The document discusses legal and ethical aspects of nursing including sources of law, nurse practice acts, licensure requirements, standards of care, professional accountability, patient rights, and codes of ethics. It covers topics like informed consent, advance directives, documentation in medical records, and decreasing legal risks.
Constitutional laws, both federal and state, provide for basic rights and create the legislative bodies (senate and assembly) that write laws governing our lives.
In health care, agencies such as the Department of Health and Human Services or Office of Professional Licensing oversee nursing and the other health care professions. Who is governed by administrative laws?
You may be guilty of a tort if you harm a patient, for example, by administering the wrong dose or type of medication. Serious crimes are called felonies and are punished with long prison terms of a year of more, or even the death penalty; less serious crimes are misdemeanors and may result in prison terms of less than a year, monetary fines, or both. What is another example of a situation in which a nurse may be guilty of a tort?
State licensure is required to practice nursing in the United States, and each state writes its own laws and regulations regarding licensure. How does our state’s nurse practice act delineate responsibilities and degrees of independence of RNs, VNs, and other nurses?
A passing score on the NCLEX-PN ® test is accepted by the states for initial licensure when all other state requirements for eligibility are met. Ask students to share their views on the licensure examination, its format, level of difficulty, and test preparation strategies. Although a growing number of states have developed reciprocity agreements, nurses who wish to practice in more than one state may need to apply for the nursing license in each state in which they practice. How would national licensure benefit the nurse?
Although a student nurse may not perform a task as quickly or as smoothly as the licensed nurse, the student will achieve the same outcome without harm to the patient. The instructor who supervises a student is responsible for proper instruction and adequate supervision and evaluation of a student. Instructors are responsible for assigning students to patients of an appropriate level of complexity so that they do not jeopardize patient safety.
Accountability means asking for assistance when unsure, performing nursing tasks in the safe and prescribed manner, reporting and documenting assessments and interventions, and evaluating the care given and the patient's response to that care. In addition to health care, what are some of the other types of professionals that are facing increased accountability lately? Discuss sources of continuing professional education, and ask students to provide examples in which friends and coworkers are pursuing continuing education.
Some states make a distinction between delegation (only to another licensed person) and assignment (to an unlicensed person). The nurse is responsible for ensuring patient safety and the observation of patient rights. Discuss a hierarchy of clinical and administrative tasks that might be delegated to each level of nursing trainee or professional. What steps might a licensed nurse take to ensure the person can handle the assignment safely?
Legally, a nurse is responsible for her or his actions under the nurse practice act and according to the standards of care that are approved by the profession. Standards are defined in nursing procedure books, institutional manuals of policies and procedures or protocols, and nursing journals that outline current skills or techniques. In what ways does the availability of written standards help the nursing student and the licensed nurse (in general and specifically for the procedure in question)?
When a licensed nurse is charged with a violation of a nurse practice act, there will be a hearing to determine if the charges are true. What may result when a nurse is found guilty of professional misconduct?
Nurses may stay current by attending programs provided by their employer; through participation in their professional organization; by attending workshops, seminars, or presentations on health care topics; by reading professional nursing journals; by formal continuing education in colleges; or by correspondence courses.
Discuss the federal government’s or your state’s role in ensuring compliance with OSHA. What experience with OSHA standards or documentation have students had? What would students do if OSHA requirements were not being followed in a practice setting in which they worked?
What may give health care personnel a clue that child abuse may have occurred? Discuss legal requirements in cases of suspected child abuse or neglect. What is the correct reporting chain of command for such incidents?
In 1964, federal legislation made it illegal for employers to discriminate (to hire, promote, or fire employees on the basis of race, color, religion, sex, or national origin). The law has been amended to include protection for people with disabilities, as well as discrimination based on age. To whom should students report discrimination they experience in the workplace?
In our society, in which sexual comments and activities are commonplace on television or in movies, we must be aware of the right time and place for sexually suggestive or explicit words or touch. What should you, as a nurse, do if you are being sexually harassed?
In most states, there is no legal requirement for a nurse to provide aid in an emergency. Who do the Good Samaritan laws NOT apply to? Why are these laws important to public health and safety?
Under some legally specified conditions, certain rights may be temporarily suspended, such as in an emergency when the patient is unconscious or unable to communicate. Who developed the “Patient’s Bill of Rights”? Ask students their views on why patients’ rights have come to the forefront of health care. What does the trend tell us about the profession and those served by the health care industry?
The Joint Commission's National Patient Safety Goals are updated every year, and are available on their website (www.jcipatientsafety.org). The National Patient Safety Goals and requirements apply to nearly 15,000 hospitals and health care organizations that are accredited by The Joint Commission. What are the differences in the way nurses and physicians are taught to communicate patient information?
The patient does have the right of access to the chart, and copies of information in the chart may be authorized by the patient to be provided to other agencies. The medical record contents always need to be accurate, pertinent, and timely. On what should charting be focused? How are electronic medical records, written records, and oral conversations safeguarded?
It is important that the nurse makes certain that she has the patient’s consent to relay information about his health care to family members. How can a patient have information sent to another agency, physician, or insurance company?
If the patient has any questions, they should be satisfactorily answered before the patient signs the consent. It is important to determine that proper consent has been obtained, both legally and ethically. Failure to obtain a valid informed consent may lead to charges of assault and battery, or invasion of privacy.
Do you need to know the content of a legal document when you are witnessing a signature on that document?
All 50 states recognize advance directives, but each state regulates advance directives differently, and an advance directive from one state may not be recognized in another, depending on the similarities or differences in their laws. Who writes a DNR order and what does it mean?
In nursing malpractice, a reasonably prudent person is a similarly educated, licensed, and experienced nurse. In order to prove malpractice, four elements must be present: duty, a breach of duty, causation, and injury. Ask students to provide an example of each illegal act.
What is litigation?
Adults who are alert and oriented have the right to refuse medications, baths, treatments, dressing changes, irrigations, insertion of a catheter, and diagnostic tests as well as surgery. It is the nurse’s responsibility to explain the reason why a particular drug or treatment is important. If the patient still refuses, the nurse should obtain a release from liability because the treatment is not done or the drug is not taken.
A person sued for slander or libel may be found innocent if the statements made were true, or were said or written with no intent to harm the person, but for a justified purpose. Ask students to provide an example of each illegal act.
When patients entrust themselves to our care, it is with the expectation of confidentiality—that what is told to the health care professional and what is learned about the patient’s health and personal history is private information to which no one else should have access. What is a growing area of concern regarding privacy?
When a person wants to leave the hospital against the advice of the physician, a release to leave "against medical advice" (AMA) is used. What information may policies require be given to the patient signing an AMA?
Nurses must be alert to the abuse of protective devices when other less restrictive techniques may be effective. Nurses should consult with their supervisor about using protective devices in an emergency situation when no physician order is available.
Establishing rapport and effective communication skills can create a relationship in which patient anger or misunderstanding can be resolved rather than grow to lawsuit proportions. What should the nurse do if hospital rules are out-of-date or unrealistic?
Incident reports should be timely, factual, and concise, and should not contain unnecessary details, such as explanations about why the event might have occurred. How does the incident report benefit the facility?
Most authors agree that it is unwise to rely on your employer's liability insurance policy to protect you because there may be situations in which the interests of the institution are at odds with your legal interests.
There are no prescribed legal penalties for violating a code of ethics, although in many instances, violation of a professional code of ethics may result in disciplinary action by a licensing or regulating agency. What are ethics closely linked to?
The International Council of Nurses (ICN), the American Nurses Association (ANA), the National Association for Practical Nurse Education and Service (NAPNES), and the National Federation of Licensed Practical Nurses (NFLPN) have developed codes of ethics for nurses. Who has set standards for nursing since 1941?
On a daily basis, nurses face personal ethical decisions involving honesty, whistle-blowing (reporting illegal or unethical actions), and provision of care. Our professional code of ethics dictates that we act as patient advocates and safeguard our patients from harm. What values does the nurses’ code of ethics promote?
![[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)