The legal implications of nursing practice are tied to licensure, state and federal laws, scope of practice and a public expectation that nurses practice at a high professional standard. The nurse's education, license and nursing standard provide the framework by which nurses are expected to practice.

1. “LEGALASPECTS AND LEGAL
ISSUES IN NURSING”
LIPI MONDAL
SENIOR TUTOR, JCN

2. IMPORTANCE OF LAW IN NURSING
• To provide a framework to establish nursing actions in the
care of clients those are legal.
• To difference the nurses’ responsibilities from other health
professionals.
• To demarcate the boundaries of independent nursing
actions.
• To assist in maintaining standards of nursing practice.
• To safeguard and protect the rights of self & clients.

3. LEGAL LIABILITIES IN NURSING
• The duty of care (It is a legal obligation to follow the
standard in caring patients.)
• Breach of duty (It means the falling on the part of nurses
to act/care as per standard.)
• Causation ( It is an element of liability to prove that the
failure to meet standard of care which caused the harm
to the patient.)
• Damages (It is a term used for the actual harm to a
patient resulting from a definite cause.)

4. LEGAL ISSUES IN NURSING
• Nursing Negligence
It is the failure by the nurse to take the
appropriate action to protect the patient from harm.
A nurse who fails to put side-rails on the sides of the
bed of a confused patient of fails to initiate standard
safety precautions to prevent patient harm is by the
charge of negligence under civil law. If the negligence
is gross, complete disregard of the client’s life dealt
under both civil & criminal law.

5. CONTD…
The common examples of negligence are:
• Burns resulting by use of hot water bottle, applying heating
pads, administering steam inhalation & sitz bath.
• The incidence of fall among elderly, sedated, pre-operatively,
post-operatively, confused, dizzy,blind & semiconscious when
nursed without fixing bed side-railing.
• Patients had fallen due to a slippery or waxed floor.
• Administration of wrong medications, wrong dose of
medication to wrong patients.

6. CONTD…
• Malpractice
Malpractice is negligence by nurses causing an injury or harm
to the patients due to professional misconduct or lack of skill in
performing standards of care. Nurses need to comply six
International “ Patient Safety Goals”: identifying patients correctly,
improving communication, safety of high alert medications,
eliminating wrong-site, wrong patient, wrong procedure surgery,
reducing the risk of hospital-acquired infections & reducing the
risk of patient harm resulting from falls in the clinical practice,
failing which ca be resulted negligence or malpractice.

7. CONTD…
The common malpractices in nursing practice can be:
Failure to select an appropriate site by the nurse to
administer an IM injection that causes permanent
damage to the patient’s extremity.
Failing to obtain a proper informed consent.
Failing to provide patient’s safety: physical, social,
spiritual, financial, political, emotional, occupational,
psychological, educational or other types of failure.

8. CONTD…
• Assault & Battery
Assault is an intentional, unlawful threat or attempts
to make bodily contact with another person without that
patient’s consent. The unconsented touching of the body
is the example of an Assault. The battery is an unjustified
harmful or offensive touching with the intention of a
crime or doing wrong with a person.

9. CONTD…
• Restraints
These are physical, chemical or environmental
measures used to control the physical or behavioral
activity of a person or a portion of his/her body. Physical
restraints limit a client’s least restraint practices & the
right to refuse proposed interventions. For example use
of bed, rails are routine in many hospitals & other care
facilities. Law requires to use that most involuntary
medical restraint when ordered by a physician.

10. CONTD…
• Defamation of Character
It is an intentional tort or the issuance of a false statement
about another person, causing harm to a person. Slander is
oral defamation of character and libel is a defamation of
character in writing. Defamation of character can be
grounded both in criminal or civil law based on the amount of
harm done to the plaintiff. Nurses who make false statements
about the patient or their co-workers have the risk of being
sued for slander or libel.

11. CONTD…
• Invasion of privacy
All the information of the patient in any form is
considered private, confidential, legal. Privacy is a human
right to maintain autonomy. Certain actions of nurse can
constitute an invasion of privacy, e.g. unnecessary
exposing patient while assisting for examination,
discussing patient information with other people insisting
patient to provide information not required, research
without the consent of the patient.

12. CONTD…
• Fraud
A person who either practices without registration or
mispresenting him or her to obtain a registration to
practice nursing is fraud under the law. The
misinterpretation of a procedure or treatment may also
consider as a fraud.

13. REGULATION OF NURSING PRACTICE
• Licensure to Practice
The INC is a statutory body, which regulates standards of education &
practices through licensure. In 1948, the Nursing Council Act came into
being as an autonomous body. It was constituted by the central
government, with the purpose of safeguarding nursing education in the
country. Every state has its own State Nursing Council that pertains to the
registration of nurses upon completion of training. On completing
training, a nurse must register name & details with the State Nursing
Council to indicate status as a registered nurse. Nurses employed for the
nursing service required possessing a valid registration certificate issued
by providing qualified nurses.

14. CONTD…
• Professional Code of Conduct
Nurses abide by the INC Professional Code of Conduct
& Code of Ethics, & Code of Ethics by Trained Nurses
Association Of India in sustaining ethical behavior of
nurses. On entering profession formally, they have to
take the “Nightingale Pledge” which is a way of stating
that they will adhere to professional conduct. They also
have to abide by laws relating to penalty for misconducts
defined by State Councils or Statutory Authorities.

15. CONTD…
• Standards of Care
Each institution/hospital needs to have the policies &
procedures defining the standards of care for the nurses
of different levels. The department must have policies &
standard operative procedures to follow. The standards
of care are inbuilt in the INC code of ethics & professional
conduct for nurses, followed by State Nursing Councils.

16. CONTD…
• Standing Orders/ Instructions
Hospital policies having standing orders for nurses
can regulate nursing practice. Nurses are required to
execute prescribed orders. In case of emergency, if
the doctor/medical personnel is not available, each
nursing service area should have standing instruction
or orders for the nurses to carry out.

17. LEGAL SAFEGUARD FOR NURSES IN PRACTICE
Informed Consent Physician Order
Correct Identity Accurate Documentation
Negotiation Drug Maintenance
Reporting crimes &
Unsafe Practices

18. LEGAL RESPONSIBILITIES IN NURSING
• Administrative and Supervisory Level
 Appointment, assignment & transfer of staff
 Quality control management
 Material management
 Maintaining proper documentation
 Maintaining public relation
 Disaster management
 Staff management

19. CONTD…
• At Operational level
Carrying out physician’s order
Transcription of verbal orders
Do not resuscitate orders
Prevention of negligence
Maintaining a safe environment
Proper use of equipment
Maintaining proper records
Intimation of short staff
Maintaining & using controlled substances
Dealing with death & dying patients
Correct identity of clients
Information regarding absconding patient

20. MEDICO-LEGAL CASES
MLC is a case requiring investigations by law enforcing
agencies apart from the medical treatment to fix the
responsibility to cause of injury/illness & to assess its health
status or the condition. The medico-legal cases have both
medical & legal implications. Usually attending doctor in the
emergency department has the authority to decide the case
as MLC in a situation where the police brought the case, a
referred case as MLC from another hospital, or by examining
the patients by attending doctor in an emergency.

21. DEALING WITH MEDICO-LEGAL CASES
• The persons who met a roadside accident, factory
accidents, unnatural mishaps or any other disaster.
• All burn cases of any cause.
• Suspected or evident homicides, suicides.
• All type of poisoning cases, sexual offences & criminal
abortions.
• Injury cases where there is a likelihood of death shortly.
• A patient who dies immediately after admission.
• Death of a patient within 24 hours in the hospital.
• Death in OT during MTP, delivery.
• Alcohol or drug related deaths.
• Patient absconded from the ward.

22. Guidelines for dealing Medico-legal Cases & Issues
• Availability of well-defined guidelines in each
department.
• Well equipped with functional monitors, life-saving drugs
& resuscitation equipment in the emergency OPD.
• Send the information to the civil police in writing
immediately, on admission & discharge, the death of
MLC.
• Make sure that the doctor prepares a medico-legal report
of the patient in duplicate with the marking of ‘medico-
legal case’ & hand over to the security officer on duty.

23. CONTD…
• Take consent for any medical examination from the
patient or legal guardian.
• All clothing worn by injured/deceased, bloodstains,
gastric lavage, bullets, vomits material, should be
preserved, sealed properly & handed over to police on
request after obtaining a proper receipt.
• Take care of all X-rays of MLCs which are of vital
importance. Mark “medico-legal case” marks at the topic
of all investigations slips & X-ray requisitions.
• Keep all the information & records of MLC confidential.
• Keep all medico-legal reports & registers in proper safe
custody as per institutional policy.

24. CONTD…
• Collect the required samples/specimen, label, preserve &
seal & send for investigation if required.
• Keep an up-to-date chart of the treatment & antidotes of
all types of poisoning cases.
• Make the availability of essential investigation facilities.
• Give due care with all the precautions while
administering IV fluids & transfusing blood.

25. THANK YOU!!!