Restoring Realistic Expectations on the Chain of Command

Chain of command is one favored tactic to put nurses (and thus the hospital) on the hook for a doctor’s decisions.  Many times this makes sense to jurors – if they as laypeople question the doctor’s course of action, they can conclude a nurse should have as well.

It’s an easy argument to make since, in hindsight, another course of action “might” have prevented a negative outcome – if only that nurse had had the guts to stand up to that wrong-headed doctor.  Unfortunately, a survey we recently conducted shows jurors expect nurses to do just that.

In a May survey of more than 1,200 potential jurors nationwide, an alarming 84 percent of respondents indicated they believe nurses have a duty to question a doctor’s decision if they disagree with it. This jibes with what we have observed during focus group research – jurors increasingly expect nurses not only to be patient advocates, but also to have enough medical knowledge to second-guess doctors.

We’ve also learned that for whatever reason, jurors believe nurses rarely if ever take the step of going up the chain of command.  The same May survey found that 39 percent of respondents believe nurses “almost never” question a doctor’s orders.  Based on our discussions of the topic during focus groups, this perception is likely due to the shared juror predisposition that many doctors are “arrogant” and would likely disregard such disagreement anyway.

We have had the most success overcoming this plaintiff theme during case research by emphasizing how the medical chain of command, like its military counterpart, functions because nurses follow doctors’ orders – except in extraordinary circumstances.  These circumstances might include a doctor who is incapacitated by health or alcohol, or who orders a C-section for a patient who has expressly withheld consent.  Like a foot soldier, however, the nurse is not considered the appropriate person to weigh in on or dispute routine medical decisions because they don’t have a doctor’s training and background – and the treatment environment and patient safety might suffer if they did.

The best way to counter a plaintiff’s chain-of-command claim will vary based on the unique factors of each case.  If you’d like to hear our thoughts about your case, contact Senior Vice President Claire Luna at cluna@juryimpact.net.

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We consistently advise clients to humanize defendants as a way to help level the playing field.  In that same vein, we will be doing more to humanize ourselves by sharing notable events for the Jury Impact team.  We look forward to working with you soon!

Senior analyst Erik Holmes will be moving to Charlotte, N.C., at the beginning of July.  His wife will be joining the faculty of the University of North Carolina at Charlotte as an assistant professor of criminal justice and criminology.  Erik will remain an integral part of the JI staff, and this move will be a great benefit to our East Coast clients.