NURS 242- Exam 2
what are examples of criminal law? what is the definition? is it intentional or unintentional?
RN found guilty of administering fatal doses of drugs to patients consequences: jail, fines, probation intentional definition: individual faces charges generally filed by the state or federal attorney general for crimes committed against an individual or society
Who is the BON composed of?
RNs, LPNs, advanced practicing nurses, and members representing the public
Name some STATE exemplars of health care policy
STATE: Scope of practice and licensing for nurses defined by state professional practice acts State public health programs and policies related to infectious diseases State public health regulations that govern health care facilities State statutes and case law related to professional negligence and malpractice
name some examples of FEDERAL statutory laws
Social security act of 1965 Social security amendment of 1963 emergency medical tx and active labor act of 1986 patient self-determination act of 1991 HIPAA patient protection and affordable care act of 2010 americans with disabilities act of 1990
what are some examples of Federal Statutory Laws?
Social security act of 1965 Social security amendment of 1983 Emergency medical treatment and active labor act of 1986 (EMTALA) Patient self-determination act of 1991 Health insurance portability and accountability act of 1996 (HIPAA) Patient Protection and affordable care act of 2010 Americans with disabilities act of 1990 (ADA)
what are examples of administrative law and regulation along with possible consequences?
State Boards of Nursing, come to work drunk, stealing pills consequences: suspension or loss of license
___________ ____ and _______= the rules and regulations established and by appointed agencies of the executive branch of the government (governor or president) examples? consequences?
administrative law and regulation examples: State boards of nursing, come to work drunk, stealing pills consequences: suspension, loss of license
_______ ______= identifies how patient wishes to be treated in event of certain medical conditions and who make decisions examples?
advance directives examples: living wills, medical POA, DNRs
_____ ___ _____= healthcare providers breach their duty to patients when they fall below standard of care or deviate standard of care that causes injury examples?
breach of duty example: if me error results in harm or injury
_______= link between breach and injury (would injury have not occurred but for the defendants actions?)- this answers this question and establishes that the breach of duty legally caused injury to the pt- RN action must directly harm pt
causation
which nursing roles are considered APRNs and require certification by a national nurse certification organization?
clinical nurse specialist nurse midwife NP registered nurse anesthetist
_____ ______= analyzed by situation under review; judge/judicial branch interprets law but misinterpretation of law leads to law itself; law based on cases rather than laws made by legislatures examples?
common law examples: informed consent, the patient's right to refuse treatment, negligence, and malpractice
Which item is NOT a component of all Nurse Practice Acts?
complete guide for nursing profession
what is monitored during the nondisciplinary alternative to discipline program?
compliance with tx, abstinence from drug and alcohol use, practice upon returning to work
______ ____ ______=enacted laws that designate who can consent/make decisions for an incapacitated patient if pt hasn't already designated someone. provider must obtain consent prior to tx
consent for treatment
______ _______= highest laws in US; interpreted by US supreme court; gives authority to other 3 sources of law examples?
constitutional law examples: fundamental laws or principles that govern a nation, society or corporation, or other aggregate of individuals ; each state has individual ones of these
_____ ______= agreement between private parties creating mutual obligations enforceable by law
contract law examples: The contract most probably includes provisions regarding your stated salary, your benefits, the length of the contract, how it can be terminated by either you or your employer, what your job requirements are, defines a breach of the contract and the consequences thereof, and how the contract can be altered or changed by either party.
what three things are included in dynamic tension in healthcarE?
cost quality access
A nurse is charged with admin. a fatal dose of K 80 meg IVP to pt on hospice that asked the nurse to "help her die" today. In which court would the nurse be charged?
criminal
what do the majority of jurisdictions include for investigation by NPA?
criminal background checks as additional requirement for licensure
what is the burden of proof required for... criminal civil administrative along with consequences?
criminal- beyond a reasonable doubt consequences: incarceration, probation, fines civil- based on preponderance of the evidence consequences: monetary damages administrative- clear and convincing standard consequences: suspension or loss of licensure
______ _____ ______ _____= physician writes rx of lethal dose of med that mentally competent pt can use to end their life if they have <6 mos to live example?
death with dignity laws example: "right to die" assisted suicide
what is the purpose of the 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- vary among states but must be consistent with provisions or statutes established at the federal level
how is BON membership constituted? which state is elected by the general public?
depends on the state- some states gives governor authority to appoint members, some require nominations from professional organizations only north carolina are BON members elected by the general public
what are the 5 elements of malpractice?
duty breach of duty causation injury harm
_______= providing a reasonable,standard of care to patients; standard of care can depend upon where one works, whether a rural or urban setting or ICU vs surgery _____ ___ _____= falling below the reasonable, standard of care owed to patients _______= can often be difficult to prove in negligence cases; is the link between breach of duty and injury/harm ____ ____ ______= may be physical or a combo of physical, mental, emotional or finanical
duty breach of duty causation injury or harm
_____= all persons owe a duty to exercise ordinary care to avoid harming another person, place or thing example?
duty example: RNs owe a professional duty of reasonable care to all of their assigned pt
what are the components of professional negligence?
duty to use due care failure to meet standard of care forseeability of harm a direct relationship between the standard of care and injury can be proved injury
what develops rules or regulations that seek to clarify or make the NPA more specific?
each state has individual rules/regulations
______= an approval process for a nurse who is licensed in another state. what obtaining licensure by this include?
endorsement prelicensure requirements, verification of licensure status from the state where the nurse obtained it by examination
what are some interrelated concepts of health care policy?
evidence, ethics, safety, healthcare quality, health care economics, health disparities, healthcare law
_______ ______= nurses seek this from patients by witnessing patients sign a standard consent form. role of RN in this is to make sure that the patient has received informed consent and to seek remedy if he/she hasnt
express consent
what are some examples of Negligence: failure to assess and monitor
failure to complete shift assessment failure to implement plan of care
what are some examples of Negligence: failure to use equipment in responsible manner
failure to follow manufacturers recommendations for operating equipment failure to check equipment for safety failure to place or position equipment properly failure to learn how equipment functions
what are some examples of Negligence: failure to communicate
failure to notify physician in timely manner when conditions warrant failure to listen to clients complaint and act on it failure to communicate failure to communicate effectively with a client
what are some examples of Negligence: failure to follow standards of care?
failure to perform a complete admission assessment or design plan of care failure to adhere to standardized protocols or institutional policies and procedures failure to allow a physicians verbal/written orders
what are some examples of Negligence: failure to act as an advocate
failure to question discharge orders failure to question incomplete or ineligible orders failure to provide safe environment
what are some examples of Negligence: failure to document
failure to record clients progress and response to tx failure to record clients injuries failure to record important nursing assess info
define negligence according to Giddens
failure to use reasonably prudent care in the same or similar circumstances. For tort and liability to attach to negligent conduct, the individual must have done more than simply act in a negligent manner
what are the 2 values that are the heart of most public policy decisions?
fairness and efficiency
______ ______= restraint of persons liberty of movement by another party who lacks legal authority or justification to do so ______=communicating to a third party false info that injures a person's reputation _______= the above definition, but spoken what are these three things examples of?
false imprisonment defamation slander all examples of intentional tort
what produces dynamic tension between competing health policy interests? what are the intersections?
federalism, participative governance, and need to negotiate values produce dynamic tension access, cost and quality are the intersections
what is the definition of health policy? examples?
goal-directed decision making about health that is the result of an authorized, public decision making process; those actions, nonactions, directions, and/or guidance related to health that are decided by governments or other authorized entities. what are some examples? decisions related to federal subsidies for the education of health professionals, state regulations that cover insurance benefits
the ED nurse is scheduling the 16-year old pt for an emergency appendectomy. which intervention should the nurse implement when obtaining permission for the surgery?
have the patients parent or legal guardian sign the permit
what is the EMTALA of 1986?
hospitals that have ERs have a duty to care for those requiring emergency medical services irrespective of patients ability to pay
what is the Patient Self-Determination act?
it's a FEDERAL act requiring healthcare faciltiies, such as hospitals and nursing homes to provide patients with info related to their preferences for end of life care (ie advanced directives, DNR)
what is the Health Information Technology for Economic and Clinical Health Act of 2009?
it's a FEDERAL act to establish a nationwide health information technology infrastructure, including the development of health IT standards, interoperability and certification, reports on quality and reimbursement incentives to improve healthcare quality. A section of the act also addresses privacy and security concerns associated with electronic transmission of health info through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules
what 3 things are included in scope of healthcare law?
legislation litigation regulation
which of the following fall under State Statutory Laws?
licensing boards, scope of practice, good samaritan acts, death with dignity or aid-in dying
What are some examples of state statutory laws?
licensing boards/practice acts immunizations public health and safety- disease surveillance, sanitation consent/ statutory surrogates advance directives death with dignity or aide in dying Good Samaritan acts CMS conditions of participation for hospitals practice acts scope of practice
name some exemplars of STATE statutory laws
licensing boards/practice acts immunizations public health and safety- disease surveillance, sanitation consent/ statutory surrogates advance directives death with dignity or aide in dying Good Samaritan acts CMS conditions of participation for hospitals practice acts scope of practice
where can you access NPA regulations?
links to NPAs are available on state BONs websites and newsletter
________ is a type of professional negligence; act or omission by healthcare provider in which conduct falls below accepted standard of practice ______= injured party _____= professional accused of causing harm _____ ____ _____= degree of quality considered adequate
malpractice plaintiff defendant standard of care
define the Good Samaritan Laws
suggest that healthcare 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 healthcare worker doesnt exceed his/her training or scope of practice in performing emergency services
who is a complaint filed with when a nurse deviates from the standard of care or commits an error? This group has ______ authority specified in the _______
the BON this group has statutory authority specified in the NPA BON can take formal action only if it finds that the nurse violated the NPA
who has the authority, granted by Nurse Practice Acts, to regulate the practice of Nursing?
the Board of Nursing
what protects RN and LPN titles from being used by unauthorized persons, thereby protecting the public
the NPA
what is joint liability?
the nurse, doctor and employer are all held liable; employers are now held liable for nurse's acts under vicarious liability; respondeat superior- "the master is responsible for the act of his servants", however each nurse is individually held liable for her own negligible practice- but supervisors can be held liable if they were negligent in supervision of those employees at the time
a state legislature enacts an NPA to regulate nursing and delegates authority to who to enforce the NPA?
the state boards of nursing
what is the basis for a nursing license?
the state's duty to protect those who receive nursing care
T/F The purpose of the Emergency Medical Treatment and Labor Act of 1986 was enacted to prevent the denial of emergency services to patients because they are uninsured and unable to pay for care.
true
what is the Social Security Act of 1965?
trust fund for establishment of medical and medicare (unemployed and retired) example: patient who doesnt have insurance thru employment gets reimbursed for care
what are the different kinds if torts?
unintentional tort- negligence (based on concept of fault that caused harm but was unintentional intentional tort- harmdoer acted intentionally (ie assault and battery, invasion of privacy, etc)
identify 3 common causes of professional nursing license suspension or revocation
1. medical errors 2. providing care while under the influence 3. HIPAA violation
what are the two pitfalls in determining if stare decisis should apply to a given situation?
1. previous case must be within the jurisdiction of the court hearing the current case 2. the court hearing the current case can depart from the precedent and set a landmark decision
what 3 things are recommended from executive summary of healthcare in crossroads: improving liability and preventing injury?
1. pursue pt safety that prevents medical injury 2. promote open communication bw patients and practitioners 3. create an injury compensation system that is patient centered and serves common good
what are the 8 recommendations from the Future of Nursing Report?
1. remove scope of practice barriers 2. expand oppurtunities for nurses to lead and diffuse collaborative improvement efforts 3. implement nurse residency programs 4. inc. proportion of nurses with BSN to 80% by 2020 5. double the number of nurses with doctorate by 2020 6. ensure that nurses engage in lifelong learning 7. prepare and enable nurses to lead change to advance health 8. build an infrastructure to collect and analyze health care workforce data
what are the major public authorities operating at the federal, state and local level? (4)
1. state and national legislatures 2. state and national and local courts and judiciary 3. executive branches of federal and state governments 4. regulatory agencies
What is the purpose of the National Practitioner Data Bank?
Workforce tool to prevent practitioners from moving state to state without disclosure or discovery of previous damaging performance
who's responsibility is it to know your state's NPA and rules before you enter that unprotected intersection of nursing care?
YOURS as the nurse
what do the prelicensure program standards include for BONs standards?
accredidation, curriculum specifics, admin and faculty qualifications, continuing approval, approval of new, or withdrawal of approved nursing education programs
the physicians order reads: give lasix 200 mg IVP over 30 mins prior to infusion of PRBCs. the nurse administers lasix as ordered on the MAR. the patient has cardiac arrest and dies at the end of her shift. during the managers review of the chart, he notes the dose of lasix was administered and asks kendra to explain. the patients family is suing kendra and the hospital. which of the following statements by kendra will not stand up in court under Tort law?
"I just followed the physician's order"
two nurses are having lunch in the hospital cafeteria when one of the nurses begins talking about a difficult patient. what response by the second nurse indicates the best understanding of the Health Insurance Portability and Accountability Act?
"It's not appropriate to discuss pt in the lunchroom"
the novice nurse asked his preceptor why he needed to be aware of the rights and duties of legal matters. What is the preceptors best response?
"to be able to better protect yourself"
what do court systems provide for health policy?
- often staging grounds for determining rights in health policy disputes through judicial review (ie can include challenging unreasonable government action, supporting the establishment of newly created rights through legislation, ensuring protection provided by healthcare law)
what do legislatures provide for health policy?
-authority to create laws - determining appropriate funding for legislative act -providing oversight for policies that are administered by government agencies
what do regulatory agencies do for health policy?
-may be part of executive branch or independent implement and enforce laws through a rule-making process -rules made by these agencies have the force of law (ie decisions related to nursing licensure by state boards)
what does the executive branch provide for health policy? who oversees tasks completed by this branch? jobs of chief executives?
-responsible for execution of laws passed by legislatures state governors, US president, chief executive chief executives- develop and implement institutional budgets, control vast resources of executive branch and usually able to use veto authority to influence policy changes
Explain each stage of the policy process: agenda setting policy formation policy adoption policy implementation policy evaluation
1. agenda setting: health related issue is identified as a problem- nurses can be helpful in this stage to frame the issue (creating a particular perspective of the issue- ie patients have the right to assisted suicide bc they have right to make their own decisions) 2. policy formulation- different policy interventions are proposed and considered 3. policy adoption- proposed intervention is selected 4. policy implementation- carrying out proposed intervention 5. policy evaluation- determining if policy achieved the desired policy goals.
what are the 8 sources of law?
1. constitutional law 2. statuory law 3. administrative law and regulation 4. tort law 5.common law 6. contract law 7. criminal law 8. civil law
what are the 8 elements of the Nurse Practice Acts (consistent among states)?
1. definitions 2. authority, power, and composition of a Board Of Nursing 3. educational program standards 4. standards and scope of nursing practice 5. types of titles and licenses 6. protection of titles 7. requirements for licensure 8. grounds for disciplinary action, other violations, and possible remedies.
explain the 1-4 elements of the Nurse Practice Acts: 1. definitions 2. authority, power, and composition of a Board Of Nursing 3. educational program standards 4. standards and scope of nursing practice
1. definitions- For the intent of a law to be useful to legislators and citizens, terms or phrases used in statutes must be clear and unambiguous. 2. authority, power, and composition of a Board Of Nursing -The NPA gives authority to regulate the practice of nursing and the enforcement of law to an administrative agency or BON that is charged with maintaining the balance between the rights of the nurse to practice nursing and the responsibility to protect the public health, safety, and welfare of its citizens 3. educational program standards - The BON must set standards for prelicensure nursing educational programs and clinical learning experiences and approve such programs that meet requirements of the NPA. 4. standards and scope of nursing practice - One's nursing care is both directed and measured by the NPA and rules. The standards and scope of nursing practice within an NPA are aligned with the nursing process.
what are the 4 elements that must be proven for negligence?
1. duty 2. breach of duty 3. causation 4. injury or harm
what are the 6 standards of negligence?
1. failure to follow standards of care 2. failure to use equipment in responsible manner 3. failure to communicate 4. failure to document 5. failure to assess and monitor 6. failure to act as an advocate
what is the Board of Nursing Complaint Process? (6 steps)
1. filing a complaint 2. initial review of complaint 3. investigation 4. board proceedings 5. board actions 6. reporting and enforcement
what are the 7 possible BON actions discipline, violations, etc. of license?
1. fine or civil penalty 2.referral to an alternative to discipline program for practice monitoring and recovery support for those with drug or alcohol dependence or some other mental or physical condition 3. public reprimand or censure for minor violation, often with no restriction of license 4. imposition of requirements for monitoring, remediation, education or other provision tailored to the particular situation 5. limitation or restriction to one or more aspects of practice, such as probation with limits on role, setting, activities or hours worked 6. separation from practice for a period or loss of license 7. other state-specific remedies
what are the 13 powers of the Board of Nursing?
1. hiring BON employees ⦁ 2. making, adopting, amending, repealing, and enforcing rules ⦁ 3. setting nursing education standards ⦁ 4. setting fees for licensure ⦁ 5. performing criminal background checks ⦁ 6. licensing qualified applicants ⦁ 7. maintaining database of licensees ⦁ 8. ensuring continuing competence ⦁ 9. developing nursing standards of practice ⦁ 10. collecting and analyzing data ⦁ 11. implementing discipline process ⦁ 12. regulating unlicensed assistive personnel. 13. regulating RNs
what are mgmt functions related to specific federal and state laws?
1. inc. knowledge regarding sources of law and legal doctrines 2. ensures organizational guidelines regarding scope of practice are consistent with NPA 3. delegates suboordiantes wisely- looks at scope of practice 4. understands and adheres to institutional policies and procedures 5. dec. risk of product liability- ensures all staff are oriented to use of equip and products 6. monitors subordinates license validity 7. uses forseeability of harm in delegation and staffing 8. inc. staff awareness of torts and assists in strategy development to dec. liability in those areas 9. provides education for tx and issues under patient self-determination act 10. protects pt under HIPAA 11. ensures pt has reasonable access to medical record following policy 12. background checks for employees 13. educational training on legal issues in nursing
Explain the 5-8 elements of the Nurse Practice Acts: 5. types of titles and licenses 6. protection of titles 7. requirements for licensure 8. grounds for disciplinary action, other violations, and possible remedies.
5. types of titles and licenses - Each state's NPA also includes statements regarding examination for licensure as RNs and LPN/VNs, including frequency and requisite education before examination and reexamination. Additional requirements of licensure by examination typically include: ⦁ application and fee ⦁ graduation from an approved prelicensure program or a program that meets criteria comparable to those established by the state ⦁ passage of the professional examination ⦁ attestation of no report of substance abuse in the last 5 years ⦁ verification of no report of actions taken or initiated against a professional license, registration, or certification ⦁ attestation of no report of acts or omissions that are grounds for disciplinary action as specified in the NPA 6. protection of titles - see above 7. requirements for licensure - see above 8. grounds for disciplinary action, other violations, and possible remedies- Disciplinary cases are often grouped into the following categories: ⦁ Practice-related: breakdowns or errors during aspects of the nursing process ⦁ Drug-related: mishandling, misappropriation, or misuse of controlled substances ⦁ Boundary violations: nontherapeutic relationships formed between a nurse and a client in which the nurse derives a benefit at the client's expense (NCSBN, 2009) ⦁ Sexual misconduct: inappropriate physical or sexual contact with a client ⦁ Abuse: maltreatment of clients that is physically, mentally, or emotionally harmful ⦁ Fraud: misrepresentation of the truth for gain or profit (usually related to credentials, time, or payment) ⦁ Positive criminal background checks: detection of reportable criminal conduct as defined by statute
What are the consequences for nurses who violate the Nurse Practice Act or regulations, or commit an error?
A complaint may be filed with the Board of Nursing
What is the duty of all nurses with respect to the Nurse Practice Act and regulations?
All nurses have a duty to understand their Nurse Practice Act and regulations and to keep up with ongoing changes as the document evolves and scope of practice expands
where are specific NPA regulations located? the _______ Nurse Practice Act Toolkit includes find Your Nurse Practice act tool that provides what?
BON website NCSBN- provides links to each states NPA and regulations
what are the 7 complaint categories in regard to disciplinary process in nursing?
Disciplinary cases are often grouped into the following categories: ⦁ 1. Practice-related: breakdowns or errors during aspects of the nursing process ⦁ 2. Drug-related: mishandling, misappropriation, or misuse of controlled substances ⦁ 3. Boundary violations: nontherapeutic relationships formed between a nurse and a client in which the nurse derives a benefit at the client's expense (NCSBN, 2009) ⦁ 4. Sexual misconduct: inappropriate physical or sexual contact with a client ⦁ 5. Abuse: maltreatment of clients that is physically, mentally, or emotionally harmful ⦁ 6. Fraud: misrepresentation of the truth for gain or profit (usually related to credentials, time, or payment) ⦁ 7. Positive criminal background checks: detection of reportable criminal conduct as defined by statute
T/F copies of incident reports should be placed in the patients chart
FALSE
T/F death with dignity laws state that a nurse is allowed to prescribe a lethal dose of meds that a mentally competent but terminally ill patient can use to end their life if the patient has less than 6 mos to live
FALSE
T/F all RNs are automatically covered by their employer's liability insurance
FALSE WRONG- need to protect yourself and your career with professional liability insurance
name some FEDERAL exemplars of health care policy
FEDERAL: Americans with Disabilities Act of 1990 Emergency Medical Treatment and Labor Act of 1986 Health Information Technology for Economic and Clinical Health Act of 2009 (electronic health records) Health Insurance Portability and Accountability Act of 1996 Patient Protection and Affordable Care act of 2010 Patient Safety and Quality Improvement Act of 2005 Patient Self-Determination Act of 1998 Promoting Health/Preventing Disease: Objectives for the Nation, Healthy People, 1990, 2000, 2010, 2020 Social Security Act of 1965 (Medicare and Medicaid) The Mental Health Parity and Addiction Equity Act of 2008 U.S. Preventative Services Task Force Mandated Health Coverage and Medicaid Expansion 2012
T/F The Patient Self-Determination Act requires health care facilities to provide information to patients regarding payment for services.
False
what can nurses use to take their jurisdictions Nurse Practice Act/Jurisprudence online, a self paced continuing education course?
Find your nurse practice act tool
What is the basis for Board of Nursing action related to complaints about nursing care?
Findings of an investigation and results of board proceedings
_______ ____ _____= provide individuals with preexisting medical conditions access to health insurance specifically if they changed/lost their job; prevent healthcare fraud and abuse and medical liability reform- privacy role- prevents sharing of privacy
HIPAA of 1996
________= provides more enforcement of noncompliance by establishing inc. levels of culpability and raising penalty amounts for compliance violations examples?
HITECH example: notifies pt when health info has been breached without authorization
Which of the following addresses privacy and security concerns associated with the electronic transmission of health information?
Health Information Technology for Economic and Clinical Health Act
Typically, the powers and duties of Boards of Nursing include, but are not limited to: Hiring Board of Nursing employees Setting fees for licensure Ensuring continuing competence All of the above
Hiring Board of Nursing employees Setting fees for licensure Ensuring continuing competence All of the above ALL
Name some LOCAL exemplars of health care
LOCAL: city and county fire codes that govern safe occupancy limits in health care facilities city and county ordinances that govern facility maintenance, signs, utilities, parking, and/or traffic around hospitals and other health facilities city and county tax districts for publicly supported facilities
What are the 3 major attributes of health policy? minor attributes (2)?
MAJOR: 1. Decisions are made by authorized government institutions (ie legislatures, courts, government-authorized entities) 2. decision-making process is subject to public review and public input 3. health policies address a public goal MINOR: 1. health policies are subject to ongoing review by governing institutions and by the public 2. health policy goals change according to changes in political and social values, trends and attitudes
who is responsible for reports containing certain info on certain adverse rxns related to practitioners, providers and supplies, along with medical malpractice payments? available to general public?
National practitioner databank NOT avail. to general public
what is the difference between negligence and malpractice?
Negligence is a failure to exercise the care that a reasonably prudent person would exercise in like circumstances. In tort law, negligence applies to harm caused by carelessness, not intentional harm.Malpractice is a type of negligence; it is often called "professional negligence"
Place the steps of the policy process in the correct order. ____Policy implementation___Policy adoption____Agenda setting____Policy evaluation____Policy formation
Place the steps of the policy process in the correct order. __4__Policy implementation __3__Policy adoption __1__Agenda setting __5__Policy evaluation __2__Policy formation
T/F Professional negligence occurs when the actions of the nurse are judged as substandard to what is expected in "reasonable and prudent" standard of practice and that result in harm to others.
TRUE
T/F The Nurse Practice Act gives authority to regulate the practice of nursing and the enforcement of law to an administrative agency for Boards of Nursing
TRUE
T/F in the absence of a specific statute to the contrary, statues of limitations are inapplicable to BON license revocation and other disciplinary proceedings
TRUE
T/F the NPAs vary among states, but all NPAs include 8 regulations
TRUE
T/F licensure status and BON actions are public information where can one access this info?
TRUE newsletters, databases and websites Nursys QuickConfirm License Verification
T/F an RNs licensure status is public information
TRUE- in federal databank, along with any actions taken against the licensure
sandy, RN is a 78 year old full time RN on a busy med-surge floor. her manager has reported her to the Board of Nursing due to many "near miss" med errors and errors in clinical judgement/pt safety. The board of nursing investigates the complaint and makes what decision for sandy?
The BON will revoke her license due physical/mental impairment related to age
The standards and scope of nursing practice within a Nurse Practice Act are aligned with:
The nursing process
what 5 things must the person giving consent must fully comprehend? who/how can a person receive informed consent? (6 ways/people)
The person giving consent must fully comprehend: 1. 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 consent may be given by: 1. a competent adult 2. a legal guardian or individual holing durable power of attorney 3. an emancipated or minor 4. mature minor (varies by state) 5. parent of a minor child 6. court order
Where can the state's Nurse Practice Act and regulations be found? They are not publicly available. Most state Board of Nursing websites NCSBN Find Your Nurse Practice Act tool Both b and c
They are not publicly available. Most state Board of Nursing websites NCSBN Find Your Nurse Practice Act tool Both b and c BOTH b and c
How can the public access information about licensure status and Board of Nursing actions? Through the National Practitioner Data Bank Newsletters, databases, and websites Nursys QuickConfirm License Verification Both b and c
Through the National Practitioner Data Bank Newsletters, databases, and websites Nursys QuickConfirm License Verification Both b and c both b and c
For what purpose did state governments establish Boards of Nursing?
To protect the public's health and welfare To oversee and ensure the safe practice of nursing To avoid public notoriety of discipline Both a and b both a and b
What is the purpose for state involvement in the regulation of nursing practice?
To protect those who receive nursing care
_____ _____= (court decisions)- action or omission that results in harm to patient; shapes and defines healthcare standards examples?
Tort Law MOST common liability for RNs examples: intentional assault and batter, fraud, false imprisonment, invasion of privacy
what are the steps for effective delegation?
UAPs have the education, legal authority and demonstrated competency to perform tasks tasks are consistent with UAPs job description tasks can be safely performed according to clean, exact and unchanging directions results of the tasks are reasonably predictible tasks dont require assessment, interpretation or independent decision making patient and circumstance are such that delegation of the task poses minimal risk to the patient consequences of performing the task improperly arent life threatening RNs provide clear instructions and guidelines to perform the task
How did the states gain regulatory authority over the practice of nursing?
Under a state's police powers
______ ______= done in emergencies; physician states in progress notes of EMR that patient is unable to sign but tx is immediately needed and is in pt's best interest- usually must be validated by another physician
implied consent
when was the first nurse registration law was enacted in which state?
in 1903 in north carolina
______ ______= can be given only after the patient has received complete explanation of the surgery, procedure or tx and indicates that he/she understands the risks and benefits related to it. only a competent adult can legally sign the form. if pt is <16 yrs, parent/guardian must give consent
informed consent
_____ or ______= resultant harm may be physical or a combo of physical, mental, emotional or financial harm example?
injury or harm example- patient cannot recover from emotional harm alone without an accompanying physical disability
Nurse James works at Kansas City Memorial Hospital. At Kansas City Memorial Hospital it is a smoke-free workplace. This policy of a smoke-free workplace at Kansas City Memorial is an example of a ....
institutional policy
name some exemplars of criminal liability
insurance fraud active euthanasia sexual assault
what are some examples of criminal liability?
insurance fraud active euthanasia sexual assault
which of the following fall under criminal liability?
insurance fraud, active euthanasia, sexual assault
what are the theoretical links with healthcare policy?
intergovernmental relationships, participative governance, values, dynamic tension
what is the Emergency Medical Treatment and Labor Act of 1986?
it's a FEDERAL act enacted to prevent the denial of emergency services to patients chiefly because they are uninsured and unable to pay for their care (ie common practice before this law was to patient dump at tax-supported public hospitals)
what do specific curriculum rules of the BON often include?
necessary standards of evidence-based clinical judgement, skill in clinical mgmt, biological, physical and social and behavioral science requirements, professional responsibilities, legal and ethical issues, patient safety, and best practice of nursing
________= the actions of the nurse are judged as substandard to what is expected in 'reasonable' and prudent 'standard of practice' and that result in harm to others
negligence
what are some examples of civil law? possible consequences? is it intentional or unintentional?
negligence, malparactice consequence: pay $$ to family unintentional
name some exemplars of TORTS
negligence/malpractice standard of care breach of duty abandonment
what are some examples of Torts?
negligence/malpractice standard of care breach of duty abandonment
A home health agency's patient filed a complaint with the BON that Nurse Joan appeared as though she was under the influence of drugs or alcohol. The BONs investigation of Nurse Joan revealed that a substance use disorder was suspected. What type of action may the BON choose in this situation?
nondisciplinary alternative-to-discipline program
what will be offered by BON if the healthcare professional is suspected of a substance abuse disorder?
nondisciplinary alternative-to-discipline program- monitoring program that the professional is adhering to the tx program, NOT tx program
how does informed consent pose ethical issues for nurses?
nurses must be careful not to disclose any new information or contraindicative info to patients- nurse is not responsible to explain procedure, but to be a patient advocate and determine the level of understanding the patient has and see that the appropriate person can answer their questions
what is the process for a patient to access their own medical record?
patient must make a written request and pay reasonable clerical costs to make records available. the provider generally permits inspection of records during business hours within several working days of inspection request
_____ _____ _____ _____ ______ ____ _ _________=includes provisions to enable americans with preexisting conditions to more easily affordable insurance, the creation of health insurance exchanges , insurance coverage more accessible, affordable for some individuals and businesses; elimination of co pays for preventative care; requires every american to have minimum health insurance
patient protection and affordable care act of 2010
_______ ______ _______ _____ ______ _____= ensures patient receives adequate discourse about end of life medical tx to ensure that pt recieve education about their right to decide future care in the event of incapacitation example?
patient self-determination act of 1991 example: advance directives
what are the guidelines for informed consent... The persons giving consent must fully comprehend what 5 things? Consent must be given by which 6 peeps?
person giving consent must comprehend: 1. Procedure to be performed 2. risks involved 3. expected or desired outcomes 4, expected complications or side effects that may occur as a result of tx 5. alternative tx that are available consent may be given by: 1. competent adult 2. legal guardian or individual holding durable power of attorney 3. emancipated or married minor 4. mature minor (varies by state) 5. parent of a minor child 6. court order
how can nurses reduce the risks of malpractice claims?
practice within scope of NPA. observe agencies policies and procedures model practice using EBP put patients first be relevant with law and legal documents practice within area of individual competence upgrade technical skills consistently- continuing education
what are some 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 function or duties of an RN participating professionally in criminal abortions not reporting substandard medical or nursing care providing patient care while under the influence of drugs or alcohol giving narcotic drugs without an order falsely holding oneself out to the public or any healthcare practitioner as a "nurse practitioner"
what are some common causes of professional nursing license suspension or revocation?
professional negligence, practicing medicine or nursing without a license, obtaining a license by fraud or allowing others to use your license, felony conviction or any offense substantially related to the function or duties of a RN, participating professionally in criminal abortions, not reporting substandard medical or nursing care, providing patient care while under the influence of drugs or alcohol, giving narcotics without an order, falsely holding oneself out to the public or to any healthcare practitioner as a nurse practitioner
what is the mission/purpose of the BON?
protect the public
what are incident reports or adverse events forms? should they be included in the pt chart? what should be included in pt chart?
records of unusual or unexpected incidents taht occur in the course of pt's tx. confidential communications- cannot be used as evidence in lawsuits; if not disclosed to patient. if disclosed to pt, theyre no longer considered confidential, so a copy of the incident report should not be left in pt chart and no entry should be made in pt record about the incidence report. chart should only provide enough info about incidence so appropriate tx can be given
what are the legal responsibilities of the nursing manager?
reporting dangerous understaffing checking staff credentials appropriate discipline seeing that staff operate equipment appropriately seeing that written protocols and policies are followed mandated reporter of abuse, communicable diseases, etc
where are actions taken against healthcare professionals reported? T/F it is available to general public
required by federal law to be reported to federal databank: The National Practitioner Databank NOT available to general public
the nurse has been named in a lawsuit concerning the care provided. which action should the nurse take first?
review the patient's chart
When referring to informed consent, which of the following must be fully comprehended by the patient?
risks involved expected or desired outcomes procedure to be performed alternative tx that are available expected complications or side effects
______ ______= relates to decisions that promote the welfare of the public (ie obesity and regulation of high fat and sugar products available in public schools, Medicare paying for weight loss programs) _______ ____= governs the workplace (ie a policy developed in workforce that relates to prevention os obesity, such as exercise facilities onsite ________= the actions of the nurse are judged as substandard to what is expected in 'reasonable and prudent' standards of practice and result in harm to others
social policy institutional policy negligence
what does the NPDB guidebook contain?
specific info regarding authorized queriers, which generally includes hospitals, other health care entities, professional societies, licensing boards, attorneys and the license.
what two important legal doctrines frequently guide all 3 courts in their decision making? _______ _____= a thing or matter settled by judgement- applies only when a competent court has decided a legal dispute and when no further appeals are possible; keeps same parties in original lawsuit from retrying the same issues that were involved in the first lawsuit ______ _____= to let the decision stand; uses precedents as a guide for decision making
stare decisis and res judicata res judica stare decisis
Who is tasked with the implementation and administration of nurse practice acts, including issuing licenses to legally practice nursing?
state regulatory agency and politically appointed board of nursing- can also make rules that have force of law- also have power to revoke licenses if nurse is practicing unsafely
_______ (legislative) _______= laws that are passed by the state or federal legislators and that must be signed by the president or governor examples?
statutory law examples: the 51 Nurse Practice Acts
______ ______= the employer is held liable for the nurse's act _____ ______= any employer required to pay damages to an injured person bc of an employee's negligence may have the legal right to recover or be reimbursed that amount from the negligent employee ______= when defamation is written, printed or broadcast ______ _____= when a product is involved, negligence doesnt have to be proved- nurses may be held liable for this.
vicarious liability respondent superior libel product liability
the scope of health policy is ______ and _____. what are some examples of macro-level? micro-level?
wide and varied macro level: i.e. medicare program funding micro: co payments for care
