legal obligation clinical dilemma faced by triage nurses

The fundamental issue in the case study is the legal responsibility clinical dilemma that triage nurses face when financial motives conflict with patient well-being. Mr. Jones reported an instance of pericardial effusion in this case.

Nurse Clark’s primary duty to the patient is the duty of care. Whereas the patient’s health concerns take precedence over any financial issues. The nurse was responsible for performing an initial evaluation to determine the level of risk on the patient in order to take appropriate action if there was a risk. It is illegal to refuse care because of financial concerns. This is regardless of the financial concerns that the patient have. Also, Nurse Clarke had the affirmative duty – duty to prevent harm to the patient. In this regard, it was the duty of the nurse and the hospital to provide chairs to avoid falls and injuries to patients.

What legal principles underlie the nurse’s obligations to the patient?

The legal obligations of the nurse to Mr. Jones are regulated by the Emergency Medical Treatment and Active Labor Act (EMTALA) (COBRA, 42 U. S. C. 1395dd). According to Moy (2014) this act prohibits health facilities from refusing care to uninsured patients (Cited in Cherry & Jacob, 2005). In this case, the nurse chose to have the patient sort out his financial concerns before assessment, which resulted to a complication. State statutes, in this case, State practice act and nursing board rules and regulations also obligate the nurse to act competently in different situations. The common law, created through cases heard regarding nurse practice guide on expected practice conduct of the nurse (Mathes, 2014). Finally, Civil Law underlie the obligation of the nurse to prevent harm to the patient (Cherry & Jacob, 2005).

What laws, if any, would govern the nurse’s decision-making process in this case?

The Emergency Medical Treatment and Active Labor Act (EMTALA) prohibits the nurse not to refuse care to a patient due to insurance issues. The State Nurse Practice Act and the Nursing boards stipulate standards of conduct for Registered Nurses (RNs). Consulting the NPA guidelines and the rules and regulations of the licensing her licensing board would have helped Nurse Clark in her decision making. The common law is also important in guiding decision-making. What the laws states in issues such as medical negligence is important in this situation.

Who would be legally liable for the delay in Mr. Jones evaluation? The nurse, registration clerk or the for-profit hospital?

The nurse is liable for the delay in Mr. Jones evaluation. Although financial considerations (the hospital being for-profit) conflict with patient well-being, the duty owed to the patient supersede that that owed to the organization. The nurse should have determined to first ensure the patient is not at risk, before allowing him to go discuss payment issues.

Does Mr. Jones bear any responsibility (Contributory Negligence) for the delay in treatment because he waited to ask about the cost of care?

Yes, Mr. Jones is liable for contributory negligence first because his case is recurrent – he says that “this has happened to me before when I ate garlic” and that he ”has been attending the hospital around the corner from my house” (Cherry & Jacob, 2005, p. 119)

Who, if anyone, is accountable for the injury sustained by the other patient waiting to be seen by the triage nurse? The triage nurse, the hospital? Mr. Jones?

Since this was an accident, no one is liable for the injury sustained by the other patient waiting to be seen by the triage nurse. However, it is important to note that the hospital has the duty of ensuring safety and preventing injury.

References

Cherry, B. & Jacob, S. R. (2005).Contemporary nursing: issues, trends and management (7th ed.). St. Louis. Elsevier Mosby.

Mathes, M. & Reifsnyder, J. (2014). Nurse’s Laws: Legal questions and answers for the practicing nurse. Indianapolis: Sigma Thera Tau International.