Traditionally the great majority of health care related malpractice suits have involved physicians and hospitals. Increasingly, however, greater attention is being given to nurses as potential defendants and thus as sources for recovery in malpractice suits. As a result, more recognition is emerging for nursing as a profession accountable for its practice. This article will examine the concept of accountability by:

1. 1. reviewing selected legal principles of malpractice;

2. 2. discussing the trend toward increased inclusion of nurses in malpractice actions and the implications of this trend; and

3. 3. describing an Expert Nurse Witness and Consultation Service which was developed to provide nursing opinion on the professionally accepted standard of nursing practice.

In the lead article Cynthia Northrop and Ann Mech discuss the growing role of nurses as expert witnesses in malpractice litigation. As they note, the increasing professionalization of nursing has led to more and more courts accepting the testimony of nurses as authoritative on the question of proper nursing practice. As a supplement to that article it is worth noting that nurses are also being called upon more frequently to testify on a wide variety of health care issues, and accordingly it is important for all nurses to have some familiarity with what goes on in a courtroom so that their testimony will be effective and useful to the judge and jury.

For example, I recently had occasion to sit in on the first day of trial of a case in Minneapolis involving the question of the appropriateness and lawfulness of an order not to resuscitate. During that day testimony was heard from four nurses, two laypersons, and one physician. Of these witnesses, only the physician seemed at home in the courtroom.

At a small community hospital, nurses are concerned about what they believe to be questionable medical care of one of the patients. The nurses frequently discuss the matter among themselves, but none of them approaches the patient's attending physician or the hospital administration.

At a large university school of nursing, a faculty member vehemently disagrees with opinions expressed in an article published in a widely circulated nursing journal. The faculty member writes a one-sentence letter to the journal's editors, cancelling her subscription.

And at a conference on legal aspects of nursing, a speaker discusses the entry into practice issue, including, of course, the 1985 proposal. There is very little audience discussion of this issue, although ample time has been allotted. Yet the written conference evaluations, filled out by the attendees, reveal that many of the nurses in the audience reacted strongly to the content. “What does the 1985 proposal have to do with nursing and the law?” wrote one nurse. “The 1985 discussion ruined the whole conference for me,” wrote another.