Identify primary problems that led to the malpractice suits (Croke, 2006), and identify the role the nurse played and what the nurse did wrong.
Nursing Malpractice: Determining
Liability Elements for Negligent Acts
Eileen M. Croke, EdD MSN RN ANP LNCC
KEY WORDS
Damages, Duty, Pecuniary Losses, Proximate Causation, Res ipsa loquitor
Nurses must be concerned about malpractice litigation because nurses may now be held accountable for their own negligence. It is important
for each nurse to know relevant law and legal doctrines, and incorporate them into everyday practice as a safeguard for the health care
provider as well as the health care recipient (Guido, 2006). This article will review each element involved in determining legal liability
for negligent acts. When reviewing a nursing malpractice case for merit, the legal nurse consultant (LNC) needs to determine if all liability
elements are present. Two case analyses of nursing malpractice are presented as examples for determining nursing liability. This article is
not intended to be a substitute for contacting an attorney when questions arise about nursing malpractice litigation.
Despite ongoing efforts to educate nurses on the law and
their professional responsibilities through nursing programs
and continuing education courses, the number of nurses
named as defendants in malpractice actions continues to
increase (Croke, 2003; Guido, 2006; National Practitioner
Data Bank (NPDB) Annual Report, 2004). In 1986, The
Health Care Quality Improvement Act, Title IV of P.L.
99-660, authorized the Secretary of Health and Human
Services to establish and monitor a national practitioner data
bank (NPDB). The mission of the NPDB is to protect the
public by “restricting the ability of unethical or incompetent
practitioners to move from State to State without disclosure
or discovery of previously damaging or incompetent
performance”(NPDB, 2004, p.10).
The NPDB is a central repository receiving information
from private and governmental agencies under U.S.
jurisdiction. Information received by the NPDB is accessible
to registered entities, such as state licensing boards and
professional societies, which are eligible to query. Although
patients cannot access the NPDB, health care providers
listed in the NPDB can access their own information to
check for misinformation. The NPDB collects information
on physicians, dentists, nurses, and other health care
practitioners who, as a result of judgments in malpractice suits,
have entered into settlements, had disciplinary action taken
against them that resulted in their licenses being revoked or
suspended, had their privileges to practice limited, or had
to pay monetary awards (Croke, 2003). According to the
National Practitioner Data Bank 2004 Annual Report, since
its inception in 1990 and continuing through 2004, there
have been approximately 5,001 malpractice claims assessed
against all types of registered nurses (RNs). The NPDB
established the following malpractice reason categories for
reporting numbers of nursing malpractice payments:
1. Anesthesia related
2. Behavioral health related
3. Diagnosis related
4. Equipment or product related
5. IV or blood products related
6. Medication related
7. Monitoring related
8. Obstetrics related
9. Surgery related
10. Treatment related
11. Miscellaneous
The NPDB classifies RNs into five categories:
nonspecialized RNs, nurse anesthetists, nurse midwives,
nurse practitioners, and clinical nurse specialists/advanced
practice nurses. Nonspecialized RNs were responsible for
the most malpractice payments (3,131 or 62.7%), followed
by nurse anesthetists (1,035 or 20.7%), nurse midwives
(459 or 9.2%), nurse practitioners (368 or 7.3%) and clinical
nurse specialists/advanced practice nurses (8 or 0.2%). The
majority of payments for malpractice claims were based upon
monitoring, treatment, and medications problems, as well as
obstetrics and surgery-related problems (NPDB, 2004).
Today’s health care environment poses even greater
liability risks for nurses. Liability risks that have contributed
to the increased number of malpractice cases against nurses
include: improper supervision/delegation, early patient
discharge, nursing shortage, hospital downsizing, increased
autonomy, advanced technology, and better-informed
consumers (Croke, 2003). The Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) defines
negligence as a “failure to use such care as a reasonably prudent
and careful person would use under similar circumstances”
and malpractice as:
improper or unethical conduct or unreasonable lack of
skill by a holder of a professional or official position;
often applied to physicians, dentists, lawyers, and public
officers to denote negligent or unskillful performance
of duties when professional skills are obligatory.
Malpractice is a cause of action for which damages are
allowed (JCAHO, 2005).
Journal of Legal Nurse Consulting • Summer 2006 • Volume 17, Number 3 •
In 2004, the median and mean payments for all types of
registered nurses were $100,000 and $302, 737, respectively
(NPDB, 2004). Nurses must be concerned about malpractice
litigation because nurses may now be held accountable for
their own negligence. It is important for each nurse to know
relevant law and legal doctrines and incorporate them into
everyday practice as a safeguard for the health care provider,
as well as the health care recipient (Guido, 2006).
Liability Elements of Malpractice Litigation
For a nurse to become liable in a malpractice action, the
law requires that certain elements be proven by the plaintiff
before a successful case can be brought against the defendant
nurse (Guido, 2006). The elements include duty, breach of
duty, foreseeability, causation, injury, and damages, except
as noted under doctrine res ipsa loquitor. When reviewing a
nursing malpractice case for merit, the legal nurse consultant
(LNC) needs to determine if all liability elements are present.
If any of these elements is missing, the nurse is not liable
for malpractice. The LNC must know relevant state laws
and definitions applicable for each element of liability. A
summary of medical malpractice laws indexed by state is
located at www.mcandl.com/states.html.
Duty. The duty of care that is owed to a patient is when
an individual engages in an activity where that individual is
under a legal duty to act as a reasonable and prudent person
would act (Guido, 2006). Two aspects are involved in the
duty of care. The first aspect that must be shown is that a
duty was owed to the patient. This aspect is created by a legal
nurse-patient relationship, not just by employment status; a
legal nurse-patient relationship must exist before a lawsuit can
commence. Examples of such a relationship include instances
when the nurse accepts a patient care assignment, receives a
report on a patient, or gives telephone advice to a patient. The
LNC may be asked by the attorney to research the nature of
the relationship between the plaintiff and alleged defendant
nurse (Iyer, 2003).
The second aspect of duty that must be proven is the
scope of care that was owed to the patient. The standard of
care owed to the patient is that exercised by a reasonable and
prudent nurse with like training and experience and under the
same or similar circumstances. Nurses are held accountable to
the standard of care that was in existence at the time the care
was rendered. Various sources for standards of care include
JCAHO, State Nurse Practice Act (NPA), National League
for Nursing (NLN), American Nurses Association (ANA),
nursing specialty organizations, institutional policies and
procedures (P&P), hospital nursing job descriptions, nursing
journals and textbooks, and expert witness testimony.
Breach of Duty. This occurs when a nurse’s care falls
below the acceptable standard of care owed to the patient. The
deviation can occur by an act of omission or commission. For
example, a nurse omits giving an ordered insulin dosage to a
known diabetic patient, and the patient lapses into a diabetic
coma. Or a nurse gives an ordered insulin dosage to a known
diabetic patient, fails to monitor his subsequent lack of oral
intake, and the patient suffers a debilitating hypoglycemic
reaction. Whether a nurse has satisfied or breached the duties
of care owed to the patient is determined by the applicable
standard of care.
Due to the fact that medical and nursing knowledge
is “more technical than the scope of common knowledge,”
most state laws require the use of expert witness testimony
for establishing the standard of care at issue in a medical
or nursing malpractice lawsuit (Iyer, 2003). The expert
witness must be qualified by reason of education, training, or
experience to opine about a given subject matter (Testimony
by Experts, 2000). If the negligence action falls within the
common knowledge exception, such as when the subject
matter is within the ordinary, common knowledge and
experience of the layperson, expert testimony may not be
required. Together, the attorney and LNC must determine
the applicable standard of care owed to the patient in existence
at the time the nurse rendered the patient care.
The LNC reviews the entire medical record, “comparing
and contrasting care with published standards determining
whether or not there was a breach in the standard of care
in a given subject matter” (Iyer, 2003, p. 262). The review
also facilitates determining case issues and selection of
qualified experts.
Foreseeability. In this area, the nurse has a responsibility
to foresee harm and take actions to eliminate the risk.
The nurse does not need to foresee events that are “merely
possible,” but only those that are “reasonably foreseeable”
(O’Keefe, 2001).
Could the nurse in the preceding example reasonably
foresee that not monitoring a patient’s lack of oral intake
subsequent to receiving insulin would result in a hypoglycemic
reaction? “The challenge is to show that one could reasonably
foresee a certain result based on the facts as they existed at the
time of the occurrence rather than what could be said based
on retrospective thinking and results” (Guido, 2006, p. 75).
Causation (proximate cause). This area is more
difficult for the plaintiff attorney to prove. Causation builds
upon cause-in-fact and foreseeability. In cause-in-fact (also
known as the “but-for” test), the plaintiff must show that
the nurse’s breach in the standard of care actually resulted in
the plaintiff’s injury and that these injuries were reasonably
foreseeable. For example, a nurse may administer a wrong
drug dosage to a patient in breach of standard of care, but
there was no subsequent injury; therefore, the plaintiff does
not have a cause of action.
When determining a nurse’s negligent action in relation
to the alleged injury, Iyer (2003) recommends that the LNC
should ask the following questions:
1. Did the negligence cause the injury?
2. Did the breach cause all or part of the plaintiff injury?
3. Is there any reason why the result would have been the
same absent the deviation?
Legal definitions for causation are found in jury
instruction guides for the jurisdiction in question. “The jury
instruction guide states the precise language that a judge will
• Journal of Legal Nurse Consulting • Summer 2006 • Volume 17, Number 3
read to the jury when instructing them about the information
to consider when rendering a verdict. The information that
the jury will be asked to consider is what the attorney will
have to prove in court” (Iyer, 2003, p. 282). State-by-state
jury instructions can be located online at www.llrx.com/
columns/reference38.htm.
Injury. In malpractice litigation, the plaintiff must prove
that the injury claimed was directly related to the negligent
act of the professional defendant. Categories of injuries are
physical, financial, or emotional, with the later two usually
accompanying physical injury. Together, the attorney and
LNC must distinguish a “proximately caused injury” from the
injury that the plaintiff would or did suffer irrespective of any
breach (Iyer, 2003). The LNC reviews, interviews, researches,
summarizes, and evaluates all medical documentation relevant
to the alleged injury.
Damages. Monetary awards are given to compensate the
plaintiff for the injury proximately caused by the negligent
action of the defendant. Categories of damages include:
1. General Damages: monetary compensation for a loss
that cannot be measured in “nominal amounts.” Types
of losses may include disfigurement, disability, and past,
present, and future pain and suffering.
2. Special Damages: monetary compensation for losses due
to injury. Types of losses may include medical expenses, lost
income, and past, present, and future losses due to injury.
(General and Special Damages may be grouped together
into one category called Compensatory Damages).
3. Emotional Damages: monetary compensation for
anxiety or emotional distress associated with injury.
4. Punitive Damages: monetary compensation for
intentional or grossly negligent misconduct. Punitive
damages are awarded to “punish” the individual and to
deter similar future actions.
Two classification awards for damages are economic and
non-economic. Economic damages concern pecuniary losses,
such as medical expenses or lost wages, and non-economic
damages concern non-pecuniary losses, including pain and
suffering, and loss of consortium. State laws vary on awarding
damages, with some capping the award amounts. For example,
in 1975, California wrote into law the Malpractice Injury and
Compensation Reform Act (MICRA), limiting non-economic
damages in medical malpractice cases to $250,000. Additionally,
24 states have enacted laws limiting caps on non-economic
damages. When an LNC or life care planner is involved in
assisting the attorney with calculating economic damages,
having knowledge of relevant state laws is a necessity.
Doctrine Res Ipsa Loquitor: “The thing stands for itself.”
Under this doctrine, the plaintiff does not need to prove how
the injury occurred or who was responsible. The basic premise is
that, without negligence, the injury would not have happened.
In most states, the plaintiff does not need the testimony of an
expert witness. For the doctrine to apply, the plaintiff must
prove the following three elements (Guido, 2006, p. 86):
1. The accident must be the kind that ordinarily does not
occur in the absence of someone’s negligence;
2.
The accident must be caused by an agency or instrumentality
within exclusive control of the defendant; and
3. The accident must not have been due to any voluntary
action or contribution on the part of the plaintiff.
The following two case analyses of nursing malpractice
are examples for determining nursing liability. They are not
intended to be a substitute for contacting an attorney when
questions arise about nursing malpractice litigation.
#1 Case Analysis
Lunsford v. Board of Nurse Examiners, 648 S.W.2d 391;
1983 Tex. App. LEXIS 4087
Case Scenario: A patient, Donald Floyd, was brought
by a friend, Miss Farrell, to Willacy County Hospital with
complaints of chest pain accompanied by numbness and pain
radiating down his left arm. Miss Farrell left Mr. Floyd in
the hospital waiting room and went in search of medical
assistance for Mr. Floyd. Within the facility, Miss Farrell
spoke with a physician who subsequently referred her to seek
help from the registered nurse on duty, Nurse Lunsford.
Nurse Lunsford was ordered by the physician to send the
patient and his companion to Valley Baptist Hospital, 24
miles away. The hospital had a policy to send all patients to
Valley Baptist Hospital unless the patient had a physician on
the hospital’s staff or unless it was a “life-death situation.”
Upon entering the waiting room, Nurse Lunsford found
Mr. Floyd lying on a table complaining of chest pain that also
had radiated to his arms. After questioning Mr. Floyd, Nurse
Lunsford learned that he had not undertaken any strenuous
exercise or eaten anything unusual that day that may have
influenced the onset of his symptoms. Despite suspecting
“cardiac involvement,” Nurse Lunsford did not take Mr. Floyd’s
vital signs. Nurse Lunsford gave the following instructions to
Miss Farrell: take Mr. Floyd to Valley Baptist Hospital; speed
there; drive with the automobile’s emergency flashers on;
and use the automobile’s citizens’ band radio to call for help
on the way to Valley Baptist Hospital. Nurse Lunsford also
asked Miss Farrell about her knowledge of cardiopulmonary
resuscitation (CPR), as there might be a chance that she may
need to use it during transport. Mr. Floyd died five miles from
Willacy Hospital on the way to Valley Baptist Hospital.
The Texas Board of Nurse Examiners (1983) conducted
a hearing on the actions of Nurse Lunsford relating to Mr.
Floyd death. The Board, citing Texas Rules of Evidence
4525 (B) (9), found that Nurse Lunsford’s conduct had been
“unprofessional and dishonorable… likely to injure patients
or the public” and suspended Nurse Lunsford’s Texas RN
license for one year. The District Court of Travis County,
200th Judicial District affirmed the Board’s decision. Nurse
Lunsford appealed, citing she did not owe a duty to Mr. Floyd
because a nurse-patient relationship had not been established
between the parties. The Court of Appeals of Texas, Third
District, Austin affirmed the judgment of the District Court.
Elements of Liability:
• Duty. Nurse Lunsford cited she did not have a nursepatient relationship with Mr. Floyd, as he had not been
Journal of Legal Nurse Consulting • Summer 2006 • Volume 17, Number 3 •
admitted to the hospital and was not a patient of the
staff physician. The Courts found that Nurse Lunsford
automatically owed a duty to Mr. Floyd through the
receipt of her Texas Registered Nurse licensure and
that a nurse-patient relationship existed when she met
Mr. Floyd in the hospital waiting room in need of lifethreatening emergency care. Texas Board of Nurse
Examiners Rule 22 T.A.C 217.11(1)(M),(3)(A)(i)
requires an RN to assess the health status of each patient
and institute appropriate nursing actions that might
be required to stabilize the patient’s condition and/or
prevent further complications.
• Breach of Duty. The Board found and Courts affirmed
that Nurse Lunsford failed to assess and implement
appropriate nursing actions. Specifically, the following
breaches in the standards of care were cited:
1. Failure to assess Mr. Floyd’s medical status;
2. Failure to inform the physician of Mr. Floyd’s cardiac
condition and potential life-death medical status; and
3. Failure to institute appropriate nursing actions,
such as taking vital signs and placing the patient
on electrocardiogram (ECG) machine, to stabilize
Mr. Floyd’s medical condition and prevent further
complications and, ultimately, his demise.
• Foreseeability. Nurse Lunsford should have been able to
reasonably foresee the potential complications related to
Mr. Floyd’s complaints, especially since she admitted to
have suspected “cardiac involvement.” Nurse Lunsford
also questioned Miss Farrell about her knowledge of CPR,
which demonstrates Nurse Lunsford’s forseseeability of
a cardiopulmonary arrest.
• Causation. Nurse Lunsford’s breach in the standards of
care proximately caused the injury. If she had assessed the
patient, communicated to the physician about the patient’s
life-threatening condition, and implemented nursing
interventions, his death could have been prevented.
• Injury. Nurse Lunsford’s breach of duty and failures
to assess the patient’s condition, to communicate his
condition to the physician, and to implement nursing
interventions to help stabilize his condition resulted in
the cardiac event that lead to his death.
• Damages. Nurse Lunsford’s RN license was suspended
for 1 year.
#2 Case Analysis
Muskopf v. Maron, 764 N.Y.S.2d 741; 2003 N.Y. App.
LEXIS 10050
Case Scenario: Susan Muskopf, a patient of Dr. Barry
Maron, was admitted to Wyoming County Community
Hospital for a unilateral hand repair due to carpal tunnel
syndrome. At the time of admission, Ms. Muskopf had been
diagnosed with bilateral carpal tunnel syndrome, although
her left hand was asymptomatic at the time of surgery. Prior
to the surgery, Ms. Muskopf questioned the hospital nurse
about the location of the surgical procedure, stating that
she thought the surgery was to be performed on her right
hand. Subsequently, the hospital nurse reviewed all the preoperative medical documents in the patient’s chart, including
the physician’s records and informed consent form signed by
the patient, and all the documents indicated that the surgery
was to be performed on the patient’s left hand. The hospital
nurse did not notify the physician of the patient’s concern
regarding the site of the surgery and did not document this
conversation in the patient’s medical record.
The patient brought a medical malpractice action suit
against Dr. Maron, the Wyoming County Community
Hospital, and the County of Wyoming, seeking damages
for injuries she allegedly sustained when the physician
operated on her left hand instead of her right hand. The
patient also brought an independent negligence cause of
action collectively against the hospital and the county for
the failure of the hospital nurse to prevent the surgical
error despite having been informed by the patient that she
thought the surgery was to be done on her right hand. The
Supreme Court, Wyoming County, granted a cross motion
of the Wyoming County Community Hospital and County
of Wyoming defendants for summary judgment, dismissing
the complaint against them (765 N.Y.S.2d 537; 2003 N.Y.
App. LEXIS 10047). On appeal to the Supreme Court of
New York, the plaintiff contended that the Supreme Court,
Wyoming County, erred in granting the defendants’ cross
motion for summary judgment. The defendants maintained
the contention that they were shielded from tort liability,
based on the fact that the hospital nurse had reviewed and
followed the physician’s pre-operative orders. On review by
the State Supreme Court of New York, it was cited that the
defendants had met their initial burden of proof, based, in
part, upon affidavit testimony provided by a nurse expert
witness, who opined that the nursing care rendered by the
hospital nurse met the standard of care: once the hospital
nurse was questioned by the patient concerning the surgical
site, the hospital nurse reviewed all the preoperative physician
records, as well as the informed consent form signed by the
patient, and all the records indicated the surgery was to be
performed on the patient’s left hand.
An issue of fact was raised by the plaintiff through affidavit
testimony provided by the physician expert witness, who
opined that the hospital had breached “the accepted standards
of medical practice by failing to undertake a comprehensive
review of the plaintiff’s case, including a specific inquiry to
the attending physician and documentation of the results of
that inquiry, when the hospital nurse learned of plaintiff’s
doubts concerning the site of the surgery” (Muskopf v.
Maron, 2003, p. 2). The plaintiff’s physician expert’s opinion
was based, in part, on the hospital nurse’s own deposition
testimony: “If a patient had a question concerning the side
on which surgery was to be performed, she [the nurse] would
document that she [the nurse] had called the doctor and that
he would be in to speak to the patient” (Muskopf v. Maron,
2003, p. 2). The Supreme Court of New York found the issue
of fact undisputable, in that the hospital nurse did not follow
through with notifying the physician of the patient’s concern
• Journal of Legal Nurse Consulting • Summer 2006 • Volume 17, Number 3
and denied the defense’s motion that they were shielded from
tort liability. The judgment was reversed on the law with
costs, the cross motion was denied, and the complaint against
the Wyoming County Community Hospital and County of
Wyoming defendants was reinstated.
Elements of Liability:
• Duty. A legal nurse-patient relationship existed between
the patient and the hospital nurse. The hospital nurse
owed a duty to the patient to ensure that the physician
was notified of the patient’s concern regarding the surgical
site. In the hospital nurse’s own deposition testimony,
she stated, “If a patient had a question concerning the
side on which the surgery was to be performed, she
[the nurse] would document that she [the nurse] had
called the doctor and that he would be in to speak to the
patient” (Muskopf v. Maron, 2003, p. 2).
• Breach of Duty. The hospital nurse breached the standard of
care with an act of omission by not informing the physician
of the patient’s concern regarding the surgical site.
• Forseeability. The hospital nurse should have been
able to reasonably foresee the potential complication of
wrong site surgery related to not informing the physician
of the patient’s stated concern.
• Causation. The hospital nurse’s breach in the standard of
care proximately caused the injury. If the hospital nurse had
notified the physician of the patient’s concern about the
surgical site, the surgical error could have been prevented.
• Injury. The patient had surgery on the wrong hand. The
left hand was asymptomatic at the time of surgery.
• Damages. For the appellants, the Supreme Court of
New York unanimously reversed the appealed judgment
on the law with costs, the defense’s cross motion for
summary judgment was denied, and the complaint
against the Wyoming County Community Hospital and
County of Wyoming defendants was reinstated.
Summary
When evaluating a nursing malpractice case for merit,
the LNC must evaluate each liability element for possible
negligence. The first element that must be determined is the
existence of a legal nurse-patient relationship between the
parties and based upon the relationship what was the scope of
care owed to the patient by the nurse [defendant]. The LNC
must then determine whether or not there was a breach in
the standard of care, identify proximate causation and injury.
Once the evaluation is complete, the LNC must be able to
provide the attorney with a precise report (verbal or written)
based upon each liability element.
continued on page 24
Journal of Legal Nurse Consulting • Summer 2006 • Volume 17, Number 3 •
are examined. Although these areas are not as frequently cited
in medical litigation as some other clinical areas, for an LNC
dealing with such, these chapters are a wonderful resource for
those individuals with minimal baseline knowledge.
In addition, this section has two chapters that address
topics often entangled in the litigation process: the office based
medical record and the independent medical examination
(IME). The IME chapter delineates the step-by-step process
of an IME, culminating with final impressions and professional
opinions regarding the IME. The section on office based
medical records was very helpful. As many LNCs are aware,
office based verbal communication may not be adequately
corroborated with written documentation – and may even serve
as the wavering domino leading to an unfortunate cascade of
events resulting in medical malpractice litigation.
Part III, chapters 21 through 38, deal specifically with
clinical specialty areas. This is the “meat and potatoes” for LNCs
who are routinely involved in medical malpractice litigation.
These chapters address many high-volume, high-risk areas
of clinical practice, e.g. critical care, emergency department,
intravenous therapy, obstetrics, orthopedics, pediatrics, skin
trauma, medication administration, and psychiatric care.
The reader will benefit tremendously from the expertise and
experience of each contributing author. If an LNC is already
clinically experienced in one of these particular fields, it is likely
that the information contained within the chapter will reinforce
an existing knowledge base. For the LNC without clinical
expertise in one or a number of these designated clinical areas,
the chapters will provide an excellent starting point to explore
pertinent definitions, patient care interventions, treatment
complications, and practice standards.
Part IV of the text explores forensic aspects of care.
Although any LNC may encounter altered medical records
or utilize a forensic document examiner, for those involved in
criminal prosecutions, chapter 41 will be highly beneficial. A
detailed discussion of forensic evidence from sexual assaults,
gunshot wounds, auto accidents, and poisonings provide
examples. The final chapter of the book addresses autopsy
reports, which may be an integral component of malpractice,
product liability, or toxic tort litigation.
The book concludes with an appendix of medical
terminology, Internet resources, textbook references, and a
glossary. These four subcomponents, as evaluated separately
from the main text, are excellent as a stand-alone reference
for the practicing legal nurse consultant.
In summary, authors Iyer, Levin, and Shea have
provided the legal and nursing community a comprehensive
and worthwhile resource for medical record examination.
Whatever your level of competence in legal nurse consulting
practice, whether novice or seasoned expert, this publication
will be as valuable addition to your reference library.
Beth C. Diehl-Svrjcek, MS RN CCRN NNP CCM
LNCC, is a Neonatal Nurse Practitioner at Johns Hopkins
Hospital in Baltimore, Maryland, where she functions as
a Transport Nurse for the Maryland Regional Neonatal
Transport Program. She has more than 27 years of
combined experience in adult critical care, neonatal intensive
care, pediatrics, post acute pediatrics, case management,
nursing staff development, utilization review, and nursing
supervision. She maintains an independent LNC practice
specializing in medical malpractice for plaintiff and defense
litigation. She has been used as an Expert Witness since
1988. A former board member of the Greater Baltimore
Area Chapter of AALNC, she maintains certifications as a
critical care nurse, case manager, and legal nurse consultant.
She can be reached at BDSConsultants@bcpl.net.
Nursing Malpractice: Determining Liability Elements for Negligent Acts
continued from page 9
References
Croke, E. (2003). Nurses, negligence and malpractice. American
Journal of Nursing, 103(9), 54-63.
Guido, G. (2006). Legal and ethical issues in nursing (4th ed.). Upper
Saddle River, N.J.: Prentice Hall Publishers.
Iyer, P. (Ed.). (2003). Legal nurse consulting principles and practice
(2nd ed.). Baton Rouge, LA: CRC Press.
Joint Commission on Accreditation of Health care
Organizations (2005). Sentinel Events Glossary of Terms.
2005. Retrieved December 30, 2005, from www.jcaho.org/
accredited+organizations/sentinel+event/glossary.htm
Lunsford v. Board of Nurse Examiners, 648 S.W.2d 391; 1983
Tex. App. LEXIS 4087. Retrieved January 9, 2006, from http://
lexisnexis.com
Muskopf v. Maron, 765 N.Y.S.2d 537; 2003 N.Y. App. LEXIS
10047. Retrieved March 1, 2006, from http://lexisnexis.com
Muskopf v. Maron, 764 N.Y.S.2d 741; 2003 N.Y. App. LEXIS
10050. Retrieved March 2, 2006, from http://lexisnexis.com
National Practitioner Data Bank 2004 Annual Report. Retrieved
December 30, 2005, from www.nphd-hipdb.com/pubs/fs/
fact%20Sheet%20-%20National%20Practitioner%20Data%20B
ank.pdf
O’Keefe, M. (2001). Nursing practice and the law: Avoiding
malpractice and other legal risks. Philadelphia: F. A. Davis.
Testimony by Experts, Federal Rule of Evidence 702 (2000).
Eileen M. Croke, EdD MSN RN ANP LNCC, is
an Associate Professor of Nursing at California State
University Long Beach, CA, where she teaches the nursing
course “Legal Issues in Health Care.” She has been an
LNC since 1989, specializing in medical malpractice and
personal injury, plaintiff, and defense litigation. She serves
as an expert witness for the California Board of Registered
Nursing. She can be reached at ECroke1@cs.com.
24 • Journal of Legal Nurse Consulting • Summer 2006 • Volume 17, Number 3
1
Article Summary and Review: Nursing Malpractice
Your Name Here
University
Course
Professor
Due Date
2
Article Summary and Review: Nursing Malpractice
The first section of the paper is called the introduction, yet the paper does not have a
heading that is labeled introduction. In this section, you would start with an introductory
paragraph. A well-written essay is similar to a trip. The introduction section is the planning stage
where you determine the place, time, and method of travel. You might also include the order of
the trip and stages of travel. Here is where you will introduce what your paper will be about. A
well-written introduction tries to get the reader to finish the rest of the paper. Use this template
for reviewing and summarizing the Croke article.
Primary Problems Leading to Malpractice Suits
Here is where you will describe the primary problems that led to malpractice suits based
on the Croke article. Make sure to be specific with the problems and support your responses.
Identification of the Nurse’s Role
Here is where you will discuss the role the nurse played related to the primary problems
leading to malpractice suits. Make sure to support your writing with scholarly sources.
What the Nurse Did Wrong
In this section, explain what the nurse did wrong. Support your writing with scholarly
sources.
Conclusion
End with a conclusion where you summarize your paper and repeat the primary points.
Remember that a well-written essay is like planning a trip. The introduction is the planning
3
stage; the body is the journey. The conclusion allows you the opportunity to reflect on where the
journey has taken you. This is similar to reviewing the pictures you took on your trip and
remembering the important places and experiences.
4
References
Butts. J., & Rich, K. (2016). Nursing ethics. Across the curriculum and into practice. (4th ed.).
Jones & Bartlett Learning. https://online.vitalsource.com/books/9781284099096
Croke E. M. (2006). Nursing malpractice: Determining liability elements for negligent acts.
Journal of Legal Nurse Consulting, 17(3), 3–24.
Pozgar, G. (2016). Legal and ethical issues for health professionals. (4th ed.). Jones & Bartlett
Learning. https://online.vitalsource.com/books/9781284089530
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Formatting
Title Page
Citation
Outline
