Despite seeing it over and over again at medical malpractice trials and depositions, I’m still a little stunned when hospitals downplay the role of nurses in healthcare. When trying to avoid taking responsibility for health care mistakes, hospital witnesses and defense lawyers often pretend that nurses aren’t expected to exercise independent critical thinking—or even worse, simply not capable of it.
Because of my background as a former hospital administrator, I know better. Nursing is a serious discipline and good registered nurses are the backbone of safe patient care.
As I’ve been preparing to take the deposition of a nurse employed by a major hospital in the Texas Medical Center, I’ve reviewed some of the hospitals policies and procedures.
One interesting hospital policy and procedure details how bedside nurses are expected to respond when a patient has an acute (rapid onset, severe symptoms, and a short course) incident and needs fast evaluation by a nurse practitioner or physician assistant. This clinical emergency response team policy and procedure instructs nurses to activate it when a patient has an acute change in blood pressure, heart rate, change in mental status, hypoxia (diminished oxygen saturation of less than 90%), change in respiratory rate, chest pain, suspected or allergic reaction, or any other situation in which the nurse believes quick medical attention is necessary.
This document goes on to describe the ins and outs of how the response team is supposed to be notified and what the nurse practitioner or physician assistant is supposed to do upon arrival of the patient’s bedside.
What got my attention about this particular policy and procedure, though, is the level of detail that the hospital expects from the bedside nurse in terms of communicating what’s going on with the patient to the emergency team. I think it accurately reflects the high confidence and training that hospitals should expect from registered nurses.
Specifically, the policy and procedure requires the registered nurse to provide a description of the problem or concern to the emergency team members using the “SBAR format.” If you look up SBAR, you’ll quickly find that it’s a rather detailed analysis that requires extensive critical thinking by the registered nurse.
The healthcare accrediting agency The Joint Commission describes the SBAR clinical tool as the “best practice for standardized communication in healthcare.” SBAR is an acronym standing for situation, background, assessment, and recommendation.
• Situation is the problem that is being reported to the nurse practitioner, physician assistant, or doctor.
• Background is a short history about the patient to give the emergency provider context about what may be going on with patient.
• Assessment is a rundown of the bedside nurse’s observations about the patient, including signs, symptoms, and vital signs.
• Recommendations include the bedside nurse’s request for medical attention and suggestions on the plan of care. I think this element of SBAR really highlights one of the classic responsibilities of quality nursing care—patient advocacy.
In contrast to the high expectations of this policy and procedure, I fully expect the defense position at the deposition to be that my client’s bedside nurse had little to no responsibility for critical thinking, making nursing diagnoses, or certainly recommending any type of heightened care to a nurse practitioner, physician assistant, or doctor.
If you’ve been seriously injured because of poor nursing, hospital, or medical care in Texas, then contact a top-rated, experienced Houston, Texas medical malpractice lawyer for help in evaluating your potential case.
