious exposure for the nurse. The case shows why the legal question and the safety question share an answer: the hospital's systems are its responsibility.

References

Darling v. Charleston Community Memorial Hospital, 211 N.E.2d 253 (Ill. 1965).

Hicks, R. W., Sikirica, V., Nelson, W., Schein, J. R., & Cousins, D. D. (2008). Medication errors involving patient-controlled analgesia. American Journal of Health-System Pharmacy, 65(5), 429-440. https://doi.org/10.2146/ajhp070194

Thompson v. Nason Hospital, 591 A.2d 703 (Pa. 1991).