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Understand laws, standards, informed consent, and ways to prevent negligence in nursing. Stay informed, prevent errors, and document accurately to avoid malpractice suits.
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CHAPTER 3 NURSING PRACTICE AND THE LAW
Meaning of Law • Statutory law • Common law • Administrative law
Sources of Law • The Constitution • Statutes • Administrative
Types of Law • Criminal law • Civil law
Criminal Law • Criminal acts are considered offenses against the state • Three categories of criminal law • Felony • Misdemeanor • Juvenile
Civil Law • Usually involve the violation of one person’s rights against another’s rights • Tort • Quasi-intentional tort • Negligence • Malpractice
Other Laws Relevant to Nursing • Good Samaritan laws • Confidentiality • Slander and libel • False imprisonment • Assault and battery
Nursing Standards • Established as guidelines for the profession to ensure quality of care • Also used as criteria to determine whether appropriate care has been delivered
Types of Standards • Internal standards • Organizational standards • Accepted state and national standards • Nurse Practice Acts • Patient Care Partnership
Internal Standards • Developed by institutions • Institutional policies • Maintained in policy and procedure manuals
Boards of Nursing • Develop the Nurse Practice Acts along with state legislatures • The courts have upheld the authority of the boards of nursing to regulate standards • With the expanded role of nursing, it is important to clarify the distinction between nursing and medicine
Uses of Standards in Nursing Negligence or Malpractice • Standards are used as a guide • State, local, or national standards • Institutional policies that alter or adhere to the nursing standards of care • Expert opinions on appropriate standards of care • Available literature substantiating current standards
Informed Consent • Without informed consent many medical procedures could be considered battery • Consent to treatment by the client gives the health-care personnel the right to deliver care without fear of prosecution
Informed Consent • The physician obtains the consent • Gives the client the information • States the risks and advantages • The nurse may be involved in the process by gaining signatures on the appropriate forms
Helpful Hints • A mentally competent adult has voluntarily given consent • The client understands exactly what he or she is consenting to • The consent includes the risks, alternative treatments, and outcomes • The consent is written
Prevention • Keep yourself informed about new information related to your area of practice • Insist that the health-care institution keep personnel informed of all changes in policies and procedures and in the management of new technological advances
Prevention • Always follow the standards of care or practice for your institution • Delegate tasks and procedures to appropriate personnel • Identify clients at risk for problems such as falls or the development of decubiti
Prevention • Establish and maintain a safe environment • Document precisely and carefully • Write detailed incident reports • File incident reports with appropriate personnel and departments • Recognize client behaviors that may cause problems
Common Causes of Negligence • Client falls • Equipment injuries • Failure to monitor • Failure to communicate • Medication errors • Medical errors
Medication Errors • Right drug • Right dose • Right route • Right time • Right client • Right documentation
Tips for Credible Documentation • Contemporaneous • Accurate • Truthful • Appropriate
The 6 Fs • Failure to appropriately assess a client • Failure to report changes in client status • Failure to document in the client record • Failure to obtain informed consent • Failure to report a coworker’s negligence • Failure to provide adequate education
The 2 Big Bad Ones • Altering or falsifying a record • Violation of an internal or external standard of practice
If a Problem Arises • When served with a complaint, immediately contact legal counsel • Never sign any documents without legal counsel • Notify your malpractice carrier if covered; notify your institution immediately • Keep all correspondence: written and verbal
End-of-Life Decisions • DNR orders • Advance directives • The “living will” • Durable power of attorney • Health-care surrogate
Mandatory Overtime • Increased demand due to nursing shortages • Physical and mental fatigue • Increased physical and emotional stress • Decreased concentration
Licensure • In the United States, granted through the state government via state boards of nursing (NCLEX-RN) • In Canada, granted through individual provinces or territories with exception of Quebec (CRNE)
Qualifications for Licensure • Graduation from an approved nursing program • English proficiency • Disclosure of criminal conviction
NCLEX-RN Examination • Computerized Adaptive Testing (CAT) • Minimum and maximum number of questions • Regulated length of time to complete the examination
NCLEX-RN Examination • Based on client needs and the nursing process • Multiple choice and alternative item formats • Fill in the blank • Drag and drop
CRNE • Paper-and-pencil format • English or French • Multiple-choice or short-answer questions • Measures identified competencies for the Canadian nurse to practice
Preparing for the NCLEX-RN • Review courses • Review books • Videos • DVDs
Moving? • Endorsement • Multistate licensure
Disciplinary Action • State boards of nursing • Canadian Nurses Association • Major Issues: • Falsifying documents • Felony • Drugs or alcohol • Functioning outside the scope of practice • Abuse
Conclusion • Nurses need to be aware of the Nurse Practice Act in their states • Nurses need to familiarize themselves with their institutions’ standards of care • Nurses need to understand the most common causes of negligence • Nurses need to document accurately and appropriately
