Ch 7 Legal Dimensions of Nursing Practice

Administrative Law

empowered by executive officers through agencies that enforce the law, example: State Boards of Nursing

Statutory law

enacted by a legislative body must be in line with federal and state constitutions example: Nurse Practice Acts

credentialing

ensures professional competence is met and maintained -Accreditation -Licensure -Certification

Fraud (intentional tort)

willful & purposeful misrepresentation that can or does result in loss or harm to person or property

battery

willful, violent or negligent touching of another

public law

government is directly involved; regulates relationships between individuals and government

an attorney is representing a patients family who is suing a nurse for wrongful death. The attorney calls the nurse and asks to talk about the case to obtain a better understanding of the nurses actions. How should the nurse respond?

"im sorry, but i cant talk with you; you will have to contact my attorney"

Legal Safeguards for Nurses

-Competent practice -Informed consent or refusal -Contracts -Collective bargaining -Patient education -Executing physician orders -Delegating nursing care -Documentation -Appropriate use of social media -Adequate staffing -Whistle-blowing -Professional liability insurance -Risk management programs -Incident, variance, or occurrence reports -Sentinel events and Never events -Patients' rights Good Samaritan Laws

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

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

Four Element of Liability

-Duty -Breach of Duty -Causation -Damages

Categories of Malpractice Claims

-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

collective bargaining

-Legal process -Organization representing employees negotiate with management about wages, working conditions, etc. -may be state nursing association -can be controversial issue

Executing physician orders

-Nurses are legally responsible for carrying out the orders of the physician in charge of a patient unless a reasonable person would anticipate the order to lead to injury -physician should write the order; limited acceptance of verbal or telephone orders -question any order that is ambiguous, contraindicated by normal practice, or contraindicated by patients present condition

Laws affecting nursing practice

-Occupational Safety and Health (OSHA) -National Practitioner Data Bank -Reporting obligations -Controlled substances -Discrimination and sexual harassment -Health Insurance Portability and Accountability Act (HIPAA) -Restraints -People with disabilities -Legal issues related to death and dying (wills, advance directives)

Tort

-a wrong committed by a person against another person or that persons property; tried in civil court -Intentional or Unintentional

a nurse answers a patients call light and finds the patient on the floor by the bathroom door. After calling for assistance and examining the patient for injury, the nurse helps the patient back to the bed and then fills out an incident report. Which statements accurately describe steps of this procedure and why it is performed? Select all that apply:

-an incident report is used as a means of identifying risks -an incident report is used for quality control -an incident report makes facts available in case litigation occurs

Intentional Torts

-assalt & battery -defamation of character -invasion of privacy -false imprisonment -fraud

Common Law

-comes from judiciary decisions -those decisions then considered law & set precedence for decisions in future cases -most law involving malpractice

Professional Liability Insurance

-crucial for nurses to carry their own liability insurance -protection of nurses best interest -limitations of employers coverage -care of advice given outside the workplace

Documentation

-crucial legal safeguard -"if its not documented, it wasnt done" -document facts not assumptions

Nurses and Legal Accountability

-decades ago nurses worked under physicians supervision & were rarely sued; it was the physician and healthcare facility who carried the legal accountability -today nurses assess and diagnose & carry much responsibility -full legal responsibility and accountability for nursing actions rest with the nurse -nurses should develop good professional relationships with their patients within their scope of practice, and identify potential liabilities and work to prevent them

just culture

-encourages open reporting of errors -recognizes that errors are usually due to a problem with the process rather than to just one individual -focuses on finding the root of the problem -3 types of behaviors lead to errors: human error, at-risk behavior, & reckless behavior

Nurse as fact witness

-has knowledge of actual event -should only testify to what he/she knows; no assumptions

Licensure

-legal document -certain requirements to keep license -nurse licensure compact

Informed consent

-needed for admission, specialized diagnostic or treatment procedure, & any experimental procedures or treatments -process -written form -name of procedure -obtaining consent is responsibility of person performing the procedure -role of nurse -patient can refuse to consent

Unintentional Torts

-negligence -malpractice

Competent practice

-nurses most important & best legal safeguard -each nurse must be sure has appropriate education & experience to fulfill responsibilities on the job

Patients Rights

-patient bill of rights -expectations, rights, & responsibilities of patient while receiving care in hospital -resident bill of rights for those in long term care facilities

Patient Education

-patient right to have information -duty of nurse -importance of assessing patients/familys learning needs and readiness to learn -helps patient manage own care -document teaching plan, patients response to education, barriers to patient education

False Imprisonment (Intentional Tort)

-prevention of movement of another without proper consent

Types of laws

-public law -private law -criminal law

patients have the right to

-see and copy their health record -update their health record -request correction of any mistakes -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 -request a restriction on certain uses or disclosures -choose how to recieve health information

Never Events

-serious reportable events that should never happen to a patient -ex: surgery performed on wrong body part or wrong patient, leaving a foreign object inside patient after surgery, discharging infant to wrong person -reimbursement issues for hospitals with never events and the resulting consequences

Sentinel Events

-signal need for immediate investigation & response -unexpected occurrence involving death or serious physical or psychological injury or risk thereof -serious physical injury specifically refers to loss of limb or function -wrong-side surgery, suicide, operative & postoperative complications -organizations must respond appropriately- root cause analysis, implementation of improvements to reduce risks, monitoring of effectiveness

nurse as expert witness

-testimony based on nurses expertise -will offer opinion on whether the nursing care in the incident met acceptable standards of care -has solid educational background, knows nurse practice act, & has strong clinical experience

Which of the following is an area of potential liability for the nurse? Select all that apply.

-the nurse fails to document refusal by the client to ambulate following surgery -the nurse documents that the clients bp has increased from 118/72 to 188/98 and decides to retake the bp in an hour

Incidence/Variance Report

-used to document an incident that is out of the ordinary that does or could, result in harm to a patient, employee, or visitor -used for quality improvement; shouldnt be punitive tool -helps identify any high risk patterns & prevent future incidents -nurses responsible for a potential or actual harmful event or who witnesses is the person who completes the incident form -do not document in patient record that an incident report was completed

Crime

-wrong against a person or the persons property as well as the public crime -misdemeanor & Felony

which of the following is an example of certification?

A nurse who demonstrates advanced expertise in a content area of nursing through special testing.

which process evaluates and recognizes educational programs as having met certain standards?

Accreditation

A nurse exits the room of a confused patient without raising the side rails on the bed. The failure to raise the side rails would be which of the following elements of liability related to malpractice?

Breach of duty

The nurse fails to contact the physician regarding a client who had an open-reduction internal fixation of the tibia and has experienced increasing leg pain (unrelieved by pain medication) for the past 4 hours. Which element of liability has been violated?

Breach of duty

A post-anesthesia nurse is reporting about a client to the intensive care unit nurse in the elevator. There are staff members and visitors in the elevator. The postanesthesia nurse is doing what?

Breaching the clients confidentiality

The nurse is preparing to administer a medication ordered by the surgeon is a dose much higher than recommended. Which action should the nurse take?

Call the surgeon to clarify the order

A nurse pleads guilty to a misdemeanor negligence charge for failing to monitor a patients vital signs during routine eye surgery, leading to the death of the patient. The nurses attorney explained in court that the nurse was granted recognition in a specialty area of nursing. What is the term for this type of credential?

Certification

A client is scheduled for a colonoscopy. The nurse realizes immediately after administering medications to induce conscious sedation that the client has not signed the informed consent. If the nurse has the client sign the informed consent, which element of informed consent would be violated?

Competence

Review of a patients record revealed that no one obtained informed consent for the heart surgery that was performed on the patient. Which intentional tort has been committed?

Assault

a nurse administers the wrong medication to the wrong patient and the patient is harmed. The health care provider who ordered the medication did not read the documentation that the patient is allergic to the drug. Which statement is true regarding liability for the administration of the wrong medication?

Both the nurse and the healthcare provider are responsible for their respective actions

A nurse assesses a client with psychotic symptoms and determines that the client needs vest restraints. However, the client asks the nurse not to put on vest restraints. What would be the best nursing action?

Contact the physician and obtain necessary orders.

A state attorney decides to charge a nurse with manslaughter for allegedly administering lethal medication. This is an example of what type of law?

Criminal Law

A client states that his recent fall was caused by the fact that his scheduled antihypertensive medications were mistakenly administered by two different nurses, an event disputed by both nurses identified by the client. Which measure should the nurse prioritize when anticipating that legal action may follow?

Document the clients claims and the events surrounding the alleged incident

A nurse who obtains a license to practice nursing by misrepresenting him or herself is guilty of what tort?

Fraud

An HIV-positive patient discovers that his name is published in a research report on HIV care prepared by his nurse. He is hurt and files a lawsuit against her. Which offense has the nurse committed?

Invasion of Privacy

When the nurse reports for duty, she finds out her neighbor is admitted to one of units in her facility. The nurse asks a coworker about the neighbor's condition. The coworker is uncomfortable with the nurse's request and confers with the charge nurse. The charge nurse informs the coworker of which potential tort violation she could be charged with if she honors the nurse's request for client information?

Invasion of Privacy

A client informs that he wants to discontinue his treatment and go home. Later, the nurse finds the client dressed to leave. Which action should the nurse take in this situation?

Let the client go after signing a document stating he is going against medical advice

Roles of Nurses in Legal Proceedings

Nurse as defendant Nurse as fact witness Nurse as expert witness

Issues Affecting Competence Practice

Nurse fatigue Impaired nurse

A nurse is caring for a client who has undergone coronary angioplasty. The cardiac monitor is showing abnormal ECG waves, indicating arterial fibrillation. The nurse does not recognize the importance of the sign; as a result, the clients condition deteriorates and the client has to be taken up for an emergency procedure. Which of the following describes the nurses legal liability?

Tort

A nurse in a NICU fails to monitor a premature newborn according to the protocols in place, and is charged with malpractice. What is the term for those bringing the charges against the nurse?

Plaintiffs

During the admission assessment of a female client age 40 years with a suspected mandibular fracture, the client discloses to the nurse that her injury came as a result of her husband hitting her. Which action should the nurse prioritize when responding to the disclosure?

Reporting the abuse to the appropriate authorities

A client on a surgical unit asks for the nurses opinion of the surgeon. The nurse replies, "He is rude. His clients always end up with infections." the nurse is at risk of being accused of which of the following?

Slander/defamation

a registered nurse has had her license suspended after being convicted of being impaired at work. What governing body has the authority to revoke or suspend a nurses license?

The State Board of Nurse Examiners

A client is admitted with symptoms of psychosis. The nurse hurries to the clients room when she hears the client calling for help. She finds the client lying of the ground. The nurse assists the client back to the bed and performs a thorough assessment. The nurse informs the physician and completes the incident report. Which statement should the nurse document in the incident report?

The client was found lying on the floor

a client is brought to the emergency department in an unconscious state with a head injury. The client requires surgery to remove a blood clot. What would be the appropriate nursing intervention in keeping with the policy of informed consent prior to a surgical procedure?

The nurse ensures that the clients family signs the consent form

A nurse comes across a screaming child in the park. The child was hit by a baseball bat, resulting in a swollen and reddened left arm. Any attempt to move the child's left arm results in the child screaming intensely. The nurse used two baseball bats to make a split, which she applied to the child's left arm. The child is transported to the hospital and later develops compartmental syndrome of the left arm. The nurse requests a meeting with the nurse attorney to discuss the possibility of being involved in a litigious suit by the child's family. After a review of the events, which important information will the attorney share with the nurse concerning the case?

The nurse is protected by the Good Samaritan Act, which states the nurse may give emergency care using good judgement

a client is unhappy with the health care provided to him. he approaches the nurse and informs her that he is leaving the facility. The client has not been discharged by the physician. The nurse finds that the client has dressed and is ready to go. What would the nurses action be in this situation?

The nurse should call the nursing supervisor and inform her about the situation

After reporting to work for a night shift, the nurse learns that the unit will be understaffed because two RNs called out sick. As a result, each nurse on the unit will need to provide care for an additional four acute clients in addition to his or her regular client assignment. Which of the following statements is true for this nurse when working in understaffed circumstances?

The nurse will be legally held to the same standards of care as when staffing levels are normal

Two nurses meet at their home, where one of the nurses discusses a client who had been physically abused. The next day, the client is shifted to another nursing unit after a surgical procedure and becomes the care of the second nurse who had been part of the original discussion. Nurse No. 2 asks the client about the physical abuse. The client discovers that his original nurse revealed the information and is hurt. What would be the charges if the client files a suit?

The nurses could now be charged for slander

Injuries related to lifting or transferring patients occur in the health care setting and may be considered a work-related injury. Which law was intended to reduce work-related injuries and illnesses?

The occupational safety and health act of 1970

Newly hired nurses in a busy suburban hospital are required to read the state nurse practice act as part of their training. Which topics are covered by this act? Select all that apply:

Violations that may result in disciplinary action, Scope of practice

Nurses are occasionally asked to witness a testator's (person who makes the will) signing of his or her will. Which of the following guidelines is true regarding a nurse's role is witnessing a testator's signature?

Witnesses to a signature do not need to read the will

assalt

a threat or attempt of bodily contact with another without permission

whistle-blowing

a warning from a present or past member of an organization to the public concerning a serious wrongdoing or danger created or masked by the organization -whistleblower laws prevent employers from retaliating against the employee

Certification

authenticates specialty knowledge, experience, & clinical judgment

Impaired nurse

about 10-15% of nurses focus on treatment rather than punishment since addiction is a treatable illness

Misdemeanor

punishable by fines or less than 1 year imprisonment

private law

civil law; regulates relationships among people

criminal law

concerns state and federal criminal statutes, defines criminal actions (murder, theft)

Four Sources of Law

constitutions, statutory law, administrative law, common law

Good Samaratin Law

created to protect nurses and other healthcare providers when assisting people in emergency situations -may differ from state to state

defamation of character

derogatory remarks made about another that negatively affect that persons repuation -spoke or written -social media

legal

developed by legislature and enforced by states minimum requirements for education and licensure

Felony

punishable by imprisonment for more than 1 year

Accreditation

minimum standards for nursing educational programs state boards of nursing & national accrediting agencies

Nurse Practice Acts

most important law affecting a nurse's practice protects the public defines legal scope of the practice of nurses in that state list violations that can result in disciplinary actions against nurse

Nurse as Defendant

needs to work closely with attorney to prepare defense

Malpractice

negligence by a professional

invasion of privacy

patients right to have his/her information kept confidential -health insurance portability & accountability act (HIPAA)

Which situation is an example of battery that the nurse may experience while performing her duties at the health care facility?

performing a surgical procedure without getting consent

Negligence

performing act that reasonable prudent person in similar situation would not do or not doing something in a situation that a prudent person would do

Risk management programs

safety programs, product safety programs, quality assurance programs

Consitutions

serve as guidelines to legislative bodies

voluntary

serve as guidelines, usually set up by professional nursing organizations

Nurse fatigue

shift work; long hours

law

standard or rule of conduct designed to protect the rights of the public

a nursing student asks the charge nurse about legal liability when performing clinical practice. Which statement regarding liability is true?

student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse

A veteran nurse, pleaded guilty to a misdemeanor negligence charge in the case of a 75 year old woman who died after slipping into a coma during routine outpatient hernia surgery. The nurse admitted failing to monitor the womans vital signs during the procedure. The surgeon who performed the procedure called the nurses action pure negligence, stating the patient could have been saved. The patient was a vibrant grandmother of 10 who had walked three quarters of a mile the mornign of her surgery and had sung in her church choir the day before. What criteria must be established to prove that the nurse is guilty of malpractice or negligence in this case?

the nurse had a duty to monitor the patients vital signs, and due to the nurses failure to perform this duty in this circumstance the patient died

A nurse is caring for a client with vertigo. During data collection, the nurse finds multiple bruises on the clients arms and back; and suspects the client is being abused. When questioned, the client denies any abuse by the daughter she lives with. Despite the clients denial, which rationale would the nurse use for reporting the suspected abuse?

the nurse has a legal and ethical responsibility to report the suspected abuse.

standards

voluntary and legal