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The Board of Nursing in your state has decided to utilize a tool developed by the National Council of State Boards of Nursing called the Taxonomy of Error, Root Cause Analysis Practice- Responsibility (TERCAP). Your nurse manager has provided you with a summary of the completed TERCAP report by your Board of Nursing’s Disciplinary Action Committee. She has asked you to review this summary and to develop a proposal of suggestions for continuing education topics on ways to minimize legal risks for your hospital’s practicing nurses. The nurse educators will develop an education series based upon your recommendations. Refer to Minnesota Boards of Nursing.


Prepare a proposal based on the summary of the TERCAP with recommendations and suggestions on minimizing legal risks that:

Part One – Review summary of completed TERCAP report below.

A patient, aged 54, admitted for back surgery secondary to compressed vertebrae and intense pain. The difficulty with pain management has caused the patient some depression and insomnia over the last month. During her first post-operative day, the patient fell attempting to go from the bed to the bathroom without assistance. Her injury was serious and involved significant harm requiring two additional days of hospitalization and an addition six weeks of physical therapy.

A review of the case determined that her assigned nurse on night shift was an RN (age 24) with nine months of experience in this unit. This was her third 12 hours shift in a row, and she was 29 weeks pregnant. There were 28 beds occupied with only two RNs and one patient technician, due to one vacancy and a call-in for illness. This community facility has experienced a turnover rate of 12% in the last year (community average of 4.5%), and has a high number of new graduates working on medical surgical units, particularly on the 7 pm- 7 am shift.

A review of the chart showed that the patient had been advised by the out-going nurse, who admitted her to the unit post-operatively, that she needed to ask for assistance with toileting for at least the next 24 hours due to the extensive back surgery and post-anesthesia response and pain medication. The RN coming on shift had received bedside shift report at 7 pm and noted the patient sleeping, so the issue of patient assistance was not repeated. She checked on her again at 8 pm and administered the requested prn medication (morphine) for pain. She was busy with other patients and did not see the patient again until the patient fell at 9:51 pm.

The patient reported that she did not recall having been instructed to ask for assistance, as she was very groggy from the anesthesia. She stated that she had pushed the nurse call button for assistance and “no one came.” There was no clerical support at the nursing station and the three staff members had been very busy with patients, so thi

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Disciplinary Action

Disciplinary Process

Issues of nursing practice negligence that have potential civil or criminal liability must be reported to the Board of Nursing. All nursing boards have specific policies on reporting nursing impairment due to drugs and alcohol. Hospitals and agencies often have a “Fit for Duty” standard that addresses both physical and mental health issues. Boards have disciplinary review committees; whose role is to investigate the incident and recommend any disciplinary actions the full Board. The names of nurses under discipline by the board are public record and are used by employers for their own decisions and for future employers and schools invalidating an active-unencumbered license to practice as an RN. Any past or present disciplinary action must be disclosed to employers.

Many of the boards of nursing have adopted an investigative tool referred to as the Taxonomy of Error, Root Cause Analysis and Practice-responsibility (TERAP) for consistency among the boards in assessing and reporting errors into a central database for quality analysis. The TERCAP review does include system breakdowns, particularly insufficient nurse staffing. The nurse, however, is responsible for her practice regardless of system issues.

In the TERCAP report, the data from the first round of use found that over 72% were unintentional errors and that 55% of cases of practice breakdown occurred when a nurse worked in a patient care position for two years or less (Benner et al. 2006). A nurse’s previous disciplinary history predicted future practice breakdown. The most common failures are safe medication administration, documentation, attentiveness/surveillance, clinical responding, prevention, intervention, interpretation of providers’ orders, and professional responsibility as the patient advocate.

Potential Actions

The boards have the authority to recommend the nurse be allowed to continue practice, practice under supervision for a period, or suspend a license until certain conditions are met.

Regardless of the board of nursing decisions, employers have the choice over whether to discipline or fire the employee. Individuals may seek civil prosecution. The District Attorney may seek criminal prosecution.

Malpractice Coverage

The purpose of liability insurance is to spread the risk of economic loss among a group of individuals with shared risk. A fee or premium is paid by the individual member for coverage that includes legal consultation, costs of litigation, and payment of awards. There are limits to various nursing liability policies, so it is essential to read and understand.

Nurses usually work for an employer who has liability insurance to protect their interests. Claims that an employer is directly liable for the actions of



TERCAP Proposal

Student’s Name

Institutional Affiliation


TERCAP Proposal

Part One-Review Summary

The case is a about a 54 year old patient admitted for back surgery secondary to compressed vertebrae and intense pain. The injury was serious and needed two days of hospitalization and six more days of therapy. The nurse assigned to the patient was a pregnant RN with nine months experience. Unfortunately, certain aspects of practice went wrong, exacerbating the patient’s pain. The patient could not get the assistance she needed from the nurse. The nurse was found to have breached nursing policy by not taking responsibility and not assessing the patient well. The nurse was also expected to undertake hourly checks, which did not happen.

Part Two: Factors That Contributed To the Event and How They Can Be Addressed

In light of situational factors, it is important to mention that the RN nurse overworked and exhausted as she was on her third 12-hour successive shift. It was inappropriate to make her work overtime for she was pregnant. Hospitals can minimize legal risk in future by giving pregnant staff shorter shift hours. Even though the scenario regards a 54-year old post-surgery patients, the pregnant RN would exercise her legal rights to sue the facility in case she suffered from an injury in the course of working overtime. Pregnancy is the nurse’s situational factor that make her unsuitable for longer shift hours. The patient would have been given a bedpan to address the need of going to the restroom. According to Eltaybani, Mohamed, and Abdelwareth (2019), post-surgery patients are always weak and cannot perform basic physical activities such as visiting a restroom. The Lack of a bedpan is a situational factor in the patient’s environment, which the management can address by having an effective nurse call system for comfortable recovery and patient length of stay.

When it comes to nursing factors, hospitals should provide high-quality care for post-surgery patients. Providing high-quality care reduces patient length of stay following admission. O’Brien, Thompson, and Hagler (2019) argues that subjecting patients to risks leads to slower recovery and readmission. For instance, the 54-year old post-surgery patient would have been discharged earlier if not for her fall while going to the restroom. The nursing issue here is that the hospital has not maintained the right nurse-patient ration, leading to exhaustion. Hiring more nurses to maintain the right nurse-patient ratio will avoid lawsuit. Interpersonal, organizational, and individual and nurse issues characterize th