School doesn’t completely prepare one for professional life — especially when it comes to that critical understanding that talent, in and of itself, is not the only key to professional success. To get ahead, you must work hard and, for the most part, play by the rules, and above all else in medicine, you must ensure the safety of patients entrusted to you. For one eager and talented young trainee, this lesson came at great cost. 


Ms. V had excelled at a prestigious nursing school, finishing at the top of her class. She further distinguished herself by quickly earning an advanced degree with honors. While in school, Ms. V was a natural leader who was often singled out for awards. After graduating, Ms. V could not wait to practice medicine. However, with heavy school loans weighing her down, she returned to where she grew up — temporarily — to move back in with her parents. Her options for employment were limited there, but Ms. V did manage to land an entry-level position at the main medical center in the community. 


From the start, the job wasn’t what Ms. V ex­­pected. “We are understaffed at this hospital,” the nursing supervisor noted, “and so everyone is expected to pitch in and help — even if technically it isn’t your job. Our goal is to provide the best care for our patients, and that means that sometimes you’ll be doing tasks that you might consider menial. But trust me, nothing here is menial. Even the most minor of assignments is important to our patients.”


Ms. V nodded vigorously in agreement. In theory, this made total sense to her. But once reality set in and she was forced to perform tasks she considered beneath her training, Ms. V’s attitude changed. Ms. V had expected to be far more involved in practicing medicine. Instead, she was spending roughly half her time attending to work that she felt was more appropriately suited to an orderly or an aide.

Ms. V understood that it was necessary for her to empty a bedpan now and then, but she was becoming increasingly dissatisfied with what she saw as the lack of opportunity for actual clinical practice. In frustration, she vented to her supervisor.


“I realize that everyone is asked to do things that are not part of our jobs,” said Ms. V, “and I’m perfectly willing to make a bed, or help turn a patient, so he doesn’t get bedsores. But I thought that this job would involve more than that. I think I could be of more value to the center in a clinical capacity.”


The supervisor smiled reassuringly. 


“You’ve only been here a few months. You need to be patient. Look around you; you’ll see that even our most senior nurses do those chores. It’s part of the job here.”


Irritated with her supervisor’s answer, Ms. V promised herself she would look for another position. And just as she was fuming over her limited prospects, Ms. V’s supervisor asked her to wheel a patient to the front door for discharge. This request irked Ms. V even more. 


Mrs. C, the patient assigned to Ms. V for discharge transport, was 59 years old and had been in and out of the hospital for the past 10 years with several serious ailments. Mrs. C clearly wanted to chat on the way down, but Ms. V was taciturn. She was extremely aggravated about her situation. 


In front of the hospital, Ms. V neglected to fully collapse the footplates on the wheelchair, and as Mrs. C tried to get out of the chair, she tripped over one plate and fell to the ground. Medical staff hurried over when they saw the patient on the ground. Within moments, Mrs. C was rushed back into the hospital and readmitted. Subsequent x-rays showed that she had shattered her left femur in the fall and that surgery was necessary. Following surgery, Mrs. C developed a pulmonary embolism as well as other fall-induced complications.


Mrs. C’s family filed a lawsuit against Ms. V and the hospital. The medical center was notified of the suit and Ms. V was placed on mandatory leave while an investigation ensued. 


Ms. V’s insurance company assigned an attorney to her, and during the initial consultation with the attorney Ms. V laid out the facts of the case. After a careful review of all evidence, the assigned counsel informed Ms. V that he intended to file a motion to dismiss the case, based on the fact that there was no physician affidavit on file.


“In this state, in order for a malpractice case to go forward, the plaintiff must file an affidavit from a physician stating that the incident was malpractice,” the attorney explained. “The plaintiff hasn’t done this, so there’s a chance we can get the case dismissed.”


The defense subsequently filed the motion, alleging that the plaintiff failed to submit the requisite affidavit indicating malpractice. The court, however, denied the motion, stating that this case was not a malpractice case, but rather a negligence case. Once it was clear that the case would not be dismissed, it was quickly settled in favor of the plaintiff, 
Mrs. C, for an undisclosed sum. Ms. V was then formally dismissed from the hospital.


Legal background


Differentiating negligence from malpractice can be tricky. Under the letter of the law, malpractice is defined as a failure to follow strict standards of professional care. Negligence, on the other hand, is more tightly defined as breach of duty and/or failure to conform to certain standards — indicating that the professional is in fact following standards, but has been remiss in some aspect of standardized care. 


The court’s decision in this case summated, “Not every negligent act is malpractice, but a negligent act or omission by a nurse that engages in medical treatment — or that bears a substantial relationship to the rendition of medical treatment by a licensed physician — constitutes malpractice.”

The court went on to state, “This action wherein a patient fell while getting out of a wheelchair (operated by 
a nurse) is more akin to negligence,” and that the facts alleged by the plaintiff as to the manner in which the accident occurred were sufficient to show a potentially meritorious negligence claim.


Protecting yourself


Ms. V felt, perhaps justifiably, that she was being under­valued professionally. The fact is that at some point, we are all asked to step in and do something that we feel either isn’t in our job description, or we feel overqualified to do. Regardless, if you are going to do a job, it should be done in the best, most responsible way possible. 


Ms. V, though irate and disgruntled after her conversation with her supervisor, should have given her full attention to discharging Mrs. C. Her carelessness in transporting the patient had drastic results; Mrs. C could have died from pulmonary embolism and Ms. V significantly damaged her professional status and, ultimately, her career. 


Ann W. Latner, JD,  a former criminal defense attorney, is a freelance medical writer in Port Washington, N.Y.