Exam 1 Leadership CH5

Implied consent example

you have an injury, and you walk into an ER, then pass out or if bleeding in ER and the RN put compression on it before consent is given

Respondeat superior

(the master is responsible for the acts of his servants): an employer should be held legally liable for the conduct of employees whose actions he or she has a right to direct or control.

Sources of Law: Constitutions -

fundamental laws or principles

Two Types of Negligence: Professional negligence (also called malpractice)

is a failure to do something by someone with specialized skills and training.

Nurse Practice Act

is a legal instrument that defines what the functions of nursing shall be and sets standards for licensure. It grants a nurse the authority to carry out those functions. Each state has its own, but all must be consistent with provisions or statutes established at the federal level

Two Types of Negligence: Ordinary negligence

is the failure to act as a reasonably prudent person.

Law and Legislation primary purpose...

is to protect the client and the nurse.

Sources of Law: Statutes -

laws that govern - State Nurse Practice Act

What is nursing's responsibility in Informed Consent?

make sure they understand, and be a witness

Do Not Resuscitate (DNR)

must have a doctors order in the chart/order

Advance Directive (AD)

says I want this, if this happens—does not have to be a legal doc

Elements of Malpractice: Malpractice:

the failure of a person with professional training to act in a reasonable and prudent manner—also called professional negligence.

Elements of Malpractice: Negligence:

the omission to do something that a reasonable person, guided by the considerations that ordinarily regulate human affairs, would do—or as doing something that a reasonable and prudent person would not do.

Laws and legislation define...

the scope of acceptable practice and protect individual rights.

Res judicata

(a thing or matter settled by judgment): applies only when a competent court has decided a legal dispute and when no further appeals are possible. -FINAL JUDGEMENT

Stare decisis

(let the decision stand): uses precedents as a decision-making guide.

Sources of Law: Court decisions

- interpret legal issues

Incident Reports (Adverse Event Forms)

--Records of unusual or unexpected incidents that occur in the course of a client's treatment. --Generally considered confidential communications and cannot be subpoenaed by clients or used as evidence in their lawsuits in most states. --A copy of an incident report should not be left in the chart, and no entry should be made in the client's record about the existence of an incident report. --Most of the time errors are because of a bad process, not an individual mistake. Incident reports are a way to find and correct these problems

Responsibilities of the Nurse in a Leadership Position

-Reporting dangerous understaffing -Checking staff credentials and qualifications -Carrying out appropriate discipline

Which is not an intentional tort? False imprisonment Defamation of character Invasion of privacy Negligence

Negligence Rationale: An intentional tort requires that the act be committed with the awareness of the perpetrator.

A nurse is charged with knowingly administering a fatal dose of morphine to a patient on hospice. In which type of court would this nurse be charged?

. Criminal Rationale: Nurses found guilty of intentionally administering fatal doses of drugs to patients would be charged in a criminal court. In civil cases, one individual sues another for money to compensate for a perceived loss. In administrative cases, an individual is sued by a state or federal governmental agency assigned the responsibility of implementing governmental programs

"Just following physician orders"

...is not a defense for malpractice. Nurses have an independent responsibility to take appropriate steps to safeguard clients.

Five Components Necessary for Professional Negligence to Occur (a select all that apply question-Schofield)

1. A standard of care is in place (minimal level of expertise delivered to a client). -must be a standard for someone to sue you 2. There is a failure to meet the standard of care (breach of duty).—what you did must be in violation of the standard 3. Foreseeability of harm must exist (ignorance is not an excuse).—3rd criteria for Prof Negli 4. There must be a provable correlation between care and harm.—hardest or most difficult to be proven in prof neg 5. Actual client injury must occur.

Reducing the Risk of Malpractice Claims

1. Practice within the scope of the nurse practice act. 2. Observe agency policies and procedures. 3. Model practice after established standards by using evidence-based practice. 4. Always put client's rights and welfare first. Be aware of relevant law and legal doctrines. 5. Practice within the area of individual competence and upgrade technical skills consistently.

RN Licensure

Boundaries for practice are defined in the Nurse Practice Act of each state. Remember that nursing licensure is a privilege and not a right.—earned not given!!!!! Since the first mandatory Nurse Practice Act was passed in New York in 1903, nursing has been legislated, directed, and controlled to some extent.

Client Medical Records

Client owns the information but the record belongs to the facility that made it and is storing it. Clients must have reasonable access to the record. Collaboration between health-care providers and clients, and documentation thereof, is a good indication of well-provided clinical care.

Guidelines for Informed Consent—(cont.)

Consent may be given by: 1. A competent adult 2. A legal guardian or individual holding durable power of attorney 3. An emancipated or married minor 4. Mature minor (varies by state) 5. Parent of a minor child 6. Court order

Frequent Causes of Claims Against Nurses

Inadequate charting. Inadequate communication with physician or supervisors about changes in client conditions. Leaving potentially harmful items within client reach. Unattended patient falls. Inaccurate counting of operative instruments and sponges. Misidentifying patients for medications, surgeries, tests.

Malpractice Insurance Dilemma

Nurses need malpractice insurance because of their expanded roles, but they also incur a greater likelihood of being sued if they have malpractice insurance, since injured parties will always seek damages from as many individuals with financial resources as possible.

Common Causes of Professional Nursing License Suspension or Revocation

Professional negligence. Practicing medicine or nursing without a license. Obtaining a nursing license by fraud or allowing others to use your license. Felony conviction for any offense substantially related to the function or duties of an RN. Participating professionally in criminal abortions. Not reporting substandard medical or nursing care. Providing client care while under the influence of drugs or alcohol. Giving narcotic drugs without an order. Falsely holding oneself out to the public or to any health-care practitioner as a "nurse practitioner."

Health Insurance Portability and Accountability Act of 1996

Provides client right to confidentiality. Essentially represents two areas for implementation: Administrative simplification plan: simplify coding and exchange of information. Privacy rules: balance between strong privacy protections and need for disclosure of information for care.

Intentional Torts

Purposeful act committed by an individual against another person that results in the latter experiencing some type of harm. -Assault and battery -False imprisonment -Invasion of privacy -Defamation of character ---Slander (spoken) ---Libel (written) (eg, social media)

The Board of Registered Nursing Protects Citizens by:

RN licensing (ie I must meet certain criteria , then get license) --Monitoring of RN educational standards ----All schools of nursing must be approved by the Board of Nursing --RN continuing education --Disciplining RNs

Patient Self-Determination Act (PSDA)

Required health-care organizations that received federal funding (Medicare and Medicaid) to provide education for staff and clients on issues concerning treatment and end-of-life issues. Includes the use of advance directives (ADs), written instructions regarding desired end-of-life care. Also likely includes durable power of attorney for health care (health-care proxy). *Document in the client's record.

Good Samaritan Laws

Suggest that health-care providers are typically protected from potential liability if they volunteer their nursing skills away from the workplace (generally limited to emergencies), provided that actions taken are not grossly negligent and if the health-care worker does not exceed his or her training or scope of practice in performing the emergency services .

Guidelines for Informed Consent

The person(s) giving consent must fully comprehend: (and speak back to me...) 1. The procedure to be performed 2. The risks involved 3. Expected or desired outcomes 4. Expected complications or side effects that may occur as a result of treatment 5. Alternative treatments that are available

Nurses Are at Increased Legal Liability in the Twenty-First Century Owing to the Following:

They have more authority and independence in decision making. They have increased legal accountability for decision making. They are performing more actions that used to be in the realm of medical practice. They are making more money. More nurses are carrying malpractice insurance.

QUESTION: Nurse practice acts are examples of statutes.

True Rationale: The 51 Nurse Practice Acts representing the 50 states and the District of Columbia are examples of statutes. These Nurse Practice Acts define and limit the practice of nursing, thereby stating what constitutes authorized practice as well as what exceeds the scope of authority.

Types of laws and courts: CIVIL Burden of proof required for a guilty verdict/consequence of a guilty verdict

based on a preponderance of the evidence/monetary damages

Nurses who are aware of their rights and duties in legal matters are...

better able to protect themselves against liability or loss of professional licensure.

Types of laws and courts: CRIMINAL Burden of proof required for a guilty verdict/consequence of a guilty verdict

beyond a reasonable doubt/incarceration, probation/fine

Types of laws and courts: ADMINISTRATION Burden of proof required for a guilty verdict/consequence of a guilty verdict

clear and convincing standard/suspension or loss of licensure

Who is responsible for providing informed consent to the patient/client?

doctor

Sources of Law: Administrative agencies -

enforce statutory laws - State Boards of Nursing