Nurses have a duty of care to patients. Understanding what that means and when and how it applies are important parts of providing patients with top-notch care.
Duty of care sets the foundation for a nurse’s responsibilities to patients. It informs regulations and policies that guide and direct a nurse’s actions and responsibilities. Upholding or violating the duty of care can also be a component in disciplinary hearings and actions. A nurse who violates their duty of care is more likely to be considered a potential danger to patients.
Allegations of professional misconduct related to duty of care can be challenging to navigate. The cases are often complicated with no easy answer.
If you’re a nurse who is facing allegations of professional misconduct, contact the Professional License Defense Team at the LLF National Law Firm. We can help you find the best option for you. Call us at 888-535-3686 or fill out our online form.
What is a Duty of Care?
Duty of care refers to having an obligation to help patients and avoid any actions that may harm patients. This can also include failing to do something that causes harm to a patient.
A duty of care is the legal and ethical responsibility to avoid causing harm or risking harm to a patient. Duty of care is the backbone of nursing ethics. It’s why all medical professionals do all they can to preserve a life.
As Bryant and Stratton College points out, nurses have a responsibility:
- To act in patients’ best interests.
- To allow patients to make their own decisions regarding care
- To do no harm to patients
- To be fair and just in how resources are used and how care is provided
Duty of care involves moral and ethical issues as well as weighing responsibility versus risk. One of the challenges with duty of care is that it often isn’t a cut-and-dry, right-or-wrong question.
On the surface, duty of care sounds simple, but in practice it’s complicated. This is why disciplinary actions that relate to duty of care can be difficult to navigate. The Professional License Defense Team at the LLF National Law Firm assists our clients in understanding these issues and building a well-organized defense.
Scope of Duty of Care
In an FAQ, the Texas Board of Nursing tackles the question of when a nurse’s duty to a patient begins and ends. The board emphasizes that a nurse’s duty is not tied to a single action, such as clocking in, but instead to relationship and responsibility.
As an example, the board points to the difference between resigning from a position and abandoning a nursing assignment. Resigning, assuming a nurse completes their responsibilities, is an employment issue. Abandoning an assignment, in comparison, means a nurse abruptly abandons their work in a way that puts patients at unnecessary risk and risks continuity of care.
Personal Scope of Competence
Duty of care can be different for each nurse. Every nurse has a scope of competence unique to them, and that matters more than general competency standards.
New York emphasizes practicing within the scope of a nurse’s abilities. Even if the law allows a nurse to perform a service, the most important consideration is if that specific nurse is personally competent to perform that service.
A nurse may face charges of professional misconduct if they perform outside of what New York law allows. They’re equally likely to face misconduct if they practice outside their personal scope of competence. As professionals, nurses should know their strengths and limitations.
One challenge with personal scope of competence is that employers or supervisors may pressure a nurse to perform tasks or assist patients in ways that the nurse believes exceed their knowledge or experience.
Nurses may be pressured to “be a team player” or “pull their weight.” The harsh truth is that, if an accident or mistake does occur, that nurse is likely to be the one blamed and the one facing disciplinary action, not the supervisor or co-worker who pushed them to go beyond their comfort level.
What is Standard of Care?
Duty of care and standard of care may sound similar, but they cover different areas of professional responsibility for nurses. Standard of care refers to the expected level of skill or knowledge that a reasonably competent nurse would bring to a position.
The terms are sometimes used interchangeably, and it can be difficult to understand the difference between the two. Duty of care is “I have a responsibility to assist this patient without injuring them.” Standard of care is “here’s what I do to avoid injuring this patient.”
Standard of care isn’t about holding nurses to an unattainable ideal. It’s about ensuring nurses provide competent, reasonable care to patients as well as following any standards set by law or policy.
Standards of care can differ based on a nurse’s level of education, experience, position, and knowledge. When considering if a nurse met a standard of care, they should be compared to reasonably competent nurses in similar positions and with similar levels of education in a similar situation.
Considerations for standard of care:
- What would be appropriate?
- What would be ethical?
- What would be safe?
Details matter. What may be an appropriate standard of care for a routine outpatient procedure may differ from five-hour cardiac surgery.
The standard of care defines how a reasonably competent healthcare provider in the same field would act under similar circumstances. It’s not about perfection—it’s about what most qualified professionals would consider appropriate, ethical, and safe according to the appropriate standard established by law. The standard of care is determined by what a reasonably competent provider would do under the same circumstances.
Washington State, for example, defines standards of care for registered nurses and licensed practical nurses. Meeting the state’s standards includes communication, documentation, and not exceeding the scope of their knowledge and abilities.
Understanding Standard of Care
California’s Civil Jury Instructions provide additional context on what’s meant by standard of care. These instructions focus on civil trials, which are different from disciplinary hearings. The instructions focus on negligence, but they reflect wider understandings of standard of care.
In California, a nurse fails to meet the expected standard of care when they fail to use the level of skill, knowledge, and care in diagnosis and treatment that a reasonably careful nurse would use in a similar situation. Part of determining if a nurse followed the expected standard of care is how their actions measure up against other nurses at their level of experience and knowledge.
It’s not always an easy answer. Appreciating this complexity, the Professional License Defense Team at the LLF National Law Firm works closely with our clients facing disciplinary actions related to standard of care.
What is a Breach of Duty?
A breach of duty occurs when a nurse fails to meet their responsibilities and causes a patient harm as a result. They may fail in their duty of care to a patient. They may fall short of the expected standard of care.
Mistakes happen. Even if a patient avoids harm, if a nurse’s breach of duty puts them at risk of harm, a nurse may be reported and face disciplinary action.
When Does a Nurse Breach Their Duty of Care?
Each state decides what qualifies as a breach of a nurse’s duty of care to a patient. In general, to breach a duty of care, it must first be shown that the nurse had a duty of care to that individual.
One medical journal article suggests five factors that indicate a breach of a nurse’s duty of care:
- All foreseeable harms
- Frequency or likelihood of harm
- Severity of the harm
- Public interest in preventing future harm
- Any moral blame attributable to the doctor
These factors aren’t required to show a duty of harm. They underline how circumstances and details matter when determining if a nurse breached their duty of care.
Circumstances and Breach of Duty
The details and facts about why a nurse did (or did not) fall short of their professional responsibility matter. For example, two nurses make the same mistake involving a piece of equipment. In both cases, the patient suffers an injury.
The first nurse should have expected the problem that led to the mistake. The equipment had been malfunctioning, and the nurse’s supervisor had warned her that care was needed to prevent any injuries to patients. The nurse did not follow the recommended change in procedure.
The second nurse responded to an unexpected emergency situation. Time was of the essence, and while the patient was injured, the nurse’s quick actions prevented a more serious medical condition.
Both nurses violated their duty of care. One had been warned about the potential for injury as part of routine procedures. The other responded to an emergency and injured the patient, but likely saved the patient from a more severe medical crisis.
Is Violating the Duty of Care Required for Disciplinary Action?
A nurse may still face disciplinary action even if they don’t have a duty of care to an individual. They may also face disciplinary action even if they don’t violate their duty of care.
Nurses should check with their nursing board’s laws and regulations. In general, a nurse who breaches their duty of care is likely to face disciplinary action. A breach of duty, however, isn’t required to trigger an investigation into potential misconduct.
For example, a nurse who commits fraud may not have breached a duty of care to a patient but may still face disciplinary action. As in most states, Virginia will place any nurse who is believed to have committed fraud or deceit to obtain a license or registration in order to practice as a nurse.
Being accused of faking or lying about their credentials doesn’t mean that a nurse has violated their duty of care to anyone. A nurse may have upheld their duty of care to all of the patients they worked with, but it doesn’t change that they committed fraud to get to that point.
Virginia nurses may also face disciplinary action for unprofessional conduct. A nurse in Virginia may face disciplinary action for misappropriation of a patient’s property. In other words, a nurse may be meeting both the duty and standard of care for a patient but face disciplinary action (and possible criminal charges) because they permanently borrowed the patient’s Rolex.
Crimes and Duty of Care
Being charged or convicted of a crime may lead to disciplinary actions in most states. Whether a nurse faces disciplinary action related to a criminal charge or conviction depends on several factors, including the crime allegedly committed.
In Florida, nurses will face disciplinary action only when they are convicted or plead guilty to certain crimes. Examples include theft, burglary, assault, and child abuse and neglect. Nurses in the Sunshine State may also face disciplinary action for indecent exposure.
Depending on the situation, indecent exposure is less likely to suggest a nurse is unable to uphold the duty of care than a conviction involving assault or child neglect. Crimes that suggest that a nurse may not be able to provide a duty of care or acceptable standard of care, such as child abuse or neglect, are more likely to result in more serious disciplinary action.
If you’ve been accused or charged with committing a crime, contact the Professional License Defense Team at the LLF National Law Firm. Criminal charges and convictions may affect your nursing license and ability to practice.
Why Duty of Care Matters in Disciplinary Actions
Even if a nurse’s alleged misconduct is separate from duty of care, that can be relevant during an investigation or hearing. Providing evidence that a nurse met the requirements for both duty of care and standard of care and has no record of putting patients at harm or risk may mitigate any disciplinary action.
At its most basic, the purpose of disciplinary action is to protect the general public and patients from harm. Showing that a nurse upheld their duty of care can be evidence that patients were not harmed or at risk of harm. This, in turn, may result in less severe disciplinary action.
Protect Your Career
When a nurse violates their duty of care to patients, they may face disciplinary action. Nurses have a responsibility not to cause harm or put patients at risk of harm. Whether a nurse should face disciplinary action related to duty of care isn’t always easy to answer.
If you’re facing professional misconduct allegations related to duty of care or standard of care, navigating the disciplinary process can be overwhelming.
We help our clients understand their options and how to protect their careers. Contact the Professional License Defense Team at the LLF National Law Firm. Call us at 888-535-3686 or fill out our online form.