Emergencies & disasters: Implications for liability & malpractice

According to Nurses Service Organization, a liability insurance provider:

From a coverage perspective, Nurses Service Organization (NSO) clarifies that there are no “disaster exclusions” on the professional liability coverage for nurses that they provide. The policy triggers during times of disaster just the same as at any other. For example, NSO managed many claims arising from abandonment or sub-standard treatment and care during Hurricanes Katrina and Sandy. Saying no to an assignment, even when you do so for valid reasons (such as being inadequately prepared) could lead to a claim of abandonment. There is no difference in how or when their policy would trigger, regardless of the disaster or circumstances (hurricane, flood, infectious disease).

If a nurse feels the assignment they have been given is outside of their practice knowledge base, an incident/occurrence report should be completed. The incident/occurrence report should document the concerns of the nurse in a manner that is not only professional but factual.

Two other items the nurse might consider include initiating the facility's chain of command process and completing an "assignment under protest" form. Most nurse practices guidelines are set by the individual's state board of nursing, so referring a nurse to their particular state for advice on refusing a patient is always best.

Read NSO’s article, Legally, When Can You Say “No”? for more information. http://bit.ly/1uajyDN

According to the Washington State Nursing Care Quality Assurance Commission:

Refusing to accept a patient assignment is an employer-employee issue, but is not a violation of conduct. The Nursing Commission does not have authority regarding employer-employee issues. Examples listed in the interpretative statement patient abandonment link below include examples such as; refusing to work in a setting because of inadequate orientation, education, training, or experience or refusing to work in an unsafe situation. Nurses should only perform those activities that they have the proper training, knowledge, skills, and ability to perform competently and safely. The Nursing Commission would evaluate and consider extenuating circumstances about complaints for abandonment such as a nurse refusing to provide care because of the lack of resources (such as proper personal protective equipment).

Once you have agreed to take assignment, you are responsible and accountable to provide nursing care. It is the employer’s responsibility to comply with the Occupational Safety and Health Act (OSHA) standards, including providing proper equipment and training, when health care professionals may be exposed to potential or suspected infectious diseases. The Nursing Care Quality Assurance Commission concludes that patient abandonment occurs when a nurse, who has established a nurse-patient relationship, leaves the patient assignment without transferring or discharging nursing care in a timely manner. This applies in any health care setting; it applies to paid or unpaid nursing care. Employee problems do not constitute patient abandonment. The Nursing Commission would review the circumstances and evaluate any complaints about abandonment based on the information they receive.

For more on patient abandonment, read the DOH Interpretive Statement on Patient Abandonment (PDF).