Legal Aspects of Nursing

1. Chapter 4 Legal Aspects of Nursing

2. Learning Outcomes List sources of law and types of law. Describe ways nurse practice acts, standards of care, and agency policies and procedures affect the scope of nursing practice. Compare and contrast the state-based licensure model and the mutual recognition model for multistate licensure.

3. Learning Outcomes (cont'd) Describe the purpose and essential elements of informed consent. Discuss the impaired nurse and available diversion or peer assistance programs. Recognize the nurse’s legal responsibilities with selected aspects of nursing practice.

4. Learning Outcomes Discriminate between negligence and malpractice. Delineate the elements of malpractice. Compare and contrast intentional torts (assault/battery, false imprisonment, invasion of privacy, defamation) and unintentional torts (negligence, malpractice).

5. Learning Outcomes Describe the four specific areas of the Health Insurance Portability and Accountability Act and their impact on nursing practice. Describe the laws and strategies that protect the nurse from litigation. Discuss the legal responsibilities of nursing students.

6. Nurse Practice Acts (NPA) Define and describe scope of nursing practice Control practice through licensing Where can you find our country Nurse Practice Act?

7. Credentialing Maintaining competence in nursing practice Licensure Certification Accreditation

8. Licensure Models State-based Separate license required for each state Challenged by changes in health care delivery

9. Certification A voluntary practice validating an individual has met minimum standards of competence in a specialty area Conducted by the Saudi council association

10. Standards of Care Internal Standards Job description Education Expertise Institutional policies and procedures

11. Standards of Care (cont'd) External Standards Nurse practice acts Professional organizations Nursing specialty-practice organizations Federal organizations and federal guidelines (MOH, Ministry of Higher Education)

12. Selected Nursing Legal Responsibilities Informed consent Delegation Violence, abuse, neglect Controlled substances Impaired nurse Death and related issues

13. Informed Consent Purpose Provides client with complete information prior to obtaining agreement by client to accept a course of treatment or procedure The informed consent is the record of the informed consent, not the informed consent itself

14. Informed Consent Express Consent Oral or written agreement Implied Consent Individual’s nonverbal behavior indicates agreement Medical emergency when a person cannot express content because of physical condition

15. Informed Consent Essential elements Consent must be voluntary Consent must be given by client or individual with capacity to understand Must be given enough information to be the ultimate decision maker

16. Informed Consent Except in specific circumstances, the following individuals cannot provide informed consent a minor, person 18 years or younger the unconscious or person injured in such as way that they are unable to consent a mentally ill person judged by professionals to be incompetent

17. Informed Consent (cont'd) a parent, legal guardian, or representative provides or refuses consent for these individuals

18. Informed Consent Important to consider the problem of illiteracy and other language barriers The consent must be read to the client or an interpreter appropriately used to be certain client understands

19. Informed Consent (cont'd) Nurses Role Client gave consent voluntarily Signature is authentic Client appears competent to give consent Remind client they have the right to refuse after signature on form continues after signing consent

20. Delegation “The transfer of responsibility for the performance of an activity from one person to another while retaining accountability for the outcome.” (American Nurses Association, 1997)

21. The Impaired Nurse Inability to perform essential job functions due to Chemical dependency on drugs Alcoholism Mental illness

22. Advanced Health Care Directives Allow persons to specify aspects of care they wish to receive if unable to make decisions Patient Self-Determination Act Recognize advance directives Ask clients if they have advance directives Providing educational material

23. Do-Not-Resuscitate Order is generally written when client wishes for no resuscitation Values and choices given highest priority DNR explicitly discussed with client, family, and designated decision maker, and health care team DNR clearly documented, reviewed, and updated Other care should not be withdrawn

24. Crimes An act committed in violation of public (criminal) law Punishable by a fine or imprisonment Does not have to be intended in order to be a crime Example: accidentally administering an additional and lethal dose of a narcotic to relieve discomfort

25. Negligence Misconduct or practice that is below the standard expected of an ordinary, reasonable, and prudent person Places another person at risk for harm Applies to anyone

26. Negligence (cont'd) Gross negligence Extreme lack of knowledge, decision making, or skill that should have been known that put others at risk for harm

27. Malpractice Negligence that occurred while the person was performing as a professional Applies to physicians, dentists, lawyers, and generally includes nurses

28. Measures to Take to Prevent Malpractice Check and recheck medications-medication error Check side rails before leaving a client-client safety Do not ignore a clients complaint-failure to observe and take appropriate action Right client-mistaken identity

29. Intentional Torts Assault and battery False imprisonment Invasion of privacy

30. Intentional Torts Assault attempt or threat to touch unjustifiably Battery willful touching that may or may not cause harm

31. Health Insurance Portability & Accountability Act of 1996 (HIPAA) Includes four specific areas Electronic transfer of information among organizations Standardized numbers for identifying providers, employers, and health plans Security rule Privacy rule

32. Unprofessional Conduct Incompetence or gross negligence Conviction for practicing without a license Falsification of client’s records Illegally obtaining, using, or possessing controlled substances Need to retain professional boundaries

33. Unprofessional Conduct (cont'd) Violation of professional ethical codes Breach of confidentiality Fraud Refusing to care for clients of specific socioeconomic or cultural origins

34. Carrying Out a Physicians Order Nurses expected to analyze procedures and medications ordered by the physician Seek clarification for ambiguous or seemingly erroneous orders Categories nurses should question Question any order a client questions Question any order if the client’s condition changed

35. Carrying Out a Physicians Order (cont'd) Categories nurses should question Question and record verbal orders to avoid miscommunication Question any order that is illegible, unclear, or incomplete

36. Providing Competent Nursing Care Provide care within the legal boundaries Nurses need to be familiar with various jobs Care to protect clients from harm Anticipate sources for injury Educate clients about hazards

37. Providing Competent Nursing Care (cont’d) Implement measures to prevent injury Client’s need to be assessed and monitored appropriately Communicate with client’s with sincere concern

38. Documentation Medical chart is a legal document Nurses need to provide accurate and complete documentation of the nursing care provided Failure to document can constitute negligence Insufficient or inaccurate assessments can hinder proper diagnosis and treatment causing harm to client

39. Incident Reports Agency record of an incident or unusual occurrence (also called unusual occurrence report) Make all the facts available to agency personnel Contribute to statistical data about incidents

40. Incident Reports (cont'd) Help health personnel prevent future incidents Filed according to agency policy

41. Information Included on Incident Reports Identify the client by name, initials, and hospital or identification number Date, time, and place of the incident Description of the facts of the incident (no conclusions or blame) Incorporation of the client’s account of the incident in quotes

42. Information Included on Incident Reports Identification of all witnesses Identification of any equipment by number and any medication by name and dosage

43. Legal Responsibilities of Students Responsible for own action and liable for their own acts of negligence Lower standards are not applied to nursing students Function within scope of education, job description and nurse practice act

44. Legal Responsibilities of Students (cont’d) Follow procedures and policies Ask for additional help or supervision in situations they feel inadequately prepared If working as an aide, can only perform tasks in job description, not from nursing school