We read with great interest the editorial by Olson and McNett1 entitled "Nurses Do Not Need an Order to Assess the Patient." Although some time has passed since the original publication date, a recent dissemination renewed the conversation, particularly in light of the RaDonda Vaught verdict.2 The editorial was enlightening and provoked our thorough consideration, although we must respectfully disagree with specific assertions of the discussion. There is no doubt in the ability of nurses to collaborate in care and advocate for their patients. Similarly, we rely on their clinical judgment and assessment skills to notify of patient deterioration, particularly in the neurocritical care setting. However, as advanced practice providers, we believe that the minimum frequency and intensity or specificity of an examination should be established by a provider.
The primary reason for this dissent is that the burden of liability should fall to the provider team. Although we have no doubt that experienced nurses may be capable of understanding the intricate pathophysiology, this knowledge is not incumbent upon the nurse to navigate in a 12-hour shift full of care transitions, tasks, and patient care. Furthermore, there should be no expectation on new nurses to amass the amount of knowledge needed to prudently assess each unique situation without additional direction from provider orders. Although increased frequency or the inclusion of an additional specific examination may be well within the scope of nursing, unrecognized patient deterioration due to reduced assessment becomes an opportunity for harm and liability.
On March 25, 2022, the collective community of nursing watched as RaDonda Vaught was found guilty of gross neglect of an impaired individual and negligent homicide.2 In brief summary, a gross medication error was responsibly reported after a patient death. Throughout the very public discussion of this case, details have emerged, which have a great implication to the conversation on nursing responsibilities and fault. In this situation, an additional assessment was not provided after the administration of a sedating medication for a diagnostic test. This additional assessment and monitoring could have identified deterioration of the patient, which may have significantly altered the outcome of these events. It should be within the rights of nursing to question the need for that enhanced monitoring after sedating medications are provided. However, if that determination remains incumbent upon provider orders, then the system should retain fault in the failure. Although this implication of burden on providers was not protective in the complex situation at Vanderbilt, every layer of protection that can be afforded to nursing should be respected and preserved.
In the current healthcare landscape, which is highlighted by the RaDonda Vaught verdict, we base this opinion on passion and respect for nursing. We believe that physician or advanced practice provider orders are protective of nursing and a feature of the collaborative process.
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