Judicial recognition of nursing as a unique profession

AORN Journal,  Nov, 2004  by Ellen K. Murphy

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One of the accepted hallmarks of a profession is the possession of a unique body of knowledge. A recent Illinois Supreme Court case finally has given judicial recognition to nurses' long-time assertion that nursing is an independent profession with a unique body of knowledge and not simply a subcategory of medicine.

Before this case, judicial decisions tended to reflect society's confusion about nursing's relationship to medicine. (1) Judges uniformly allowed physician testimony on nursing standards, even when challenged. Sometimes they did so with complete confidence (eg, "Surely a qualified doctor would know what was standard procedure for nurses to follow." Goff v Doctor's General Hospital, 166 CA2d 314, 319 [1958]). At other times, especially recently, courts have been more ambivalent in their support of physician testimony about nursing standards. Sometimes they have recognized that the physician may not be the best possible witness but have allowed physician testimony because "all areas of medical expertise within the knowledge of nurses are also within the knowledge of medical doctors" (Taylor v Spencer Hospital, 292 A2 449, 452-452 [Pa Super 1972]).

Even more recently, courts have allowed physicians to testify about nursing standards but only after they have established some foundation as to how the physicians came to possess their expertise related to nursing standards. For example, in Logsdon v Miller (Tex App LEXIS 2055 [unpublished] 2002), the court was willing to accept physician testimony about nursing standards but only if the physician described how he or she was familiar with these standards. The court was not willing to assume, as had previously been the case, that all physicians know about all nursing standards.

SULLIVAN V EDWARD HOSPITAL

In 2004, a state supreme court held in Sullivan v Edward Hospital (WL228956 [Ill 2004]) that a physician is not qualified to testify regarding the standard of care for the nursing profession. The 74-year-old plaintiff in the case had suffered a stroke in March 1995, which caused partial paralysis to his right side and impaired his ability to walk independently. He also could not speak but could understand and would respond with physical gestures.

In November 1997, he was admitted to a hospital for treatment of a urinary tract infection. On admission, he was assessed as a Level II fall risk because of his partial paralysis. The evening after his admission, he tried to get out of bed on three occasions, even though all the bedside rails were up and despite the nurse's assessment that he was alert and had understood her instructions to stay in bed on the first two occasions.

After his third failure to follow instructions, the nurse asked the attending physician to order a vest restraint. The patient appeared to be agitated, however, and the treating physician was concerned that a vest restraint would cause more agitation. Instead, the physician ordered lorazepam to calm the patient and help him sleep. He prescribed a small initial dose--the precise dosage is not specified in the case report--with more to be administered if the nurse deemed it was necessary.

The nurse administered 1 mg of lorazepam at 10 PM. Between 10 PM and midnight, the nurse and a nurses' aide checked on the patient approximately every half hour. He was sleeping at each check. At approximately 12:05 AM, a nurse's aide noted he appeared to be sleeping. At 12:10 AM, a monitor technician heard a noise from the patient's room and informed the nurse. The nurse found the patient on the floor, his head bleeding from a cut above the left eye. The patient was found to have a subdural hematoma caused by the fall. He later sued, alleging the nurse and the treating physician had failed to properly monitor, medicate, and restrain him to prevent the fall.

At trial, the plaintiff attempted to establish the negligence of the nurse. He called a board certified internist who had experience in observing and working with physicians and nurses in the area of patient fall protection. The internist testified that the nurse had failed to adhere to proper nursing procedures. After the physician denied the request to order a vest restraint, the nurse failed to communicate her concerns that the patient would get out of bed up the nursing chain of command. She also failed to provide alternatives to the vest restraint, such as having someone sit in the room or moving the patient to an area where he could be supervised constantly.

At the close of the plaintiff's case, the trial court judge struck the internist's expert testimony (ie, he would not allow the jury to consider it) on the grounds that "a physician is incompetent to testify to the standard of care placed upon a licensed nurse" (Id at 6). This physician was the plaintiff's only expert testifying about the nursing standard of care. When his testimony was disallowed, therefore, the plaintiff had no evidence to offer regarding the nursing standard of care, and the judge directed the verdict in favor of the hospital.