legal issue in nursing.

•LEGAL ISSUES IN NURSING:
NEGLIGENCE, MALPRACTICE,
INVASION OF PRIVACY AND
DEFAMATION OF CHARACTER

INTRODUCTION:
• As a nurse it has become an important necessity to be aware of the
legal aspects associated with caring and helping people in the
health industry today .Unfortunately, the more and more
negligence cases are there. The first nursing law was created
regarding nursing registration in 1903.

LEGAL ISSUES IN NURSING:
• 1. PERSONAL LIABILITY: As an educated professional, nurses are
always legally responsible or liable for their action. Thus, if a physician
or supervisor asks you to do something that is contrary to your best
professional judgment and says, ‗I‘ll take responsibility that person is
acting unwisely. The physician and supervisor giving the directions
may be liable if harm results but that would not remove your liability.
Although each person is legally responsible for his or her own actions,
there are also situations in which a person or organization may be
held liable for actions taken by others.

2. EMPLOYER LIABILITY: The most common situation in which a person
or organization is held responsible for the actions of another is in the
employer-employee relationship. In many instances, an employer can
be held responsible for torts committed by an employee. The law holds
the employer responsible for hiring qualified personnel, for establishing
an appropriate environment for correct functioning and for providing
supervision or direction as needed to avoid errors or harm. Therefore if
a nurse, as an employee of a hospital, is guilty of malpractice, the
hospital may be named in the suit. The employer’s liability may exist
even if the employer appears to have taken precautions to prevent
error.

3. CHARITABLE IMMUNITY: In some states, non-profit hospitals have
charitable immunity. This means that the non profit hospital cannot be
held legally liable for harm done to a patient by its employees. The
employees of that nonprofit hospital are still legally responsible for
their own actions.

4. SUPERVISORY LIABILITY: When a nurse is in the role charge nurse
,head nurse, supervisor or any other role which involves supervision or
direction of other people ,the nurse is potentially liable for the actions
of others .The supervising nurse is responsible for supervisory role .This
includes making appropriate decisions about assignments and
delegation of tasks. If poor judgment was used in assigning an
inadequately prepared person to an important task the supervisory
nurse might be liable for resulting harm.

• DUTY TO REPORT OR SEEK MEDICAL CARE FOR A PATIENT: A nurse
who is caring for the patient has legal duty to ensure that the patient
receives safe and competent care .This duty requires that the nurse
maintain an appropriate standard of care and also that the nurse take
action to obtain an appropriate standard of care from other
professionals when it is necessary. The nurse has a duty to continue
all efforts to obtain appropriate medical care for the patient.

• INFORMED CONSENT:A nurse may present a form for a patient to
sign and the nurse may sign the form as a witness to the signature.
This does not transfer the legal responsibility for informed consent for
medical care to the nurse .If the patient does not seem well informed,
the nurse should notify the physician so that further information can
be provided to the patient. The nurse has ethical obligations to assist
the patient in exercising his or her rights and to assist the physician in
providing appropriate care

• MEDICATION ERROR: Some errors results from drugs with similar
names ,look alike medication containers, poor systems for
communication in which hand writing problems may contribute to
lack of clarity. When medications errors do occur, fraud or intentional
concealment may be charged and may contribute to the awarding of
punitive damages as well as ordinary damage.

• DO‟S AND DON‟TS FOR SAFE PRACTICE:
• 1. Do document all unusual incidences
• 2. Do report all unusual incidences
• 3. Do follow policies and procedures as established by your employing
agency.
• 4. Do keep current year to practice
• 5. Do perform procedures that you have been thought and that are within
the standard scope of your practice
• 6. Do protect the patient from injury
• 7. Do not advice that is contrary to the doctor‘s order or nursing care plan
• 8. Do not work as a nurse in state in which you are not licensed

• LEGAL RESPONSIBILITIES OF NURSE:
• 1. Responsibility of appointing and assigning
• 2. Responsibility in quality control
• 3. Responsibility for equipment
• 4. Responsibility for observation and reporting
• 5. Responsibility to protect public
• 6. Responsibility for record keeping and reporting
• 7. Responsibility for death and dying

• ROLE AND FUNCTIONS OF NURSE MANAGER IN LEGAL ISSUES.
• 1. Serves as a role model by providing nursing care that meets or
exceeds accepted standards of care.
• 2. Reports substandard nursing care to appropriate authorities
• 3. Fosters nurse-patient relationships that are respectful, caring and
honest
• 4.Join and actively supports professional organizations to strengthen
the lobbying efforts of nurses in health care legislation
• 5. Practices nursing within the area of individual competence
• 6. Prioritizes patients right and welfare first in decision making

• 7. Delegates to subordinates wisely, looking at the managers scope of
practice and that of those they supervise.
• 8. Increases staff awareness of intentional torts and assist them in
developing strategies to reduce their liability in these areas
• 9. Provides educational and training opportunities for staff on legal
issues.

TORTS:
• Torts are civil wrongs committed by one person against another. The
wrong may be physical harm, psychological harm or harm to
reputation, livelihood or some other less tangible value.

• INTENTIOAL TORTS:
• Assault: Assault is any intentional threat to bring about harmful or
offensive contact. The law protects clients who afraid of harmful
contact. It is an assault for a nurse to threaten to give a client for an X-
ray procedure when the client has refused consent. The key issue is
the client consent. In an assault lawsuit, if the clients gives consent,
the nurse is not responsible.

• Battery: Battery is un-consented or unlawful touching of a person.
For battery to occur ,the touching must occur without consent.
Remember that consent may be implied rather than specifically
stated. Therefore, if the patient extends an arm for injection, he
cannot later charge battery, saying that he was not asked. But if the
patient agreed because of a thread(assault), the touching would still
be considered battery because the consent was not freely given.

• LAW OF PRIVACY
• Privacy law is the area of law concerned with the protection and
preservation of the privacy rights of individuals. Increasingly,
governments and other public as well as private organizations collect
vast amounts of personal information about individuals for a variety
of purposes. The law of privacy regulates the type of information
which may be collected and how this information may be used and
stored

• Specific privacy laws
• These laws are designed to regulate specific types of information.
Some examples include:
• Health privacy laws
• Financial privacy laws
• Online privacy laws
• Communication privacy laws
• Privacy in one's home
• Information privacy law

• UNINTENTIONAL TORTS
• 1. NEGLIGENCE:
Definition
• 1. Negligence refers to the act of doing something or refraining from
doing something that any other reasonable medical professional
would do or refrain from doing in a similar situation

• Avoiding Negligence
• It is important for nurses to document their actions very closely and
accurately at the time because sometimes negligence cases come
about later when details are difficult to remember. Charting
everything makes it easy to determine the details surrounding each
action or inaction and to find a logical reason as to why it was done.
This, in combination with a nurse who follows the proper scope of
practice, will likely keep a nurse from being prosecuted for nursing
negligence.

• 2. MALPRACTICE:
Definition
• Malpractice is defined as improper or negligent practice by a lawyer,
physician, or other professional who injures a client or patient. The
fields in which a judgment of malpractice can be made are those that
require training and skills beyond the level of most people's abilities.
Medical malpractice is defined as a wrongful act by a physician, nurse,
or other medical professional in the administration of treatment— or
at times, the omission of medical treatment, to a patient under his or
her care. Although dentists, architects, accountants, and engineers
are also liable to malpractice suits, most lawsuits of this type in the
United States involve medical malpractice.

• Medical malpractice is professional negligence by act or omission by
a health care provider in which care provided deviates from accepted
standards of practice in the medical community and causes injury or
death to the patient. Standards and regulations for medical
malpractice vary by country and jurisdiction within countries. Medical
professionals are required to maintain professional liability insurance
to offset the risk and costs of lawsuits based on medical malpractice

• Types of Nursing Malpractice
• Nursing malpractice takes many forms, including:
• - Medication errors – giving a patient the wrong medication or the
wrong dose, or dispensing medication to the wrong patient
• - Failure to follow a physician‘s orders
• - Delaying patient care and/or failure to monitor a patient
• - Incorrectly performing a procedure, or trying to perform a
procedure without training -Documentation error
• -Failure to get informed patient consent

• Consequences of Nursing Malpractice The consequences of nursing
malpractice can range from minor to potentially fatal, and may
include:
• Medication overdose
• Adverse drug reaction
• Coma
• Brain, heart, kidney or other organ damage
• Infection
• Death

PATIENT CARE ISSUES, MANAGEMENT ISSUES,
EMPLOYMENT ISSUES AND MEDICO LEGAL ISSUES
• INTRODUCTION Nursing is defined as providing care to the healthy or
sick individuals for preventive, promotive, curative and rehabilitative
needs. The Consumers are patients with complex needs. With
increased awareness of health care, health care facilities and
consumer protection Act, patients/clients are getting awareness
about their rights. Nurses also have now the expanded role, with the
result the legal responsibility is increased.

• Hence, it is important for nursing personnel working in hospital,
community and educational field to develop understanding of Legal
and Ethical issues of Nursing. Issues need deliberations and common
consensus. They need to be reviewed periodically. Issues which seem
not feasible, and ideal, may become practice with the change of time.
Some of these issues threaten nurses who do not keep up with the
changing development. These issues are base for the future trends in
care.

• MEANING OF LEGAL ISSUES It is a standard or rules of conduct established
and enforced by the government. These are intended to protect the public.
A. PATIENT CARE ISSUES
• Nursing covers a wide range of disciplines and health-care issues that are
always changing and at the forefront of what guides this career path. Issues
such as health-care reform, nursing shortages, low salaries and ethics are
some of the issues being faced. With nursing being an integral part of
hospitals, nursing homes, home health agencies and colleges, the discipline
has to keep current of changing policies and be prepared to address
whatever may arise.

• Nurses have always been involved with health-care reform as
advocates for patients. The American Nursing Association (ANA) has
been working to have the voice of nurses heard. Nurses are in
support of a public plan, so Americans who are underinsured or
uninsured will have access to affordable, quality health insurance. The
ANA has taken the stand that health care is not a privilege but a right.
It is lobbying for a reduction in cost and an end to high out-of-pocket
costs for services, as well as ending discrimination pertaining to pre-
existing conditions

• c. Low salaries
• d. Standard Care
• State Nurse Practice Act
• ANA-Standards of Clinical Nursing Practice
• National Association of School Nurses (NASN)
• School policy and protocols

• B. MANAGEMENT ISSUES
• Nurses working in doctors' offices and hospitals have a difficult job
caring for patients and meeting the needs of both coworkers and
superiors within the institution. Nurse Managers who work in the
medical professional also have a complex and challenging role. It is a
considerable challenge to meet the needs of the organization, the
needs of patients, and the needs of the nurse employees.

• a. Turnover
• Maintaining adequate staffing levels is a major issue in nursing
management. Representatives working in nurse management and
leadership are often faced with the responsibility of controlling
turnover rates. Nurses faced with long work hours for relatively little
pay have few motivations to remain in one position and often seek
employment opportunities at competing hospitals and neighboring
clinics

• b. Funding
• Lack of funding is an issue for many nurse managers who seek to
provide sufficient compensation to existing nurses as well as offer
suitable compensation in an attempt to recruit new nursing
professionals for hire. An underfunded institution cannot attract and
provide for the right professionals, and funding inadequacies can also
become a detriment to the level of training provided to medical staff,
in addition to the needs for medical equipment and supplies. When
the medical institution's quality of staff and training standards must
be lowered because of budgetary concerns, the overall level of
patient care is unavoidably reduced.

• c. Workload
• Individual nurse manager workload and overall medical workload are
issues in leadership. The medical profession is one that never sleeps
and has an almost constant need for qualified professionals both in
hiring and scheduling. Not only do nurse professionals work long
hours and many days per week, but nurse managers and leaders are
also faced with an ever-increasing workload. Dealing with patient
concerns, providing training and support to nurses, and acting as

a liaison between doctors, nurses and medical administration members can
be taxing and stressful. Many nurses are unwilling to enter into the nurse
management field because of the added stress and responsibility. When you
add to all that the secondary stresses of budgetary cutbacks and fewer nurse
leadership roles, it means that existing nurse managers are faced with
enormous challenges when it comes to balancing their leadership functions.
• d. Issues regarding malpractice in nursing management
• Issues of delegation and supervision
• The failure to delegate and supervise within acceptable standards of
professional practice.
•

• Issues related to staffing
• Inadequate accreditation standards- adequate number of staff
members in a time of advancing patient activity and limited
resources.
• Inadequate staffing, i.e. short staffing.
• Floating staff from unit to unit.

• e. Ethics
• Nurses are held to a high standard of ethics when it comes to
patients, co-workers and themselves. They provide care, promote
human rights and values, and help meet the needs of the less
fortunate and vulnerable. A major ethical goal is to also keep patients'
information confidential, and this includes not discussing patients in
public places. Another ethical issue is protecting patients from
negligent co-workers who may endanger them. The individual nurse
must not endanger the patient and has to be accountable to the
standards of the field.

• f. Effect
• Effects of reform, shortages, ethics and salaries are issues that keep
nurses constantly thinking, growing and changing. Nursing instructors
make far less money than nurses in the clinical setting. They also
make less than other educators in different fields. In order for nursing
to succeed, there needs to be qualified candidates educated, but with
these low salaries nurses are not flocking to this career path. Without
these types of nurses being adequately filled then qualified
candidates will not have the opportunity to be taught. These salaries
need to be increased, and colleges and universities need to see the
value in these instructors.

• g. Issues in Nursing Curriculum Development
• Where are we now?
• As nursing faculty we need to answer the question and analyze the
present situation which means the validation of curriculum or
judgemental process in which an attempts is to be made to describe a
degree of worth or value to a curriculum in the context of
professional education and preparation of participants for their
professional role.

• Where we want to go?
• This deals with the thinking and aspiration for future. Faculty must
think whether the educational program what is designed will help to
meet the expectations of individuals, families and communities in
accordance far with the developed countries or not.
• What we want to achieve?
• Nurse educators must be able to analyze and think critically that we
are preparing the students with the adequate skills to perform their
expected roles in all the three domains of professional tasks such as
practical, communication and intellectual skills according to the
institutional goals and educational objectives. The three types of skills
to be achieved:-

• Domain of attitudes (communication skills)
• For example, feelings, values and interpersonal relationships
• Domain of practical skills
• Domain of intellectual skills
• For example, Interpretation of data and problem solving.

• How can we achieve?
• h. Collaboration issues
• The nursing profession is faced with increasingly complex health care
issues driven by technological and medical advancements an ageing
population, increased numbers of people living with chronic disease,
and spiraling costs. Collaborative partnerships between educational
institutions and service agencies have been viewed as one way to
provide research which ensures an evolving health care system with
comprehensive and coordinated services that are evidence- based,
cost – effective and improve health care outcomes. These
partnerships also ensure the continuing development of the
professional expertise necessary to meet these challenges.

• C. EMPLOYMENT ISSUES
• a. Issues related to Nursing Shortage
•
• The nursing shortage is another international event. Why is there a nursing
shortage? There are many opinions regarding that question. I have been a
nurse long enough to recognize that nursing shortages wax and wane. This
shortage is more noticeable, however and it is lasting longer. The nurse
shortage itself is a contributing factor because the shortage creates staffing
problems, mandatory overtime, and constant calls for additional shift
work. National nursing organizations are making strong efforts at stopping
the shortage by mandating better nurse- to-patient ratios, eliminating
mandatory overtime, and increasing salaries and benefits for nurses.

• B Issues in Nurse Migration
• Nurse migration has attracted a great deal of political as well as media
attention in recent years. The rights to healthcare as well as workers‘ rights
are paramount to understanding the interests of health sector
stakeholders, including the consumer or patient, In this section a discussion
on the right to work and the right to practice is, by necessity, followed by a
warning that cases of exploitation and discrimination often occur when
dealing with a vulnerable migrant population. Additionally, international
migration policy issues addressing the somewhat conflicting sets of
stakeholders' rights are presented, and ethical questions related to nurse
migration are noted.
•

• c. The Right to Work and the Right to Practice Professionally active
nurses are important players in an increasingly competitive and global
labor market. Unable to meet domestic need and demand, many
industrialized countries are looking abroad for a solution to their
workforce shortages; the magnitude of current international
recruitment is unprecedented (ICN, 2005). For nurses to practice their
profession internationally, they need to meet both professional
standards and migration criteria. The right to practice, e.g., to hold a
license or registration, a professional criteria, and the right to work,
e.g. to hold a work permit, a migration criteria, are sometimes linked.
Yet they often require a different set of procedures with a distinct set
of competent authorities.

• d. Exploitation and Discrimination One of the most serious problems
migrant nurses encounter in their new community and workplace is that of
racism and its resulting discrimination (Chandra & amp; Willis, 2005).
Incidents are, however, often hidden by a blanket of silence and therefore
difficult to quantify (Kingma, 1999). Migrant nurses are frequent victims of
poorly enforced equal opportunity policies and pervasive double
standards. Some migrant nurses are experiencing dramatic situations on
the job where colleagues purposefully misunderstand, undermine their
professional skills, refuse to help, and sometimes bully them, thus
increasing their sense of isolation (Allan & amp; Larsen, 2003; Hawthorne,
2001; Kingma, 2006). If we recognize that international migration will
continue and probably increase in coming years, the protection of workers
is a priority issue and should be safeguarded in all policies and practices
that affect migrant health professionals.

• Essential Terms and Conditions in an Employment contract
•
• An employment relationship has traditionally been governed by the
terms and conditions of the employment contract. Previously, the
employer retained sole control in respect of the terms and conditions
of employment to be incorporated into the employment contract.
However, over the years there has been an increase in the implied
terms and conditions which are also read into the contract.
Additionally, then there are the statutory terms and conditions which
also apply.

• f. Unsatisfactory work performance and termination of employment
• The Courts have time and again reiterated that employees enjoy security of
tenure of employment. The maxim "easy to hire difficult to fire" is a truism
even in the case of probationers. No employer having hired a person at
considerable cost and having exposed the person to training, formal or
otherwise, will want to terminate the person. However, when an employee
has an attitude problem or whose work performance is not up to the
expectations he cannot be terminated by the employer simply by invoking
the termination clause in the employment contract. The employer has to
follow certain rules and procedures and only at the end of it can he
terminate the services of a non-performing employee. Even then, there are
no iron clad assurances that the termination will not be challenged by the
employee at the

• g. Misconduct and imposition of punishment
•
• It has long been held that the employer has the inherent right to discipline his workers.
Should misconduct be committed, the employer after a proper inquiry has been
instituted can impose a suitable punishment, including dismissal if the offence
committed was of a serious nature. The decision on the type of punishment to be
imposed is under all circumstances a subjective one. The Courts will interfere if, among
others, the action taken by the management was perverse, baseless or unnecessarily
harsh or was not just or fair. There have been occasions where employers have imposed
the punishment of dismissal for misconduct which they have assessed as serious but
these cases have been reviewed by the Industrial Court and the decision of the employer
substituted. Given that imposition of punishment is a subjective matter, what factors or
criteria should an employer apply in determining appropriate punishment for misconduct
committed in employment. This talk, among others, will examine some of the issues to
be taken into account.

• i. Sexual harassment at the workplace
• Sometime ago this subject matter received a great deal of attention especially
with the launching of the Code of Practice on the Prevention and Eradication of
Sexual Harassment at the workplace by the Ministry of Human Resources.
However, the response to the adoption of the Code by employers was not
encouraging. Some NGO's have called for the introduction of statutory measures
to deal with the problem. Some recent judicial pronouncements appear to make
it difficult to prove sexual harassment had indeed taken place. Regardless of all
these what is the proper attitude that ought to be taken by employers in this
matter. Do employers have a legal responsibility to safeguard their employees
from sexual harassment at the workplace? To what extent can employers dictate
without being accused of encroachment into a person's private life and social
interaction. How is an employer to deal with sexual harassment cases and what
standard of proof is called for when usually harassments are .private and
confidential incidents'.

• j. Renewal of nursing registration
•
• So that registration office is updated with nurses in practice. Of
course re- registration may qualify its periodicity and qualifications of
nurses e.g. clinical experience, attendance at continuing education
etc.
• k. Diploma vs degree in nursing for registration to practice nursing
This issue need indepth study of merits and demerits as well as its
feasibility before it could come on the surface.

• l. Specialization in clinical area
•
• It could be either through clinical experience or education. Specialization in
cure and specialized care required for patients demand that nurses be
highly skilled in the unit. Generalization of care seems remote and
unacceptable for patients under specialized treatment.
• m. Nursing care standards
•
• Standards must be laid down and followed so that clients understand the
quality of care expected from the nurses.

• D. MEDICO LEGAL ISSUES
•
• Nurses face legal issues daily. Those issues may be in connection to
negligence, administering medication and advocating for the patient.
The Nurse Practice Act lists all of the duties and role of a nurse,
except the legal and ethical issues. If these duties and regulations are
not followed, the nurse is at risk of losing his license and facing a
malpractice suit.
• a. Legal Issues Specific to Nursing

• Duty to seek Medical Care for the patient
•
• It is the legal duty of the nurse to ensure that every patient receives
safe and competent care. The nurse cannot guarantee the patient will
receive medical care that the nurse be a strong advocate for the
patient and use every resource to ensure medical care is received. If
you determine that a patient in any setting needs medical care, and
you do not do everything within your power to obtain that care for
the patient, you have breached your duty as a nurse.

• Confidentiality
• It is a privilege to care for other people. At times, your patients will
relate to you in a personal way. One of the outcomes of your
relationship is that you may be told information of a personal
nature.in addition to what a patient may share with you, you have
access to the person‘s hospital records. The law requires you to treat
all such information with strict confidentiality. This is also an ethical
issue. Unless a patient has told you something that indicates danger
to self or others, you are bound by legal and ethical principles to keep
that information confidential.

• Permission to treat
•
• When people are admitted to hospitals, nursing homes, and home health
services, they sign a document that gives the personnel in the organization
permission to treat them. Every time the nurse provides nursing care to person,
however, permission must be obtained. The courts have ruled that people are
expected to have some understanding of basic care, which means the nurse
should explain briefly what he or she is about to do. The concept of permission to
treat should be in your mind as you give nursing care. For example, most
personnel who pass food trays automatically ask, ―Are you ready to go for a walk
now? These automatic questions actually are permission to treat questions.
When you are giving medication, you may say, ―Here are your pills,‖ Here is the
new medication the doctor ordered for you.‖ If the patient takes the medication,
he or she has given you permission to treat.

• Informed consent
•
• The concept of permission to treat is closely tied to the concept of
informed consent. The law states the persons receiving health care
must give permission to treat based on informed consent. The
principle of informed consent states that the person receiving the
treatment fully understands the possible outcomes, alternatives to
treatment, and all possible consequences. The physician is
responsible for obtaining informed consent for medical procedures,
such as surgery, whereas the nurse is responsible for obtaining
informed consent for nursing procedures.

•
Negligence
• The law requires nurses to provide safe and competent care. The
measure of safe and competent care is the standards of care. A
standard of care is the level of care that would be given by a
comparable nurse in a similar situation. Negligence occurs when a
person fails to perform according to the standards of care or as a
reasonably prudent person would perform in the same situation. It is
the responsibility of the nurse to monitor the patient. If a patient calls
for a nurse to come and assist him in going to the restroom for
example, the nurse is to assist, or if the is busy with another patient,
have another nurse assist the patient. Ignoring the patient or
responding after a lengthy delay could be considered negligence, and
if the patient is hurt from trying to move himself, the nurse could face
legal suits. Also, it could be considered negligence if a physician
orders the nurse to administer a prescription, and the nurse did not
do so.

• Malpractice
• Malpractice is a term used for negligence. Malpractice specifically
refers to negligence by a professional person with a license. You can
be sued for malpractice once you have your LPN license. If you are a
nursing assistant right now, you may be negligent, but it wouldn‘t be
malpractice because you are not licensed.

• Fraud
•
• Few cases of fraud exist in nursing, but it does need to be mentioned.
Fraud is a deliberate deception for the purpose of personal gain and
usually is prosecuted as a crime. Most courts are harder on cases of
fraud compared with cases of negligence or malpractice because
fraud is deliberate and results in personal gain.
• Assault and Battery
•

• False Imprisonment
•
• Preventing movement or making a person stay in a place without
obtaining consent is false imprisonment. This can be done through
physical or non physical means. Physical means include using
restraints or locking a person in a room .

• Invasion of privacy
• Clients have claims for invasion of privacy‘, e.g. their private affairs,
with which the public has no concern, have been publicized. Clients
are entitled to confidential health care. All aspects of care should be
free from unwanted publicity or exposure to public scrutiny. The
precaution should be taken sometimes an individual right to privacy
may conflict with public‘s right to information for e.g. in case of
poison case.

• Nurse Practice Act
• Each state has what is called a Nurse Practice Act. The guidelines and
laws outlined in the act pertain to all nurses who are licensed in that
particular state. Nurse limitation is one of those laws. Each nurse has
a limitation on what he is allowed and trained to do. He must follow
the chain of command, especially with the care of a patient. If he
does not have the authority or knowledge to give a prescription,
analyze a lab report, or advise the patient on treatment, he may not
legally do so. Any wrong information or practice he commits is
punishable by the law and the patient or family may file a suit against
him and the health agency or hospital he works for.

• Administering Medication
• Nurses are responsible for administering the correct doses and medications
to patients. If the nurse gives a fatal dosage amount, she may face legal
malpractice suits. It is also the responsibility to research the patient's
records, or ask the patient and family members if there are any allergies or
complications that may pose a risk if a certain medication is administered.
• Rights to Privacy
• The nurse is responsible for keeping all patient records and personal
information private and only accessible to the immediate care providers,
according to the Health Insurance Portability and Accountability Act of
1996 (HIPAA). If records get out or a patient's privacy is breached, the
liability usually lies on the nurse because the nurse has immediate access
to the chart.

• Document, It is the nurse's responsibility to make sure everything
that is done in regards to a patient's care (vital signs, specimen
collections, noting what the patient is seen doing in the room,
medication administration, etc.), is documented in the chart. If it is
not documented with the proper time and what was done, the nurse
can be held liable for negative outcomes. A note of caution: if there
was an error made on the chart, cross it out with one line (so it is still
legible) and note the correction and the cause of the error.

• BAJAJ COMMITTEE, 1986 An "Expert Committee for Health
Manpower Planning, Production and Management" was constituted in
1985 under Dr. J.S. Bajaj, professor at AIIMS. Manpower is one of
the most vital resources for the labour intensive health services
industry. Health for all (HFA) can be achieved only by improving the
utilization of these resources

Major recommendations are:
• Formulation of national medical and health education policy.
• Formulation of national health manpower policy.
• Establishment of an educational commission for health sciences (ECHS)
under UGC.
• Establishment of health science universities in various states and union
territories.
• Establishment of health manpower cells at center and in the states.
• Vocationalization education at10+2 level as regards health related fields
with appropriate incentives, so that good quality paramedical personnel
may be available in adequate numbers.
• Carrying out a realistic health manpower survey

• In relation to nursing, the Bajaj Committee recommended staffing
norms for nursing manpower requirements for hospital nursing
services and requirements for community health centers and primary
health centre’s on the basis of calculations as follow:
•
• Hospital Nursing Services-
• 1. Nursing superintendents. 1:200 beds
• 2. Deputy nursing superintendents ` 1:300 beds
• 3. Departmental nursing

• 4. Ward nursing 8:200 + 30% leave reserve
• supervisors/sisters
• 5. Staff nurse for wards 1:3 (or 1:9 for each shift)
• +30 leave reserve
• 6. For OPD, Blood Bank, X-ray, 1:100 (1:5 OPD)
• Diabetic clinics etc +30% leave reserve
• 7.For intensive units 1:1 (1:3 for each shift)
• beds ICU + 30% leave reserve

• Community Nursing Service
• Projected population - 991,479,200 (medium assumption) by 2000
AD
• 1 Community Health Centre - 1,000,00 population
• 1 Primary Health Services - 30,000 population in plain area
• 1 Primary Health Services - 20,000 population in difficult areas
• 1 Sub-centre - 5000 population in plain area
• 1 Sub-centre - 3000 population for difficult area

• It also requires nursing manpower to cater to the needs of the rural community as
follows:
• Manpower requirements by 2000 AD:
•
• Sub-centre ANM/FHW 323882
• Health supervisors /LHV 107960
• Primary Health Centres PHN 26439
• Community health centre Nurse-midwives 26439
• Public health nursing supervisor 7436
• Nurse-midwives 52,052
• District public health nursing officer 900
• In additional to the above, 74361 Traditional Birth Attendants will be required

• NURSING EDUCATION Nursing education to be fitted into national stream of
education to bring about uniformity, recognition and standards of nursing
education.
• The committee recommends that;
• 1. There should be 2 levels of nursing personnel - professional nurse (degree
level) and auxiliary nurse (vocational nurse). Admission to professional nursing
should be with 12 yrs of schooling with science. The duration of course should be
4 yrs at the university level. admission to vocational /auxiliary nursing should be
with 10 yrs of schooling .The duration of course should be 2 yrs in health related
vocational stream.
• 2. All school of nursing attached to medical college hospitals is upgraded to
degree level in a phased manner.
• 3. All ANM schools and school of nursing attached to district hospitals be
affiliated with senior secondary boards.

• 4. Post certificate B.Sc. Nursing degree to be continued to give
opportunities to the existing diploma nurses to continue higher
education.
• 5. Master in nursing programme to be increased and strengthened.
• 6. Doctoral programme in nursing have to be started in selected
universities.
• 7. Central assistance be provided for all levels of nursing education
institutions in terms of budget( capital and recurring)
• 8. Up gradation of degree level institutions be made in a phased
manner as suggested in report.

• 9. Each school should have separate budget till such time is phased to
degree/vocational program. The principal of the school should be the
drawing and the disbursing officer.
• 10. Nursing personnel should have a complete say in matters of
selection of students. Selection is based completely on merit.
Aptitude test is introduced for selection of candidates.
• 11. All schools to have adequate budget for libraries and teaching
equipment's.
• 12. All schools to have independent teaching block called as School Of
Nursing with adequate class room facilities, library room, common
room etc. as per the requirements of INC.

legal issue in nursing.

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