Chapter 11 Legally Responsible Nursing Practice

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

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.

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

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

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

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.

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

Legal Issues for Nurses #1 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

Legal Issues for Nurses #2 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

Legal Issues for Nurses #3 False imprisonment-confining or restricting someone to a place Restraint Violation of confidentiality Defamation of character Violating informed consent-Patients have the right to choose to receive treatment Assault and battery-threatening to touch someone without touching; touching someone without permission Fraud

Legal Issues for Nurses #4 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

Legal Issues for Nurses #5 Gross Negligence Human life endangered or lost Often tried under Criminal law

Legal Issues for Nurses #6 Malpractice Claims Patients’ perceptions Impersonality of the American health care system Health care is big and profitable business Liability insurance justifies making claims Frequent new stories of enormous judgments encourage lawsuits

Legal Issues for Nurses #7 Traits of “suit-prone” patients High levels of criticism Fault-finding Hostility Uncooperativeness Sensitivity to being offended Successful prior lawsuits

Legal Issues for Nurses #8 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

Legal Issues for Nurses #9 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.

Legal Issues for Nurses #10 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.

Legal Issues for Nurses #11 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.

Legal Issues for Nurses #12 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.

Legal Issues for Nurses #13 Gifts Don’t accept gifts or money. It is legal but not ethical to accept or solicit gifts.

Criminal Law and Nursing #1 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.

Criminal Law and Nursing #2 Grossly negligent acts are considered crimes. Example is restraining a patient and there is injury Criminal background, patient abuse, elder abuse, and child abuse checks done prior to being hired. Drug and alcohol screening prior to hire.

Criminal Law and Nursing #3 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