As stated in the Code of Ethics for Nurses (1985), the nurse assumes responsibility and accountability for individual nursing judgments and actions. In other words, the nurse is ultimately responsible for all interventions and aspects of care that he/she gives the patient, whether it is knowledge-based and appropriate, negligent and improper, or even honest human mistakes that at times result in patient deaths. Those honest human mistakes that nurses have the possibility of making and that do result in patient deaths can cause nurses their licenses and even put them in jail.
However, should nurses be criminally prosecuted for their mistakes that result in patient deaths? According to Christy Lyon (1998), healthcare practitioners across the country are asking the very same question. The nationwide debate on sanctions that nurses should face for mistakes made on the job began in April 1997 when three Registered Nurses in Denver, Colorado were charged with criminally negligent homicide in the death of an infant. In this case, a physician ordered an intramuscular injection of penicillin for a day-old infant at risk of syphilis.
The pharmacist incorrectly dispensed a syringe containing 10 times the prescribed amount. Although the infant’s primary nurse did not notice firsthand, a staff nurse noticed the large dose and discussed it with a neonatal nurse practitioner, who then told the staff nurse to change the route of administration to intravenous so the child would only be stuck once. Although the nurses consulted several books, they did not consult with the physician before administering the penicillin. The baby soon died thereafter.
The Colorado Board of Nursing suspended the nurse practitioner, placed the staff nurse on probation, and dismissed charges against the infant’s primary nurse. Then the district attorney stepped in and submitted the case to a grand jury, which indicted all three nurses for criminally negligent homicide. Under Colorado state law, criminal negligence occurs “when there is a gross deviation from the standard of care that a reasonable person would exercise and when that person fails to perceive a substantial and unjustifiable risk that a result will occur or that a circumstance exists.
Recently, the nurse practitioner and staff nurse accepted a plea arrangement that keeps their records clear of negligent homicide charges if they stay out of legal trouble for two years, and the jury acquitted the primary nurse. Advocates of criminal charges say nurses should be held accountable for their actions. They argue that charging nurses protects the public from future harm. Robert Grant, the district attorney of Colorado, states that the board of nursing has nothing to do with public accountability and that his office deals with criminal standards, not professional standards.
Before the case was tried, Grant wrote a letter to the nursing community stating, “Nurses do not need to fear being prosecuted for simple mistakes. However, if their care falls to the level of criminal negligence, such as when a doctor’s orders regarding the route of administration are knowingly changed without authorization, leading to deadly consequences, they cannot expect to be immune from responsibility. ” Opponents of criminal charges against nurses agree with Grant in that nurses need to be held responsible for their mistakes and in protecting the public.
However, many feel that the state boards of nursing are the best way to protect the interests of both nurses and the public. The American Nurses Association (ANA) argues that nursing boards are uniquely qualified to evaluate nurses’ performance, especially since their members and staff are usually nurses. Gerri Marulio, MSN, RN, executive director of the ANA at the time, states that boards of nursing “can fit the punishment to the protection of the public and the prevention of future harm.
Leslie Morrison, JD, MS, RN, president of the Northern California chapter of the American Association of Nurse Attorneys, agrees that the state board of nursing is the best way to sanction nurses who make errors on the job. She states, “Criminal prosecution without criminal intent is the wrong way to go, as long as there are civil sanctions, such as license suspension. Accidents happen. They shouldn’t be condoned, but going through licensing channels is more important than pressing charges. ”
In my opinion, nurses should not be prosecuted for mistakes made on the job. Nurses are human beings, which makes them capable of making mistakes. In criminally prosecuting nurses for these mistakes, nurses will less likely report and hide them, thus causing harm to the patient and the public. Also, although nurses have an extensive knowledge base when it comes to patient care, nurses are continually learning while still on the job. At times, learning means making an honest mistake and nurses should not be prosecuted for that.
In making mistakes, nurses tend to fell bad as it is; they punish themselves emotionally even when the error did not harm patient. This is right in line with Adam Smith in which he states, “…to hurt or injure another…there is no commonly honest man who does not more dread the inward disgrace of such an action, the indelible stain which it would forever stamp upon his own mind, than the greatest external calamity which, without any fault of his own, could possibly befall him (p. 107).
I am not condoning non-punished errors, however, it should be up to the state board of nursing to decide on the punishment that would best fit the error. Then depending on the severity and negligence of the error, should the state board of nursing call in the district attorney, rather than the district attorney stepping in on his own. All in all, however, I think that nurses should only be prosecuted when there is the intention and direct infliction of harm on the patient, while all other errors should be punished using civil sanctions.
