Nursing Malpractice: Sidestepping Legal Minefields, by Ann Helm. Philadelphia, Pa: Lippincott, Williams & Wilkins 2003. 246 pages, softcover.
Nurses care, comfort, support, teach, and advocate. When asked why nursing was chosen as a professional career, most young women and men articulate altruistic, helping motives. Few enter clinical practice with expectations that they will be the victim of litigation that puts their very professional livelihood at risk.
Helm's recent book, Nursing Malpractice: Sidestepping Legal Minefields, offers both novices and experienced nurses a clearly written, concise guide to avoiding legal pitfalls. Helms first asks why nurses are sued-for example, failure to document, failure to communicate with colleagues, patients, and families appropriately, failure to maintain a safe environment-and then organizes the book to answer this question.
The initial chapters briefly discuss common legal definitions, malpractice law, specialty practice liability, statute of limitations rules, and common malpractice defense strategies. For most practicing nurses, these chapters review concepts that were studied in more depth during their basic nursing education. Subsequent chapters then open with 2 actual, current nursing malpractice lawsuits; they offer the reader insight into the legal points at issue in each case, the nurse's defense, the outcome, and most importantly, specific ways to avoid a similar professional situation.
Each chapter's "lessons in practice," provide clear, practical guidelines that not only allow a nurse to practice safely and within the legal scope of her role but guide her communication with colleagues and patients as well. For example, if a nurse plans to refuse to administer a drug she believes is potentially harmful, the text outlines specifically the reasons she may verbalize in refusing. The practice guidelines also clearly define the "chain-of command" communication necessary in providing responsible care. This reiteration may be especially useful to novice practitioners who are not yet as confident or assertive in their professional communication.
Helm's chapters concerning documentation and assessment are perhaps the most essential to practicing nurses. Complete, timely, accurate, and objective documentation is key to continuity of care. However, given increasingly large nurse:patient ratios and an avalanche of regulatory and routine paperwork, documentation may often be neglected. The cases discussed truly bring home the critical need to document the care and assessments provided. A particularly useful part of the documentation chapter centered in the pros and cons of nursing flowsheets-a ubiquitous port of any patient's record. The discussion of patient assessment and the analysis of the assessed data was nicely tied to standards of care and the need for nurses to know, understand, and deliver care within these accepted norms.
The book briefly discusses ethical concerns within the arena of professional malpractice and offers practical advice on patient advocacy but little information on resolving complex ethical dilemmas. Staffing issues (the nursing shortage, understaffing, floating) are also discussed within the context of legal vulnerability.
Overall, Helm's book provides a brief, clear review of most legal problems nurses might encounter. The language is easily understood, case studies provide useful illustrations of both good and bad practice, and the glossary helps clarify terms without extensive reading of text. The book is probably most useful to novice nurses who are still growing into their professional roles or to nursing leaders who are managing nurses and unliscensed assistive staff. The book would be a positive addition to any clinical unit's library.