The Nurse's Duty to Protect Patient Safety
What if a nurse doesn't report a quality of care or patient safety issue? Is he or she likely to be disciplined?
Let's look at Texas law on reporting. It appears that reporting of a patient safety issue involving an agency or facility problem is optional ("may report"), but reporting of another nurse is mandatory ("shall report").
Here is the language that says reporting a facility is optional:
In a written, signed report to the appropriate licensing board or accrediting body, a nurse may report a licensed health care practitioner, agency, or facility that the nurse has reasonable cause to believe has exposed a patient to substantial risk of harm as a result of failing to provide patient care that conforms to:
(1) minimum standards of acceptable and prevailing professional practice, for a report made regarding a practitioner; or
(2) statutory, regulatory, or accreditation standards, for a report made regarding an agency or facility.
Here is the language that says reporting a nurse is mandatory in Texas:
(1) "Conduct subject to reporting" means conduct by a nurse that:
(A) violates this chapter or a board rule and contributed to the death or serious injury of a patient;
(B) causes a person to suspect that the nurse's practice is impaired by chemical dependency or drug or alcohol abuse;
(C) constitutes abuse, exploitation, fraud, or a violation of professional boundaries; or
(D) indicates that the nurse lacks knowledge, skill, judgment, or conscientiousness to such an extent that the nurse's continued practice of nursing could reasonably be expected to pose a risk of harm to a patient or another person, regardless of whether the conduct consists of a single incident or a pattern of behavior.
A nurse shall report to the Board in the manner prescribed under Subsection (d) if the nurse has reasonable cause to suspect that:
(1) another nurse has engaged in conduct subject to reporting; or
(2) the ability of a nursing student to perform the services of the nursing profession would be, or would reasonably be expected to be, impaired by chemical dependency.
Under Texas law, therefore, the nurse may, but has no obligation to, report a facility to the appropriate licensing board, when the nurse has reason to believe that a patient has been exposed to substantial risk for harm. But a nurse must report another nurse.
Here is what Texas law says about failure to report: "(a) A person is not liable in a civil action for failure to file a report required by this subchapter. (b) The appropriate state licensing agency may take action against a person regulated by the agency for a failure to report as required by this subchapter.
In Texas, the Board of Nursing could take action against a nurse who failed to report, but isn't required to do so.
Let's go back to the state law language cited earlier that implies that nurses must safeguard patient safety. A search of the disciplinary actions of the Maryland Board of Nursing indicates that the language "a nurse shall act to safeguard a client..." is invoked when it is the nurse who is incompetent or unethical. The nurse is supposed to report him- or herself, but not necessarily report someone else, or a facility. I found no cases where that clause was used to discipline a nurse who discovered that someone else was incompetent, and failed to report it. I could find no disciplinary actions reported on the Texas Board of Nursing Website against nurses who had failed to report a patient safety issue.
Other states may have different law on this, or no law on this, but it is becoming clear that a nurse doesn't have to report a facility and will do better personally if he or she does not.
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Cite this: Carolyn Buppert. Should Nurses Blow the Whistle or Just Keep Quiet? - Medscape - Jun 24, 2014.