Professional Nursing: Healthcare Law

Negligence

Conduct that falls below the standard of care.

Laws that empower patient decision-making

Consent for treatment Competence and capacity Substituted judgement and best interest standard Advance Directives Death with dignity laws

Sources of law

Constitutional Law Statutory (Legislative) Law Civil Law Criminal Law Administrative Law and Regulation Common Law Tort Law Contract Law Property Law

Patient Protection and Affordable Care Act (PPACA)

Consumer rights and protections Affordable health care coverage Increased access to care Quality of care that meets the needs of patients

Administration and regulation

Federal regulation and administrative agencies: United States Department of Health and Human Services, USDHHS had 11 federal agencies Licensing and scope of practice: Nursing Practice Act (NPA) and Board of Nursing (BON) Licensing of health care institution: Requirements vary from state to state

health care law Attributes:

Created by a government body (legislature, agency, court) Requires or prohibits actions Usually has enforceable sanctions Publicly available and accessible Consistent with federal and state constitutions Can be modified, changed or upheld

Administrative Law and Regulation

DHHS; HIPPA

Beginning and End-of-Life Nursing Issues

Death with dignity Physician-assisted suicide Termination of pregnancy

Health Insurance Portability and Accountability Act (HIPAA)

Establishes patient rights regarding privacy of their health care information and records.

Educator

Explains concepts and facts about health, describes teh reason for activities, demonstrates, reinforces, and evaluates teh client's progress in learning.

Autonomy

Independent nursing interventions that the nurse initiates without medical orders.

Patient Protection and Affordable Care Act

Make affordable health insurance available to more people. Expand Medicaid program to cover all adults with income below 138% of the federal poverty level . Support innovative medical care delivery methods designed to lower the cost of health care generally.

Torts

Intentional - Assault (threat), Battery (actual act), False imprisonment (doing something without an order) Quasi-intentional - Acts in which a person may not intend to cause harm to another but does Defamation of character (Ruin their reputation) Slander (said words) Libel (Written words)

Communicator

Is essential for all nursing roles and activities.

Public health laws

Laws affect individuals, populations, and communities that are intended to improve the health of people

Scope of concept

Legislative process_: introducing, adopting, changing, or repealing law regulatory activities: putting laws into action through the establishment of rules HIPAA Precedent setting judicial opinions: seeking help through the courts using the results of previous court cases

Licensure and certification

Licensure: NCLEX-RN® examination Licensure: NCLEX-PN® examination Certification: requirements vary

Good Samaritan laws

Limit liability and offer legal immunity if a nurse helps at the scene of an accident

Unintentional torts

Negligence (duty, injury or cause, breach of duty, causation) Malpractice (duty, injury or cause, breach of duty, causation) Standard of Proof (what would a nurse have done in the same spot) Malpractice Insurance (protecting yourself from lawsuits)

You are getting ready to administer an oral medication and you question the dosage. You should: Administer the medication. Withhold the medication. Notify the physician for an order clarification. Document that the dosage appears to be incorrect.

Notify the physician for an order clarification.

Emergency Medical Treatment and Active Labor Act (EMTALA)

Prohibits the transfer of patients from private to public hospitals without appropriate screening and stabilization. Patients who enter the hospital cannot be discharged or transferred until their condition is stable. Prevents patient dumping. Ensures that patients are medically screened when they come to the emergency department.

Advocate

Protects clients' human and legal rights and provides assistance in asserting these rights.

Americans with Disabilities Act (ADA)

Protects rights of people with physical or mental disabilities They have to provide reasonable accommodations as long as it is not a financial burden Cannot ask about health status before hiring

The Omnibus Budget Reconciliation Act (1987)

Older adults Restraints

Quality improvement

Patient safety and improved care are the goals

Healthcare fraud

Government oversight extends across state and federal agencies Health Care Fraud and Abuse Control Program (HCFAC) was established in 1997 Recovers funds from alleged fraud and abuse

Confidentiality laws

HIPAA: protect patient information and its distribution State laws can be specific to patient information

Manager

Has personnel, policy, and budgetary responsibility for a specific nursing unit.

Omnibus Budget Reconciliation Act

Has reduced the use of chemical and physical restraints. Has improved the quality of care in the nursing home.

Uniform Anatomical Gift Act

Helps regulate body donations to science, medicine, and education. The act sets a regulatory framework for the donation of organ, tissues, and other human body parts in the U.S.

Caregiver

Helps the client maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence.

Employer/employee liability

Respondent superior and vicarious liability Employer liable for the acts of its employee if the employee was acting as an agent of the employer and the actions resulted in injury within that scope of employment

Nursing Workforce Guidelines

Staffing and nurse-to-patient ratios Nursing assignments Patient abandonment - once you have established care you cannot leave Nurse delegation - RN can delegate to unlicensed personnel and LPN Nursing students - Stay in your scope of practice

Nurse Practice Act

State laws intended to protect citizens, make nurses accountable and assure that care is consistent with best practice within the scope and standards of nursing

Nurse Practice Acts

State laws intended to protect citizens, make nurses accountable and assure that care is consistent with best practice within the scope and standards of nursing.

Defamation of character

Publication of false statements that result in damage to a person's reputation.

Malpractice

Referred to as professional negligence; below the standard of care.

Beginning- and end-of-life nursing issues

Termination of pregnancy Death with dignity or physician-assisted suicide

Nurse Experts

Testifies about the standards of nursing care as applied to the facts of a case Determine that no conflict of interest exists before accepting a case Depositions Base their opinions on existing standards of practice

A nurse is teaching the staff about professional negligence or malpractice. Which criteria to establish negligence will the nurse include in the teaching session? (select all that apply) Injury did not occur. Client understands benefits and risks of a procedure. Nurse carried out the duty. The duty was breached. Caused an injury that resulted in damages. Duty of care was owed to the client.

The duty was breached. Caused an injury that resulted in damages. Duty of care was owed to the client.

A 16-year-old single mother of a 1-year-old infant and the infant's grandmother bring the baby to the emergency department and repot that the infant accidentally fell down the stairs. The nurse knows that a consent form for treatment would be signed. Who has the responsibility for signing the consent? The mother, despite her age. Family court, because the mother is a minor. The grandmother, because she is a relative. No one, because it is an emergency

The mother, despite her age.

Good Samaritan Law

This law does not cover a provider if they provide aid or treatment that is beyond their skill set or education. Correct answer: These laws limit liability and offer legal immunity if a nurse helps at the scene of an accident.

Correct match: Assault

Threatening to do harm.

False imprisonment

Unjustified restraining of a person without legal warrant

Standard of Proof

What a reasonably prudent nurse would do under similar circumstances.

Emergency Medical Treatment and Active Labor Act

When a patient presents to an emergency department, they must be treated

Slander

When one person speaks falsely about another person.

Libel

Written defamation of character

Duty of Care

another nurse woulda done the same thing you did

Tort Law

negligence; false imprisonment; battery; assault

Civil Law

nurse practice act

Constitutional Law

organization and functioning of government right to refuse

Injury or harm

physical, mental, emotion, or financial

Accountability

responsible for your actions and inactions; ultimately responsible

Causation

states if the breach of duty caused harm or not

Torts

Civil wrongful acts or omissions made against a person or property

Scope and Standards of Practice

1960: Documentation began Standards of Professional Nursing Practice Standards of Professional Performance Code of Ethics

Medical negligence/malpractice—argued under the area of tort law

Duty of Care Breach of Duty Causation Injury or harm

State board of nursing

A state board of nursing holds the legal authority for nursing practice and regulates nursing practice through: Establishing the requirements to obtain a nursing license Issuing nursing licenses Determining the scope of practice Setting minimum education standards Managing disciplinary procedures

Health care law Criteria

Accepted standards or guidelines to achieve compliance or interpret the law Standards of practice or best practices Report from agencies and data analytics Self-limited and may vary in scope

Informed consent and health care acts

An explanation of the procedure or treatment The names and qualifications of people performing and assisting in the procedure A description of the serious harm, including death that may occur as a result of the procedure and anticipated pain and/or discomfort Knows that he or she has the right to refuse the procedure/treatment Knows that he or she may refuse the procedure/treatment

Battery

Any intentional touching without consent

Unintentional torts

Arise when a person is harmed, and the person inflicting the harm knew, and the actions were less than the standard of practice.

The Uniform Determination of Death Act

Determines actual death

Patient Self-Determination Act (PSDA)

Durable power of attorney for health care Advance Directives Living Will

Americans with Disabilities Act (ADA)

Employers must consider needs and must provide reasonable accommodations for individuals with a disability. Protects rights of people with physical or mental disabilities.

Risk management

Identifying possible risks Analyzing risks Acting to reduce risks Evaluating the steps take to reduce risks

Professional Involvement

It is important to implement actions in your own practice that will help reduce your legal risk. Develop and use clinical judgment to identify patient needs and make sound clinical decisions. Remain aware of current issues in healthcare. Become involved in professional organizations and committees that define the standards of care for nursing practice.

Theoretical Links

Jurisprudence: theoretical study of law Normative jurisprudence: defines the proper function of law Health care laws try to: distribute health care fairly and equitably. make health care affordable to all. Monitor and punish bad behavior and bad actors (insurance fraud)

Health Information Technology Act

Nurses must ensure PHI is protected

Nurse Practice Acts (NPAs)

Overseen by State Boards of Nursing Regulate scope of nursing practice Protect public health, safety, and welfare

A recent immigrant who does not speak English is alert but requires hospitalization. What is the initial action that the nurse must take to enable informed consent to be obtained? Request an official interpreter to explain the terms of consent. Use hand gestures and medical equipment while explaining in English. Notify the nursing manager that the patient doesn't speak English. Ask a family member to translate what the nurse is saying.

Request an official interpreter to explain the terms of consent.

Patient Self-Determination Act

Requires health care institutions to provide written information to patients concerning their rights to make decisions about their care, including the right to refuse treatment and to formulate an advance directive

Mental Health Parity and Addiction Equity Act

Requires health insurance companies to provide coverage for mental health and substance abuse disorder (SUD) treatment

Federal statutory laws impacting health care

Social Security Act of 1965 & 1983 Consolidated Omnibus Budget Reconciliation Act of 1986 Federal Nursing Home Reform Act, 1987 Patient Self-Determination Act of 1991 Health Insurance Portability and Accountability Act (HIPAA) Patient Protection and Affordable Care Act, 2010

A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? Surgeon Nurse manager Nurse Family member

Surgeon

Health care law

The practice of law involving federal, state, or local law and rules or regulations regarding the delivery of healthcare services. Health law includes legal issues regarding relationships between and among providers and payers

Invasion of privacy

The release of a patient's medical information to an unauthorized person

Breach of Duty

fall below standard of care and causes harm

Criminal Law

felonies/ misdemeanors / assisted suicide

Common Law

functions as an adversarial system, a contest between two opposing parties before a judge who moderates.

Property Law

govern ownership; frozen embryos; court decides who they belong to

A student nurse employed as a nursing assistant may perform care. identified in the hospital's job description. requiring technical rather than professional skills. as learned in school. identified in the hospital's job description. expected of a nurse at that level.

identified in the hospital's job description.

Statutory (Legislative) Law

the laws passed by the legislature.

Contract Law

voluntary and deliberate; binding agreement; surgery