NUR 544 Module 5 Legal Issues Discussion Example

Discussion Board 2: Legal Issues

The Swelling Nobody Charted: Negligence, Documentation and an Infusion Nurse's Legal Duty

Initial Post

For this week, I want to analyze a composite case from oncology. A nurse started a vesicant chemotherapy infusion through a peripheral IV in a patient's forearm. Forty minutes later, the patient said the site felt tight and burned a little. The nurse saw mild swelling, assumed it was positional, slowed the infusion and did not check for blood return or notify the provider. The nurse did not document the patient's complaint. Two days later, the patient returned with a blistering wound that eventually needed surgical care. This is an extravasation, the leakage of a vesicant drug into surrounding tissue, which can cause severe tissue damage; published guidance calls for stopping the infusion at once when extravasation is suspected and acting promptly to limit injury (Pérez Fidalgo et al., 2012).

Negligence in nursing is usually analyzed with four elements: duty, breach, causation and damages. Duty: the nurse had a duty to the patient once she began care. Breach: the standard of care for vesicant infusions, reflected in oncology guidelines and hospital policy, calls for frequent site checks, stopping the infusion when extravasation is suspected and notifying the provider; the nurse failed to do this. Causation: continuing the infusion after signs of leakage plausibly caused or worsened the tissue injury. Damages: the patient suffered a wound requiring surgery. All four elements appear to be present, which is why this case would likely be considered negligence.

Documentation matters twice in this case. First, the absence of a note about the patient's complaint means there is no record of the nurse's assessment or reasoning; in legal terms, care not documented is hard to prove. Second, honest documentation of a complication, along with prompt reporting, is part of the standard of care. Our reading on legal issues notes that accurate, timely documentation protects patients and nurses alike (Friberg & Saewert, 2023).

The nurse practice act in each state defines the scope of nursing practice and the standards the board of nursing enforces. A board could investigate this nurse for failure to meet minimum standards, regardless of whether a lawsuit is filed. That is a separate process from civil liability.

For me, the lesson is that legal risk and patient safety point in the same direction, and the professional code's expectation of accountability for one's own practice says the same thing in ethical terms (American Nurses Association, 2025). Stopping the infusion, assessing, notifying and documenting would have protected the patient and the nurse. Fear of reporting complications is a bigger legal danger than the complication itself.

Reply to a Classmate

Chloe, your discussion of verbal orders in the emergency department raised the same documentation theme. You noted that nurses sometimes act on a verbal order and enter it later from memory. In my setting, chemotherapy verbal orders are not accepted at all for that reason. Does your emergency department have a read-back policy, and is it followed during codes, when it is hardest?

References

American Nurses Association. (2025). Code of ethics for nurses. https://codeofethics.ana.org/

Friberg, E. E., & Saewert, K. J. (Eds.). (2023). Conceptual foundations: The bridge to professional nursing practice (8th ed.). Elsevier.

Pérez Fidalgo, J. A., García Fabregat, L., Cervantes, A., Margulies, A., Vidall, C., & Roila, F. (2012). Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. Annals of Oncology, 23(Suppl. 7), vii167-vii173. https://doi.org/10.1093/annonc/mds294