Unraveling the Complexities of a Nursing Negligence Case – Part 1 - What are Standards of Nursing Care?

All nursing negligence cases are based on the premise that the nurse failed to follow the Standards of Nursing Care.? It may have been a while since ?you sat in a nursing lecture regarding Nursing Standards of Care.? Let’s take a moment to refresh our knowledge. There are several sources for Nursing Standards of Care beginning with:

Legal Sources – National and State

·?????? American Nurses Association created and published 18 Standards of Care including The Nursing Processes: 1) assessment, 2) diagnosis, 3) outcomes identification, 4) planning, 5) implementation, 6) evaluation, 7) ethics, 8) advocacy, 9) respectful and equitable practice, 10) Communication, 11) Collaboration, 12) Leadership, 13) Education, 14) Scholarly Inquiry, 15) Quality of Practice, 16) Professional Practice Evaluation,? 17) Resource Stewardship, and 18) Environment Health.

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·?????? The State Board of Nursing in TN reiterates and expands the ANA Standards to Professional Practice by stating it is the RN and ANP’s ?responsibility to implementation the Nursing Process.? The State BON also defines responsibilities by the RN in regards to delegation and supervision of services to lesser trained nurses (LPN and CNAs).? The APN is given additional responsibilities regarding diagnosis and treatment.

Regulatory Sources are created and published by Accreditation organizations.

·?????? Joint Commission standards address areas of safe care such as infection protections, medication management.? In other words, we know that nurses are required to assess the IV and diagnose abnormal signs and symptoms. ?The State BON states that this process must be performed by a Registered Nurse or a nurse with advanced education.? Joint commission states that part of RN’s Standards of Care is to protect the patient’s safety by implementing measures to prevent infection of the IV site/cannula as part of the Plan of Care.

·?????? National Committee for Quality Assurance

Authoritative Sources are created and published by Professional Associations (not a complete list):

·?????? National Cancer Institute

·?????? National Institutes of Health

·?????? National Prssure Injury Advisory Panel

·?????? ASPAN- American Society of Peri Anesthesia Nurses

·?????? INS – Infusion Nurses Society? - The Infusion Nurses Society further defines all standards regarding IV infusion including the timing of IV site assessments which range from every 5 minutes for a vesicant medication to every 4 hours for a non- vesicant infusion in an awake and oriented adult.? The overriding principle is to discontinue the IV site in the presence of signs or symptom of a complications, without regard to how long it has been in place.

·?????? AACN-American Academy of Critical Nursing

Facility Specific policies and procedure – Your inpatient, outpatient, long term care facility and ?homecare IV specific policies and procedures should follow these same standards and should be updated to reflect any changes yearly.

Primary Literature or peer reviewed literature – The number of articles written on nursing standards of care are limitless.?

Hadaway, L. (2012, July 28) Short peripheral intravenous catheters and infections. Journal of Infusion Nursing, pp. 230 - 238

Evidence-Based Research - This article was published in 2019 is still referenced today.

Barruel, G (2019, August). Effectiveness of insertion maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infections in hospital patients: A systematic review.? Infection Disease & Health, pp.152 0 168.

Your opinion, whether reviewing a medical record as a behind the scenes LNC or serving as an LNC Testifying Expert, must be based on nationally published and recognized Standards of Care and not your individual opinion and experience.? Use the resources to support your opinion to avoid being challenged.

Coming some a nursing negligence case discussion.