The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines negligence as a "failure to use such care as a reasonably prudent

and careful person would use under similar circumstances." JCAHO defines malpractice as "improper or unethical conduct or unreasonable lack of skill by a holder of a professional or official position; often applied to physicians, dentists, lawyers, and public officers to denote negligent or unskillful performance of duties when professional skills are obligatory. Malpractice is a cause of action for which damages are allowed."4 Malpractice is defined variously under state nurse practice acts, institutional policies, and federal guidelines such as JCAHO standards, all of which may be taken into consideration in court.

Negligence Definition
o Negligence refers to the act of doing something or refraining from doing something that any other reasonable medical professional would do or refrain from doing in a similar situation. It goes without saying that every situation is different, and that is where the law becomes somewhat cloudy. However, when reviewing a nursing negligence case, assumptions and circumstantial evidence are taken into account to determine if there was negligence.

Examples
o Common examples of nursing negligence include malnutrition, inadequate hydration, physical abuse, medication errors, and mental and emotional abuse. In nursing homes or other places of long-term care, there are also often injuries due to bedsores, infections and falls. Malnutrition and dehydration cases come from leaving a patient unattended for too long, ignoring his needs, or simply refusing to feed and provide water. Abuse comes in a variety of forms and, in many cases, nurses do not feel they will be reported, especially if the patient is mentally handicapped. Medication errors, bedsores, infections and falls are most frequently the result of carelessness and lack of paying attention to their patients as necessary.

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Proof
o The legal review of a nursing negligence case requires proof that injury was done, and that it was the result of the nurse's care or lack thereof. There are five main elements in a nursing negligence case, and all elements must be proven in order for a case to be valid. If one or more of the elements is not present, the case may be difficult to pursue--(1) the nurse had a duty to perform, (2) the appropriate care was apparent in the situation, (3) there was a breach or violation of care, (4) there was an injury proven to result from the nurse's negligence, and (5) there is proof that damages occurred as a direct result of the situation.

Avoiding Negligence
o It is important for nurses to document their actions very closely and accurately at the time because sometimes negligence cases come about later when details are difficult to remember. Charting everything makes it easy to determine the details surrounding each action or inaction and

to find a logical reason as to why it was done. This, in combination with a nurse who follows the proper scope of practice, will likely keep a nurse from being prosecuted for nursing negligence.

Protecting You
o If you believe you are or have been a victim of nursing negligence, you may be able to file a lawsuit. Contact a law firm if you believe you have a case, present the facts to them, and they will notify you if they believe they can help you. It can be difficult to pursue a nursing negligence case because nurses are protected in almost everything they do as long is it is within their scope of practice. This is not to say, however, that you should not attempt to pursue a case if something happened as a direct result of a nurse's interaction with you.

Nurses caring for patients have a responsibility to be an advocate for the patient. While not bearing responsibility for making medical decisions and judgments, the nurse bears significant accountability for intervening when it appears that decisions and judgments are not consistent with the standard of care. An effective communication policy that is well known by all nursing staff and physicians can, by its very existence, improve the quality of care delivered to patients, thereby improving patient outcomes and hopefully lessening the number of catastrophically injured infants.