ISSUE 54 EWJ web - Journal - Page 25
Do Nurses and Midwives have Adequate
Knowledge and Understanding of Medical
Negligence and the Medico-legal Process?
Medical negligence case costs continue to rise across the UK. In the year 2022/23 NHS
resolution report that the amount spent on claims was 2.64 billion, compared to 2.5 billion
in the previous year (NHS Resolution, 2023).
From a nursing and midwifery expert perspective,
there are common recurring themes evident in many
negligence cases, namely; lack of documentation,
failure to follow local policy, failure to recognise the
deteriorating patient and failure to escalate.
The common theme for many of the module titles
covering law in pre-registration training across the
UK is “Professional codes, ethics, law and humanities.” Having looked at the content of these modules, I have
been unable to find anything concrete in relation to
medical negligence.
More often than not, failure to recognise a deteriorating patient, and indeed failure to escalate can be
attributed to the experience and subsequent knowledge of the nurse or midwife. However, could adequate knowledge of the medico-legal process and the
role of the expert witness result in ensuring that standards and policies are followed, along with more accurate and meaningful documentation? Furthermore,
would a move to bring knowledge of expert witness
work to the forefront result in more interest in the
role, and subsequently more experts available to
assist the courts?
On questioning a senior lecturer on this subject I was
told “To my knowledge I don’t think we cover medical
negligence formally anywhere in the pre reg (sic) programme.
The importance of documentation in relation to preventing
negligence claims will be covered, but I think that is probably
all. . . it would be more likely covered in midwifery pre reg
(sic) because of the more autonomous nature of the role. . .
Most pre reg (sic) struggle to come to terms with what
negligence looks like let alone what to do in it’s presence!”
On further enquiry I discovered that there is also very
little in the way of medical negligence information
within midwifery pre registration training.
What is the current status in pre-registration
training?
Having always had an interest in law, I was very much
looking forward to ‘law and ethics’ in my pre-registration training, and I was soon disappointed when I
realised that there was very little information regarding law, and that the sessions mainly covered ethics in
relation to decision making, and a small amount of
law in relation to this. This was 24 years ago, when the
United Kingdom did not seem quite as saturated with
compensation claims. However, from initial enquiries
into the current offering in relation to law and medical negligence in pre-registration training, I have ascertained that there does not seem to have been any
change.
And post registration?
Clinically, as an advanced nurse practitioner, I work
autonomously making decisions regarding diagnosis
and treatment of patients presenting with undifferentiated and undiagnosed conditions. It would be a
sensible assumption to make then, that having undertaken courses in advanced practice at both degree
and Master’s level, that I would be fully informed of
the legal implications of my practice. And indeed I am
fully informed, but this is entirely due to my work as
an expert witness, and very little to do with my post
registration training.
I distinctly remember a session very early in my nurse
practitioner training (circa 2009), that covered what
would happen at court; the lecturers attempting to act
out a court scene, where a nurse practitioner was
being cross examined. Following my eleven years
working as an expert witness, I now know that this
session was wholly inaccurate. In addition, we were
told, if your documentation was lacking do not fear!
Your previous consultations will be reviewed, and providing that they were up to scratch, all would be well
(!). Again, in my time as an expert witness I have never
been asked to review anything other than a consultation in question.
The relatively new Nursing and Midwifery Council
Standards of proficiency for registered nurses (2018)
state that “At the point of registration, the registered nurse
will be able to: . . . 1.2 understand and apply relevant legal,
regulatory and government requirements, policies and ethical
frameworks, including any mandatory duties, to all areas of
practice, differentiating where appropriate between devolved
legislatures of the United Kingdom.” While medical negligence does sit within this, the broad nature of the
point, as well as it covering such a huge area does suggest that it is likely that the subject of medical negligence gets trumped by subjects such as ethical decision
making, just as it did during my training all of those
years ago. On reviewing the Standards of proficiency
for midwives (2019), the wording in relation to law is
much the same as for registered nurses. Given the autonomous nature of the midwifery role, I was
surprised that the standard was so vague.
EXPERT WITNESS JOURNAL
The Royal College of Nursing Standards for
Advanced Level Practice (2018) state that “Registered
nurses working at this advanced level must meet the
following standards: . . .Be educated to Masters (sic) level . .
This education will include the following core areas . . .
accountability – including legal and ethical issues,” yet I do
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