Critical Care Nursing: Safety, Legal Responsibilities, and Reflection

This report delves into the critical responsibilities of critical care nurses, examining a specific incident involving patient safety and legal issues. The author, a nursing student, reflects on a clinical placement in a CCU where a failure to adhere to the patient care pathway led to a patient fall and subsequent disciplinary action. The report analyzes the incident as a patient safety issue, highlighting the nurse's duty to continuous monitoring and accurate documentation, and the consequences of neglecting these responsibilities. The report also explores the legal ramifications of the incident, including potential negligence and malpractice, emphasizing the importance of accurate documentation as per legal standards like the Health Records and Information Privacy Act 2002. The conclusion stresses the need for critical care nurses to be vigilant, follow care protocols diligently, and maintain accurate records to ensure patient safety and avoid legal issues. The report references several key studies to support its analysis, including Chamberlain, Pollock, & Fulbrook (2018), Considine, Trotter, & Currey (2016), Jakimowicz & Perry (2015), Jokiniemi, Pietilä, Kylmä, & Haatainen (2012), and Shields (2013).

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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Introduction:
Australia as an advanced health care system and with the increase in modern
complexities of health care system, there is high expectation regarding registered nurses to
achieve highest level of skills to maintain international standards of care. Because of this
demand, many registered nurses are taking up specialist nursing role (Shields, 2013). Critical
care nursing is also a specialist role where nurses are responsible for providing care to patients
who are critically ill. The key difference between the skills of a critical care unit (CCU) nurses
compared to a registered nurse is that they CCU nurse are nurses who take specialist education
and training to respond to patient with life threatening illness in critical care setting. Specialist
nurse also have certain specific safety and legal responsibility during care delivery (Jokiniemi et
al., 2012). This reflective paper aims to describe issues of safety or legal responsibility in relation
to the experience of providing care to a patient in the specialty area of critical care nursing. The
paper will identify issues specific to the speciality area by review of current practice standards
and key role and responsibilities in the role.
Patient safety issues in the specialty area:
During one of my clinical placement in a CCU unit, I was assigned to the care of a 75
year old patient with advanced stage of dementia. However, she was admitted to the hospital for
knee replacement surgery after she fell in the bathroom and fractured her knee. According to my
role and responsibilities as critical care nurse, I followed the handover report for the day and
completed vital sign assessment. I communicated with the patient regarding her state of health
now and any issues she faced. I gave her the medications prescribed and took permission to
leave. Then I moved on to inspect and assess others patients in the CCU. However, one mistake

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that I did during my clinical practices as a CCU nurse was that in the handover report, it was
written in bold ‘hourly round in pathway’. However, I ignored it and did not go to see the patient
again. In addition, while documenting patient’s progress on the ‘patient care pathway’ form, I
wrote that the patient was asleep during last round. Meanwhile, the issue that took place was that
the patient had a fall from his bed. I was called for disciplinary action because of involvement in
patient safety and legal issues.
On analysis of my action, the incident is a patient safety issue because ignorance of the
patient care pathway resulted in clinical deterioration of patient. As part of my role and
responsibilities as a critical care nurse, I had the responsibility to adequately assess patient,
monitor their progress and report about any changes to the physician. In accordance with my
specialist role, I had the duty to provide round the clock care and monitoring to ensure that
patients are safe and at no risk of clinical deterioration (Chamberlain, Pollock & Fulbrook,
2018). However, I was involved in disciplinary action because I failed to complete my
responsibility of round the clock care and monitoring. In addition, I violated my responsibility of
completely following patient care pathway and my assigned duties during shift. Jakimowicz and
Perry (2015) explains that for critical case nurse, it is extremely important to keep patient safe
and perform task exactly as instructed to them. They need to continually monitor the care
provided to patient. They have the responsibility to work quickly in stressful conditions and stay
alert even after many hours of work. However, my action of ignoring hourly round proved costly
for me. By ignoring hourly round, I missed to identify that the patient was dosing off and there
was no bed rail that could prevented fall. If I had visited patient on an hourly basis, the same
situation could have been avoided.

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Legal issues related to specialty practice:
Through my action of ignoring hourly round and engaging in false reporting about
patient, I was involved in legal actions too because by falsifying the procedure understand, I was
involved in negligence and malpractice. According to Considine, Trotter and Currey (2016),
negligence issues that lead to malpractice law suits included failure to appropriately document
care and conceal the actual care provided to patient. This is a highly unacceptable act particularly
by specialist nurse as this violates their responsibility towards patient safety and also reflects
engagement in false documentation process. According to legal standards for documentation, it is
necessary to provide date and time of each intervention and present factual and sequential record
of the consumer condition and the support offered during the practice (Considine, Trotter &
Currey, 2016). However, I violated this standard I did not reported about actual patient condition
and wrote that the patient was sleeping without actually completing the assigned intervention.
This could lead to legal actions because according to the Health Records and Information
Privacy Act 2002, engaging in proper documentation of care is associated with strict disciplinary
actions (NSW Legislation, 2019). Hence, by not stating the procedures completed in reality and
giving false information without actually visiting the patient, I created professional and legal risk
for myself.
In accordance with my scope of practice, I could have avoided fall for patient had I taken
the patient care pathway seriously and understood that according my professional responsibility,
it was necessary for me to be alert all the time and quickly monitor any changes in patient
condition. If I had understood the significance of my responsibility to act as champions of
patients who cannot speak, I would have prevented the fall issues. In addition, I should have
followed the legal standard related to accurately recording patient’s current progress and

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improvement in vital signs. This would have prevented me from any legal actions during the
placement at the CCU.
Conclusion:
To conclude, the discussion regarding the involvement in a patient safety issue highlights
specific role and responsibilities of a critical care nurse. It highlights the fact that unlike
registered nurse, critical care nurse have the responsibility to be alert all the time and follow each
care responsibilities diligently to ensure that any clinical deterioration related situation is
promptly dealt with. The discussion regarding legal responsibility highlights the significance of
accurate documentation to prevent involvement in negligence and malpractice lawsuits.

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References:
Chamberlain, D., Pollock, W., & Fulbrook, P. (2018). ACCCN Workforce Standards for
Intensive Care Nursing: Systematic and evidence review, development, and
appraisal. Australian Critical Care, 31(5), 292-302.
Considine, J., Trotter, C., & Currey, J. (2016). Nurses' documentation of physiological
observations in three acute care settings. Journal of clinical nursing, 25(1-2), 134-143.
Jakimowicz, S., & Perry, L. (2015). A concept analysis of patient‐centred nursing in the
intensive care unit. Journal of advanced nursing, 71(7), 1499-1517.
Jokiniemi, K., Pietilä, A. M., Kylmä, J., & Haatainen, K. (2012). Advanced nursing roles: a
systematic review. Nursing & health sciences, 14(3), 421-431.
NSW Legislation (2019). Health Records and Information Privacy Act 2002 No 71. Retrieved
from: https://www.legislation.nsw.gov.au/#/view/act/2002/71/full
Shields, L. (2013). A personal essay on the role of the nurse. Contemporary nurse, 43(2), 213-
218.