Nurses working in hospitals have important legal responsibilities when caring for patients. Nurses are responsible for patient care but sometimes feel frightened by complex medical issues or have inadequate knowledge. They need additional training through their curriculum and refresher courses. Hospital administrators must ensure nurses are properly trained to care for patients safely and in accordance with the law.

1. LEGAL RESPONSIBILITIES OF NURSES
Prof. Dr. Ram Sharan Mehta, BPKHS

2. The wind may blow from
any direction, in which, you
go depends on how you set
the sails.

3. Managing change:
 Reasonable man adapts himself
to world; the unreasonable one
persists in trying to adapt others
to himself. - Peter F Druker
History of Dinosaurs?

4. Errors Due To Human Factors
 Poor Training
 Fatigue
 Staffing level
 Communication
 Distractions
 Punitive culture
Nurses
Many Roles One Profession

5. Importance of Nursing in Hospital Services
Hospital service is a complex service because:
 Diversity of goal
 Verities of employees
 Works 24 hours
 Dowel authority
 Output is difficult to measure
 Quality is difficult to measure
 Public demand increasing
 Hospital deals with life and death
 Difficult to organize and manage.

6.  The World is a book. Every step we
take, opens up a new page for us.
-Lamartine

7. Introduction:
• Hospitalized patients are under
nurses control.
• Nurses are responsible for patient
care.
• Nurses: Frightened with
medicological problems.
• Has inadequate knowledge.
• Needs : Input in curriculum,
refresher course

8. Growing complexity of health care system:
1. Different products and services.
2. Different types of personnel.
3. Work force retention & migration issues.
4. Different stakeholders group.
5. Different modes of health care delivery.
6. Different processes to plan & define priorities.
7. The need for effective communication
8. Advanced technology.
9. Financial constrains.
10. Political influences on health.
11. Increased media intrest in health.

9. Living on the edge:
 Some global & national trends are:
Globalization.
Competition.
Workforce diversity.
Explosion of information & technology.
Economic & social upheaval.
Message, “if survival is the aim, change is the game”
 So, we are “living on the edge”.
 World wise changes:
Collapse =if not adopt change

10. Some basic things you have
to learn to live by:
1. You cannot live with the status quo.
2. You may need to make major changes in
thinking and behaviour.
3. If you keep trying to resist or block major
changes, people may just step ground
you- you become invisible to the people in
power.
4. You must continue to look for opportunities,
even when the issues seem enormous.
5. You must be proactive, not reactive.

11. We have choice.
 Governments have a choice.
 Organizations have a choice.
 Nursing has a choice.
 Nurse leaders have a choice.

12. You must learn to
seek solutions, not
re-define problems

13. If you have the power of positive
thinking…
 You can Face whatever comes
 You stay Light and Easy
 No Worries
 No Confusion
 You take Benefit from all Scenes
 You love Life
 You love People

14. Positive Thinking Demands
that You:
 Create Positive Thoughts
 Resist Negative Thoughts
 Accumulate internal power
 Accumulate determination
 Can say ‘No’ when necessary
 Can say ‘YES’ when necessary

15. Malpractice and Negligence
Malpractice
Negligence

16. The Law
Laws may be thought of as rules of
conduct that guide interactions among
people.

17. Laws RT Nursing and Health
 Muluki Yen (Antarim Sambidhan)
 Swath Sewa Niamabali
 NNC Act
 Abortion Law
 Narcotic Drug Law
 Oragan Transplant Law
 BPKIHS Niamabali
 Quality of Drug Law
 Etc

18. Nurses Facing Difficulties in MLC at BPKIHS
My own Experiences:
 Corrections of documents:in Emg.
 Dead body-OPP-handover to relateves M-2
 Physical assult-verbally told police to hand
over body- court ask for postmortem report-
M-2

19. Medico Legal Cases Nurses has to Care:
 Insurance policy cases.
 Compensations
 Self-Injury.
 Mal-practice suits.
 Will-cases:during hospitalization.
 Criminal cases: murder, disfigurement, rape,
RTA, Burn, poisoning, political cases,Suicide
etc.

20. Difficulties Common in All Wards:
 Problems
:Ad,Dis,TRF,LAMA,absconded,free
process,Death, DDA,Deoisit of
bills,Redeposit,IP Number,visitor
control,security.
 Lacking consent and finger prints in
admission sheet.
 Missing case sheet.
 Communication problem with police, visitors,
doctors and other heath team members.

21. Legal Issues in Specialties
 Community Health
 Emergency Dept.
 Pediatrics
 Medical –Surgical and Geriatrics
 Critical Care
 Operating Room
 Psychiatric
 Home Health

22. IN EMERGENCY UNIT:
 MLC cases brought without relatives.
 False history – attendants.
 MLC stamp-- missing.
 Miss handling of specimens.
 Poor recording and reporting of MLC.
 MLC forms some times not filled by DMO.
 Problems with: uncooperative, alcoholic, suicidal
 Lack of cooperation from police:brought by
police and left in emergency.
 Problem with security:absconded and close
observation.

23. Continue
 Problems With Police:.
 Not available in time.
 Poor communication.
 More verbal response (don’t want to write)

24. In Medical Surgical Wards
 MLC stamp-missing.
 Communication with police.
 Absconded-Lack of security-Nurse
busy.
 Missing documents and reports-MLC.
 Lawaris/dead body-TRF/hand over.

25. In Operation Theater
 High risk consent problem.
 Bill payment and material management.
 O.T.death-no admission register.
 Gyanae O.T.-case sheet sent to bill
counter and patient send to OT with out
case sheet(IP No/ bill/consent.)

26. In Psychiatric Ward
 Visitors not available:-
 - Admission problem.
 -Staff security-violent patient.
 - Patient security-absconded.
 - Restrains

27. In Maternity Ward
 Unmarried mother.
 Criminal abortion.
 Baby – full term- Marriage late.
 Rape.
 Married-abortion-husband out.
False history
privacy
Ethical Legal problem
Human rights
 Blame-baby exchange.

28. Moral and Ethics

29. Values and ethics
 Values and ethics are inherent in all
nursing acts.
 A value is a strong personal belief; an
ideal that a person strives to uphold.
 Your values reflect cultural and social
influences, relationships and personal
needs. Vary among people and develop
and change over time.

30. Six Standards of Nursing Practice
 Accountability
 Continuing Competence
 Application of Knowledge, Skills and Judgment
 Professional Relationships and Advocacy
 Professional Leadership
 Self-Regulation

31. Ethical Principles
 Autonomy
 Nonmaleficence
 Beneficence
 Justice

32. Nursing Practice & the Law
 Nursing practice falls under both public
and civil law.
 Nurses are bound by rules and
regulations stipulated by the nursing
practice act given by NNC and GON.

33. Skillful Communications
 The nurse must communicate accurately
and completely both verbally and in
writing.
 Many malpractice or negligence cases
complain of a lack of communication by
the nurse.

34. Skillful Communications (FLAT)
 F – factual: charting should express what the
nurse sees, not what he or she thinks happened
 L – legible: no erasures; corrections should be
made with a single line drawn through the error
and initialed
 A – accurate: complete (What color was the
drainage and how much was present? How many
times, and at what times, was the doctor notified
of changes?)
 T – timely: completed as soon after the
occurrence as possible; “late entries” should be
avoided or kept to a minimum

35. Legal Safe-guards in
Nursing Practice
 Licensure:valid and current.
 Good Samaritan laws:In emergency.
 Good rapport with client.
 Standards of care:set standards,procedure
manuals.
 Standing orders:better in written than oral.
 Inform consent:Admission,treatment,operation
 Correct identity: Name tag in OT, New born,
dead body.

36. Legal Issues in Nursing
 Abortion
 HIV/AIDS
 Death and Dying
 Right to Refuse Treatment
 Physician-Assisted Suicide
 Organ Donations
 Surrogate Pregnancy Contracts
 Living Wills

37. Legal - Summary
 We live in a legality society.
 We live in a high technological world.
 We live in a society that is evolving rapidly
with what is acceptable or not.
 Know the laws regarding health care and
the nursing practice.
 Know how to prevent legality, follow
standards of care.
 Know the legal issues in nursing practice.

38. Summary
• Hospitalized patients are under
nurses control.
• Nurses are responsible for patient
care.
• Nurses: Frightened with
medicological problems.
• Has inadequate knowledge.
• Needs : Input in curriculum,
refresher course

39. Otherwise Disaster Looms..
Nurses
Many Roles One Profession

40. THANK YOU

41. Singapore

42. I liked in Singapore
 Building
 Planned city
 Road
 Cleanliness
 Security
 Train services
 Bus services
 Aeroplane

43. I liked in Singapore
 Job oriented
 Rule and regulation
 Equal treatment/Behavior for all
 Cultural harmony: Malaya, Chinese, Tamil
 Punctuality
 Cultural diversity: Indian, Chinese colony
 Food from Malaysia
 Goods from china
 Freedom for Individuals: under rule eg: smoking

44. I liked in Singapore
 Single: Tax 45%
 With 2 or more child: Tax 6% only
 Policy: Plenty of child plenty of money
 No bargaining
 Every shopping complex auto detector
machines.
 No cheating of tax.
 Phone, Email free inside airport
 No public telephone shops only coin phones

45. CGH at a glance
 800 beded hospital
 Government funded hospital
 Facilities : Class A, B1, B2, C
 2000 staffs
 1200 Nurses
 Clinical trial facilities separate units
 No separate hospital pharmacy: drugs supplied
in hospital
 Established before 15 years

46. CGH at a glance
 Separate home care teams
 Diet as per individual patient choice
 Birth day special diet
 Diet and laundry service by Robert
 Charge A : 400 S$/day
 Insurance for most of citizens
 Best referral systems

47. CGH at a glance
 Nurse patient ration: 1:6 , (Australia 1:4)
 Emergency : 500 patient/day
 Celebration of special days: patient
safety, food festival etc.
 For new nurses: 2 days hospital
orientation and 4 weeks nursing
orientation by in-service education team
on CPR, IVI, etc

48. CGH at a glance
 Nurses from: Philippine, Thai, Burmese,
Chinese etc
 Salaries: 2000 S$/Month
 IEC in OPD complex, indoor corridors, duty
stations and other public places.
 Need based inventions: e.g. during SARS,
invention of autodetection mechine in OPD
for screening of all patients TPR BP SPO2
etc.

49.  In OPDs Patient first Screened by Nurses
and then send to specific specialty
department. Recorded Vitals.

50. History of Nursing

51. Singapore at a glance

52. Singapore at a glance

53. Singapore at a glance

54. CGH

55. CGH

56. CGH

58. Singapore at a glance

59. Similarities with BPKIHS
 Same beded
 Same duration of establishment
Buy not comparable in quality and
services like Thai air and RNAC (NAC)

60. Thank you