JNPs’ fulfillment of legal liability in medical practice
The results of the analysis of JNPs’ legal liability in their medical practice showed three scopes of understanding: “determination as to whether the JNP has the ability to perform the assigned medical procedure,” “anxiety when performing medical procedures in place of a doctor,” and “follow up medical practice through to the end.”
Determination as to whether the JNP has the ability to perform the assigned medical procedure
With regards to the first scope of understanding, the data showed that even if a JNP was requested or permitted by a doctor to perform a medical procedure on behalf of that doctor, the JNP was responsible for assessing the patient’s condition and the content of the procedure to be performed and determining whether to perform the medical procedure. Depending on the type of medical procedure involved, even if there was no problem with a JNP’s ability to perform the procedure, it was possible that the patient’s state could suddenly change to one that would require a doctor, because of the implementation of the procedure. Therefore, even if JNPs were permitted to perform a certain medical procedure by a doctor, they might not do so if they judged it to be dangerous.
When conducting medical practice, it cannot be said that accidents will definitely not occur. Specifically, when performing invasive procedures instead of the doctor. The doctor has said, "I'll leave everything to you, so you can do anything." However, if any complications occur after medical procedures, the doctor may say, "You were the one who did this." In that case, it’s tough, because I’m forced to accept legal liability. When it comes to legal liability, I feel that I have to be careful when dealing with it. (NP2)
I choose only to do medical procedures that will not cause complications, so, I haven't done the insertion of a peripherally inserted central catheter, ever. I don’t perform such difficult medical procedures. In other words, I restrict myself. There are 38 medical procedures I am qualified to perform, but I do not do all of them. I will not even do the exchanges required for gastric fistulas. I try to simulate the procedure in my head and do hands-on medical practice. Once I have confidence, I can carry out the medical procedure and am occasionally observed by a doctor while performing it. I think that I cannot do dangerous medical procedures, and I do not do medical procedures that I judge to be dangerous. (NP3)
Anxiety when performing medical procedures in place of a doctor
For the second scope of understanding, the data showed that when JNPs were tasked with performing medical procedures on behalf of a doctor, but they were not among their specified 38 performable medical tasks, they experienced anxiety about whether or not they should be performing the tasks and felt pressure to not make mistakes whilst doing so. By law, JNPs do not have the authority to diagnose and prescribe directly. However, if doctors had JNPs act as their substitutes, diagnoses and prescriptions were provided. Although these actions performed on behalf of a doctor were ultimately confirmed by the doctor, who remained responsible for determining the content of the orders, the JNPs were required to input their own ID numbers to implement medical procedures and therefore felt pressure to not make mistakes in diagnosis and prescription, and anxiety about their own legal liability in the case of mistakes occurring.
For things like fractures, I write down the diagnoses. I have to write things like “it’s fractured here” on behalf of a doctor, so I can’t afford to make any mistakes. That’s number one. Because there can’t be any mistakes, I feel I have to write diagnoses down properly. I can’t write down any misdiagnoses. (NP 3)
I’m prescribing medicine on my own, so it’s very scary. I can’t prescribe medicine that I do not know, so in that case, I ask somebody (for example, pharmacists or doctors who are familiar with the medicine). When my doctor tells me to prescribe medicine, I ask the doctor why this medicine is necessary.…Because I am the one giving instructions for the medicine, it’s scary to prescribe it without knowing the patient’s state or the effect of the drugs.(NP 1)
Follow up medical practice through to the end
For the third scope of understanding, the data showed that JNPs were concerned about patients' progress with respect to their medical practice, and they wanted to ensure follow up to the end, without leaving anything unfinished. Although JNPs cannot treat patients directly, their responsibility is signified by the task of confirming the progress of patients involved. Furthermore, in understanding the changes that resulted from their direct actions with patients, JNPs were able to comprehend their legal liability more clearly.
Basically, I see my patients the whole time until they are discharged. Occasionally, I go to see patients when they come in for outpatient care. I ask them "How are you doing? Are you taking care of yourself?” Sometimes the patients come to see me. I’m involved in the lives of the patients, so I'm worried about patients…I think that for patients, hospitalization is a turning point in their lives. It is a life-changing event, so I wonder how patients' lives have changed and how they’re doing. (NP1)
I think that it’s best to check and assess bed sores and debridement every day, but I can't follow up on this because I can only check and assess those conditions once a week. I have to leave it to the doctors or other nurses, but I feel some hesitation in leaving these tasks to others…The patient’s condition may be alright when I’m looking after them, but infection, bleeding, or something else could set in later on. These things are real possibilities, so I feel I need to be somewhat cautious. If our hospital weren’t so far from patients, we’d be able to respond to patients more quickly. (NP2)