Registered nurse (RN) roles, duties, and medical malpractice in Texas

Last week, I was at the Harris County Civil Courthouse twice for oral hearings that focused, in part, on the role of nursing care in medical malpractice cases. In one case, a patient in his 30s died from operating room complications. In the other, a middle-aged patient was left with a permanent brain injury caused by a misdiagnosed stroke that went without treatment.

The question that’s raised over and over again in trial courts is, “What’s the role of nurses in modern health care?” It’s an important one with high stakes because hospitals can only be held responsible, under Texas law, for the mistakes of their nurses and employees, not doctors on the medical staff.

While attorneys for hospitals and surgery centers in medical malpractice invariably deny that there was any negligence at all, they’re also quick to point the finger at the physicians in the room. Some common arguments include that only doctors can make a medical diagnosis, order a medication or treatment, or discharge a patient from the hospital.

What is the role of registered nurses?

If some registered nurses happened to be sitting in a Texas courtroom, I think they’d be shocked to hear how their hospital or surgery center employers describe them as little more than mindless nincompoops. The reality is that these arguments are nonsense! Let me explain why.

In reality, while doctors are often responsible for making the final call, the decision-making is shared with nurses.

Section 2.3 of the American Nurses Association Code of Ethics for Nurses says that, “The complexity of health care requires collaborative effort . . . of all health professions . . . Collaboration intrinsically requires mutual trust, recognition, respect, transparency,  shared decision-making, and open communication among all who share concern and responsibility for health outcomes.”

In Texas, our laws and regulations make it clear that nurses are much more than mindless robots. Indeed, they have independent duties and responsibilities to patients. For instance, Texas Nursing Board Rule 217.11 lists some significant requirements for all registered nurses, including:

•  Accurately and completely report and document nursing care rendered and contacts with other healthcare team members concerning significant events regarding the patient’s status.

•  Implement measures to promote a safe environment for patients.

•  Institute appropriate nursing interventions that might be required to stabilize a patient’s condition and/or prevent complications.

•  Collaborate with members of the healthcare team in the interest of the patient’s health care.

•  Develop a plan of care based on the assessment and nursing diagnosis.

In addition, Texas Nursing Board Rule 217.19(a)(5) describes that a nurse’s duty is to always advocate for patient safety, including any nursing action necessary to comply with the standards of nursing practice.

To sum it up, Texas registered nurses are a critical part of healthcare teams. They’re required to assess their patients and keep them safe. They must identify concerning signs and symptoms, formulate nursing diagnoses, and implement nursing interventions in the interest of patient safety. These roles include advocating for patient safety.

While defense lawyers and some trial courts have taken a skeptical view of the role of nursing advocacy, it’s one of the most important things nurses can do to keep their patients safe. In the operating room, recovery area, and post-anesthesia care unit (PACU), patients are asleep and can’t advocate for themselves. They entrust nurses to be their voice.

Advocacy includes speaking up when a nurse thinks that the doctor doesn’t have all the information, or is ignoring something important when making a medical diagnosis or treatment decision. Most of the time, that’s all that’s needed. In extreme cases, though, when a physician is impaired or making a decision that would endanger the patient, advocacy requires going over the doctor’s head and invoking the chain of command. While that’s rarely needed, it’s sometimes required.

When nurses don’t advocate and speak up, patients may be harmed

In my experience as a Houston, Texas medical malpractice lawyer, I’ve seen so many times where the patient outcome would have been different if nurses had simply advocated for their patients.

I’m working on a Texas medical negligence case now where an emergency physician ordered the patient discharged from the hospital while he was having a stroke. The doctor had missed key findings that the emergency room nurse had caught on his assessment. There was no advocacy by the nurse, though, so the patient went home instead of getting treatment that would have likely prevented a brain injury.

I’m working on another Texas medical malpractice lawsuit where a patient was combative and had trouble breathing in the operating room after surgery. The providers were in a hurry to get him out of the operating room (I suspect so they could start making money on a new surgery in that space) rather than taking a few minutes to stabilize the patient and secure his airway. The operating room nurses didn’t advocate for the patient’s safety and it wasn’t long until he was deceased.

In other cases, patients and family members have shared with me how hospital nurses were impossible to reach with a call button and were unwilling to communicate concerns and requests for help to doctors.

In all of these cases, we look carefully at the facts and medical records to determine if nursing errors contributed to the ultimate patient injuries or death. If so, there’s just cause for a medical malpractice suit.

We are here to help

If you or a loved one has been seriously injured by hospital or nursing care, then the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, are here to help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.

All consultations are free and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.


Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.