NUR 301 Legal Issues in Professional Nursing Practice
damages
was there actual injury, harm, or damage to the plaintiff's person or property?
fraud
willful misrepresentation (identity, role, outcomes, documentation) that could cause harm or loss to a person or property -student nurse pretending to be a RN; documenting guess or inaccurate intake volume
living will
written health care instructions effective when the patient can no longer make decisions for him/herself
criminal law
wrong against a person or the person's property as well as the public -misdemeanor: punishable by fines or less than 1 year of imprisonment -felony: punishable by imprisonment for more than 1 year *punish wrong doers
plaintiff
person or organization bringing suit; the accuser
litigation
process of bringing and trying lawsuit
Georgia Nurse Practice Act
"practice nursing as a registered nurse" means to practice nursing by performing for compensation any of the following A: ASSESSING the health status of individuals, groups, or both throughout the lifespan B: establishing a NURSING DIAGNOSIS C: ESTABLISHING NURSING GOALS to meet identified healthcare needs D: PLANNING, IMPLEMENTING, AND EVALUATING nursing care E: providing for safe and effective nursing care rendered directly or indirectly F: managing and supervising the practice of nursing G: collaborating with other members of the healthcare team in the management of care H: teaching the theory and practice of nursing I: administering, ordering, and dispensing medications, diagnostic studies, and medical treatments authorized by protocol, when such acts are in conformity with those laws J: administering as prescribed by a physician practicing medicine, medication and treatments in accordance with Article 2 of Chapter 34 of this title, a dentist practicing dentistry in accordance with chapter 11, or a podiatrist practicing podiatry in accordance with chapter 35 K: performing any other nursing act in the care and counsel of the ill, injured, or infirm, and in the promotion and maintenance of health with individuals, groups, or both throughout the lifespan
Good Samaritan Law in GA
-"any person, including any person licensed to practice medicine and surgery ... and including any person licensed to render services ancillary thereto, who in good faith renders emergency care at the scene of an accident or emergency to the victim or victims thereof without making any charge therefore shall not be liable for any civil damages as a result of any act or omission by such person in rendering emergency care or as a result of any act or failure to act to provide or arrange for further medical treatment or care for the injured person." -in most states - protection of nurses and other clinicians who render emergency aid outside of the agency setting and give care a reasonable person with a similar background would provide
patient's rights
-American Hospital Association (AHA) 1972, 1992, 2003 - A Patient's Bill of Rights --> The Patient Care Partnership -AHA encourages customization by hospitals and health care agencies -care standards not law, but... -"legally prudent nurses must be familiar with how different [agencies] define patient rights and responsibilities"
additional laws affecting nursing practice
-Occupational Safety and Health Administration (OSHA) -National Practitioner Data Bank -reporting obligations (law enforcement, adult and child protective services, CDC, etc.) -controlled substances -discrimination and sexual harassment -Health Insurance Portability and Accountability Act (HIPAA) -Americans with Disabilities Act -EMTALA: hospital and ambulance services required to provide care to anyone needing emergency treatment regardless of citizenship, legal status, or ability to pay -legal issues related to death and dying (wills, advance directives)
informed consent
-a competent adult has the right to consent to treatment and to decided whether it is necessary and advisable (respecting the patient's self-determination) -practitioner responsible for performing the diagnostic or procedure must obtain consent (RNs do not obtain consent) -nurse is responsible for making sure signed consent form is "on patient's chart" and answering patient questions about consent -signed consent is not valid if patient does not understand what he or she agreed to; it must be informed consent
three outcomes of malpractice litigation
-all parties work toward fair settlement -case is presented to malpractice arbitration panel -case is brought to trial court
recommended approach to never events
-apologize to the patient -report the event -perform root cause analysis (RCA) -waive costs directly related to the event
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 importance variables -documentation by physician of medical examination of person involved
duty to rescue
-concept in tort law -party can be held liable for failing to come to the rescue of another party in peril -ten states (CA, FL, MA, HI, MN, OH, RI, VT, WA, & WI) have limited laws requiring someone to seek aid or notify law enforcement for victims in peril if the rescuer can do so without endangering self (GA does not have this law) -exceptions: --defendant's negligence created the danger for the plaintiff --if defendant begins rescue, under some circumstances may be required to continue rescue if a reasonable person would have done so --special relationship (teacher-student, doctor-patient, EMT-patient, nurse-patient, etc.)
roles of nurses in legal proceedings
-defendant: nurse is accused of malpractice, intentional tort, or crime (cooperate fully and honestly) -fact witness: nurse is a witness who knows something about the circumstances in this specific legal case -expert witness: nurse is not familiar with the particulars of this specific case but is being asked to testify if a reasonable nurse with the same education, training, and experience as the defendant would act in the same manner under the same circumstances
Georgia Board of Nursing
-described and empowered in the Georgia Registered Professional Nurse Act -among 23 responsibilities --define and enforce qualifications for licensure at the state level --evaluate nursing education programs; approve or withdraw approval --set standards for competency --award, renew, suspend, revoke and reinstate licenses of qualified nurses (provide approval to sit for the NCLEX-RN) -investigate complaints and implement disciplinary process
informed consent is a process
-disclosure of the procedure, risks, benefits, and alternatives -comprehension: patient/surrogate can describe in own words what they are consenting to -competence: patient/surrogate is capable of comprehending the situation and making the decision -voluntariness: patient/surrogate was no manipulated or coerced into consenting or refusing
recommendations for nurse defendants
-do not discuss the case with those involved in it -do not alter patient records -cooperate fully with attorney -be courteous on witness stand -do not volunteer any information
as a student nurse..
-do not misrepresent your role -do not act beyond your current scope of practice -if you do not know how to do something you are asked to do speak up to your clinical instructor, nurse on the unity, any valid resource, person, or person in authority -if you see something dangerous or wrong, escalate through appropriate chain, the same as you will when an RN -do not put your patients, selves, or colleagues at risk
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
nurse's best defense during investigation
-early legal counseling -character and expert witness -thorough preparation for all proceedings
common sources of nurse malpractice
-failure to follow agency policies, protocols, and procedures (e.g. standards for insulin administration or other injectable medications) -failure to use equipment in a responsible way -failure to assess, evaluate, and monitor -failure to communicate -failure to advocate for patients or follow chain of command -failure to document accurately or in a timely, professional manner
registered professional nurses
-means a person who is authorized by a license issued under this article to practice nursing as a registered professional nurse
due process for revoking a license
-notice of investigation -fair and impartial hearing; multifactorial - age of complain, history of nurse (multiple complaints over time), egregiousness of complaint, work-related complaint versus complain does not relate to nurse's job (impaired at work vs. arrest for assault and battery in dispute with neighbor) -proper decision based on substantial evidence
negligence
-performing an act that a reasonably prudent person under similar circumstances would not do -failure to perform an act that a reasonably prudent person under similar circumstances would do
malpractice
-related to a professional group (doctors, lawyers, nurses, etc) which has standards of practice -specialized type of negligence: a failure to meet a professional standard of care -example: not assisting a post op client with ambulation and the clients falls and fractures hip
safeguards to competent practice
-respect legal boundaries of nursing practice -follow institutional procedures and policies, unless they violate state nurse practice act -own personal strengths and weaknesses -evaluate proposed assignments -keep current in nursing knowledge and skills -respect patient rights and develop rapport with patients -keep careful and accurate documentation -work within agency for management policies
nursing as a professional discipline
-standards set by structured organizations -strong service orientation -code of ethics -recognized authority (scope of practice) -autonomy and self-regulation -well-defined body of specific and unique knowledge -ongoing research
professional and legal regulation of nursing practice
-state nurse practice acts: most important law affecting your nursing practice -standards: voluntary professional nursing standards such as ANA nursing: scope and standards of practice AND guide to the code of ethics for nurses: interpretation and application
Student nurses?
-student nurses are responsible for their own actions or lack of actions -student nurses are held to same standard of care as registered nurse
source of law examples
-the Georgia Registered Nurse Practice Act is an example of statutory law (laws passed by a legislative body) -the Georgia Registered Nurse Practice Act legislates or legally empowers the Georgia Board of Nursing to define and enforce administrative laws
HIPPA - Ensured Patient Rights
-to see and copy their health record as defined by the health care agency process -to update their health record -to request correction of any mistakes -to get a list of the disclosures a healthcare institution has made independent of disclosures made for the purpose of treatment, payment, and healthcare operations -to request a restriction on certain uses or disclosures (patient determines who is authorized to receive information) -to choose how to receive health information
OSHA legal regulations
-use of electrical equipment -use of isolation techniques -use of radiation -use of chemicals
What can an RN do?
-when performing a nursing procedure or other patient-care related activity, ask two questions 1. Do RNs in this state have the legal authority to do this? (language in the state registered nurse practice act does not address specific nursing activities or procedures) 2. Is the RN competent in doing this? -agencies and managers do not have the legal authority to direct a nurse to exceed the RN scope of practice in the state's registered nursing practice act -pre-licensure and advancing practice education programs evaluate student competencies -the joint commission (TJC) expects agencies and employers to regularly check nurse competency levels in practice
four sources of law
1. US and state constitutional law: foundation for all US and state law (e.g. bill of rights; medicaid, medicare) 2. statutory law (legislative body): e.g. Georgia Nurse Practice Act 3. administrative law (administrative agencies): Georgia Board of Nursing; County Board of Health) 4. common law (judicial interpretation): precedents from previous court decisions; most law involving malpractice is common law
most common mistakes made by new nurses
1. errors with medication -32% r/t distraction; to resolve --> focus entirely on patient 2. infection issues 3. charting or documentation errors 4. calling for help without the right information on hand 5. falling accidents involving patients 6. body mechanics 7. equipment injuries 8. failure to prioritize (delay of care or treatment)
accreditation
CCNE is a national, autonomous agency which ensures that quality and integrity of baccalaureate, graduate, and residency programs in nursing
the mission of the National Council of State Boards of Nursing (NCSBN) is to...
provide education, service, and research through collaborative leadership to promote evidence-based regulatory excellence for patient safety and public protection; NCSBN oversees NCLEX-RN content and administration among other responsibilities
certification
provided by specialty nursing organizations; validates specialty knowledge, experience, and clinical judgement
protocol
a detailed written set of instructions to guide the care of a patient or to assist the clinician in the performance of a procedure -hypoglycemia, deep vein thrombosis prevention, etc -can be an algorithm with branching logic (such as BLS CPR, ACLS Bradycardia, etc)
advanced directives
a legal statement made by an individual which indicated their wishes in the event they lose their decision making abilities -living will, durable power of attorney, DNR
licensure
a license is a legal document from the state board of nursing permitting a person to offer professional service and skills to the public (licensure measures entry-level or basic competence)
policy
a principle or guideline governing activities in a facility that employees or members of the institution are expected to follow -administrative policies: visiting hour rules, acquisition of equipment, no smoking, etc -human resources policies: vacation days, shift assignments, scheduling, etc -patient care: admissions process, discharge process, patient transfer, etc
procedure
a series of steps followed in a regular, orderly, definite way, by which a desired result is accomplished; often very specific -placing an indwelling catheter; changing a central line dressing; administering medication through a feeding tube, etc
tort law
a wrong committed by a person against another person or that person's property; tried in civil court -intentional -unintentional *compensate victims
intentional torts
assault, battery, false imprisonment, fraud, defamation of character, invasion of privacy
durable power of attorney
authorizes another person to make decisions on the behalf of the patient if the patient is incapacitated
four conditions that must be present for an organization or individual to be liable
duty, breach of duty, causation, damages
never events
are adverse events that are serious, largely preventable, and of concern to both the public and healthcare providers for the purpose of public accountability (national quality forum)
defamation of character
derogatory remarks about another person's reputation
breach of duty
did the defendant fail to perform the duty according to reasonable practice standards?
duty
did the defendant have a professional obligation to the plaintiff?
causation
did the defendant's actions or inactions directly or indirectly cause harm to the plaintiff?
invasion of privacy
discussing patient information with people not entitled to the information -examples: exposure of patients while moving them through a hallway or while caring for them in their room, preparing written or oral class assignments about patients without concealing their identify, discussing patient information with people not entitled to the information, and discussing a patient on social media with enough descriptors that he/she could be identified
DNR
do not resuscitate (allow natural death) -make sure orders exist -patient and family understand implications of decision -does not mean withholding care for living patient - but resuscitation will not be attempted if patient's heart and circulation stop
risk management when something happens
identification, analysis, evaluation, reduction, and elimination of risks to organization's patients, visitors, and employees -maintain rapport with patient and family -record the incident (process depends on agency) --report to supervisor --don't blame or implicate anyone --don't place or refer to in EMR or patient chart -report every incident (process depends on agency) --helps to jog your memory keep current on what happened --helps administrators to change policy and procedures --helps administrators decide whether or not to provide restitution
public law
issues that affect the general public or state or society as a whole -types of public law include administrative, constitutional, municipal -criminal: created to provide guidance and protection to those injured by offenses against society (i.e. forgery, burglary, theft, assault, battery, rape, murder); exists to deter crime and punish/rehabilitate perpetrators
liability
legally responsible for one's acts or omissions
unintentional torts
negligence, malpractice
battery
nonconsensual bodily contact with another or anything attached to or held by the other person (note: injury is a not a determinant of battery) -inserting a catheter after a client refused, then the client experiences injury
red flags in documentation
occur when what is recorded or not recorded in the medical record suggests -lack of treatment -delayed, substandard, or inappropriate treatment -lack of patient teaching or discharge instructions -charting inconsistencies such as time lapses -patient abandonment -"battles" between healthcare providers -lack of informed consent prior to treatment -late entries appearing to be self-serving rather than genuine addenda -fraudulent or improper alterations of the record -destruction of records or missing records -references to an incident report (do not include incident reports in EMR!)
credentialing
one approach to ensure and maintain professional competence -accreditation -licensure -certification
defendant
person or organization being accused of a crime or torts -presumed innocent until proven guilty
private law (civil law)
rights and obligations of individuals, families, businesses, and small groups; exists to assist citizens in disputes over private matters -contract law, property law, succession law, family law -tort law: rights, obligations, and remedies provided to someone who has been wronged by another individual
law
standard or rule of conduct established and enforced by government and designed to protect the rights of the public
assault (threat or attempt)
to make bodily contact without consent (offender must have ability to commit battery) -threaten to hold patient down to administer shot he/she refused
the purpose of the Georgia Registered Professional Nurse Act is
to protect, promote, and preserve public health safety, and welfare through legislative regulation and control of registered professional nursing education and practice; this article ensures that any person practicing or offering to practice nursing or using the title registered professional nurse, as defined in this article within the state of GA, shall be licensed as provided in this article
sentinel events
unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient's illness (TJC) -reporting internally and externally to a nation database -root cause analysis (RCA) -do everything to prevent from happening again
false imprisonment
unjustified retention or prevention of movement of another person without consent
