A nurse’s role in medication administration carries a deep professional responsibility because the potential for severe patient harm is inherent in the process. Negligence in this context is the failure to meet the established standard of care, which results in injury to a patient. This failure can occur through a direct action, such as giving the wrong drug, or an omission, like failing to monitor a patient after a high-risk dose. Understanding how this duty is established and subsequently breached provides clarity on how a nurse may become legally negligent.
Establishing the Professional Standard of Care
A nurse’s actions are judged against the benchmark of what a reasonably prudent nurse would do when working in a similar role and environment. This professional standard of care is defined by state laws, hospital policies, and the collective body of nursing practice. Deviation from this accepted practice is the first step toward a finding of negligence.
The practical foundation of safe medication practice is summarized by the “Rights” of medication administration. These rights establish the baseline for the nursing process, ensuring safety at every step.
The standard of care requires the nurse to adhere to these rights, which include:
- Administering the right drug
- To the right patient
- In the right dose
- Via the right route
- At the right time
- Confirming the right documentation
- Confirming the right reason for the medication
- Monitoring for the right patient response
Adhering to these steps systematically verifies the safety and appropriateness of the treatment. They represent the minimum expected level of professional conduct.
Direct Medication Errors Resulting in Breach of Duty
A nurse becomes negligent when an action directly violates a core principle of medication safety, constituting a clear breach of the professional standard of care. These breaches often involve errors related to the physical drug product itself, immediately placing the patient at risk.
Administering the wrong drug occurs when a nurse selects a medication that is not the one prescribed, often due to look-alike or sound-alike drug names. Giving a patient a medication intended for another person, known as the wrong patient error, is also a direct violation of the standard. Both mistakes bypass the fundamental safety checks requiring at least two identifiers to confirm identity before administration.
Wrong dose errors are a frequent and serious breach, often resulting from calculation mistakes or misreading a prescription. For instance, a miscalculation in a pediatric setting involving a weight-based dose can lead to an administration ten times the prescribed amount. A wrong route error occurs when a medication is given via an unintended pathway, such as giving an intravenous-only drug orally, which can lead to improper absorption or severe systemic reaction.
Procedural Failures and Omissions
Negligence is not limited to errors involving the wrong pill or dose; it also includes failures in the procedural responsibilities surrounding medication administration. These procedural failures are omissions in the nursing process that fall below the expected standard of care, involving a failure to act when a prudent nurse would have done so.
A failure to assess adequately before administration can lead to a negligent act. This includes not checking a patient’s vital signs, such as blood pressure before giving an antihypertensive, or failing to review the patient’s current allergy list or contraindications. If a patient is allergic to a drug and the nurse administers it anyway, the failure to perform a pre-administration assessment directly causes the resulting injury.
Failure to monitor the patient after giving a high-risk medication, such as insulin or an opioid, is a serious omission. The nurse is responsible for observing the patient’s response to the drug to catch adverse reactions or signs of toxicity early. Missing a change in a patient’s condition, such as a rapidly increasing heart rate following a medication, and failing to notify the physician constitutes a negligent failure to communicate.
A failure to document the administration accurately or in a timely manner is another common procedural breach. Not recording that a dose was given creates the risk that a subsequent nurse will accidentally repeat the dose, leading to an overdose. Conversely, documenting a medication before it is physically administered is an unacceptable practice that compromises the integrity of the medical record.
Defining the Legal Elements of Negligence
For a medication error or procedural failure to legally qualify as negligence, four specific legal elements must be established. The first element is the existence of a duty of care, which is automatically established the moment a nurse-patient relationship begins. The nurse is legally obligated to provide care that meets the accepted professional standard.
The second element is a breach of that duty, proven when the nurse’s action or failure to act falls below the standard of care that a reasonably prudent nurse would have provided. The errors and omissions described previously serve as evidence of this breach.
The third element, causation, requires proof that the nurse’s breach of duty directly caused the patient’s injury. For example, a patient must show that the incorrect dose of medication, not an underlying illness, was the direct reason for their subsequent health deterioration. The fourth element is damages, meaning the patient must have suffered actual, quantifiable harm, such as physical injury, financial loss, or pain and suffering.