Three examples of nursing legal and ethical issues experienced as a student and how the instructor carried out risk-management strategies
In my undergraduate program I learned about legal and ethical issues that surround nurses as a whole. Legal issues such as fair treatment, grievance processes, clinical performance evaluations and confidentiality were just a few issues stressed, as well as ethical issues, such as academic dishonesty, academic performance and student-faculty relationships. As an undergraduate student, I was not taught about the liabilities that are imposed on the faculty. Today, after learning how these issues effect faculty and nurse educators, I can reflect to when I was an undergraduate student and share three types of risk-management strategies my instructors either did or did not carry out.
The first example that comes to mind was an instructor who went by the book. She made sure she set clear expectations for the class. She did not tolerate class clowns, nor did she tolerate tardiness. She expected the students to act in a respectful manner and if she thought there was a problem she would request the student to speak with her in private. She had a great demeanor and kept us engaged in our learning. She was fair, followed good moral standards and was honest. We all respected her for that. One day we had a pop quiz. It was obvious when the class moaned at the announcement that not all were prepared for the quiz. During the quiz, the instructor got up from her desk, approached a fellow student, whispered something to her, then meet the student at the back of the classroom. The student left. Later, we learned from the student that she had asked her leave the classroom and schedule a meeting with the instructor. The instructor had caught this student cheating on the quiz by looking onto her neighbor’s paper. The student said when they met in the office, the instructor asked her if she had difficulty with the quiz because she noticed she was looking onto her neighbor’s paper. The instructor reviewed with the student the expectations she had set at the beginning of the class and explained her action violated the code of conduct. The student was given a zero for the quiz. According to Harris, setting behavioral and academic expectations, demonstrating professional boundaries and maintaining confidentiality. The demonstration of the instructors reaction to the students conduct revealed an example of an ethical risk-management strategy. It would have been easy for the instructor to announce in the classroom she had seen the student cheating and ask her to leave. Instead she followed the appropriate pathway and dealt with the situation while protecting the student’s confidentiality.
A second example I remember was during a clinical rotation. The instructor during this rotation was friends with a student in my group. The student did not have the responsibilities that the rest of us did. She could arrive late to clinical, only had one to two patients when the rest of us had five and would leave the floor whenever she wanted, often not informing the instructor, and when she would return she would not be reprimanded or talked to about her behavior. The student had a “no-care” attitude and often talked poorly of the patients she had to anyone who would listen. The student would brag that she was sliding through this rotation. The instructor always looked the other way when it came to this student. One morning after signing in and accepting her assignment, the student performed her assessment on her two patients then decided she would go to the cafeteria for breakfast. She did not inform the instructor she was leaving, nor did she inform the instructor that one of her patients had complained of abdominal pain. Several hours passed and a family member approached the nurses station asking why the nurse had not returned. Upon further investigation, the floor nurse discovered the patient had complained of abdominal pain and after assessing the patient called the physician. The patient was ultimately taken to the operating room and had an exploratory laparotomy performed. The patient had a perforated bowel and had to have a bowel resection. It was discovered the instructor had not followed up with the student regarding assessments and had not ensured the patient was being taken care of. Legal action was taken against both the instructor, the student and the nursing school. Typically, when legal action is taken, it is done under tort law, which is a civil law that handles wrongs committed by an individual against another. Negligence towards a patient is the most common tort law action that is taken against a nurse (Patton, 2015). In this case, the instructor was responsible for the patient and demonstrated negligence which resulted in harm to the patient. There was no structured approach and no actions taken to avoid a risk. The opportunity to avoid a risk was missed by the instructor not assessing the situation and identifying the factors involved which caused negligence and harm to the patient. By disregarding her duties as an instructor, she set herself, the student and the nursing school up for legal liability.
The third example was experienced by a nurse educator that came to the floor during a clinical rotation. There was a trial that was about to occur with new intravenous catheters. The nurse educator took the time to provide education on the intravenous catheter to the staff and when she realized the floor had students, she took it upon herself to include us in the education inservice. She provided written information, talked through a demonstration, explained the reasoning behind the trial, gave opportunities to ask questions and allowed for return demonstrations as she supervised and gave feedback to us all. Nursing practical skills and knowledge develop the foundation for nurses (Jerlock, 2003). The risk-management strategy the nurse educator took was providing education for staff with a product to ensure they had all information about the product and how to use the product. She properly trained the staff and the students who were providing care in the facility. She made sure that all had been prepared to perform an intravenous catheter stick and each had to be checked off for competency in the sue of the intravenous catheter. If she had not preformed her duties as an educator she could have been held liable if an error occurred.
Faculty and nurse educators have a huge responsibility when it comes to risk management. The key to avoiding situations which may lead to legal pitfalls is to stay focused on student and patient safety (Jerlock, 2003), and to understand and follow the Nurse Practice Act. Reportedly, only 10% of hospitals and nurse executives believe new graduate nurses are fully prepared to provide safe and competent care to patients (Berkow, 2009). This is an astounding number. It helps to support the importance of continuously improving practices and confirming proficiency through competency. Understanding the legal and ethical issues that can help protect faculty and nurse educators is essential for us as graduate students so that we may set an example for those we encounter. It is our responsibility to lead by example while protecting all involved against liability.
Post 2 Student name is Gabriela
Upon reflecting on my undergraduate nursing courses that I took I was able to identify 3 concrete examples of how my instructors carried out strategies regarding ethical and legal issues in the classroom.
The first example that occurred in one of my undergraduate course involved appealing test scores. For example, this particular professor allowed students to appeal quiz and text scores in private. The professor would hold office hours following the test. During this brief period student were individually provided with time to review their exam and dispute any disagreements. If the student could explain the rational and location of the correct answer the professor would award those additional points. From my personal experience and what I was hearing from my fellow classmates rarely the grade was actually changed. The reason for this was when trying to explain the rational the student, including myself, was able to figure out why they got the answer wrong and what the correct answer was. In this example, we can see that the professor was giving the same opportunity to all student in the class. Student have the right to be treated equally.
The second example, occurred during my clinical rotation. According to Patton & Lewalle (2015), practical strategies to decrease nurse educator liability are faculty-student ratios, faculty and preceptor qualifications, building relationships with nursing staff on unit, and teaching strategies for working with students. During my clinical rotations, these strategies were clearly being applied by my clinical educator. She was also employed at the unit that we were doing our rotation. This gave here the ability to be familiar with the unit and also made here very qualified. It was obvious that she had developed relationships with other staff nurses. We were also separated into small groups so that she can have a smaller ratio and allow for one to one education. I have to say that this was one of the best clinical experiences that I had through my undergraduate courses.
The finally example is involving the class/ clinical rules and the code of conduct. All classes that I have attended have included a class syllabus. Most classes also included us signing a code of conduct agreement. This ensures the you have read and acknowledge the course rules. Professor can hold students accountable, on the other hand students can also hold professors accountable. This is the student teacher agreement and can have legal ramifications. When writing the syllabus professors bust comply with university standards and regulations and should also consider the language (Alexander, G.R., 2016).
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