From the desk of Adrianne E. Avillion, DEd, RN

Staff Development Weekly: Insight on Evidence-Based Practice in Education, November 18, 2011

Editor's note: This feature is written by nursing professional development expert Adrianne E. Avillion, DEd, RN. Each week, Adrianne writes about an important issue in the area of professional development or answers reader questions. If you have a question for Adrianne, e-mail her at

Legal issues in Nursing Professional Development

Most of us have attended or provided education sessions on legal implications of clinical nursing practice. However, the legal issues pertaining to nursing professional development (NPD) practice are addressed far less often. Let's look at the four elements of malpractice and how they can apply to NPD.

  • Duty: A clinical duty is established when the nurse accepts the responsibility to provide care to a patient in accordance with licensure, nurse practice acts, patient care standards, and organizational policies and procedures. NPD specialists have a duty to both learners and patients. NPD specialists must provide education that is accurate and relevant to the learner population. We must also evaluate whether or not learners have achieved learning objectives and how education impacts job performance and patient care. Indirectly, we have a duty to the patient populations that are served by the clinicians we teach. Providing inaccurate information and/or failure to properly assess the learner's achievement of learning objectives may cause a learner to provide substandard patient care. Such care can have adverse impacts on patient outcomes. In the case of such substandard care a breach of duty exists.
  • Breach of duty: A breach of duty exists clinically when a nurse fails to provide care according to licensure, nurse practice acts, patient care standards, and organizational policies and procedures. NPD specialists must provide accurate education, and assess the effectiveness of that education, in order to facilitate the clinician's ability to provide nursing care. Here is an example of an NPD specialist breach of duty:
    • An NPD specialist is teaching a program regarding administration of new chemotherapeutic agents, including psychomotor skill assessment. He or she fails to adequately assess a learner's ability to demonstrate competency in administering these new agents. The nurse makes a serious error in the actual clinical setting. The NPD specialist has breached his or her duty to the learner by failing to assess competency and, ultimately to the patient, who did not receive appropriate care. Establishing a duty and committing a breach of duty are not enough to prove malpractice. There must be harm or injury to the patient.
  • Harm or injury to the patient: The patient must have suffered harm or injury. For example, in the preceding scenario, chemotherapeutic drugs were administered incorrectly after the NPD specialist failed to assess the learner's competency. Due to this failure and subsequent substandard care, the patient had a serious adverse medication reaction causing severe skin damage, and subsequent infection.
  • Harm or injury must be linked to the breach of duty: For example, the skin damage and infection the patient suffered after having chemotherapeutic agents administered incorrectly can be directly linked to substandard care or breach of duty. The NPD specialist's role can be directly linked to this breach since he or she failed to assess the learner's competency.

We sometimes forget that as educators we have legal obligations to the learners and, indirectly, to the patient populations served. We must also remember to carefully document and retain records of what was taught, how it was taught, and how learning was measured. Such documentation is every bit as important as a clinician's documentation of patient care.

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