Torts, Professional Relationships, and Practice Issues for Senior Nursing Students

Caitlin Hope

Welcome to the show! I'm Caitlin Hope with Heather Murphy, and Heather, picture this NCLEX question: a nurse gives opioid pain medication, does not come back for the reassessment, the patient tries to get up alone, falls, and gets injured... The stem asks: is this negligence or malpractice?

Heather Murphy

And that word reassessment is doing a LOT of work there. Because once you said opioid, missed reassessment, and patient fall, I'm already thinking professional duty was attached to that nurse.

Caitlin Hope

Exactly. Here's the quick lesson burst. Negligence is the broad idea: failure to do what a reasonable person would do in a similar situation, or doing something careless that a prudent person would avoid. Malpractice is professional negligence. So on an exam, if the bad act is tied to nursing judgment or nursing care, malpractice is usually the sharper answer.

Heather Murphy

Right, and malpractice has FOUR components. I'm gonna number them because students mix up the middle two. One: the nurse had a duty to the patient. Two: there was a breach of that duty. Three: injury, harm, or damage occurred. Four: that harm was CAUSED by the breach. No causation, no malpractice claim.

Caitlin Hope

That fourth one—caused by the breach—is the part people skip. I had a new nurse once who wanted to chart, like, three paragraphs after a near-miss. I told her, calm down, we still fix it, we still report it, but harm matters in the tort question. In our NCLEX scenario, the nurse had a duty to reassess after pain med, breached it, the patient fell and was injured, and the missed reassessment connects to the injury. That's malpractice.

Heather Murphy

And the source notes give classic malpractice buckets: failure to properly assess and monitor, failure to administer medications properly, failure to communicate, failure to act, failure to use medical equipment properly, failure to properly plan and administer nursing care, and failure to exercise ordinary care to avoid emotional harm.

Caitlin Hope

Let me turn that into fast bedside examples. Not checking respirations after an opioid—assess and monitor. Hanging the wrong dose—medication administration. Seeing a critical change and not calling the provider—communication. Bed alarm broken and you keep using the bed anyway—equipment. Sending a confused high-fall-risk patient to the bathroom alone—planning and administering care safely.

Heather Murphy

Okay, now flip it. Intentional torts are different because the act is INTENDED. The notes say there must be intent to interfere, intent to bring about the consequences, and the act substantially causes those consequences. So NCLEX cue words matter here.

Caitlin Hope

Yep—if you see intended, threat, restrained, private information, false statement... your brain should go intentional tort. Assault is a verbal threat. Battery is physical harm or unwanted touching. False imprisonment is holding someone against their will without consent or legal authority.

Heather Murphy

Give me the bedside version of assault versus battery, because students swap those constantly.

Caitlin Hope

Assault: “If you don't hold still, I'm going to give you this shot anyway.” That's the THREAT. Battery: actually giving the shot without consent. Threat first, contact second. If nobody touches the patient, it can still be assault.

Heather Murphy

And false imprisonment—say a competent patient says, “I'm leaving,” and a nurse blocks the doorway or applies restraints without proper authority. That restrained piece should jump out.

Caitlin Hope

Invasion of privacy is another big one. Sharing private information, posting patient photos, discussing details where others can hear—those are exam traps. Fraud is deliberate deception for unfair or unlawful gain. Defamation harms reputation. Spoken false words are slander; written words or images are libel.

Heather Murphy

So if a nurse tells coworkers a false story that a colleague diverted narcotics, that's slander. If they post it online, now we're in libel territory.

Caitlin Hope

That “posted online” piece sticks. Also, quick board-of-nursing reality check: disclosing patient photos, chronic drug or alcohol abuse, criminal conviction, falsifying an employment application, misappropriating meds or supplies—those can trigger investigation. Different lane from NCLEX tort questions sometimes, but still very testable.

Heather Murphy

Let me do a rapid quiz. Nurse forgets to raise side rails after care and the patient falls?

Caitlin Hope

Unintentional—likely negligence or malpractice depending on the professional duty described.

Heather Murphy

Nurse threatens to tie a patient down if he won't stop yelling?

Caitlin Hope

Assault.

Heather Murphy

Nurse shares patient lab results in the elevator?

Caitlin Hope

Invasion of privacy.

Heather Murphy

Good. On the exam, don't just ask, “Was something bad done?” Ask, “Was it careless—or was it intended?” That one question clears up a lot.

Heather Murphy

Now imagine a student nurse getting corrected in front of everyone at the nurses' station: “Why would you even think that was the right med pass?” The unit goes quiet. That one moment can be plain incivility—or part of something more serious.

Caitlin Hope

And that scene is not abstract. Every nurse remembers some version of it. So let's separate the terms cleanly. Incivility is rude, disrespectful, discourteous, offensive behavior—gossiping, spreading rumors, refusing to help a coworker, name-calling, condescending tone, public criticism. Bullying is more frequent, more intense, repeated abuse of power meant to humiliate, offend, and cause distress.

Heather Murphy

That phrase repeated abuse of power is the key token. One rude comment is bad. A pattern of targeted humiliation is bullying. And students sometimes normalize it—“Well, that's just how the floor is.” No. It is still harmful.

Caitlin Hope

Yes. We do not get to call cruelty “high standards.” Now, the notes separate horizontal and lateral violence a little differently than students expect. Horizontal violence here includes top-down and bottom-up. Top-down is supervisors harming those who report to them—oppressive supervision, constant criticism, unrealistic demands. Bottom-up is workers or students being uncivil or bullying toward supervisors or educators—public criticism, social media bashing, overt rudeness, vindictive remarks.

Heather Murphy

And lateral violence is between equals. Peer to peer. Nurse to nurse on the same level, student to student, coworker to coworker. Same rank, same table, still harmful.

Caitlin Hope

So in our student scenario—public correction on the unit—what's the best response? Because I know what people WANT to do, which is cry in the supply room or clap back. I've seen both.

Heather Murphy

Understandable... but professionally, pause first. Protect the patient in the moment. Ask for clarification if needed, privately if possible. Then document what happened: date, time, exact words if you can remember them, witnesses. Report through the clinical instructor, preceptor chain, or unit leadership depending on the setting. Self-protection matters—facts, not emotion-heavy summaries.

Caitlin Hope

That “exact words” tip is gold. If someone said, “You are unsafe and useless,” write THAT, not “preceptor was mean.” Specifics protect you. And if it's a repeated pattern, reporting pathways matter more, not less.

Heather Murphy

You know what this connects to? End-of-life care, oddly enough. Because conflict gets louder when families are stressed and clinicians are divided. Medical futility means interventions are judged to have very little or no medical benefit, or the chance of success is low.

Caitlin Hope

So think advanced illness, multiple failing systems, and a treatment that's technically possible but not really helping. That's where students hear, “Why are we still doing this?” and feel the moral tension.

Heather Murphy

Exactly. Now compare palliative care and hospice. Palliative care focuses on comfort and support for patients and families facing terminal illness, but there is no definite timeline until death. Hospice gives comfort at end of life when the patient is expected to pass in six months or less.

Caitlin Hope

That six months or less—I'm never not going to say it out loud. If the stem gives prognosis in that range, hospice should pop into your head. If the patient has serious or terminal illness and needs comfort support but not that defined prognosis, think palliative care.

Heather Murphy

Let's make it concrete. Patient with advanced illness, increasing pain, fatigue, family overwhelmed, but no clear six-month prognosis?

Caitlin Hope

Palliative care. Comfort and support now.

Heather Murphy

Same patient, now the team expects death within six months or less?

Caitlin Hope

Hospice becomes appropriate.

Heather Murphy

Now the documents. A living will gives directions to healthcare providers about withholding or withdrawing life support if certain conditions exist. A durable power of attorney for health care lets a competent person designate someone else to act on their behalf if they cannot make their own decisions.

Caitlin Hope

So living will or advance directive equals INSTRUCTIONS. Durable POA equals DECISION-MAKER. That's the clean exam split. If the question asks, “Who speaks for the patient now that the patient can't?” you're probably looking for the durable power of attorney. If it asks, “What did the patient say about life support ahead of time?” that's living will territory.

Heather Murphy

And when both exist, you identify the document, determine the patient's condition, and choose the response that protects patient rights and dignity. Not staff convenience. Not family volume. Patient rights.

Caitlin Hope

That's really the thread through all of this—from bullying to hospice to legal documents. Under pressure, do we protect people, or do we protect our own discomfort? That's maybe the question I want students to sit with.

Heather Murphy

That's a good place to leave it. Thanks for being here with us.

Caitlin Hope

See you next time.