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Chris Cox looks at risk management and accountability issues for nurses, especially those undertaking extended roles
Summary
Shifting boundaries in healthcare roles have led to anxiety among some nurses about their legal responsibilities and accountabilities. This is partly because of a lack of education about legal principles that underpin healthcare delivery. This article explains the law in terms of standards of care, duty of care, vicarious liability and indemnity insurance.
Keywords
Law, ethics, legal responsibility, accountability, liability, duty of care, education
AS THE working boundaries between healthcare practitioners shift, with registered nurses taking on many of the tasks previously undertaken by medical colleagues, and healthcare support workers assuming responsibility for activities traditionally performed by registered nurses, issues of risk management and legal accountability inevitably arise.
Questions typically raised by practitioners, their colleagues and their managers in a perpetually moving healthcare environment concern whether:
* They will be held responsible by a court for their actions.
* It is legal for them to undertake certain work.
* They retain accountability for tasks even though they have delegated them to others properly.
* They need separate insurance or indemnity arrangements for extended roles.
Such uncertainty reflects a gap in education about the legal principles that underpin the delivery of health care. In fact, the answers to these questions are reasonably straightforward.
First, the law generally does not prescribe who might perform particular healthcare tasks or roles, although there are exceptions. Under mental health legislation, for example, only doctors are empowered to perform certain compulsory' mental healthcare procedures. But these exceptions are limited and the general rule applies to most healthcare interventions.
Even if the law is not prescriptive in the identification of who can do what in health care, it nevertheless provides a regulatory framework for how this care should be delivered in practice.
This is realised through the ordinary principles of civil, or common, law, known as the law of tort, and, in particular, the law of negligence. Although both criminal and contract law are also relevant, neither are as significant as the ordinary principles of negligence law and are therefore not considered further in this article.
Appropriate standards
The law imposes a duty of care on practitioners, whether healthcare support workers, registered nurses, doctors...