This document discusses legal and professional issues for nurses. It covers what defines a profession, codes of ethics, sources of law including statutes, regulations, and court decisions. It discusses intentional torts like assault, battery, defamation and negligence. Nurses must follow legal requirements, document properly, maintain patient privacy, obtain informed consent, and administer medications correctly to avoid liability. Professional regulation includes licensure, certification, and following the nurse practice act. Common challenges include staffing, relationships, safety, technology advances and maintaining certifications.

1. LEGAL &
PROFESSIONAL ISSUES
DR. MAHESWARI JAIKUMAR.
maheswarijaikumar2103@gmail.com

2. What makes a nurse
professional?

3. • Extended education.
• Theoretical body of knowledge.
• Provide a specific service.
• Autonomy in decision making and
practice.
• Code of ethics.

4. PROFESSIONAL CODE OF
ETHICS
• Professional code of ethics is
statements encompassing rules
that apply to persons in
professional role .
• There are some professional ethics.

5. 1. Professional etiquette good
manners based on loyalty.
2. Knowing the lines of authority
and responsibility.

6. 3. Each person should be treated
with dignity.
4. When death occurs, they need
empathy, support and
understanding. More practice is
needed in an isolated area.

7. 5. Should know what others are
doing and be faithful in supporting
each other.
6. Coordinate with all.
7. Have partnership and cooperate
with physician.

8. 8. Good communication based on
giving and receiving.
9. The nurse relates in the
community as a worker and to
improve health standards.

9. • Nurses are more accountable
than ever to the public, patients,
their employers and the
profession and it is vital that
they have a clear understanding
of the legal, ethical and
professional dilemmas they will
face in the course of their
professional career.

10. WHAT IS A LAW?
• Laws are “rules of conduct,
established and enforced by
authority, which prohibit extremes
in behavior so that one can live
without fear for oneself or one’s
property”.
- By Sullivan and Decker, 2001

11. IMPORTANCE OF LAW TO
THE NURSE
• Nurses have more responsibility.
• Increased numbers of Advanced
Practice Nurses.
• Law is there to assist in the
decision-making process involved
in nursing practice.

12. • Law is there for the protection of
nursing practice.
• Law is there for the
identification of the risk of
liability.

13. HOW TO PROTECT
YOURSELF
1. Know your state laws affecting
Nursing practice.
2. Follow your state’s Nurse
practice act rules &regulations.

14. 3. Deliver safe, competent Nursing
care.
4. Develop & use your critical
thinking abilities & skills.

15. SOURCES OF LAW
• 1. THE CONSTITUTION: It is a
system of fundamental laws or
principles that governs a nation
or society.

16. 2. STATUTES
laws that govern. It is enacted by
the legislative body or legislative
law. Laws passed by council or
parliament. For example, nurse
practice act.

17. 3. ADMINISTRATIVE
AGENCIES
The rules and regulations
established by executive branch
of the government executive
officers, mayors are responsible
for law enforcement. For
example, INC, Board of Nursing
State/ Central level.

18. TORT LAW OR COURT
DECISION
• Judicial and decisional laws are
made by the court to interpret
legal issues. Court decisions can
be changed, but only with strong
justifications.

19. TYPES
• 1. Criminal law
• 2. Civil law
• 3. Administrative law

20. CRIMINAL LAW
• Nurses found guilty of
intentionally administering fatal
dozes of drug to the patients.

21. CIVIL LAW
• One individual sues another for
money to compensate the loss.

22. ADMINISTRATIVE LAW
• An individual issued by a state
board or council in violation of
the nurse practice act.

23. • It is violation punishable by the
state. It is a wrong against a
person or her property.

24. TYPES OF CRIME
• FELONY: punishable by
imprisonment for more than 1
year.
• MISDEMEANOR: less serious crime
punishable with fines
imprisonment for less than 1 year.

25. • It is a wrong committed by a
person against another person or
his or her property.

26. INTENTIONAL TORT
• The act was done on purpose or
with intent.
• Assault
• Battery
• Invasion of Privacy
• Defamation of character

27. UNINTENTIONAL TORT
• Torts:Do not require
intent,but require an
element of harm.
Malpractice
Negligence

28. INTENTIONAL TORTS
• ASSAULT: it is a threat or an
attempt to make bodily contact
with another person without
that person consent.

29. • BATTERY: it is an assault that is
carried out and includes every
willful angry and violent or
negligent touching of another
person’s body or clothes.

30. EXAMPLE :
• Forcibly removing patient’s
clothes.
• Administering injection after the
patient has refused it.
• Pushing a patient into the chair.

31. DEFAMATION
It is an intentional tort makes
offensive remarks about another.

32. TYPES OF DEFAMATION
Slander: oral defamation of
character.
Libel: written defamation (petition.)
For example, about patient or co-
workers.

33. INVASION OF PRIVACY
• All information about patient is
considered to be private or
confidential,whether written on
paper,saved on a computer,or
spoken aloud.

34. • All information should be
confidential .
• Interacting with family members.
• Avoid unnecessary exposure.

35. FALSE IMPRISIONMENT
• A person cannot be legally
forced to remain in health
centers or hospital (unjustified
intention).

36. FRAUD
• Willful and purposeful
misrepresentation that could
cause or has caused, loss or
harm to a person or property.

37. UNINTENTIONAL TORTS
• Unintentional torts are referred
to as negligence.
• A nurse who fails to initiate
proper precautions to prevent
patient harm is subject to the
charge of negligence.

38. NEGLIGENCE
• An act of negligence may be enact of
omission or commission.

39. EXAMPLE
• Not properly identifying a
patient.
• Performing an unfamiliar
procedure
• Medication errors.
• Failure to use aseptic technique.

40. MALPRACTICE
• Is the term generally used to
describe negligence by
professional personnel.

41. • 1.When harm results from
professional misconduct.
• 2.Unreasonable lack of skills.
• 3.Illegal or immoral conduct.

42. 8 COMMON NEGLIGENCE
ACTS
• Failure to assess and monitor.
• Failure to notify the health care
provider of problems.

43. • Failure to follow orders.
• Failure to follow the 10 rights of
medication administration.
• Failure to convey discharge
instructions.

44. • Failure to ensure safety.
• Failure to follow policies and
procedures.
• Failure to properly delegate and
supervise.

45. LIABILITY
• It involves four elements that
must be established to prove
that malpractice or negligence
has occurred.

46. 1.DUTY AND DOCUMENTATION
• Refers to an obligation to use
due care.
• Eg: execution of safety
measures.

47. BREACH OF DUTY
• Failure to meet standard care.
Ex.failure to note and report to
higher authority about the
seriousness.

48. CAUSATION
Failure to meet the standard of
care actually caused the injury.
Eg: failure to use appropriate
safety measures.

49. DAMAGES
Damages are the actual harm or
injury resultingto the patient.
Eg:lengthened hospital stay and
need for rehabilitation.

50. COMMON CAUSES OF
LEGAL ISSUES
• Professional negligence e. g.
ignoring the seriousness.

51. • Practicing medicine without
license in community.
• Obtaining nursing license by
fraud or allowing others to use
your license Felony conviction
for any offence.

52. • Practicing medicine without
license in community.
• Obtaining nursing license by
fraud or allowing others to use
your license Felony conviction
for any offence.

53. • Providing patient care while
under the influence of alcohol or
drugs.
• Giving narcotics without an
order.

54. • Falsely holding oneself as family
practitioner or nurse
practitioners.

55. PROFESSIONAL AND LEGAL
REGULATION OF NURSING
PRACTICE
• Every state has ‘’ Nurse Practice
Act’’ that protects the public
define the legal scope.

56. NURSE PRACTICE ACT
• Nurse Practice Act- violation
of rule can result in
disciplinary action.

57. GUIDELINES
Guidelines issued by councils-
qualification, standards, rules and
regulation.
E.g. unrecognized courses.

58. CREDENTIALING
• The ways in which professional
competence is ensured and
maintained.

59. PROCESS OF
CREDENTIALING
• ACCREDITATION.
• LICENSURE.
• CERTIFICATION.

60. ACCREDITATION
• Education program is evaluated
and recognized by National
Accreditation Board.

61. LICENSURE
• The state determines certain
requirement to practice as nurse.
(e.g. negligence, malpractice,
wrong treatment and
alcoholism)

62. CERTIFICATION
• Entry level competence. Specific
knowledge and experience in
specified areas needed. All the
certificates cannot be registered
(e.g. nursing asst course.)

64. Remember !
• 1. Signatures Are Golden
• 2. Documentation
• 3. Report It or Tort It
• 4. Rights to Privacy
• 5. You’re doing WHAT?

65. SIGNATURES ARE GOLDEN
• When a physician or other
health care provider orders a
procedure be done to a patient,
it is the nurse’s responsibility to
obtain an informed consent
signature.

66. PURPOSES OF INFORMED
CONSENT
• An agreement by the patient to
accept treatment or procedure
after receiving complete
information.

67. • It is the fundamental right of the
client and is based on the
principle of autonomy.

68. ELEMENTS OF INFORMED
CONSENT
• Consent must be voluntary.
• Must be obtained prior to
treatment.
• Patient must be competent with
capacity to understand.

69. • Patient has the right to withdraw
consent at any time.
• The nurse witnesses signature
only and must establish patients
understanding the procedure
and the alternative options.

70. • Has had a chance to ask the
provider any questions about
the procedure.
• Understands the risks and
benefits of the procedure.

71. • Chooses to sign or not sign to
have the procedure performed.
• If the nurse does not obtain
signatures, both the nurse and
the operating provider can be
held liable for damages incurred.

72. DOCUMENT.. DOCUMENT..
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.

73. • If it is not documented with the
proper time and what was done, the
nurse can be held liable for negative
outcomes.

74. • 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.

75. HELPFUL HINT -
DOCUMENTATION
Are all entries legible ?
Are there grammatical or
spelling errors ?

76. Are entries signed correctly ?
Are entries dated and timed ?
Is the chart free of erasures
and other alterations ?
Are known allergies
highlighted ?

77. REPORT IT OR TORT IT
•Allegations of abuse are
serious matters.

78. • It is the duty of the nurse to
report to the proper authority
when any allegations are made
in regards to abuse (emotional,
sexual, physical, and mental)
towards a vulnerable population
(children, elderly, or domestic).

79. • If no report is made, the nurse is
liable for negligence or
wrongdoing towards the
victimized patient.

80. 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).

81. • 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.

83. • Name cannot be posted on room
door.
• Charts must be kept in
secure,non public location

84. • Printed copies of protected health
information should not be left
unattended in a printer, fax or on
counter top.
• Access to protected health
information should be limited to
only those authorized to obtain it.

85. YOU ARE DOSING WHAT ?
• Medication errors account for
7,000 deaths and 770,000
patients injured each year in the
US.

86. • Nurses are responsible for
administering medications
within their scope of practice
and individual competence and
should be knowledgeable about
the effects,side effects and
interactions of medications and
take necessary actions.

87. It is the nurse’s
responsibility to follow the
10 “rights” of medication
administration:

88. • Right patient.
• Right dose.
• Right drug.
• Right route.
• Right time.

89. • Right documentation.
• Right history and assessment.
• Drug approach and Right to
refuse
• Right drug-drug interaction and
evaluation.
• Right education and information.

90. • If a nurse pays attention to those
details, the likelihood of a
medication error is greatly
reduced, thereby saving the
nurse and health care institution
from liability for damages.

91. 6 WAYS TO MINIMIZE
LIABILITY
• Delegate appropriately.
• Protect patient from injury.
• Report all incidents
• Always document/know any order
that is questioned
• Know own strength and weaknesses
• Maintain clinical competencies.

92. LEGAL SAFEGUARDS FOR
THE NURSE
• Executing Informed consent or
refusal
• Contracts
• Collective bargaining

93. • Competent practice
• Patient education
• Executing physician orders
• Documentation.
• Adequate staffing
• Professional liability insurance
• Risk management program .

94. LEGAL ROLE OF NURSE
• Provider of Service.
• Ensure that client receives
competent, safe, & holistic care.

95. • Render care by “standards of
reasonable, prudent person”.
• Supervise/evaluate that which has
been delegated.
• Documentation of care .
• Maintain clinical competency.

96. COMMON PROBLEMS IN
NURSING
• STAFFING
As healthcare costs increase,
decreasing the number of staff
nurses is often seen as the
logical way to combat it.

97. • Inadequate staffing and/or
increased job responsibilities both
cause problems and stress for
nurses. This is especially true for
those staff nurses facing a variety of
patient acuities.
• In response, some states have
adopted legislation to mandate a
fixed nurse-to-patient ratio.

98. INTER-PROFESSIONAL
RELATIONSHIPS
• Conflicting views and feeling that
you are being disrespected often
cause problems.

99. • These conflicts in nursing
relationships can arise between
nurse and their patients, their
co-workers, partner physicians,
and/or administrators.

100. PATIENT SATISFACTION
• Nurses are already stretched too
thin to accommodate staffing
issues.

101. • But patients still have needs and
expectations. Unfortunately,
meeting these are difficult.
• This is especially true as
healthcare conditions become
more chronic, and the number of
personnel decreases.

102. ON JOB HAZARDS & SAFETY
• Overflowing sharps containers
and slippery floors can pose risks
for staff members.
• Similarly, lifting heavy patients
can pose a physical challenge.

103. • And since we do work with those
patients who are “sick,” there is
a likelihood of contracting their
illness.
• These hazards also include the
behavior of other people.

104. • In some cases, nurses report
feeling threatened by angry
patients. That lack of respect
and/or verbal abuse may also
come from administrators,
physicians, and other members
of the care team.

105. MANDATORY OVERTIME
• There are also cases when nurses
have to go on mandatory
overtime.
• This can be the result of
insufficient staffing levels and/or
high patient acuity.

106. “ASK THE NURSE”
• We don’t know everything about
healthcare and related diagnoses
simply because we are nurses.

107. • However, friends and family still
feel free to call us at any given
hour to ask our perspective on a
symptom or prescribed
medication, just because we are
in the nursing profession.

108. PATIENT RELATIONSHIPS
• It is easy to develop a close
relationship with our patients.

109. • When that patient struggles or
even dies, we feel their pain and
we feel that loss.
• So maintaining a healthy,
professional relationship with
the patient is a must.

110. ADVANCES IN TECHNOLOGY
• As technology advances, so do
our career roles.

111. • For example, with the growth of
the Internet and smartphones,
our roles and duties have
changed. Documentation and
databases are now mostly
electronic.
• As professionals, keeping abreast
with these advances is essential.

112. CERTIFICATION
• Demonstrations of competence
are a must. Maintaining
continuing education hours and
related certifications are often
required.

113. • And while these equate to safer
patient care that adhere to best
practices, maintaining the
required certifications are often
overwhelming when you’re
juggling a full-time position and
personal responsibilities.

115. • For the nurse in a traditional
medical setting, ethical decisions
occur occasionally and at times
the nurse may face ethical
dilemmas.

116. • In contrast, the correctional nurse
may face ethical situations daily.
• The correctional nurse makes
ethical decisions about care
delivery, caring and patient
advocacy in planning and providing
safe patient care.

117. ETHICAL PRINCIPLES
• There are six ethical principles
that arise frequently for the
nurse who works in the
correctional setting.

118. • 1. Respect for persons (Autonomy
and self-determination).
2. Beneficence (Doing good).
3. Nonmaleficence (Avoiding
harm).

119. • 4. Justice (Fairness, Equitability,
Truthfulness).
5. Veracity (Telling the truth).
6. Fidelity (Remaining faithful to
one’s commitment).

120. Providing Safe, compassionate,
competent and ethical care

121. ETHICAL RESPONSIBILITIES
• Nurses engage in compassionate
care through their speech and
body language.

122. Nurses build trustworthy
relationships as the foundation of
meaningful communication.
Nurses question and intervene to
address unsafe, non- compassionate,
unethical or incomplete practice or
conditions that interfere with their
ability to provide safe care.

123. Nurses admit mistakes’ and take all
necessary actions to prevent or
minimize harm arising from an
adverse event.
Nurses planning to take job action or
practicing in environments where
action occurs take steps safeguard the
health and safety of people.

124. • Nurses support, use and engage
in research and other activities
that promote safe, competent.
• Nurses work to prevent and
minimize all forms of violence
by anticipating and assessing
the risk of violent situations.

125. • During a natural or human-
made disaster, including a
communicable disease
outbreak, nurses have a duty to
provide care using appropriate
safety precautions.

126. PROMOTING HEALTH &
WELLBEING
• Nurses provide care directed
first and foremost toward the
health and well- being of the
person, family, or community in
their care.

127. • When a community health
intervention interferes with the
individual rights of persons
receiving care, nurses use and
advocate for the use of the least
restrictive measures.

128. • Nurses collaborate with other
health- care providers and other
interested parties to maximize
health benefits to person
receiving care, skills and
perspectives of all.

129. PROMOTING & RESPECTING
INFORMED DECISION MAKING
• When family members disagree
with the decisions made by a
person with health- care needs,
nurses assist families in gaining
an understanding of the person’
decisions.

130. • Nursing respect the informed
decision- making of capable
persons, including choice of
lifestyles or treatment not
conductive to good health.

131. • When illness or other factors
reduce a person’s capacity for
making choice , she must assist
him to participate in making
choice appropriate to their
capability.

132. • Nurses along with other health-
care professionals with
substitute decision- makers,
consider and respect the best
interests of the person receiving
care.

133. PRESERVING DIGNITY &
INTRINSIC WORTH
• Nurses in their professional
capacity, relate to all persons
with respect.

134. Nurses support the person, family,
group, community receiving care in
maintaining their dignity and
integrity.
The nurse must take into account
their unique values, customs and
spiritual believes & social and
economic case.

135. Nurses respect the physical
privacy of persons by providing
care in a discreet manner and by
minimizing intrusions.
When providing care, nurses
utilize practice standard, best
practice guidelines and policies
concerning restraint usage.

136. • Nurses maintain appropriate
professional boundaries and ensure
their relationship are always for
the benefit of the persons they
serve.
• In all practice settings, nurses
work to relieve pain and suffering
by pain management, to allow
persons to live with dignity.

137. When a person receiving care is
terminally ill or dying, nurses
foster comfort, alleviate suffering,,
support a dignified and peaceful
death.
Nurses treat each others in a
respectful manner.

138. MAINTAINING PRIVACY &
CONFIDENTIALITY
• Nurses respect the right of
people to have control over the
collection, use, access and
disclosure of their personal
information.

139. • When nurses are conversing
with persons receiving care,
they take reasonable measures
to prevent confidential
information in the conversation
from being overheard.

140. • When nurses are required to
disclose information for a
particular purpose, they
disclose only the amount of
information necessary for that
purpose and inform only those
necessary.

141. • When nurses engage in any
form of communication,
including verbal or electronic,
they ensure that their discussion
of persons receiving care is
respectful.

142. • Nurses respect policies that
protect and preserve people’s
privacy, including security
safeguard in information Tech.

143. Nurses do not abuse their access to
information by accessing health-
care records for purposes
inconsistent with their professional
obligation.
Nurses do not use photo or other
technology to intrude into the
privacy of a person receiving care.

145. • Nurses do not engage in any
form of lying, punishment or
any form of unusual treatment
or action that is inhumane or
degrading.

146. • Nurses make fair decisions
about the allocation of
resources under their control
based on the needs of persons,
groups ( provide fair treatment
and for fair distribution of
resources)

147. • Nurses do not engage in any
form of lying, punishment or
any form of unusual treatment
or action that is inhumane or
degrading.

148. • Nurses make fair decisions
about the allocation of
resources under their control
based on the needs of persons,
groups ( provide fair treatment
and for fair distribution of
resources)

149. BEING ACCOUNTABLE
• Nurses as members of a self-
regulating profession, practice
according to the values and
responsibilities in the Code of
Ethics

150. • Nurses practice within the
limits of their competence.
When beyond their level of
competence, they seek
additional information or
knowledge, seek help from their
supervisor.

151. • Nurses are honest and practice
with integrity in all of their
professional interaction.

152. • Nurses maintain their fitness to
practice. If they are aware that they
do not have the necessary physical,
mental or emotional capacity to
practice safely and competently,
they withdraw from the provision of
care after consulting their employer.
Nurses then take the necessary steps
to regain their fitness to practice.

153. • Nurses are attentive to signs that
a colleague is unable to perform
his or her duties ( protect the
safety of persons receiving care).

154. Nurses clearly and accurately
represent themselves with
respect to their name, title and
role.
Nurses disclose actual or
potential conflicts that arise in
their professional roles.

155. THANK YOU