Nursing’s responsibility for patients’ rights

The National League for Nursing (NLN) has traditionally been concerned about nursing’s responsibility for patients’ rights, according to Margaret E Walsh, NLN executive director. Speaking at the biennial convention of the California League for Nursing in San Diego, Walsh said that the League was the first health professional organization to design a patients’ bill of rights in 1959, and it is now being revised to reflect the changes in nurs- ing service since that time.

The first of seven program goals adopted by the NLN membership calls for “assurance of the rights and dignity of individuals as consumers of nursing service,” she said.

Consumerism in health services has been slow in developing for several reasons. When people are sick, their first priority is recovery, and they frequently give up rights they would ordinarily assert vigorously. Our health care system is primarily cure-oriented, and illness is an unusual situation rather than an every-day occurrence. When not ill, most people prefer not to think about sickness or about organizing to protect their own and others’ rights within the health services sys- tem.

However, Walsh continued, consumer movement attention has been directed to- ward health services recently because of the rising cost of health care and the movement toward national health insurance, nationwide publicity about incidents in which the protec- tion of rights of patients have been ques- tioned, an increase in malpractice litigation, and the increase in medical technology, which sometimes results in less humane treatment.

One of the mechanisms to insure quality of health care in hospitals, is hospital accredi- tation, currently a function of the Joint Commission on Accreditation of Hospitals. However, Walsh said, the main concerns about JCAH accreditation standards are that they are minimal standards, and they are optional4CAH lacks the power to enforce them.

The American Hospital Association pre- pared a Bill of Rights for patients in 1973, and this, too, lacks enforcement power, stat- ing merely that “observance” of these rights will “contribute to more effective patient care.”

The AHA Bill of Rights has been praised by some and criticized by others, and only a fraction of hospitals have made all the rights available to their patients. However, the statement has provided an impetus for some state legislatures to take action. Minnesota was the first state to adopt a patients’ bill of rights. California has passed a resolution en- couraging, rather than requiring, hospitals to distribute the AHA Bill of Rights to their pa- tients.

“There are two areas of patients’ rights which I believe should be priorities for en- forcement,” stated Walsh. The first is right of consent, both to experimentation and to treatment. Experimentation on human sub- jects must continue, but not at the expense of society’s underprivileged groups.

The right of consent to treatment might seem self-evident, but it is not always ob- served. Surveys show that although some patients are upset at discovering the risks of

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operations, or other treatments, most prefer to know and are more comfortable after re- ceiving the information.

“The second area of patients’ rights I think should be a priority is access to records,” Walsh said. The only legal method by which hospital patients in more than 40 states may see and copy their records is by filing a malpractice suit. Records may be difficult to obtain even if state law permits access.

What is nursing’s responsibility in enforc- ing these rights? There is little in the litera- ture on the legal responsibilities of the nurse in guaranteeing certain patient rights.

“There is as yet no legal answer to the nurse’s role in patients’ rights, but it is our responsibility as nursing leaders to explore this role and to develop a legal framework to guide nurses in their decisions on these mat- ters,” concluded Walsh.

A chain is no stronger than its weakest link, says Hunter Robb, MD, who devised the foot spigot attachment to keep an operator’s scrubbed hands from becoming contaminated by Unsterile fWCetS. (Robb, Aseptic Surgical Technique, 1894)

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