the individual nurse implies that issues surrounding professional accountability
and autonomy require closer examination.
This change in the underlying philosophy of the delivery of health care in some
ways is running in tandem with the growth of legal problems which may arise for
the nurse. Problems arise in attempting to provide patient care and maintain the
professional standards expected of the ordinarily skilled' practitioner. The chan- ges have had, and continue to have, resources implications. The reduction of resources may increase the instances in which nurses are placed in situations which require them to perform duties which it could be argued are beyond their level of competence or qualification. The development of professional skill and qualification is directly dependent on the training receivedon-the-job'.
If resources are stretched the qualified nursing staff will be fully utilised in the
delivery of patient care, with time for training limited. Unrealistic demands may be
placed on the student or newly qualified nurse, yet, in the eyes of the law, the
standards required will remain objective. The spectre of liability demands that
attention be given to demonstrable training for, and the maintenance of standards
of, the professional nurse. It will be up to individual nurses to show that their
qualifications and training are sufficient to the role and task in each and every
situation.
Of necessity, the changes in the NHS will not only have personal and profes-
sional implications for the nurse but also implications of a systemic nature. The
role of the nurse in relation to the patient as well as to the nurse managers will be
tested. The nurse has been seen to be the advocate on behalf of the patient and also
accountable to a manager. However, the nurse could possibly be placed in a
situation where there is a conflict of interest. The UKCC Code deals with the
obligatory reporting by nurses when witnessing poor standards of patient care.
The 1998 Act offers some protection where the nurse chooses to act in the patients'
interests. Yet at the heart of the matter is the relationship between cost, quality and
quantity of treatment which it is not open to the individual nurse to resolve.
8.11 Notes and references
- SeeBarnettv.Chelsea and Kensington HMC[1968] 1 All ER 1068;Goldv.Essex CC
[1942] 2 All ER 237;Urbanskiv.Patel[1978] 84 DLR /3d) 650; Lee, R. /1979) Hospital
admissions ± duty of care.New Law Journalp. 567. - Liability will not inevitably follow for a number of reasons. There may be no resulting
damage, or the medical error may not be the causative factor or later injury, or the
damage may be too remote. - Note the incorporation of this principle into statute: Congenital Disabilities /Civil
Liability) Act 1976, section 1/5). - See also Deutsch, R.L. /1983) Medical Negligence Reviewed.American Law Journal,87,
p. 674. - Brazier, M. /1987) Patient Autonomy and Consent to Treatment: The Role of the law,
Legal Studies,p.170. For a wider review of Lord Denning's approach to standards of
care see McLean, S. /1981) Negligence ± a dagger at the doctor's back?. In Robson, P. &
Watchman, P. /1981)Justice ,Lord Denning and the Constitution.Gower, Aldershot.
1981.
148 NursingLawandEthics