1. Legal Dimensions of Nursing Practice
Chapter 7
Legal Dimensions of Nursing Practice

2. Introduction
As the roles and responsibilities of nurses have expanded, so has their legal accountability
Nurses are increasingly being brought to court to defend their practice
It is critical nurses document their actions
Nurses should act in ways to prevent malpractice

3. Definition of Law
Standard or rule of conduct established and enforced by government
Designed to protect the rights of the public

4. Types of Laws Public law—government is directly involved
Regulates relationships between individuals and government
Private law—civil law
Regulates relationships among people
Criminal law—concerns state and federal criminal statutes
Defines criminal actions (e.g., murder, theft)

5. Question
Tell whether the following statement is true or false. A body of law known as statutory law has evolved from accumulated judiciary decisions. A. True B. False
Answer: B. False
Rationale: A body of law known as common law has evolved from accumulated judiciary decisions. Most law involving malpractice is common law.

6. Four Sources of Law
Constitutions: federal and state constitutions serve as guides to legislative bodies
Statutory law: enacted by a legislative body, Example nurse practice acts
Administrative law: empowered by executive officers (president, state governors, city mayors)
Common law: judiciary system reconciles controversies, creates body of common law-court made law, the case that first sets down the rule is called a precedent. Most law involving malpractice is common law.

7. Law Terminology Litigation: process of bringing and trying a lawsuit
Plaintiff: person bringing suit
Defendant: person being accused of a crime
Presumed innocent until proven guilty

8. Professional and Legal Regulation of Nursing Practice
Nurse practice acts-in each state is the most important law affecting your nursing practice, each state has their own nurse practice act
Standards-ANA standards of practice
Credentialing-ways to ensure professional competence is ensured and maintained
Accreditation-NLNAC (National League for Nursing Accrediting Commission) & AACN (American Association of Colleges of Nursing) are agencies that accredit nursing schools
Licensure-Passing an approved accredited school and passing the NCEX examination, cannot be revoked without due process
Certification-voluntary certification that validates specialty knowledge, experience, and clinical judgement

9. Question
Tell whether the following statement is true or false. The state nurse practice act is the most important law affecting nursing practice. A. True B. False
Answer: A. True
Rationale: The state nurse practice act is the most important law affecting nursing practice. Each nurse practice act protects the public by broadly defining the legal scope of nursing practice.

10. Reasons for Suspending or Revoking a License
Drug or alcohol abuse
Fraud
Deceptive practice
Criminal acts
Previous disciplinary actions
Gross or ordinary negligence
Physical or mental impairments, including age

11. Due Cause for Revoking a License
Notice of investigation
Fair and impartial hearing
Proper decision based on substantial evidence

12. Nurse’s Best Defense of License Investigation
Early legal counseling
Character and expert witnesses
Thorough preparation for all proceedings

13. Criminal Law
Crime: wrong against a person or the person’s property as well as the public, punishable by the state
Misdemeanor: punishable by fines or less than 1 year imprisonment
Felony: punishable by imprisonment for more than 1 year
Tort: a wrong committed by a person against another person or that person’s property; tried in civil court
Intentional
Unintentional

14. Intentional and Unintentional Torts
Assault (threat or attempt to make bodily contact with another person without their consent) and battery (assault that is carried out may be violent, angry)
Defamation of character-one party makes derogatory remarks about another to diminish their reputation
Invasion of privacy -HIPAA
False imprisonment-unjustified or prevention of the movement of another person without proper consent
Fraud-willful and purposeful misrepresentation that could cause loss or harm to a person or property
Unintentional
Negligence-performing an act a prudent nurse would not do or failing to perform an act a prudent nurse would do
Malpractice-negligence by professional personnel

15. HIPAA-Ensured Patient Rights
To see and copy their health record
To update their health record
To request correction of any mistakes
To get a list of the disclosures a health care institution has made independent of disclosures made for the purposes of treatment, payment, and health care operations
To request a restriction on certain uses or disclosures
To choose how to receive health information
HIPAA includes rules that protect the patients confidentiality, protect the patients data
Nurses need to remember to discuss patient information in private areas only with those that are a part of the patients health care team, keep notes covered, computer screens off when not in use, never share username and password, close door, pull curtain

16. Categories of Malpractice Claims
Malpractice-negligence by professional personnel
Failure to follow standards of care
Failure to use equipment in responsible manner
Failure to assess and monitor
Failure to communicate
Failure to document
Failure to act as a patient advocate

17. Question
Which is the correct term for this nursing action: A nurse falsely imprisons a patient by an unauthorized use of restraints. A. Crime B. Tort C. Misdemeanor D. Felony
Answer: B. Tort
Rationale: A tort is a wrong committed by a person against another person or that person’s property. False imprisonment is an intentional tort. A crime is a wrong against a person or that person’s property as well as the public. Crimes can be classified as misdemeanors or felonies.

18. Four Elements of Liability
Duty-obligation of care, standards of care
Breach of duty-failure to meet standards of care
Causation-most difficult to prove, failure to meet the standard actually caused the injury
Damages-actually harm or injury resulting to the patient

19. Three Outcomes of Malpractice Litigation
All parties work toward fair settlement.
Case is presented to malpractice arbitration panel.
Case is brought to trial court.

20. Roles of Nurses in Legal Proceedings
Nurse as defendant-the nurse should work with an attorney
Nurse as fact witness-nurse who has knowledge of the actual incident
Nurse as expert witness-to explain what happened based upon the patients record and offer an opinion about whether the nursing care met standards of care

21. Recommendations for Nurse Defendant
Do not discuss the case with those involved in it.
Do not alter patient records.
Cooperate fully with your attorney.
Be courteous on witness stand.
Do not volunteer any information.

22. Legal Safeguards for Nurses
Competent practice-is the most important best legal safe guard
Informed consent or refusal-every person is granted freedom from bodily contact by another person unless consent is granted, obtaining informed consent and explaining the procedure is responsibility of person performing diagnostic procedure, nurse confirms it was signed and answer questions the patient might still have
Contracts-Exchange of promises between two people
Collective bargaining-legal process in which representatives of organized employment negotiate with employers about such matters as wages, hours, and conditions
Patient education-nurses need to know what specific aspects of patient education are the responsibility of the nurse
Executing physician orders-nurses legally responsible to carry out physicians orders
Delegating-RNs may delegate but they can not delegate the nursing process, RN remains accountable for delegated task
Documentation-If it wasn’t documented it wasn’t done

23. Legal Safeguards for Nurses (cont.)
Adequate staffing
Whistle-blowing-warning from a present or past member of organization to the public concerning a wrongdoing or danger masked by organization.
Professional liability insurance-nurses should carry their own
Risk management programs-quality assurance programs in facilities involved in ongoing evaluation of patient care
Incident, variance, or occurrence reports-anything out of ordinary that results in harm
Sentinel events-unexpected occurrence involving death or serious injury
Never events-errors that should never happen, surgery on wrong body part
Patients’ rights-Patients have rights
Good Samaritan Laws-protect health practitioners when they give aid to people in ER situations

24. Safeguards to Competent Practice
Respecting legal boundaries of practice
Following institutional procedures and policies
Owning personal strengths and weaknesses
Evaluating proposed assignments
Keeping current in nursing knowledge and skills
Respecting patient rights and developing rapport with patients
Keeping careful documentation
Working within agency for management policies

25. Elements of Informed Consent
Disclosure-patient/surrogate informed procedure, risks, alternatives, no outcomes guaranteed
Comprehension-patient can repeat in his/her own words information the patient is getting before signing the consent
Competence-The patient understands the information needed to make the decision, is able to reason, and can communicate
Voluntariness-patient voluntarily consents or refuses

26. Information Contained in Incident Reports
Complete name of person and names of witnesses
Factual account of incident
Date, time, and place of incident
Pertinent characteristics of person involved
Any equipment or resources being used
Any other important variables
Documentation by physician of medical examination of person involved

27. Question
Tell whether the following statement is true or false. In all health care agencies, informed and voluntary consent is needed for admission, for specialized diagnostic procedures or medical–surgical treatment, and for any experimental treatments or procedures. A. True B. False
Answer: A. True
Rationale: In all health care agencies, informed and voluntary consent is needed for admission, for specialized diagnostic procedures or medical–surgical treatment, and for any experimental treatments or procedures.

28. Student Liability Students are responsible for own acts
Held to same standard of care as RN
For no reason should students attempt a clinical procedure if you are unsure of the steps involved
Nursing instructors may share responsibility for damages

29. OSHA Legal Regulations
Occupational Safety and Health Administration establish safety standards. They have regulations that promote health and safety precautions.
Use of electrical equipment
Use of isolation techniques
Use of radiation
Use of chemicals

30. Laws Affecting Nursing Practice
Occupational Safety and Health (OHSA)
National Practitioner Data Bank-identification and discipline of practitioners who engage in unprofessional conduct
Reporting obligations-nurses must report child abuse, rape, communicable diseases
Controlled substances-nurse responsibility includes keeping them locked and adhering to appropriate documentation
Discrimination and sexual harassment-protects employees from discrimination
Health Insurance Portability and Accountability Act (HIPAA)
Restraints-be familiar with institutional policies
People with disabilities-prohibits the discrimination of disability and requires facilities to “reasonable accommodate”
Legal issues related to death and dying (wills, advance directives)- wills describes intentions to be carried out in the death of the patient