Nurses who work in hospitals are on the front lines of patient care. Their main responsibility is to observe, document and report any changes in a patient’s condition.
But as nurses’ workloads increase, so do their chances of making mistakes — like not communicating a change in a patient’s condition to doctors or other medical staff. This failure to document and report can result in malpractice liability for not only the hospital, but the nurse as well.
In recent years, there has been a significant increase in the number of malpractice claims brought directly against nurses, reports AmericanNurseToday.com. What is the primary complaint? That nurses are not providing timely updates on the condition of their patients.
When nurses do not communicate changes in a patient’s condition with doctors and other medical staff, it can result in a delay in care, which can be life-threatening to the patient. Changes in a patient’s condition can include the development of a fever, a rise or drop in blood pressure, bleeding, loss of consciousness, or a change in heart rate.
Not only is documenting a patient’s condition challenging for nurses because of the workplace demands being placed on them, but also because many hospitals are now using electronic medical records. With electronic records, nurses must use pre-made electronic forms, with check boxes and drop-down menus. Although electronic records are efficient, they do not always let a nurse list everything about a patient’s condition because there is often limited space for notes. Electronic medical records can also present challenges when it comes to finding information entered by another member of the medical staff.
It is understood that nurses are busy. But the fact is, if nurses don’t document their findings and communicate them with doctors and other medical staff to ensure proper patient follow-up, they will be held responsible for the outcome.