This document summarizes a lecture on medical staff privileges and nursing law. The lecture covered topics like medical ethics, credentialing processes, physician legal issues, and nurses and the law. It discussed how hospitals have a duty to properly credential medical staff and ensure caregiver competency. The discussion included cases where lack of proper credentialing or supervision resulted in liability. The lecture also explained state nursing practice acts, licensure, and how nurses can be held liable for negligence.

1. this is a discussion not a PAPER. this is the scenario need up to
date references
HAS 515, Lecture 5, Medical Staff Privileges and Nursing and
the Law
Slide #
Scene/Interaction
Narration
Slide 1
Scene 1: Exterior Strayer University Building/Classroom
Slide 2
Scene 2
Professor Charles enters classroom and introduces the topics for
today’s lesson and begins the lecture.
HSA515_5_2-PC-1.mp3
: Hello everyone! Welcome back to class. Today, we are going
to discuss an overview of medical ethics, the credentialing
process, physician legal issues, and finally, nurses and the law
with the context of health services organizations.
Keep in mind that a physician must bear the responsibility to
patients first and foremost, as well as society, other health
professionals, and themselves. These ethical principles have
been adopted by the American Medical Association.
Furthermore, the medical staff organization of a hospital is
defined by its hospital bylaws. The medical staff is formally
organized with officers, committees, and bylaws. At regular
intervals, the various committees of the medical staff review
and analyze their responsibilities, clinical experiences, and
opportunities for improvement.
The responsibilities of the various committees including:

2. The Quality Improvement Council;
Executive Committees;
Tissue Committee;
Medical Records Committee;
Credentialing Committee; and
The Infection Committee includes patient care standards and
practices;
Management functions;
Administrative duties; and
Credentialing of its members.
Let’s first discuss the role of the Hospital Medical Director.
What do you think are some of the Medical Director’s duties?
HSA515_5_2-C-2.mp3:
The Medical Director is a liaison between the medical staff and
the Board of Trustees or Directors and senior management.
HSA515_5_2-D-1.mp3
: I agree with Casey, but would I’d like to add to the Medical
Director’s duties with the enforcement of the medical staff
bylaws and governing body.
HSA515_5_2-C-3.mp3
: In addition to what has already been noted, I would say that
the Medical Director is certainly a physician who monitors the
quality of medical care in the hospital.
HSA515_5_2-PC-2.mp3
: Absolutely.
What are some of the liabilities of the Medical Director?
HSA515_5_2-C-4.mp3

3. : The
patient care monitoring
is critical and any failure by the Medical Director to fulfill
their duties can hold the hospital and him or herself liable for
patient injuries.
HSA515_5_2-PC-3.mp3
: What is an example of such liability?
HSA515_5_2-D-2.mp3:
I remember there being a case where a nursing home was
indicted by a grand jury for the death of several residents. The
Medical Director was also indicted. They explained that they
merely signed papers and attended meetings; however this did
not absolve them of their responsibility to ensure the adequacy
and the appropriateness of the medical services in the
organization.
HSA515_5_2-PC-4.mp3
: Great job, Donald!
Now let’s take a closer look at how medical staff privileges are
restricted to those professionals who fulfill the requirements as
described in a hospital’s medical staff bylaws.
Slide 3
Check Your Understanding
Which of the following is a code of medical ethics?
A. Physicians shall uphold the standards of financial collection
of patient bills.
B. Physicians shall support access to medical care for all
people.
C. Physicians shall respect only the rights of paying patients.
Correct Feedback:
B. Physician shall support access to medical care for all people.
Incorrect Feedback:
A. Physicians shall uphold the standards of financial collection

4. of patient bills.
C. Physician shall respect only the rights of paying patients.
Slide 4
Scene 3
Discussion between Prof Charles and students.
HSA515_5_3-PC-1.mp3
: Appointments to the medical staff, and medical privileges
should be granted only after there has been a thorough
investigation of the applicant.
The delineation of clinical privileges should be discipline
specific and based on appropriate predetermined criteria that
adhere to national standards.
The
privileging
and
credentialing
process is to evaluate the competency of the physician
applicant to determine whether he or she is qualified for
appointment to the medical staff. Previous memberships on
hospital medical staffs and residency training and education are
scrutinized carefully; along with any licensing or malpractice
problems.As a former hospital CEO, I am very familiar with the
arduous and time consuming vetting conducted of every
applicant. The hospital’s duty and legal responsibility is to
provide a safe environment for the patient.

5. HSA515_5_3-PC-2.mp3
: Disruptive physicians have a negative impact on the
organization and eventually the quality of patient care. The
hospital should have a Wellness Committee to enforce the right
policies as they relate to conflict resolution and professional
misconduct among caregivers. The behavior of the privileged
physician must be monitored as well as having been thoroughly
vetted by the hospital before being credentialed to be on the
hospital medical staff. The hospital must provide a safe patient
environment and disruptive behavior by the physician can
jeopardize effective treatment. A disruptive physician can be
counseled by the Wellness Committee and dismissed from the
medical staff, if necessary, to prevent harm to the patient and
also, interfering with hospital patient care.
HSA515_5_3-C-1.mp3
: So, Professor Charles, can you tell us about failing to meet
ethical standards?
HSA515_5_3-PC-3.mp3
: Absolutely! The Credentialing Committee, for instance, has
the choice of enforcing ethical standards and denying privileges
based on disruptive patterns of behavior by the physician and
interference with the delivery of quality patient care.
I was the hospital CEO in which a physician was denied
privileges by the governing board based on unethical behavior
as shown through patterns of rude, abusive, and disruptive
behavior. The specific instances were temper tantrums,
condescending remarks about women, and several instances of
throwing a scalpel.
HSA515_5_3-D-1.mp3
: Just to be clear, The board was concerned that the physician’s

6. behavior would continue until a patient was injured as a result
of his actions?
HSA515_5_3-PC-4.mp3
: Yes, and much of such instances can be detected, not just by
hearsay, but through the hospital Wellness Committee.
Misdiagnosis
is the most frequently cited injury in malpractice suits against
physicians. Although diagnosis is a medical art and not an exact
science, early detection can be critical to a patient’s recovery.
HSA515_5_3-C-2.mp3
: I am still not quite clear on how wrong site surgery occurs.
Can you help me understand it better, Professor Charles?
HSA515_5_3-PC-5.mp3
: Sure….I was involved in a case in Florida, as the hospital
corporate negligence expert, where the surgeon amputated the
wrong leg. The hospital practiced corporate negligence when
the operating room nurses allowed the operating room
blackboard to be covered with chalk dust so that it could not be
clearly determined whether the patient’s “right” or “left” leg
was checked to be amputated. Of course, the surgeon and
operating room nurses should have reviewed the patient’s chart
to confirm the leg to be amputated and the wrist ID band to
identify the patient.
.
Slide 5
Check Your Understanding
The hospital board determines the competency of a physician
applicant to be on the medical staff through _________.
A. Credentialing
B. Privileging

7. Correct Feedback:
A. Credentialing is the correct answer. It’s when the
Credentialing Committee and the board vet or screen the
physician for competency
Incorrect Feedback:
B.
Privileging is determined after a physician is credentialed.
Privileges are the particular procedures the physician is allowed
or not allowed to perform in the hospital.
Slide 6
Check Your Understanding
A physician who repeatedly misrepresented his/her credentials
by claiming to be Board Certified in Internal Medicine can be
brought before the state medical licensing board and
_____________ .
Place physician on probation.
B. Permanently revoke the physician’s license.
C. Suspend the physician’s license.
D. Reprimand
Correct Feedback:
B. Permanently revoke the physician’s license. Physicians who
repeatedly misrepresent their credentials damage their
credibility and present a potential danger to the public. The
state licensing board duty is to protect the public from deceitful
physicians and harm.
Incorrect Feedback:

8. A. Incorrect.
Probation is of no consequence to the physician who deceives
the public.
C. Incorrect.
Please try again. Suspension still allows the physician to
practice medicine again and deceive the public.
D. Incorrect.
Please try again.
Remember, the physician can still practice medicine with a
suspension.
Slide 7
Scene 4
Discussion of nursing and the law
HSA515_5_4-PC-1.mp3
: Now let’s discuss nursing and the law.
Can anyone explain what the
state nursing practice act
does?
HSA515_5_4-C-1.mp3
:
I think I can. Through state law, the nurse practice act oversees
the actions, duties, and limits of nurses in their particular roles.
Nursing continues to change in response to advances in
technology, changes in patterns of demand for health services,
and the evolution of professional relationships among nurses,
physicians, and other health professionals.

9. HSA515_5_4-PC-2.mp3
:
Very good Casey!
That is an excellent explanation.
HSA515_5_4-D-1.mp3:
Prof. Charles, what
about nurse licensure
?
HSA515_5_4-PC-3.mp3
: Donald that is a great question! Each state has a nurse
licensing board organized and operated within guidelines of
specific legislation to license all professional and practical
nurses. A nurse must graduate from a nurse-approved school
and pass a state licensing exam before being licensed.
HSA515_5_4-C-2.mp3
:
So is it safe to say that nurses who transfer to other states may
be licensed by reciprocity, waiver, examination, and
endorsement?
HSA515_5_4-PC-4.mp3
: Yes, Casey, I believe that is a pretty good distinction.
HSA515_5_4-D-2.mp3
: I do know that the discussion on nurse licensure has really
clarified some questions for me.
Now, a little more clarification on the law would really help.
HSA515_5_4-PC-5.mp3:
Well, that is a great lead-in to the next topic, which is the law

10. and practice of nursing.
Slide 8
Scene 5
Discussion on the law and the practice of law.
HSA515_5_5-PC-1.mp3
: The nurse manager is a qualified
RN
or
registered nurse
who has the authority, responsibility, and accountability for the
function, activities and training of the nursing staff.
A manager who knowingly fails to supervise an employee’s
performance or assigns a task to an individual whom he or she
knows or should have known is not competent to perform the
task can be held personally liable if injury occurs to the patient.
The employer will be held under the doctrine of
respondeat superior
as the employer of both the manager and the individual who
performed the task in a negligent manner. The nurse manager is
not relieved of responsibility even though the employer is liable
under
respondeat superior.
In determining whether a nurse manager has been negligent, the
nurse is measured against the standard of care of a competent
and prudent nurse in the performance of supervisory duties.
Who can tell us the role of agency or temporary nurses who
work in the hospital but are not employees of the hospital?
HSA515_5_5-C-1.mp3:
I would say that the hospital is equally responsible for contract
nurses as it is for nurse employees. Hospitals have a duty to
ascertain the competency of contract nurses as they do for
employee nurses.

11. HSA515_5_5-PC-2.mp3
: Exactly! It is so important to remember that the organization’s
responsibility to the patient cannot be delegated to others.
If the hospital retains a contract nurse to care for its patients the
hospital still has the same duty to provide a safe patient
environment as it does employing its own nurse employee.
HSA515_5_5-D-1.mp3
: Professor, in our discussion, you have provided us with a
significant amount of information about nurses. It seems as
though the nurse is between a rock and a hard place if a
physician’s orders jeopardizes the well-being of a patient.
HSA515_5_5-PC-3.mp3:
Donald, nursing guidelines in place but not followed, in spite
of the doctor’s orders, are of no value and can fail to protect the
patient from harm. The nurses have a duty to report the problem
to the supervising nurse and take appropriate action to
safeguard the patient.
A nurse, who fails to report a patient’s condition or symptoms
to the attending physician resulting in injury to the patient, is
negligent and thus the hospital is also negligent under the
doctrine of
respondeat
superior
.
HSA515_5_5-C-2.mp3:
So anytime any caregiver deviates from the standard of care

12. resulting in harm to the patient, the caregiver and employer are
held liable?
HSA515_5_5-PC-4.mp3
: Exactly. Among the common acts for which nurses can be
found negligent include:
Improper or inappropriate administration of medications;
Negligent injections;
Failure to follow physician orders;
Departure from acceptable practice;
Burns;
Infections;
Delay in treatment;
Failure to correctly transcribe telephone orders;
Patient falls and so on.
Slide 9
Scene 6
Summary
Picture of Casey and Donald as they speak.
HSA515_5_6-PC-1.mp3
: We are just about out of time.
Let’s go over what we learned in this lesson.
We discussed medical ethics, medical staff organization, the
credentialing process, legal risks of physicians and nurses, and
the nurse practice act.
We learned that the
corporate negligence doctrine
states that hospitals have a duty to provide an adequately
trained medical and nursing staff and a safe environment for the
patient. We then noted that hospitals have a responsibility to
ensure the competency of their medical, nursing staff and all
caregivers, and to evaluate the quality of medical treatment

13. rendered on the premises. We also discussed that the medical
staff and nurses have ascribed to a body of ethical statements
developed primarily for the benefit of the patient. The main
theme of our lesson is that nurses and physicians must
recognize responsibility to patients first and foremost, as well
as to society.
Before we adjourn, are there any questions?
HSA515_5_6-D-1.mp3
: I have no questions; I think that the information was clearly
presented, Professor.
HSA515_5_6-C-1.mp3
: No further questions for me.
HSA515_5_6-PC-2.mp3
: Well, if there are no further questions, please take some time
to complete the threaded discussions for this week. Take care
and see you again soon!