N520 Module 2 assignment: legal concepts case responses on negligence, defenses and documentation, a full sample

Duty, Breach, Causation, Harm: Analyzing Nursing Negligence, Defenses, and Documentation in a Composite Hospital Fall

Student Name

Master of Science in Nursing Program, Aspen University

N520: Legal and Ethical Issues in Health Care

Instructor Name

Month Day, Year

Duty, Breach, Causation, Harm: Analyzing Nursing Negligence, Defenses, and Documentation in a Composite Hospital Fall

This paper answers the Module 2 prompts using a composite case. Mrs. P., 78, was admitted to a medical unit at 10 p.m. with pneumonia and new confusion. The admitting nurse completed a brief assessment but did not record a fall risk score or order a bed alarm. At 1 a.m., a physician resident ordered a sedating medication for agitation by telephone. The nurse gave it but did not reassess Mrs. P. for three hours because two other patients deteriorated and the unit was short one nurse. At 4 a.m., Mrs. P. was found on the floor with a hip fracture, which required surgery. She later sued the nurse, the resident, and the hospital.

Evidence That Establishes a Negligent Act

Negligence requires the plaintiff to prove four elements: a duty owed, a breach of the standard of care, causation, and harm (Guido, 2020). Duty arises from the nurse-patient relationship; once the nurse accepted Mrs. P.'s assignment, the duty was established (Brous, 2019a). Breach is measured against what a reasonably prudent nurse would do in similar circumstances, and the plaintiff typically shows it with an expert witness, the hospital's own policies, and published professional standards (Brous, 2019b). Here, evidence of breach would include the missing fall risk assessment, the absence of a bed alarm for a confused older patient, and the three-hour gap in reassessment after a sedative.

Causation asks whether the injury probably would not have happened without the breach, judged on the civil standard of a preponderance of the evidence (Brous, 2019c). The defense might argue that Mrs. P. could have fallen even with an alarm, but an expert could testify that timely reassessment and fall precautions would likely have prevented an unsupervised attempt to get up. Harm is clear: a hip fracture requiring surgery, with pain, disability, and costs (Brous, 2020). Each element must be proven separately; a documentation gap alone proves breach only if it reflects care that was not given.

Defenses Available to the Nurse

The nurse's defenses include challenging causation, as above; arguing that the standard of care was met given the circumstances, including the unit's emergencies and short staffing; and asserting comparative negligence if Mrs. P. had been instructed to call for help and understood the instruction, which is unlikely given her confusion (Guido, 2020). Short staffing is not a complete defense, since the nurse remained responsible for prioritizing and seeking help, but it can shift some responsibility to the hospital. A procedural defense, the statute of limitations, is discussed below.

How Statutes of Limitations Protect Nurse-Defendants

A statute of limitations sets the time within which a lawsuit must be filed, commonly two to three years for professional negligence, depending on the state (Guido, 2020). The period usually begins when the injury occurs or, under the discovery rule, when the patient knew or reasonably should have known of it. For minors, the period is often extended until they reach majority. These statutes protect defendants from claims brought after evidence and memories have faded. In Mrs. P.'s case, the injury was known immediately, so the period began on the day of the fall.

Preventing Quasi-Intentional Torts

Quasi-intentional torts involve harm to a person's reputation, privacy, or dignity rather than physical injury. They include defamation, which is a false statement that harms reputation (slander when spoken, libel when written), and invasion of privacy or breach of confidentiality (Guido, 2020). After Mrs. P.'s fall, a nurse who wrote in the chart that the night nurse "was lazy and ignored her patient" or who discussed the fall with visitors in the hallway would risk exactly such a claim. Nurses prevent these torts by documenting facts rather than opinions, discussing patients only with those who need to know, never posting about patients on social media, and reporting concerns about colleagues through proper channels rather than in the medical record.

Why Admission Documentation Matters

The admission assessment establishes the patient's baseline and identifies risks that shape the plan of care. A documented fall risk score for Mrs. P. would have triggered precautions under most hospital policies and would have shown that the nurse recognized the risk. Its absence suggests the risk was not assessed. In litigation, the record is often the most important evidence, and juries tend to believe that care not documented was not performed (Brous, 2019b). Complete, timely admission documentation protects the patient by guiding care and protects the nurse by showing that the standard was met.

Determining Liability Among Several Defendants

Liability can be shared. The nurse is personally liable for her own negligence. The hospital is vicariously liable for its employees' negligence under the doctrine of respondeat superior, and it may also be directly liable under corporate negligence for inadequate staffing and for failing to ensure that fall-prevention policies were followed (Guido, 2020). The resident may be liable if ordering a sedative without assessing a confused older patient fell below the physician standard of care. In many states, a jury apportions fault among defendants by percentage; depending on state law, defendants may be jointly and severally liable, so that the plaintiff can collect the full judgment from any one of them. In practice, the hospital, with its insurance and direct role in staffing, would likely bear the largest share.

Lessons for Nurse Leaders

For a graduate-prepared nurse in a leadership role, the case points to systems as much as to individuals. A unit that is routinely short one nurse on nights, with no process for redistributing assignments when two patients deteriorate at once, creates conditions in which reassessments are missed. Leaders can reduce that risk by building fall risk scoring into the admission workflow so it cannot be skipped, requiring reassessment within a set time after sedating medications, escalating staffing shortfalls through a documented chain of command, and reviewing falls as system events rather than only as individual failures. These measures protect patients first, and they also strengthen the hospital's defense against a corporate negligence claim.

Conclusion

Mrs. P.'s case shows how negligence is built from four elements, how defenses and statutes of limitations limit liability, how quasi-intentional torts can follow careless words, and how responsibility is shared among nurse, physician, and hospital. The most practical lesson is that careful assessment and documentation at admission, and timely reassessment afterward, protect both patients and nurses.

References

Brous, E. (2019a). The elements of a nursing malpractice case, part 1: Duty. American Journal of Nursing, 119(7), 64-67. https://doi.org/10.1097/01.NAJ.0000569476.17357.f5

Brous, E. (2019b). The elements of a nursing malpractice case, part 2: Breach. American Journal of Nursing, 119(9), 42-46. https://doi.org/10.1097/01.NAJ.0000580256.10914.2e

Brous, E. (2019c). The elements of a nursing malpractice case, part 3A: Causation. American Journal of Nursing, 119(11), 54-59. https://doi.org/10.1097/01.NAJ.0000605380.52689.af

Brous, E. (2020). The elements of a nursing malpractice case, part 4: Harm. American Journal of Nursing, 120(3), 61-64. https://doi.org/10.1097/01.NAJ.0000656360.21284.50

Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Pearson.