1. Chapter 23 Legal Implications in Practice

2. Legal Limits of Nursing Sources of legal guidelines come from: Statutory law (Nurse Practice Act) Criminal law (felonies or misdemeanors) Civil law Regulatory law (administrative law) Common law (judicial decisions)

3. Legal Limits of Nursing (cont’d) Standards of care Legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care Best known comes from the American Nurses Association (ANA) Set by every state Set by state and federal laws that govern where nurses work Joint Commission requires policies and procedures (P&P).

4. Kentucky Board of Nursing www.kbn.ky.gov www.kbn.ky.gov www.kbn.ky.gov 4

5. Proof of Negligence The nurse owed a duty to the patient. The nurse did not carry out the duty or breached it. The patient was injured. The patient’s injury was caused by the nurse’s failure to carry out that duty.

6. Federal Statutory Issues in Nursing Practice Americans With Disabilities Act Emergency Medical Treatment and Active Labor Act Mental Health Parity ActUniform Anatomical Gift Act

7. Federal Statutory Issues in Nursing Practice (cont’d) Living Wills, Durable Power of Attorney Advance Directives Health Insurance Portability and Accountability Act Restraints

8. State Statutory Issues in Nursing Practice Licensure Good Samaritan Laws Public Health Laws

9. State Statutory Issues in Nursing Practice (cont’d) The Uniform Determination of Death Act Physician-Assisted Suicide

10. Civil and Common Law Issues in Nursing Practice Torts Intentional Assault Battery False imprisonment

11. Civil and Common Law Issues in Nursing Practice (cont’d) Quasi-intentional Invasion of privacy Malice Slander Libel Unintentional Negligence Malpractice

12. Common Negligent Acts Failure to assess and/or monitor, including making a nursing diagnosis Failure to monitor in timely fashion Failure to use proper equipment to monitor the patient Failure to document the monitoring  Failure to notify the health care provider of problems  Failure to follow orders Failure to follow the six rights of medication administration

13. Common Negligent Acts (cont’d) Failure to convey discharge instructions Failure to ensure patient safety, especially for patients who have a history of falling, are heavily sedated, have disequilibrium problems, are frail, are mentally impaired, get up in the night, and are uncooperative Failure to follow policies and procedures Failure to properly delegate and supervise

14. Statutory Guidelines for Legal Consent for Medical Treatment Adults A. Any competent individual 18 years of age or older for himself or herself B. Any parent for his or her unemancipated minor C. Any guardian for his or her ward D. Any adult for the treatment of his or her minor brother or sister (if an emergency, and parents are not present) E. Any grandparent for a minor grandchild (if an emergency, and parents are not present)

15. Statutory Guidelines for Legal Consent for Medical Treatment (cont’d) Minors A. For his or her child and any child in his or her legal custody B. For himself or herself in the following situations: 1. Lawfully married or a parent (emancipated) 2. Pregnancy (excluding abortions) 3. Venereal disease 4. Drug or substance abuse

16. Statutory Guidelines for Legal Consent for Medical Treatment (cont’d) Minors (cont’d) C. Unemancipated minors may not consent to abortion without one of the following: 1. Consent of one parent 2. Self-consent granted by court order 3. Consent specifically given by a court

17. Abortion Issues 1973 Roe v. Wade U.S. Supreme Court ruled that there is a fundamental right to privacy, which includes a woman’s right to have an abortion. 1989 Webster v. Reproductive Health Services Some states require viability tests if the fetus is more than 28 weeks’ gestational age.

18. Nursing Students You are liable if your actions cause harm to patients, as is your instructor, hospital, and college/university. You are expected to perform as a professional when rendering care. You must separate your student nurse role from your work as a certified nursing assistant (CNA).

19. Malpractice Insurance A contract between the nurse and the insurance company Provides a defense when a nurse is in a lawsuit involving negligence or malpractice insurance Nurses covered by institution’s insurance while working

20. Abandonment and Assignment Issues Short staffing Legal problems occur if inadequate number of nurses will provide care. Floating Based on census load and patient acuities Physician’s orders Nurses follow orders unless they believe an order is given in error or is harmful.

21. Risk Management A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs Steps involved: Identify possible risks. Analyze risks. Act to reduce risks. Evaluate steps taken.

22. Risk Management (cont’d) One tool used in risk management is the incident report or occurrence report. Occurrence reporting Serves as a database for further investigation Alerts risk management to a potential claim situation.