Legally Responsible Nursing Practice: Laws, Responsibilities, and Liabilities

1. Chapter 11Legally Responsible Nursing Practice

2. OBJECTIVES • 1. Discuss the purpose of Good Samaritan laws. • 2. List the two sources of laws and give examples of each. • 3. Discuss the relationship between the nurse practice acts and the state boards of nursing. • 4. Explain the association among responsibility, accountability, and legal liability. • 5. Define the term respondeat superior. • 6. Define the term breach of contract. • 7. Define the term tort and give two examples of torts. • 8. Illustrate the difference between a tort and a crime. • 9. Differentiate negligence and gross negligence. • 10. Discuss how nurses can assist in preventing malpractice claims. • 11. Explain the purpose of malpractice insurance. • 12. Give examples of crimes that may involve nurses.

3. Legally Responsible Nursing Practice • A nurse’s duty is to do good and to avoid harm in accordance with the law • Laws are rules of conduct derived from: • Cultural values • Moral practices • Ethical beliefs

4. Good Samaritan Statutes • Protect people from prosecution who voluntarily aid others in an emergency • Intend to encourage giving emergency care outside the hospital or health care facility • Some states require people to help strangers in distress • To act or not act is an ethical decision

5. Sources of Laws • Public (federal, state, and local government) • Constitutional law • Administrative law • Criminal law • Private • Contract law • Laws of torts

6. Regulation of Nursing Practice • Administrative Law—The Nurse Practice Act • Defines legal functions, powers, and duties of the state board of nursing • Enforces the Nurse Practice Act • Holds disciplinary hearings • Identifies membership of the board and how to become a board member • Defines terms • Includes laws governing licensure and legal titles

7. Responsibility and Liability • Responsibility is being accountable for your actions • Explain the action and accept any consequences • Liability is the legal obligation to make good for the loss of, or damage to, something for which he or she is responsible. • Nurses are personally and legally responsible for their nursing actions. • Best protection against charges: • Carry out duties at or above the standard expected

8. Legal Relationships Between Employer and Employee • Employer has right to hire employees, direct, and control performance of work • Employee accepts wages, provides service to employer • Respondeat superior • Both the nurse and the employer can be held liable for nurse’s acts • Employer’s guidelines (policies and procedures) state what action is expected in a specific situation

9. Standards of Care • Guidelines to identify appropriate levels of professional care • Rules and regulations defining care expected of professional and practical/vocational nurses • Accrediting agencies and organizations develop standards of care • Employer policy and procedure manuals

10. Legal Issues for Nurses Contracts • An agreement between two or more parties • Written or verbal promises with exchange of something of value • Breach of contract • Failure to fulfill any or all parts of a contractual obligation

11. Legal Issues for Nurses Torts • An injury or wrong committed by one person, group, or organization against another person, group, or organization • Strict Liability • Describes actions that cause injury to others • Intentional • Injuries caused by willful, forceful and aggressive behavior

12. Legal Issues For Nurses • False imprisonment • Violation of confidentiality • Defamation of character • Violating informed consent • Assault and battery • Fraud

13. Legal Issues for Nurses • Negligence • Failure of a reasonable person to do something or not do something that a reasonable person in the same circumstances would or would not do • General term describing neglect by a physician or nurse to apply education and skills which other physicians or nurses apply in similar circumstances

14. Legal Issues for Nurses • Gross Negligence • Human life endangered or lost • Often tried under Criminal law

15. Legal Issues for Nurses Malpractice Claims • Patients’ perceptions • Impersonality of American health care system • Health care is big and profitable business • Liability insurance justifies making claims • Frequent news stories of enormous judgments encourages lawsuits

16. Legal Issues for Nurses • Traits of “suit prone” patients • High levels of criticism • Fault-finding • Hostility • Uncooperativeness • Sensitivity to being offended • Successful prior lawsuits

17. Legal Issues for Nurses • Prevention of or discouraging lawsuits • Strict personal and institutional adherence to high standards of care • Attention to accurate documentation • Being aware of areas where nurses are often found negligent

18. Legal Issues for Nurses Documentation • Patient’s medical record is a legal document • Entries must be factual, to the point, accurate, legible, related to patient’s needs or plan of treatment, objective, consistent • Use agency-approved abbreviations and chart-correction procedures • Computer charting confidentiality

19. Legal Issues for Nurses Delegation of Nursing Duties • Licensed nurse is accountable for the appropriateness of delegated nursing tasks • The best way for a nurse to avoid being sued for negligence is to constantly look for and correct situations in which a patient may suffer an injury.

20. Legal Issues for Nurses Malpractice Insurance • Institutional employers carry malpractice liability insurance to protect employees and themselves • Personal malpractice liability insurance policy is a wise investment • Settlements may exceed employer’s policy limits • Employer’s insurance company may sue you • Claims-based rather than occurrence-based policies

21. Legal Issues for Nurses Wills • Legal statement of a person’s wishes regarding disposition of property after death • Attorney is most appropriate to help write a will • Follow institutional guidelines regarding witnessing a will

22. Legal Issues for Nurses Gifts • Don’t accept gifts or money • It is legal but not ethical to accept or solicit gifts

23. Criminal Law and Nursing • A crime is an offense committed against the public welfare or safety • The state prosecutes criminal acts • Minor offenses • Misdemeanors • Felonies • Practicing without a nursing license is a felony

24. Criminal Law and Nursing • Grossly negligent acts are considered crimes • Criminal background, elder abuse, and child abuse checks done prior to being hired • Drug and alcohol screening prior to hire

25. Criminal Law and Nursing • Other crimes in which nurses may become directly or indirectly involved: • Right-to-die situations • Violations of federal and state narcotic and controlled substance laws • Fraud • Robbery • Death due to lack of or incorrect nursing care • Murder

26. Question • Is the following statement true or false? Respondeat superior means that your employer cannot be held liable for your acts as a nurse.

27. Answer • False • Rationale: Respondeat superior means that both the nurse and the employer can be held liable for a nurse’s acts.

28. Question • Putting a person into his room, locking the wheelchair wheels and closing the door to keep him from annoying others is known as: A. Fraud B. False imprisonment C. Battery D. Violating informed consent

29. Answer • B. False imprisonment • Rationale: Confining a person to a room, locking the wheelchair locks to prevent the person from moving about is false imprisonment.

30. Question • Is the following statement true or false? It is illegal for a nurse or any other health care provider to accept or solicit gifts from patients or families.

31. Answer • False • Rationale: It is legal but not ethical to accept or solicit gifts from patients or families.

32. Question • Which of the following is true about documentation? A. It is not a legal document B. Never use abbreviations when charting C. When making an error, just cross it out so it is illegible D. Entries must be objective and consistent

33. Answer • D. Entries must be objective and consistent • Rationale: The patient’s medical record is a legal document. Use agency-approved abbreviations and chart correction Procedures.

34. Question • Is the following statement true or false? Laws are rules of conduct that derive from ethical beliefs, moral practices, and cultural values.

35. Answer • True • Rationale: Laws are rules of conduct that derive from ethical beliefs, moral practices, and cultural values.