The professional status of nursing: a view from the courts

The judicial system regards nursing as an occupation that, for the most part, possesses a body of knowledge that is not known to lay persons. However, according to the courts, nursing does not possess a monopoly on that knowledge, since physicians also possess nursing knowledge. Until recently the courts implied that physicians not only possessed nursing knowledge, but possessed it to a superior degree. The ability of the physician to testify to nursing knowledge is rarely questioned and even when questioned, it has been allowed. Courts are confused about the relative independence of nurses from physicians and are reluctant to find nurses liable when they are following physicians' orders. However, courts do expect nurses to exercise independent judgment in the implementation of those orders. Recently, trial level courts have demanded that nurses take affirmative steps to protect patients from the negligent acts of physicians and have found nurses liable for failure to do so. This is true despite the clear statutory mandate that nurses are not competent to diagnose and treat medical conditions. When nurse practitioners engage in acts that could be construed as diagnosis, one state supreme court found they are entitled to be held to a standard of care separate from that of a physician. In so doing, the court recognized nursing as a distinct profession, entitled to its own standard of care, even when performing traditional medical acts.