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Relief nurses must document their involvement
MAY 1984, VOL 39, NO 6
AORN JOURNAL
OR Nursing Law Relief nurses must document their involvement
Q
Some OR nurses at my hospital have strong feelings about recording the time they actually staff a particular case. The issue usually arises when a nurse is providing relief during lunch and breaks but is not assigned a particular room for an entire shift. Some nurses insist on recording in the operative record the specific time they are providing coverage. They think this clearly documents their involvement on staffing cases, particularly if an incorrect count or other complication occurs. Is this practice legally necessary?
A
The practice of relief nurses accurately documenting the specific time of their coverage on the operative record is not only proper but should be standard procedure. Your letter does not indicate whether your hospital’s operating mom protocol addresses this issue. Even if it is silent on the topic, I recommend that relief nurses document the specific times they are on duty in the operating room. In the event of a malpractice suit, the relief nurses have documented evidence as to when they were on and off duty.
Q
I am a supervisorin the operating room at a 50-bed hospital. Recently at a nursing supervisor’s meeting, informed surgical consents were discussed. Many of us believe the terminology used in surgical consents should include laymen’s language as well as medical terminology. We are concerned many patients
do not understand the procedure to which they consent. What do you recommend?
A
The JCAH standards require informed consent for surgical procedures and that the procedure be described in laymen’s terminology when possible. There may be some surgical procedures that cannot easily be described in laymen’s language. The informed consent language must allow the patient to be informed to the extent possible so he or she may understand the surgical procedure and its inherent risks and benefits.
Q
I have been an OR nurse for eight years. Unfortunately, I have been assigned to wo with an incompetent nurse. Her incompetence is acknowledgkd by surgeons, anesthesiologists, and the entire OR staff, from the OR supervisor down. Do I have a right to refuse to work with her?
A
If incompetency is acknowledged by all, as you indicate, appropriate action should be taken immediately by the OR supervisor to avoid a malpractice suit. The surgeons, anesthesiologists, and OR staff should provide the documentation necessary. I suggest you document your reasons for your refusal to work with this nurse to nursing administration. This should elicit responsive action. You should not have to work with an incompetent nurse. 941
M A Y 1984, VOL ___-.
39, NO 6
Q
I am an OR supervisor in a small New England hospital. I am trying to introduce disposable drapes into our OR and am meeting with organized resistance at every step of the way. Could the hospital have any liability for malpractice for wound infections resulting from using linen instead of disposables?
A
If it can be shown that a wound infection results from the linens, there could be iiability. If your question is should the use of linen be considered negligence per se, the answer is no. I am interested in why there is such organized
AORN JOURNAL
resistance to your actions. WILLIAM A REGAN,JD MANAGING ASSOCIATE WILLIAM ANDREW REGAN& ASSOCIATES PROVIDENCE, RI William Andrew Regan died suddenly on M u c h 1. He hns been N contributing editor f o r the AORN Journal since 1977. His analysis of medical-legal situations nnd the advice given to opemting room nurses in the column “ORNursing Lm,”h m been appreciated by our readers. We offer our sincere condolences to his family nnd collecigues.
Day-care Disease More than 3 million American children spend time in day-care centers, and more than 1 million adults staff those centers. These numbers have prompted new concern about the spread of day-care diseases, according to William Schaffner, MD, chairman of preventive medicine, Vanderbilt University Medical Center, Nashville. Physicians are particularly concerned about the spread of three infections-shigellosis, giardiasis, and hepatitis A. These diseases can spread quickly within centers and outside to families and communities. The diseases are intestinal disorders and are most often spread in the stool of diapered babies, reports Dr Schaffner. They are causing an increased amount of illness, particularly among adults, resulting in absenteeism and large medical bills. The cure is relatively simple. Elementary good hygiene, such as handwashing, can be effective in stopping transmission of most day-care diseases. Shigellosis is a bacterial infection resulting in severe diarrhea for a few days. Giardiasis, a parasitic infection, also causes diarrhea, but the illness is intermittent and protracted. Hepatitis A, a mild inflammation of the liver, may not be serious in small children, with no symptoms displayed. However, the
disease may be transmitted to parents or other adults, who then have severe stomach cramps and develop mild jaundice. Handwashing, diaper-changing, and disinfecting certain areas serves to interrupt transmission of these infections, Dr Schaffner says. Keeping sick children at home if possible, or at least separating them from other children in the center may also prove effective. And adequate toilet facilities and sufficient numbers of caretakers will also help prevent spreading illnesses.
ANA Commits Funds to BSN At a meeting Dec 14 to 16, the American Nurses’ Association board of directors committed $100,000 a year for five years, beginning in 1984, to establish the baccalaureate degree as the educational requirement for professional nursing. According to the American Nurse, major portions of the monies will be used to help state nurses ’ associations influence adoption of regulations and legislation in support of the BSN requirement.
949
AORN JOURNAL
OR Nursing Law Relief nurses must document their involvement
Q
Some OR nurses at my hospital have strong feelings about recording the time they actually staff a particular case. The issue usually arises when a nurse is providing relief during lunch and breaks but is not assigned a particular room for an entire shift. Some nurses insist on recording in the operative record the specific time they are providing coverage. They think this clearly documents their involvement on staffing cases, particularly if an incorrect count or other complication occurs. Is this practice legally necessary?
A
The practice of relief nurses accurately documenting the specific time of their coverage on the operative record is not only proper but should be standard procedure. Your letter does not indicate whether your hospital’s operating mom protocol addresses this issue. Even if it is silent on the topic, I recommend that relief nurses document the specific times they are on duty in the operating room. In the event of a malpractice suit, the relief nurses have documented evidence as to when they were on and off duty.
Q
I am a supervisorin the operating room at a 50-bed hospital. Recently at a nursing supervisor’s meeting, informed surgical consents were discussed. Many of us believe the terminology used in surgical consents should include laymen’s language as well as medical terminology. We are concerned many patients
do not understand the procedure to which they consent. What do you recommend?
A
The JCAH standards require informed consent for surgical procedures and that the procedure be described in laymen’s terminology when possible. There may be some surgical procedures that cannot easily be described in laymen’s language. The informed consent language must allow the patient to be informed to the extent possible so he or she may understand the surgical procedure and its inherent risks and benefits.
Q
I have been an OR nurse for eight years. Unfortunately, I have been assigned to wo with an incompetent nurse. Her incompetence is acknowledgkd by surgeons, anesthesiologists, and the entire OR staff, from the OR supervisor down. Do I have a right to refuse to work with her?
A
If incompetency is acknowledged by all, as you indicate, appropriate action should be taken immediately by the OR supervisor to avoid a malpractice suit. The surgeons, anesthesiologists, and OR staff should provide the documentation necessary. I suggest you document your reasons for your refusal to work with this nurse to nursing administration. This should elicit responsive action. You should not have to work with an incompetent nurse. 941
M A Y 1984, VOL ___-.
39, NO 6
Q
I am an OR supervisor in a small New England hospital. I am trying to introduce disposable drapes into our OR and am meeting with organized resistance at every step of the way. Could the hospital have any liability for malpractice for wound infections resulting from using linen instead of disposables?
A
If it can be shown that a wound infection results from the linens, there could be iiability. If your question is should the use of linen be considered negligence per se, the answer is no. I am interested in why there is such organized
AORN JOURNAL
resistance to your actions. WILLIAM A REGAN,JD MANAGING ASSOCIATE WILLIAM ANDREW REGAN& ASSOCIATES PROVIDENCE, RI William Andrew Regan died suddenly on M u c h 1. He hns been N contributing editor f o r the AORN Journal since 1977. His analysis of medical-legal situations nnd the advice given to opemting room nurses in the column “ORNursing Lm,”h m been appreciated by our readers. We offer our sincere condolences to his family nnd collecigues.
Day-care Disease More than 3 million American children spend time in day-care centers, and more than 1 million adults staff those centers. These numbers have prompted new concern about the spread of day-care diseases, according to William Schaffner, MD, chairman of preventive medicine, Vanderbilt University Medical Center, Nashville. Physicians are particularly concerned about the spread of three infections-shigellosis, giardiasis, and hepatitis A. These diseases can spread quickly within centers and outside to families and communities. The diseases are intestinal disorders and are most often spread in the stool of diapered babies, reports Dr Schaffner. They are causing an increased amount of illness, particularly among adults, resulting in absenteeism and large medical bills. The cure is relatively simple. Elementary good hygiene, such as handwashing, can be effective in stopping transmission of most day-care diseases. Shigellosis is a bacterial infection resulting in severe diarrhea for a few days. Giardiasis, a parasitic infection, also causes diarrhea, but the illness is intermittent and protracted. Hepatitis A, a mild inflammation of the liver, may not be serious in small children, with no symptoms displayed. However, the
disease may be transmitted to parents or other adults, who then have severe stomach cramps and develop mild jaundice. Handwashing, diaper-changing, and disinfecting certain areas serves to interrupt transmission of these infections, Dr Schaffner says. Keeping sick children at home if possible, or at least separating them from other children in the center may also prove effective. And adequate toilet facilities and sufficient numbers of caretakers will also help prevent spreading illnesses.
ANA Commits Funds to BSN At a meeting Dec 14 to 16, the American Nurses’ Association board of directors committed $100,000 a year for five years, beginning in 1984, to establish the baccalaureate degree as the educational requirement for professional nursing. According to the American Nurse, major portions of the monies will be used to help state nurses ’ associations influence adoption of regulations and legislation in support of the BSN requirement.
949