On a background of an increasing number of Nurse-Led Clinics and Endocrine Specialist nurses taking on many varying extended roles and responsibilities, 2015 has seen several important developments in the medicolegal aspects of practice.
Nurse-led endocrine clinics often develop ad ho, and whilst there is very helpful guidance available (a Royal College of Nursing accredited Competency Framework developed by the Society for Endocrinology, and the new 2015 Nursing and Midwifery Council code to professional practice), many aspects of these clinics continue to run within an unclear legal framework making staff potentially vulnerable to litigation.
The practice of obtaining informed consent in endocrine nurse-led clinics varies between centres. However, the law surrounding Consent has changed this year; the Bolam test, whereby practice accepted by a reasonable body of medical opinion was not negligent, has been extended by the Supreme Court. The test of adequacy of informed consent of material risk means that the clinician must make the patient aware of any risk to which a reasonable person in the patients position would be likely to attach significance.
Whistle-blowing in the NHS is an on-going important issue. Following the Francis enquiry, the Freedom to Speak up review has highlighted 15 principles involving a culture change whistle-blowing or raising concerns by NHS employees regarding the workplace and practice.
Between 2008 and 2012, complaints by patients increased by 196% in nursing and midwifery. There is a contractual duty on NHS staff to report all incidents resulting in moderate/severe harm or death. The Nursing and Midwifery Council has provided draft guidance on a nurses duty of candour.
Other challenges include adequacy of documentation, equality and diversity, email and telephone advice, recording of consultations, and relationships with pharmaceutical companies. Thus, whilst Nurse-led clinics remain popular and very valuable, awareness of these various issues is essential.