Question 1 3
Question 2 4
The results of the Commission on Inquiry Report are somewhat depressing and dismal which is not the objective of a hospital or health care institution. The complaints from the report were as follows: assaulted, neglected and left to die patients under grave conditions; uncaring healthcare providers; and lack of sufficient care for patients who need more than medication. These are clear indications of the hospitals’ lack of concern to the welfare of their patients and lax and sloppy hospital administration. However, there are times that the administrations of the hospitals or whatever institution is blamed for this negligence. People think that administration guides its employees in providing better services for the public. This is called the vicarious liability.
According to Rostant and Cady (2000, p.66) that vicarious liability is a legal concept from the Latin word vicar which means deputy. The relationship of the vicar or deputy to his superior is important to be established in vicarious liability since this will dictate the depth of involvement of the employee and employer (Rostant and Cady, 2000). Under this concept, nurses are most of the time agents of the hospitals or physicians for whom they work; hence, vicarious liability is used if the nurse will commit negligence while on duty under the employment of a hospital or a physician (Rostant and Cady, 2000).
Moreover, an employer’s responsibility is restricted to an employee’s acts performed in the course of employment (Daly, Speedy and Jackson, 2014). Hence, a healthcare employer can be considered accountable to compensate an injured patient whose injuries resulted from employee’s negligence (Daly, Speedy and Jackson, 2014). The employer can only be exempted from negligence if the nurse’s actions are so far considered to be included in his duties in the hospital and part of the duties as part of the nurse’s roles then that would only be the time that the employer will not be held responsible for injuries caused under the nurse’s care (Daly, Speedy and Jackson, 2014).
In the first scenario the result of the Commission on Inquiry Report on nursing homes in provincial hospitals where patients who are neglected, assaulted and left to die in terrible situations. This shows that under the care of the nurses the elder patients are not cared for properly. Clearly these nurses are employed in the hospital which means that vicarious liability is evident. The nurses looked as if they do not care on the impact of the effects these results have on their reputation and the hospital’s reputation.
This is somewhat related to another scenario that the junior nursing personnel does not know his rights and responsibilities and does not know whom to turn to tell the grievances of the patients. This will eventually lead to accidents due to unclear duties and responsibilities of nurses and other staff for the patients. If something wrong happens it will be the hospital which will be accountable again for these since nurses and other staff since the employee and employer relationship is clearly established.
For the last scenario, the nurses choose not to care at all with other patients who need more care than others. Another incident in the same hospital reported that instead of using linen for the patient, the staff used plastic shroud to wrap the patient which is used in mortuaries. The relatives voiced out their complaints but they were ignored.
Aside from vicarious liability, another concept for this kind of problems in the hospitals is the respondeat superior or “let the master answer” (Iyer, 2001). The two scenarios showed that the nurses and other staffs choose to ignore and inflict injury to then injured and ill patients. Since they are employed in the hospital, the hospital will be accountable to pay damages or harm done to the patients. Likewise for the junior nursing personnel who was not oriented on the rights and duties of the nursing staff, he might meet some incidents which will bring harm to patients. Again, the hospital will be held responsible for untoward accidents which inflict pain, damage or harm to patients under the care of the said nursing staff.
Nurses are known to have sense of commitment and duty to their patients. Their primary objective is to help their patients lessen the pain they are experiencing or about to be experienced. However, from the reports given by the Commission of Inquiry Report, this benevolent nature of nurses is not seen. Accountability, responsibility and legal liability should be discussed to enlighten nurses and healthcare staff on their duties and responsibilities.
The meaning of accountability comes from different perspectives in the nursing profession. In simple terms, “accountability is about justifying actions, explaining why was or was not done” (Hendrick, 2001). People are seen as accountable if they have good enough reasons to act on something that they are perceived as confident and adept on their profession.
According to Caufield (2005) there are four pillars of accountability: professional, ethical, law and employment. Professional accountability is the ethos of nursing which is based on promoting the welfare and well-being of patients through nursing healthcare (Caufield, 2005). Moreover, professional accountability permits nurses to work within the parameters of practices and principles of conduct that sustains the patient’s trust in the individual nurse and to the healthcare system (Caufield, 2005). The regulatory body of Nursing and Midwifery Council or NMC also states from the NMC Code of Professional Conduct clause that they are personally accountable for their practice (Caufield, 2005). This means that they are answerable for their actions and omissions, regardless of advice or directions from another professional (Caufield, 2005).
For legal accountability, nurses follow the two types: civil and criminal law. The types of civil law that will have an impact on the accountability on nursing practice which includes conflicts with employers, cases against nurses because of negligence, and cases against employers by the nurses when they got injured during their work (Caufield, 2005). Criminal law is utilized if there is a violation on the laws drafted in a country (Caufield, 2005).
Employer accountability simply means that the nurses are accountable to their employers (Caufield, 2005). The employers expect the nurses to execute their duties and responsibilities properly. Likewise with the nurses who are expecting their employers to provide ample resources so that they can carry out their duties and responsibilities (Caufield, 2005). Lack of anything from both sides of the employer and employee will yield to unfortunate events which will put the patients in a grievous situation.
Ethical accountability needs decision making on the part of the nurse (Fowler, 2010). This means that there are ethical dilemmas presented and the nurse should choose one weighing the ethical values of the society. If a nurse chose something which is only right to him and wrong in the ethical values set by the society then, it means that he has committed violation of the ethical accountability as a nurse.
Accountability goes both ways from the scenario and the results given. First, the nurses are accountable to their actions since they are not helping the patients to reduce the pain and only add to their injury. They are accountable for their actions since they are called professional healthcare providers. Being a professional nurse means you are adhering to the Code of Professional Conduct in your field. From the above mentioned four pillars of accountability, the nurses from the scenario violated all of it.
A person is responsible for something in the sense of dealing with a job or task (Hendrick, 2001). Furthermore, role responsibility surfaces whenever people occupy a certain place in the society with distinct duties to be fulfilled (Hendrick, 2001).
According to Hendrick (2001), responsibility can be legal or moral. For instance, the nurse’s shift is considered legal responsibility since the nurse is still responsible in everything they do during this time (Hendrick, 2001). On the other hand, moral responsibility is shown when a nurse promises to one patient to visit her even after her shift (Hendrick, 2001).
In the scenario shown role responsibility is clearly not fulfilled properly. Going back to the nurses’ Code of Professional Conduct, the nurses were not able to reduce the pain instead they caused more injury or pain to the patients. One instance in the scenario was that the relatives took care of the patient because the nurse neglected the patient already.
According to Venema (2007), a nurse may be held liable, that is, they have to pay monetary damages, for providing professional care that is below the standard followed by the profession. Most of the times malpractice liability is what some of the nurses committed.
Professional liability is committed when the nurse is doing his responsibility during his shift (Venema, 2007). On one hand, civil liability is the need to perform one’s profession even if the nurse is done with his shift. However, Good Samaritan laws in nurses lighten the burden of civil liability if harm is done during care after a nurse’s shift.
The nurse in the scenario is perceived to have professional liability since they did not perform in the standard followed by their profession. They even let other patients die under their care. As a nurse too, you should be aware of your duties and responsibilities so that you can help the patients. This is a confusion which happened in the scenario wherein the junior nursing personnel does not know how to deal with the grievances of the patients. Nurses too, should not choose who they will aid or assist just like the woman with gangrene who developed bed sores because they did not attend to her needs. These can be considered professional liability.
Canadian Nurses Protective Society. n.d. Vicarious Liability. [pdf] Available at:
Caufield, H. 2005. Vital notes for nurses: Accountability. Blackwell Publishing: Oxford
Daly, J., Speedy, S. and Jackson, D. 2014. Contexts of nursing. Elsevier: Victoria
Fowler, M. 2010. Guide to the Code of Ethics for nurses: Interpretation and application. Silver Spring: California
Hendrick, J. 2001. Law and ethics in nursing and health care. Stanley Thrones: London
Iyer, P. 2001. Nursing malpractice. Lawyers and Judges: California
Rostant, M. and Cady, R. 2000. Liability issues perinatal nursing. Lippincot: New York
Venema, T. 2007. Disaster nursing. Springer: New York.