Negligence is a civil wrong of which medical malpractice itself is a form.  There are 4 elements to negligence: duty, breach, cause and harm.  In order to have a claim for negligence, all 4 of these elements must be present.

Let’s first look at negligence in a context outside of health care.

Imagine you’re driving along and approach a stop sign.  You have a “duty” to come to stop at the sign.  If you go into the intersection without stopping, you have committed a “breach” of your duty.

If you are fortunate in NOT colliding with another car in the intersection, you may get ticketed but you have not committed negligence.  On the other hand, if you breach your duty to stop and collide with another vehicle in the intersection, causing damage to the other car and possibly harm to the passengers, you will have all of the 4 elements: duty, breach, cause and harm.

Now let’s put this into a couple of nursing contexts.  You have a duty to give the proper medication.  A doctor orders aminophylline but you misread it and give ampicillin.  You administer the ampicillin by mistake but the patient is not harmed.  While that is a med error, it is not negligence.  It’s just like going past the stop sign without causing a collision.  Duty is the standard of care and standard of care is defined as what those acting under same or similar circumstances would do.  No nurse should give the wrong medicine.

But, if you were to administer that ampicillin and the patient has an allergic reaction, then duty, breach, cause and harm are all present.  That is negligence or, in our field, medical malpractice.

Fortunately, in nursing there are not very many situations in which a nurse causes harm.  But keep these 4 elements in mind … duty, breach, cause and harm … to protect yourself from medical malpractice.