Negligence is behavior or conduct that is unreasonable under the circumstances or that fails to meet the standard of care. When unreasonable conduct is practiced in a professional setting the negligence is termed malpractice and in a nursing setting it is nursing malpractice. The components or elements that must be established to support a claim of negligence are: 1) duty, 2) breach of duty, 3) injury, and 4) causation.
A duty indicates that the nurse had a duty or responsibility to the individual who has claimed negligence. Establishing that the nurse had a duty of care for the person in many allegations of negligence may be very simple. If the nurse was assigned to care for the person while he or she was a patient in a health care facility, the nurse's duty to provide safe, competent care is established.
A breach of duty is defined as a failure to take a precaution, that a reasonable nurse would have taken in similar circumstances, if the precaution was available, e.g., putting up side rails, checking a name band before administering a medication. Or a breach of duty may be defined as demonstrating behavior toward a patient that a reasonable nurse would not have done, e.g., performing a procedure without any prior experience or information about the procedure.
An injury that results from a breach of duty is generally thought to be a physical injury, e.g., a broken bone, a burn, or organ damage. However, the injury alleged to have resulted from the breach of duty may also include financial losses and mental suffering.
The causation element of negligence is perhaps the most interwoven portion of the negligence claim. Causation means that the nurse's alleged breach of duty caused the resulting patient injury. This may not be as simple to demonstrate as it appears at first glance. The essential question the element of causation raises is, "If the nurse breached her duty, did the injury result from the breach?" If the patient was heavily medicated, confused or unable to understand his surroundings and did not have side rails put up, it may be clear that the reason he is lying on the floor is that he fell out of the bed. However, if the patient with a cardiac condition was erroneously given a medication that has a side effect of cardiac arrhythmias and then had a cardiac arrest, the question raised is, "Did the patient's condition or the medication precipitate the cardiac arrest?" The incorrect medication seems to establish a breach of duty but the more critical question is, "Did the administration of the medication precipitate the patient's death?"
- Aiken, T.D., & Catalano, J.T. (1994). Legal, ethical, and political issues in nursing. New York: F-A. Davis.