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Table of Contents Features News amp; Trends Departments 内容特征的新闻与趋势表部门；.doc

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Table of Contents | Features | News Trends | Departments | Experts | Classifieds Feature November 2007 | Volume 43, Issue 11 Don’t neglect the nurse’s duty of care Nurses serve as advocates for their patients. When something goes wrong and a doctor breaches the standard of care, the nurse has a duty to speak up. Michael A. Worel and David G. Wirtes Jr. Florence Nightingale established nursing principles—including careful observation and sensitivity to the patient’s needs—in her best-known work, Notes on Nursing, in 1860. 1 Almost 150 years later, these principles still resonate in the nursing profession. According to the American Nurses Association (ANA), “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.” 2 But what should happen when a nurse’s failure to promote or advocate for his or her patient’s health, safety, or rights results in injury? Are nurses expected simply to follow doctors’ orders, or are they bound to question those orders when something is amiss? Consider an example: An elderly woman on Coumadin, an anticoagulant, falls and hits her head. She goes to the emergency room with an obvious head wound, but the emergency room physician elects not to order a CT scan, choosing instead to place the woman in the hospital for observation. The next day, over the course of five hours, the patient deteriorates neurologically. On four different occasions, the nurse informs the attending physician, who is out of the hospital, of the progressive deterioration, but the doctor elects not to visit the patient and instead enters phone orders for medications. The woman becomes comatose and is transferred to another hospital, where she receives a CT scan, and a subdural hematoma is discovered. The woman dies. When the woman’s family files suit, they learn that the physicians have woefully inadequate insurance coverage. Is there a way to impose liability on the hospital for the acts and omissions of its nurses even th