1. Impact of Legal Issues for
Today’s Nurse
Presented By:
April Holt
Heather Whitson
Jessica Harrison
May 3rd, 2016
Jefferson State Community College
St. Clair, Alabama
1
2. Part I.
How law within nursing is determined
TYPES OF LAW:
O I. Constitutional Law- interpretation and application of principles
within our U.S. Constitution. Includes basic rights to all natural of
U.S. born citizens.
O II. Common Law- Enacted by former case decisions and/or
customs.
O III. Statutory Law- Law that demands/prohibits certain actions to
be taken and addresses certain requirements be met. Nurse
Practice Acts fall under this type of law, and is enacted by our state
legislators.
O IV. Administrative Law- Created by states, governing bodies, and
federal agencies. Enforces administrative orders before
administrative law judge. Boards of Nursing fall under this type of
law.
2
3. Nurse Practice Acts
A common NPA has following provisions:
• Licensure requirements
• Definition of the scope of nursing practice
• Board of Nursing Authorities
• Board of Nursing Responsibilities
• Grounds of disciplinary actions, including
licensure revocation or lesser sanctions. 3
4. Nurse Practice Acts in a nutshell:
O Delineate areas of professional nursing
O Protect the nurse from charges of
unlicensed practices.
O AND in addition, provide for a Nursing
Licensure Compact
4
5. How do we define what is meant by
Nursing
O Nursing theorists:
O Florence Nightingale- “…how to put the
constitution in such a state as that it will have
no disease, or that it can recover from disease.”
(Nightingale, 1898)
O American Nurses Association statement
O International Council of Nurses statement
5
6. What is meant by Nursing Scope of Practice
O What does it mean to function as a safe,
competent, and legally compliant nurse?
O What is an example of what can cause a dilemma
within your scope of practice?
O What is meant by what is termed “breach of
duty”?
6
7. Examples of Professional Resources for
Nursing Practice
O American Nursing Association:
O Nursing’s Social Policy Statement (ANA 2010b)
O Code of Ethics for Nurses with Interpretive Statements
(ANA, 2001)
O Nursing: Scope and Standards of Practice (ANA 2010a)
O Hospice and Palliative Nurses Association
O Oncology Nursing Society
O State Nurse Practice Acts
O Boards that certify nurses
O Organizational Policies and Procedures
O Medicare laws and regulations
7
8. It is our duty to keep up with Nursing
Practice changes
O Become thoroughly familiar and up-to-date with ANA
standards of practice.
O Know your scope of practice; review your state practice
act annually.
O Know the scope of practice of the LPN/LVN, and
unlicensed assistive staff to whom you delegate tasks
and their level of care provision.
O Know your organization's current policies and
procedures.
O Be knowledgeable about the current regulations in your
setting.
8
9. Recognizing that Law and Ethics often Overlap
O Nine provisions in Nursing’s Code of
Ethics address:
O Nurse’s values and commitment
O Boundaries of duty and loyalty
O Duties that transcend patient encounters
9
10. Part II.
Common Issues Addressed by Law That Affect
Nurses
“I will do no harm…”
O NEGLIGENCE- defined by doing something
or failing to do something that a careful and
reasonable person would or would not do in
the same situation.
O Malpractice
O Assault
O Battery
O CONFIDENTIALITY- The duty of nurses or
other healthcare professionals not to disclose
information confided in them by a patient.
O HIPPA violations 10
11. NEGLIGENCE is a dirty word..
O The Board of Nursing proposes minimum
standards for nursing competence and
authorization to practice.
O Employers ensure that the practice
environment is conducive to competent
practice.
O Nurses are held accountable for
competent nursing within their scope of
practice.
In other words, there is no excuse for negligence since
all nurses have free access to guidelines and laws
provided to upon licensure and hire. 11
12. Difference Between Malpractice and
Negligence
O Malpractice is a form of negligence.
O What is the care that reasonably should have
been performed under the circumstances?
O Did you act with the degree of competence
expected based on established standards
within your education, training, and scope of
practice?
12
13. What is meant by Standard of Care?
O Reasonable actions expected of a nurse with a
certain level of education and training.
O Important to know because if sued for
malpractice, a judge/jury will consider what
the appropriate standards are established by:
O ANA
O Nurse Practice Acts
O Specialty Nursing Organizations
O Institutional Policies
13
14. Most Common Claims Against Nurses
O Failure to follow standards of care.
Example: Not performing
complete admission
assessment.
O Failure to use equipment properly.
O Failure to communicate properly.
Example: Not notifying the
HCP in a timely manner
when patient’s condition
warrants.
O Failure to document.
Example: not noting a
patient’s progress and
response to treatment.
O Failure to assess and monitor
Example: not interpreting
signs and symptoms.
O Failure to act as the patient’s
advocate.
Example: Not questioning
medical orders.
14
15. How would a plaintiff win a malpractice lawsuit?
Whether civil (negligence, breach of contract), or criminal lawsuit, charges must have specific legal
elements that plaintiff must prove to win a proposed case.
O Nurse had a legal duty to the
plaintiff and breached that duty.
(failed to observe the legal
duty or ethical obligation)
O The client must prove he/she
actually suffered harm.
O Lawsuit falls within the statute of
limitations for the plaintiff.
O The nurse’s breach of duty to the
client must have caused the harm.
O Client must prove that damages
resulted from the harm caused by
the nurse’s breach of duty.
O Client must prove amount of
damages that require
compensation for harm suffered.
15
16. What Type of Evidence is Used to Prove a
Breach of Duty?
O Written documents
O Clients medical chart
O Photos
O X-rays
O Testimony from witnesses
(includes experts in the field
along with family and client
themselves).
Your attorney should
challenge all evidence
and objections by cross-
examination.
16
17. How are the Plaintiff’s Damages
Determined?
Any out-of-pocket medical and
related expenses resulting from
the malpractice..
Damages must be
proven by..
O Pain and suffering
O Through testimony of plaintiff,
plaintiffs family members,
physicians, and other medical
experts.
O Economic losses
O Wages
O Future lost wages
O Documented evidence
O Receipts
O Wage records
O Medical Bills
17
18. I’ve Been Served!! What Now?
O FIRST: Inform your employer and/or your
employer’s legal counsel.
O Next: Find out if the company’s malpractice
insurance policy.
O Next: Find out if your employer’s attorney
will represent you, or if your employer’s
malpractice company wants to take over the
suit and defend you.
O You may not have a choice of which attorney
will represent you, which is an example of
why it may be a good idea to secure your own
malpractice insurance policy. Then your
insurance carrier may represent you.
O If not, you will need to find your own
attorney! Find out early before the risk of a
malpractice suit who a good attorney might be
should the need arise.
18
19. Breach of Confidentiality
Florence Nightingale taught that the
nurse who takes the pledge of the
Hippocratic Oath promises to “hold
in confidence all personal matters
committed to my keeping and all
family affairs coming to my
knowledge” (ANA, 2013, para.2)
Confidentiality- duty of nurses or other healthcare
professional to not share or publicize information
without the patient’s consent.
19
20. Violations of Patient’s
Rights to Confidentiality
O Unauthorized person gains access
to patient's health information
without client’s consent.
Common Examples:
O Computer screen(s) not closed
down when walking away from
desk.
O Medical records turned over to
unauthorized person(s).
O Discussions about a client with
healthcare persons not directly
involved with the client’s care.
O Client’s assigned nurse talks
about the client’s care with family
members or other persons
without client consent.
O Discussions about the client that
may be overheard on the unit by
persons unrelated to the client’s
care.
O HIPPA- Healthcare
Insurance Portability
and Accountability
Act, 1996.
Exceptions: Reporting abuse, neglect, or domestic
violence; reporting exposure to communicable
diseases, reporting possible outbreaks of reportable
disease to the CDC, facilitate organ donation.
20
21. What Happens if HIPPA is Violated?
Fines range from $100 per violation when the violator did
not know that the HIPPA law was being broken
to $50,000 or more per violation where willful neglect. Jail
time for 5 years or imprisonment for up to 10 years may
apply depending on the type of violation.
21
22. Part III.
Remembering the Impact of Law in My Nursing
Practice
Keeping up with change is essential.
O Ask potential employers about the training to
prepare you to learn of the organization’s
policies and procedures
O Keep up with Evidence Based Practice
through journals, continuing education
opportunities.
O Review laws under the Nurse Practice Act(s)
that apply to you.
O Keep up with your State Board of Nursing's
regulations and licensure requirements, how
it could be revoked.
22
23. Know How to Prevent a Lawsuit
O Be armed with your own malpractice insurance.
O Assess Head-to-toe always at beginning of shift.
O Make certain you document changes in a client’s
condition and incidents in a timely fashion and
notify the HCP if necessary asap.
O Documentation needs to be thorough and specific.
O Practice safety first.
O Be prepared to question any orders that seem out
of place for a client.
O Never encourage arguments and prevent conflicts
with the client.
23
24. More…..
O Understand patient's rights to care and refusal to care.
O Understand HIPPA.
O If in doubt of your skills, ask a more qualified nurse for help.
O Consult your nursing manager or nursing supervisor if you
suspect any nurse is acting under the influence of drugs or
alcohol. You will be held responsible in a court of law if a client is
harmed.
O Consult your nursing manager or nursing supervisor if you
observe or suspect another nurse is endangering the life of any
client, not following the organization’s policy, breaking HIPPA.
O Report any suspected abuse, negligence, or domestic violence
of your client.
24
25. More…
O Assess patient’s personal boundaries.
O Communicate in a therapeutic approach vs. any type of
condescending or passing-the-buck type of approach.
O Be a nurse that is always willing to learn from your
mistakes.
O Be the type of nurse that is open to learning new ways of
doing things by EBP.
25
