Introduction to the board of nursing and legal issues in nursing

Functions of the BON

- Establishes standards of practice & regulate practice - Interprets NPA & Rules & Regulations to nurses and the public - Investigates possible violations of NPA - Disciplines violators through legal action - License qualified applicants to practice nursing - RN, LVN, APN - Grants licensure to nurses from other states - Recommends to legislature appropriate changes in NPA - Establishes standards for nursing education and approves nursing education programs - Provides consultation to nursing education programs - Provides advice and counsel to faculty, staff of health agencies utilizing nurses, and to nurses to improve professional service

Role of legislature and BON

- Legislature passes changes to NPA - BON interprets the NPA and develops rules and regulations to implement the NPA

categories of potential hazards found in hospitals

-biological -chemical -psychological -physical -environmental, mechanical/biomechanical

What evidence can help me in a lawsuit? Medical Record

1 in 4 cases decided on what's in the medical record integrity, accuracy, and completeness makes claim defensible or indefensible good documentation- best defensive action document extensively, accurately, and very factually

Texas Nursing Practice Act was passed in

1907

HIPPA

1996 national standards for electronic health care transactions national identifiers for providers, health plans, and employers security and privacy of health data

Physician and other independent practitioner liability

NOT ultimately responsible for everything that happens to pt nurses follow orders, but not those unsafe for patients or out of scope of practice

Laws governing nursing practice: 1938

New York passed first mandatory NPA required applicants to pass a licensure exam has to pass exam to use RN

Examples of OSHA requirements

PPE blood borne pathogens: safety needles airborne pathogens: engineering safety ergonomics- back safety reproductive hazards- X-ray

A surgeon asks the nurse to get an informed consent signed by a patient needing brain surgery for a tumor. The condition is causing mental confusion for the patient. What should the nurse do?

The patient should not sign the consent form the nurse must determine if the spouse has the legal right to sign the form, or who has the legal right the nurse should determine if this person is adequately informed, if informed sign consent

The joint commission mission

To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value

Safe harbor

a process that protects a nurse form employer retaliation and licensure sanction when a nurse makes a good faith request for peer review of an assignment or conduct the nurse is requested to perform and that the nurse believes could result in violation of the NPA or board rules

what is the professional duty owed

act as a reasonable nurse would under the same or similar circumstances

Laws governing nursing practice: 1970's

all states has passed mandated licensure of nursing

Assault

attempt or threat to touch someone unjustifiably

invasion of privacy

breach of confidentiality

in due process, an incident-based peer review committee's decision

cannot be overruled, changed, or dismissed

Institutional liability

carry insurance policies or lack of common claim in court

Nurses must report nursing students who's ability to perform the services of the nursing profession would be impaired by

chemical dependency

What is an expert witness?

common way to establish duty owed testifies what a reasonable nurse would do in similar circumstances

Informed consent

communication process between provider and patient of explaining procedures and treatments risks, benefits, alternatives must be disclosed results in patient agreeing to procedures or treatments allows pt opportunity to ask and gave answered questions about procedure, follow-up, complications etc. communication must be in language pt understands provider must be certain that patient understands what has been said and that the patient is willing to accept risks of procedure

defamation

communication that is false, or made with careless disregard fro the truth and results in injury to the persons reputation

civil law

concern private interests and rights between individuals involved in cases sometimes an event can have both criminal and civil consequences

Graduate Nurses' Association of Texas

concerned nurses who wanted control of nursing education to be by nurses

What are established policies and procedures?

crucial pieces of evidence for establishing a standard of care resources for questions regarding certain procedures

common law

decisions made by judges in court cases (Ex. pt right to refuse treatment: negligence and Malpractice)

libel

defamation by print, writing, pictures

slander

defamation by the spoken word

Major provisions of the NPA

definition of nursing establishes the BON and sets administrative functions and processes requirements for licensure and renewal whistleblower protection for nurses

intentional torts

deliberate acts intended to cause harm

Possible disciplinary actions of BON

denial of application for a license issue a written warning administer a public reprimand limitation on the license that might practice or specific activities or stipulate periodic BON review suspension of a license assessment of a fine require counseling, continuing education, practice be under supervision of another RN or public service

Personal liability

each individual accountable for own actions you are held to professional standard of care

What is nursing incident based peer review

evaluating the nursing services evaluate the qualifications evaluate the quality of patient care evaluate complaints concerning a nurse or nursing care conclude a recommendation regarding a complaint

Peer Review for nurses

evaluation process of quality of care Two kinds of peer review: incident based, safe harbor organizations that employ more than 10 nurses must have peer review plan all proceedings are confidential

The Texas Nursing Practice Act is amended

every 2 years during regular session of Texas legislature (odd years)

What are accreditation and facility licensing standards?

evidence of standard of care for nurses working in accredited facilities

Nurse Practice Acts

exmples of state satutory laws defines the scope of nursing practice and expanded nursing roles

categories of negligence

failure to follow standards of care failure to use equipment in a reasonable manner failure to communicate failure to document failure to assess and monitor failure to act as patient advocate

Laws governing nursing practice: 1903

first nurses practice act north carolina did not define nursing people could practice nursing, but couldn't use the title "RN"

Good Samaritan statues

given immunity from malpractice to those attempting to give assistance at scene of accident

medical durable power of attorney

grants another person the right to act as legal representative for you to make decision related to medical care

Standards of practice

guide professional behavior of nurses used as standard in issues related to practice and malpractice nurses must know and conform to: NPA, rules and regulations, federal ,state, local laws affecting their area of practice

Nurse's request for safe harbor must be made _____ before the assignment is accepted by the nurse

in writing

unintentional torts

incidents or accidents

Advanced directive- 2 signatures and at least 1 witness can't be someone who

is related by blood or marriage has claim to estate designated to make heath care decisions on your behalf your attending physician is employed by attending physician is an employee of a health care facility in which you reside, if the employee is involved in providing direct patient care to you

A physician writes "I have informed patient of risks of surgery, expected outcomes, and alternative treatment. please get consent form signed". should the nurse have pt sign consent form

it depends on the hospitals policy

advanced directive is in effect until

it is revoked can be revoked at any time

Advance Directive

legal document that allows person to make decision about end-of-life-care directs physician about preferences at end-of-life all treatments be discontinued or continued

specific protections of HIPPA

limits the use of pre-existing condition exclusions prohibits health plans form discriminating by denying coverage or charging extra based on past or present poor health guarantees small employers and people who lose job-related coverage the right to purchase health insurance

negligence

misconduct or practice that is below the standard expected of an ordinary, reasonable, and prudent person

Statutory Law

most common type of law affecting nurses

Nursing malpractice

most common unintentional tort action brought against nurses is a malpractice claim important for nurses to know basic elements that must be proved before malpractice can occur

Absolute bars to licensure

murder kidnapping sexual assault aiding in suicide robbery

nurse compact

mutual recognition of model of licensure allows you to be licensed in one state and practice in other compact states states must enact legislation to authorize Nurse License Compact Nurse must reside in state

A patient is brought into the ER with an abdominal gun shot wound and is hemorrhaging and emergency surgery is required. Is informed consent necessary

no medical emergency

The joint commission (TJC)

non-profit org founded to evaluate and accredit hospitals establishes standards for quality and safety onsite eval every 3 years or sooner

What are the basic elements of malpractice

nurses must have a duty (must be a professional nurse-patient relationship) nurses must have breached that duty (fallen below standard of care) nurses breach of duty must have been a foreseeable cause of the patients injury damages or injury must have occured

OSHA

occupational safety and health act of 1970 to assure safe and healthful working conditions establish standards of practice provide for research, information, education, and training in the field of occupational safety and health

Criminal law

occurs when you have done something considered harmful to society as a whole (misdemeanor or felony)

Nurses must report

other nurses

If no advanced directive, and patient incapable or incompetent of communication and guardian or family member is not present, then what?

physician and another physician who is not involved in the treatment of the patient or who is on the hospital ethics committee can make decision

civil actions

plaintiff files lawsuit for compensation for damages suffered from perceived wrong

CMS (Medicare and Medicaid) will not reimburse if these occur during hospitalization

pressure ulcers preventable injuries, such as fractures, dislocations, and burns CAUTI's vascular catheter associated infections certain surgical-site infections object left mistakenly inside surgical patients air emboli blood in incompatibility reactions

malpractice

professional negligence

mission of the board of nursing

protect and promote the welfare of the people of Texas ensures that licensed nurses are competent to practice safely

Whistleblower protections: what is it?

protections available to a nurse that prohibit retaliatory action by an employer or other entity

HIPPA compliance and Nursing Practice

pt name cannot be posted near or on room door charts should be in secure, non-public place printed copies of health information should not be in unattended at fax or printer notice informing pt of their rights about privacy and their health information should be posted voice levels should be lowered to minimize disclosure of information nurses stay current with HIPPA regulations

deposition

recorded oral questioning

constitutional law

refers to rights, privelages, and responsibilities from U.S. constituiton, including Bill of Rights

Whistleblower protections: protections

refusal to engage in conduct relating to patient care that would violate NPA or Board, making a lawful report of unsafe practitioners/unsafe patient care practices or conditions

Student liability

responsible for OWN actions held to standard of RN for performed tasks don't accept assignments beyond preparation communicate frequently with instructors

regulatory or administrative law

rules and regulations passed by State Boards of Nursing (Ex. Requirement to report incompetent or unethical nursing conduct to BON)

Due process provide the nurse the opportunity to

submit a written statement regarding the event under review call witnesses and question witnesses be present when testimony or evidence is being presented ask questions of the committee and respond to questions of the committee make an opening statement

Good faith

taking action supported by a reasonable factual or legal basis

supervisory liability

task properly assigned to competent worker adequate supervision provided nurse provided appropriate follow-up and evaluation of delegated task

What does a nurse need to do when having consent signed

the nurse attests to: authenticity, voluntariness, capacity

capacity

the pt understood the explanation of the procedure, risks, and alternatives, read the consent form, understood the consent form, and agreed to the proposed treatment

voluntariness

the pt was not forced to sign

authenticity

the signature belongs to pt

licensure for the APN/RN/LVN

to practice nursing, you MUST have a license you may not use the titles RN, LVN, APN if you have not met the requirements of the Bon and have been granted a license to practice

OSHA mission

to prevent work-related injuries, illnesses and deaths

If no advanced directive, and patient incapable or incompetent of communication:

treatment decision can be made by physician and one of these in the order listed 1. spouse 2. available adult children 3. parents 4. nearest living relative

false imprisonment

unjustifiable detention of a person without legal warrant to confine the person

battery

willful touching a person that may or may not cause harm

interrogatories

written questions

First nursing school in Texas

John Sealy Hospital School of Nursing - Galveston, Texas in 1890

What is the minimum due process for nurses?

Exclude from committee, including attendance at the peer review hearing, any persons with administrative authority for personnel decisions directly relating to the nurse required is a description of the events to be evaluated of the incident, circumstances and conduct, specific dates, times, locations, and individuals involved