Legal Aspects of Nursing

1. Legal Aspects of Nursing Dr. Belal Hijji, RN, PhD October 31 & November 01, 2010

2. Learning Outcomes At the end of this lecture, students will be able to: • Define law and identify the its functions in nursing • Discuss selected legal aspects of nursing practice

3. Definition of Law • Law is “the sum total of rules and regulations by which the society is governed”. The law exists to regulate all persons. Functions of the Law in Nursing • It tells us about which nursing actions in the care of clients are legal • It distinguishes the responsibilities of the nurse from those of other healthcare providers • It helps establish the boundaries of independent nursing action • It assists in maintaining a standard of nursing practice by making nurses accountable to their actions

4. Selected Legal Aspects of Nursing Practice • Nurses need to know and apply legal aspects in their various roles. As client advocates, nurses should ensure the client’s right to informed consent; identify and report violent behaviour and neglect of vulnerable clients. Also nurses are required to report a nurse who is an chemically impaired, and should be aware of issues related to delegation.

5. Informed Consent • Informed consent is an agreement by a client to accept a course of treatment or a procedure after being fully informed of it. • Consents are either express or implied. Express consent could be oral or written. If the procedure is more invasive and/ or the potential for risk to the client is great, a written permission is needed. • Implied consent exists when the client’s nonverbal behaviour indicates agreement such as in positioning their bodies for an injection or when their vital signs are recorded. • Obtaining an informed consent for specific medical or surgical procedure is the responsibility of the person who performs the procedure

6. Information to be Given to a Client to Make an Informed Decision • Diagnosis or condition that requires treatment • Purpose of treatment • What the client can expect to feel or experience • The intended benefits of the procedure • Possible risks • Advantages and disadvantages of alternatives to treatment (including no treatment)

7. What are the Major Elements and Exceptions of Informed Consent? • The consent must be voluntary • The consent must be given by a client who is capable and competent to understand. This means that certain population groups cannot provide consent such as children, whose appointed guardians must give consent before minors are treated. A second group is persons who are unconscious or severely injured. A third group is persons who are mentally ill. • The client must be given enough information to be the ultimate decision maker.

8. The Nurse’s Role in Obtaining A Client’s Informed Consent • The nurse is not responsible for explaining the medical or surgical procedure but for witnessing the client’s signature on the consent form. The nurse’s signature means: • The client gave voluntary consent after receiving enough information • The client’s signature is authentic • The client appears competent to give consent • In the United States, nurses could be liable for interfering with the client-provider relationship

9. Delegation • Delegation is “the transfer of responsibility for the performance of an activity from person to another while retaining accountability for the outcome”. • In the us, the process of delegation is governed by laws and regulations such as the Nurse Practice Act (NPA), the Unlicensed Assistive Personnel (UAP) job description and skill level. The NPA defines and describes the scope of nursing practice. • When delegation is to occur, the nurse needs to determine the answers to the following questions: • Does the NPA permit delegation • Is there a list of procedure a nurse can delegate? • Are there guidelines explaining the nurse’s responsibilities when delegating?

10. In Palestine, we know that staff nurses delegate the responsibility of performing certain tasks to practical nurses. However, it remains imperative to know whether this process is regulated or not.

11. Violence, Abuse, and Neglect • Violent behaviour can include domestic violence, human abuse, and sexual abuse. • Neglect is the absence of care necessary to maintain the health and safety of a client • Nurses are in position to identify and assess cases of violence. • When an injury appears to be present resulting from abuse, neglect, or exploitation, the nurse must report the situation to the appropriate authority.

12. Controlled Substances • Laws regulate the distribution of controlled drugs such as narcotics, depressants [drugs that temporarily reduce the function or activity of a specific part of the body or mind, such as alcohol and morphine], and stimulants.

13. The Impaired Nurse • This term (impaired nurse) refers to a nurse whose ability to perform nursing functions is diminished by chemical dependency on drugs, alcohol, or mental illness. • Chemical dependence is a real problem caused by high levels of stress in health care settings, increased workloads, decreased staffing, fatigue, isolation, and access to addictive drugs. • In the US, more than 50% of impaired nurses started abusing drugs including alcohol before they finished their nursing education. In the US, these nurses and student nurses receive treatment and support, not discipline.

14. Sexual Harassment • Sexual harassment is defined as “unwelcome sexual advances, requests for sexual favors, and other verbal of physical conduct of a sexual nature”; it is a violation of the individual’s rights and a form of discrimination. • Sexual harassment occurs when submission to such conduct is considered a condition of an employment, when submission or rejection of such conduct is used as the basis for employment decisions affecting the person, and when such a conduct interferes with a person’s work performance. • Nurses must develop skills to deter sexual harassment in workplace and must be familiar with existing policies and procedures related to sexual harassment that must be enacted in every institution.

15. Abortion • Abortion laws in the US provide specific guidelines for nurses about what is legally permissible. Women have the right to abort her fetus in the early stages of pregnancy Do-Not-Resuscitate Orders (DNR) • Clients who are terminally sick with irreversible illness may be ordered DNR. This order is generally written when the client or relatives express the wish for no resuscitation in case of respiratory or cardiac arrest.

16. Areas of Potential Liability in Nursing • Nurses need to know the differences between malpractice (unintentional tort) and intentional tort. Nurses must also recognise nursing situations in which negligent actions are most likely to occur and take measures to prevent them.

17. Crimes and Torts • A crime is an act committed in violation of public (criminal) law and punishable by a fine or jail (US). • Crimes could be felonies [جناية] or misdemeanors [جنحة]. A felony is a crime of serious nature, such as murder. A misdemeanor is an offence of a less serous nature usually punishable by a fine or short-term jail, or both. • A tort is a civil wrong committed against a person or person’s property. The persons responsible for the tort are sued for damages.

18. Privacy of Client’s Health Information • It is a nursing responsibility to protect client’s confidentiality. By this, we mean health and identifying information including diagnosis, social security number, name, address, phone number, and website address. • The American Health Insurance Portability and Accountability Act of 1996 (HIPPA) protects the privacy of client’s information.

19. Examples of HIPPA Compliance and Nursing Practice • A client’s name cannot appear near or on the room door. • Client’s medical records should be kept in safe, secure, and non-public location to prevent unauthorised access. • Printed copies of protected health information should not be left unattended near fax machines or printers • Access to protected information is permitted for authorised personnel • Voice levels should be lowered, and a notice informing clients of their rights about privacy, should be provided

20. Loss of Client’s Property • Loss of client property is a concern to hospital personnel • However, institutions nowadays assume less responsibility for client’s property, and request client’s to sign a waiver relieving a hospital and its employees form any responsibility. • Nurses can take the responsibility of safeguarding the client’s property when s(h)e can’t sign a waiver.

21. Unprofessional Conduct • Unprofessional conduct is one of the grounds for action against the nurse’s license • Unprofessional conduct includes incompetence, gross negligence, conviction of practicing without license, falsification of client’s records, and illegally obtaining controlled substances. • Having personal relationship with a vulnerable client may be considered unprofessional conduct, because nurses are responsible for retaining professional boundaries. • Unethical conduct includes violation of ethical codes, breach of confidentiality, or discrimination in the provision of care.

22. Reporting Crimes, Torts, and Unsafe Practices • Nurses may report colleagues or other professionals if for practices that endanger the health and safety of clients. This may include alcoholism, drug use, theft and unsafe nursing practice. • Reporting a colleague is not easy, as the reporting person may feel disloyal, disapproved by others, or risks promotion.