Legal issues in nursing practice

2. About Legal Issues
Rights, responsibilities, scope of nursing practice
As defined by state nursing practice acts
Sources of laws
Sum total of rules and regulations by which a society is
governed
Law made at federal, state, and local levels

3. Figure 47-1 Overview of the sources of law.

4. About Legal Issues, continued
Criminal and civil laws
Address conduct harmful to another individual or
society
May be punishable by fines or imprisonment
Crime
Act prohibited by statute, common law principles
Civil law
Deals with rights and duties of private persons

5. Tort Law
Tort  civil wrong committed against a person or
person’s property
Unintentional torts
Negligence
Professional negligence
Malpractice

6. Professional Negligence or
Malpractice
Five elements:
Duty
Breach of duty
Forseeability
Causation
Injury or harm

7. Professional Negligence or
Malpractice, continued
Related doctrines:
Respondeat superior
Res ipsa loquitur
Statute of limitations

8. Intentional Torts
Assault
Battery
False imprisonment
Invasion of privacy

9. Strategies to Prevent IncidentsMaintain client safety
Falls
Mistaken identity
Minimize risk of medication errors
Apply the Five Rights
 Right drug
 Right dose
 Right client
 Right route
 Right time

10. Strategies to Prevent Incidents,
continued
Use effective communication
Helps decrease risk of bad outcomes
Attentive listening
Accurate documentation and reporting
Professional liability insurance
Nurses should carry to manage personal financial risk

11. Standards of Care
Based on
Nurse Practice Act (NPA)
Administrative rules
Job descriptions
Policies and procedures
ANA

12. Selected Laws
Informed consent
Client’s legal and ethical rights to be informed of, give
permission for procedure, treatment
Client must not be coerced
Client understanding essential
Follow agency’s specific protocols
Competency for consent
Consent in an emergency
Child participation in decision

13. Selected Laws, continued
Controlled Substance Act
Federal law
Good Samaritan laws
Encourage health care providers to help victims in an
emergency
Protects health care workers from potential liability
Nurse responsible for following through with
emergency care

14. Nurse Practice Acts
Nurse Practice Acts (NPAs)
Defines:
 Scope of practice
 Standards for education programs
 Licensure requirements
 Grounds for disciplinary actions
Enforced by state boards of nursing (BON)

16. Figure 47-3 Relationship among the Nursing Practice Act, Administrative Rules, and position/advisory statements.

17. Licensure
Allows nurses legal privilege to practice nursing as
defined by NPA
Each BON oversees administration of a licensure
examination
National Council of State Boards of Nursing
NCLEX-RN®
NCLEX-PN®

18. BONsResponsibilities
Actions against nurses found guilty
Giving false information
Nolo contendere
Conduct that endangers public health
Unfit or incompetent to practice
Engaging in conduct that deceives, defrauds, or harms
the public
2009 NCSBN report www.NCSBN.org.

19. National Council of State
Boards of Nursing
Membership
Functions
Nurse Licensure Compact
Mutual recognition model

20. NPAs
Certification
Federal organizations
Joint Commission
Centers for Medicare and Medicaid Services
Nursing students
Standards of Practice

21. Standards of Nursing Practice
ANA Standards of Nursing Practice
Standards are authoritative statements by which the
nursing profession describes the responsibilities for which
its practitioners are accountable. Standards reflect the
values and priorities of the profession and provide
direction for professional nursing practice and a
framework for the evaluation of this practice. They also
define the nursing profession’s accountability to the public
and the outcomes for which registered nurses are
responsible.
 http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingStan
dards.aspx

22. ANA
Standards of Professional Performance
Quality of practice
Professional Practice Evaluation
Education
Collegiality
Ethics
Collaboration
Research
Resource Utilization
Leadership

23. Professional Nursing Practice
Nurse Practice Acts
Licensure and Certification
Science and Art of Nursing practice

24. Figure 47-4 Impact of laws and standards on the nurse.

25. Advance Directives
Legal document
Expresses an individual’s desires regarding medical
treatment
Patient Self-Determination Act
Types of advance directives
Living will
Durable power of attorney for health care

26. Elements of Advance
Directives
Surrogate decision maker authority to:
Consent to or refuse medical treatment or diagnostic
procedure
Hire or discharge medical providers
Authorize admission to medical and long-term care
facilities
Have access to all medical records
Consent to comfort care, pain relief measures
Any measures to carry out wishes

27. Role of Nurse
Reassure clients and families that they have option to
change their decision
Assess whether clients, families have accurate
understanding of life-sustaining measures
Be supportive of clients’ decisions

28. Health Information and Portability and
Accountability Act
HIPAA
Purposes
Minimizes exclusion of preexisting conditions
Designates special rights for those who lose other health
coverage
Eliminates medical underwriting in group plans
Includes Privacy Rule

29. Protected Health Information
Protected by Privacy Rule:
Individually identifiable health information
Information that identifies individual
Access to medical records
Required notice of privacy practices and opportunity
for confidential communications
Limits on use of medical information
Prohibition of use of personal information for
marketing

30. Privacy vs. Confidentiality
Privacy  right of individuals to keep their personal
information from being disclosed
Confidentiality  the assurance client has that
private information will not be disclosed without
client’s consent

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