1. Chapter 11Legally Responsible Nursing Practice

2. OBJECTIVES 1. Discuss the purpose of Good Samaritan laws.
2. List the two sources of laws and give examples of each.
3. Discuss the relationship between the nurse practice acts and the state boards of nursing.
4. Explain the association among responsibility, accountability, and legal liability.
5. Define the term respondeat superior.
6. Define the term breach of contract.
7. Define the term tort and give two examples of torts.
8. Illustrate the difference between a tort and a crime.
9. Differentiate negligence and gross negligence.
10. Discuss how nurses can assist in preventing malpractice claims.
11. Explain the purpose of malpractice insurance.
12. Give examples of crimes that may involve nurses.

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. Legal Issues for Nurses
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

11. Legal Issues for Nurses
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

12. Legal Issues For Nurses
False imprisonment
Violation of confidentiality
Defamation of character
Violating informed consent
Assault and battery
Fraud

13. Legal Issues for Nurses
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

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

15. Legal Issues for Nurses
Malpractice Claims
Patients’ perceptions
Impersonality of American health care system
Health care is big and profitable business
Liability insurance justifies making claims
Frequent news stories of enormous judgments encourages lawsuits

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

17. Legal Issues for Nurses
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

18. Legal Issues for Nurses
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

19. Legal Issues for Nurses
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.

20. Legal Issues for Nurses
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

21. Legal Issues for Nurses
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

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

23. Criminal Law and Nursing
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

24. Criminal Law and Nursing
Grossly negligent acts are considered crimes
Criminal background, elder abuse, and child abuse checks done prior to being hired
Drug and alcohol screening prior to hire

25. Criminal Law and Nursing
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

26. Question Is the following statement true or false?
Respondeat superior means that your employer cannot be held liable for your acts as a nurse.

27. Answer
False
Rationale: Respondeat superior means that both the nurse and the employer can be held liable for a nurse’s acts.

28. Question
Putting a person into his room, locking the wheelchair wheels and closing the door to keep him from annoying others is known as:
A. Fraud
B. False imprisonment
C. Battery
D. Violating informed consent

29. Answer B. False imprisonment
Rationale: Confining a person to a room, locking the wheelchair locks to prevent the person from moving about is false imprisonment.

30. Question Is the following statement true or false?
It is illegal for a nurse or any other health care provider to accept or solicit gifts from patients or families.

31. Answer
False
Rationale: It is legal but not ethical to accept or solicit gifts from patients or families.

32. Question Which of the following is true about documentation?
A. It is not a legal document
B. Never use abbreviations when charting
C. When making an error, just cross it out so it is
illegible
D. Entries must be objective and consistent

33. Answer D. Entries must be objective and consistent
Rationale: The patient’s medical record is a legal document. Use agency-approved abbreviations and chart correction Procedures.

34. Question Is the following statement true or false?
Laws are rules of conduct that derive from ethical beliefs, moral practices, and cultural values.

35. Answer
True
Rationale: Laws are rules of conduct that derive from ethical beliefs, moral practices, and cultural values.