(PrepU) Chapter 7: Legal Dimensions of Nursing Practice

A nurse confides in a nurse friend, "I never report minor incidents. The charge nurse always wants a variance report filled out and they take so much time." Which responses by the friend are indicated? Select all that apply.

"Having documentation might keep you out of trouble someday." "Reporting helps us fix problems that result in danger to clients." Incident or variance reports serve as a tool for trending to identify risk and avoid it in the future. Having correct documentation is very beneficial if error or injuries lead to litigation. Simply documenting problems in a client chart is not enough, as they may apply to more than just that client and may be overlooked. Injury is not always immediately obvious. Variance reports should not be used punitively.

Nursing students are discussing the requirement that they carry personal professional liability insurance as students. The nurse instructor should offer additional information when which statements are made? Select all that apply.

"Since I am a student, my instructor is the one liable if I make a mistake." "I thought we would be covered by the hospital's malpractice insurance." "I think this is an unnecessary expense." "I will be protected both as a student and at my CNA job." Students are responsible for their own actions and are held to the same standards as the RNs at the hospital. The insurance protects students only in their educational role, not in the role as a CNA as well. Malpractice insurance is a good protection for nurses. The hospital does carry malpractice insurance, but it may not cover students as individuals.

Which process evaluates and recognizes educational programs as having met certain standards?

Accreditation Accreditation is the process by which an educational program is evaluated and recognized as having met certain standards. Credentialing refers to ways in which professional competence is ensured and maintained. Licensure is the process by which a state determines that a candidate meets certain minimum requirements to practice in the profession—and grants that person the license to do so. Certification is the process by which a person who has met certain criteria established by a nongovernmental association is granted recognition in a specified practice area.

Which action constitutes battery?

An older adult client refuses an intramuscular injection, but the nurse administers it. If the client refuses a procedure or medication and the nurse proceeds with it, it is battery. Threatening to touch a client without consent is assault. Discussing a client within earshot of others is an invasion of privacy. Keeping a client against the client's wishes, regardless of health status, is false imprisonment.

An oncology nurse is caring for a client suffering from metabolic encephalopathy and end-stage kidney disease. The client has no known family and no advance directives. Upon entering the room, the nurse observes the client is pale and has no spontaneous respiration. What is the priority action the nurse should take?

Begin CPR. A code status refers to how health care providers are required to manage care in the case of cardiac or respiratory arrest. A full code means that all measures to resuscitate the client are used. The nurse should immediately begin CPR. Although it is necessary to notify the physician and charge nurse, this is not the priority. It is not appropriate to contact the coroner at this time.

A client has been in the emergency department for 3 hours for treatment of a migraine headache. Care has been delayed due to a multiple fatality car accident. The client gets up to go to the bathroom unattended, faints, and suffers a subdural hematoma. The family threatens to sue for malpractice. Which element of malpractice will be the most difficult for the attorney to prove?

Causation Typically, causation is the most difficult component of malpractice to prove. Causation asks the question, "Did the nurse's actions directly cause the damages?" Duty is typically outlined in standards of care, breach of duty can be proved by documentation of the visit, and damages are clearly evident.

A nurse is being sued for malpractice in a court of law. What elements must be established to prove that malpractice or negligence has occurred? Select all that apply.

Causation Duty Breach of duty The elements that must be established to prove that malpractice or negligence have occurred include duty, breach of duty, and causation. Intent to harm would be intentional torts. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Punitive damages are monetary compensation awarded in a legal case to the injured party.

When talking with family over dinner, the nurse shares about a client with infertility at the hospital, identifying the person by name. Which tort has the nurse committed?

Invasion of privacy Invasion of privacy involves a breach in keeping client information confidential. Slander is oral defamation of character. Assault is a threat or attempt to make bodily contact with another person without that person's consent. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property.

A client has a prescription for amoxicillin 500 mg P.O. every 8 hours. The nurse administers the medication via the intravenous route. Based on the nurse's action, the client develops complications and has an increased length of stay. The client files a lawsuit against the facility and the nurse. Which legal action has the nurse's attorney identified that meets the criteria for the client's lawsuit?

Malpractice The facility and nurse could be charged with malpractice, which is failing to perform (or performing) an act that causes harm to a client. Administering the medication intravenously instead of orally as prescribed has caused harm to a client. Negligence is failing to perform care for a client. When a person threatens to touch a client without consent, it is assault, whereas battery is carrying out the implied threat (assault).

A client being discharged from the hospital asks the nurse, "When I go visit my family out of state, should I take my living will with me, or do I need a new one for that state?" Which is the most appropriate response by the nurse?

"Take it with you. It is recognized universally in the United States." A separate or different advance directive is not needed for each state; an advance directive can be used in any state, regardless of where it was created. The nurse should advise the client to take it when travelling out of state. The client should not assume that the family knows the client's wishes; the whole purpose of having an advance directive is to avoid the ambiguity and potential confusion that making such assumptions can cause. Other hospitals may not know who to contact to request a copy of the advance directive; therefore, it would be much safer for the client to take a copy of it while travelling.

Which scenario is an example of certification?

A nurse who demonstrates advanced expertise in a content area of nursing through special testing Certification is a voluntary process whereby a person who has met criteria established by a nongovernmental association is granted special recognition in a specified practice area. Licensure is granted by the state to a graduate of a nursing education program who passes the NCLEX-RN. Accreditation is a voluntary process by which a nursing education program is recognized as having met certain standards by the NLN Commission for Nursing Education Accreditation and/or the American Association of Colleges of Nursing. The Joint Commission can also accredit health care agencies.

Which nursing student would most likely be held liable for negligence?

A nursing student administers medication to a resident while working as an unlicensed assistive personnel (UAP) at a local nursing home. The nursing student who administers medication to a resident while working as an unlicensed assistive personnel (UAP) at a local nursing home is performing a task outside the scope of the job responsibilities of a UAP. The other options demonstrate legally defensible actions by the nursing student.

A nurse threatens to restrain a verbally abusive client if the abuse continues. Which legal tort has the nurse committed?

Assault Assault is threatening to touch a person, such as by applying restraints, without consent. Sharing a client's confidential information without consent is an invasion of privacy. When a person performs an act that a reasonable person would not do under the same circumstance, it is negligence. Defamation of character occurs when one makes statements that damage another person's reputation.

The nurse is providing care to a client who had orthopedic surgery. The nurse has medicated the client for pain. However, the client reports that the pain is unrelieved. The nurse takes no further action regarding assessment and intervention for the client's pain. The nurse does not notify the surgeon regarding the client's pain. The nurse's failure to take further action represents which element of liability in this case?

Breach of duty Breach of duty is the failure to assess, intervene, or notify the health care provider regarding the client's condition. It does not meet the expected standard of care. Duty refers to an obligation to use due care and is defined by the standard of care appropriate for the nurse-client relationship. Causation is when the failure to meet the standard of care caused injury. Damages are the harm or injury to the client.

A nurse talks with family members about an AIDS client from the clinic where the nurse works. Which tort has the nurse committed?

Invasion of privacy Invasion of privacy involves a breach of keeping client information confidential. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Slander is oral defamation of character. Assault is a threat or attempt to make bodily contact with another person without that person's consent.

The health care provider prescribes orders for a client with newly diagnosed uncontrolled seizure activity. When reviewing the prescriptions, the nurse correctly identifies that which prescription, if followed, puts him at risk for negligence charges?

Restrain all four extremities The nurse is obligated to carry out the health care provider's orders unless it is unclear or incorrect. The client with seizures must be protected from harm. Restraints restrict the client's movement and can cause harm. Diazepam, oxygen, and frequent neurologic assessments are correct interventions for a client with uncontrolled seizure activity.

What governing body has the authority to revoke or suspend a nurse's license?

The State Board of Nurse Examiners The State Board of Nurse Examiners in the United States may revoke or suspend a nurse's license or registration. The employing health care institution may have submitted the paperwork regarding the allegation of the issue but does not suspend or revoke the nurse's license. The National League for Nursing is a national organization for faculty nurses and leaders in nurse education. The Supreme Court is the highest judicial court in a country or state. The Supreme Court does not rule on a nurse's license.

A physician is called to see a client with angina. During the visit the physician advises the nurse to decrease the dosage of atenolol to 12.5 mg. However, because the physician is late for another visit, the physician requests that the nurse write down the order for the physician. What should be the appropriate nursing action in this situation?

The nurse should ask the physician to come back and write the order. The nurse should ask the physician to come back and write down the order. Nurses are discouraged from following any verbal orders, except in an emergency. The nurse should never write an order on a physician's behalf because this is a wrong practice. The client should be informed about the change of medications, but this is not an appropriate action. The nurse should not leave the work for a later time, because the nurse may forget it.

A nurse enters the client's room and finds the client lying on the floor experiencing a seizure. After stabilizing the client, the nurse informs the physician. The physician advises the nurse to prepare an incident report. What is the purpose of an incident report?

To evaluate the quality of care provided and assess the potential risks for injury to the client An incident report is a written account of an unusual, potentially injurious event involving a client, employee, or visitor. Incident reports determine how to prevent hazardous situations and serve as a reference in case of future litigation. Accurate and detailed documentation often helps to prove that the nurse acted reasonably or appropriately in the circumstances. It may not always serve as a method of determining the nurse's fault in the incident. The document does not evaluate the immediate care provided to the client but states the actions taken.

A client states that the client's recent fall was caused by his scheduled antihypertensive medications being mistakenly administered by two different nurses, an event that is disputed by both of the nurses identified by the client. Which measure should the nurses prioritize when anticipating that legal action may follow?

Document the client's claims and the events surrounding the alleged incident. It is imperative for nurses to carefully and accurately document assessment findings and the nursing care that they provide, especially when legal action is anticipated. This thorough and accurate assessment should precede consultation with the legal department, the state board of nursing, and colleagues.

Professional regulations and laws that govern nursing practice are in place for which reason?

To protect the safety of the public Governing bodies, professional regulations, and laws are in place to protect the public by ensuring that nurses are accountable for safe, competent, and ethical nursing practice. The other options do not describe accurately the role and responsibility of the governing bodies and the regulations and laws of nursing.

A nurse hired to work in an ambulatory setting attends new employee orientation. The nurse never worked in ambulatory before and is concerned about the Scope and Standards of Practice for Professional Ambulatory Care Nursing. Which response by the nurse educator would further explain the Scope and Standards of Practice for Professional Care Nursing to the new nurse?

"The Scope and Standards of Practice for Professional Ambulatory Care Nursing deals with the professional obligations of a nurse working in the ambulatory setting." The Scope and Standards of Practice for Professional Ambulatory Care Nursing are the standards of care for nurses working in the ambulatory arena. It does not take precedent over the facility's policies and procedures, but must be worked in conjunction with the policies and procedures. It is not used for assessing nurses. NCLEX determines if a nurse is minimally competent to practice as a nurse.

A client informs the nurse about leaving the health care facility because the client is not satisfied with the treatment. The nurse knows that the client's treatment is incomplete and further testing and evaluations are scheduled. Which action by the nurse would be most appropriate to prevent false imprisonment?

Ask the client to sign a release without medical approval. If a client wants to leave the health care facility, the nurse should ask the client to sign a release stating that the client left without medical approval. The nurse cannot restrain the client because it amounts to false imprisonment. Calling the health care provider may be seen by the client as a delay tactic, although the nurse should follow facility protocol. Additional options would include having the client meet with the health care provider or client advocate if the client was willing to remain for care while those actions were initiated. Telling the client that the client may not be able to access the health care facility again is an inappropriate response because health care is a right and the client can access it whenever necessary.

A nurse fails to communicate a change in the client's condition to the physician. Which element related to proving malpractice has been met?

Breach of duty Failing to communicate a change in the client's condition reflects a breach of duty. Duty describes the relationship between the person and the person being sued. Nurses have a duty to care for their clients. The existence of a duty is rarely an issue in a malpractice suit. The action or lack of action must be proven as the cause of the injury. Damages refer to the injury sustained by the client.

Having recently completed a specialty nursing program in neonatal care, a nurse is now preparing to leave the medical unit and begin providing care in the hospital's neonatal intensive care unit (NICU). The nurse has completed which process of credentialing?

Certification The process of certification involves the attainment and validation of specialized nursing knowledge and skills. Certification is often necessary to ensure that the nursing care provided in specialized and high-acuity settings is safe and appropriate. Accreditation is the process by which an educational program, rather than an individual nurse, is identified as meeting standards. The process of licensure involves the determination that a nurse meets minimum requirements to practice but not necessarily that the nurse has the specialized knowledge that is necessary for some care settings. Validation is not a specific aspect of the process of credentialing.

The nursing supervisor is preparing to delegate some aspects of the nursing care plan interventions to other healthcare providers on the unit. Which are the responsibilities of nursing supervisors? Select all that apply.

Knowing the job descriptions and capabilities of each person on the team in depth Assigning to registered nurses rather than nonprofessional staff the practice-pervasive functions of assessment Ensuring that care is delivered accurately and appropriately Nursing supervisors must know the job descriptions and capabilities of each person on the team in depth. Nursing supervisors should not assign tasks to staff according to each member's preference to improve staff moral but rather according to each member's capabilities and scope of practice. Nursing supervisors and other registered nurses may delegate specific aspects of care to nonprofessional staff but must select appropriate nursing care measures for these personnel to perform are held accountable ultimately for the care that is provided. Nursing supervisors and other registered nurses may not delegate the practice-pervasive functions of assessment, planning, diagnosis, evaluation, and nursing judgment to nonprofessional staff (NCSBN, 2005). Nursing supervisors and other registered nurses may delegate technical activities (i.e., feeding, ambulating) or provision of amenities (i.e., hospitality services, including making beds, setting up meals, cleaning the care environment), but the activities must not require critical thinking or professional judgment (American Nurses Association, 2005). Nursing supervisors also must ensure that nursing care measures have been carried out correctly.

A nurse witnesses a traffic accident and dresses the open wounds sustained by a child. Later, in the hospital, the child develops complications from an infection in the wound. The family holds the nurse responsible for the complications and attempts to file a lawsuit. Which statement is true regarding how the Good Samaritan law applies to this case?

The Good Samaritan law will provide legal immunity to the nurse. The Good Samaritan laws provide legal immunity to passersby who provide emergency first aid to victims of accidents. Therefore, the law is applicable to the nurse in this scenario; moreover, Good Samaritan laws apply to those who do not accept any compensation for services provided. The law is equally applicable to everyone but does not provide absolute exemption from prosecution in cases of negligence. Paramedics, ambulance personnel, physicians, and nurses who stop to provide assistance are still held to a higher standard of care because they have training above and beyond that of average lay people. In cases of gross negligence, health care workers may be charged with a criminal offense.

A family brings the client to the emergency department in an unconscious state with a head injury. The client requires surgery to remove a blood clot. What would be the appropriate nursing intervention in keeping with the policy of informed consent prior to a surgical procedure?

The nurse confirms that the client's family has signed the consent form. The nurse should confirm that the client's family has signed the consent form. However, the health care provider is responsible for having the client, or in this case, the client's family sign consent. This client cannot sign the consent form because the client is not in an alert state and is unable to communicate. If the client is not in a condition to sign the consent form, a family member may sign the consent form on the client's behalf. Advance directives are written statements identifying a competent person's wishes concerning terminal care and are not applicable here. A living will is an instructive form of advance directive; that is, it is a written document that identifies a person's preferences regarding medical interventions to use in a terminal condition, irreversible coma, or persistent vegetative state with no hope of recovery.

A client is unhappy with the health care provided and informs the nurse that the client is leaving the facility. The client has not been discharged by the physician. The nurse finds that the client has dressed and is ready to go. What should the nurse's action be in this situation?

The nurse should call and inform the nursing supervisor of the situation. The nurse should call and inform the nursing supervisor of the situation. The client should be made to sign the document stating that the client is responsible for the client's own actions. The nurse cannot restrain the client because that would be false imprisonment. Likewise, the nurse cannot overlook the incident because there is a responsibility for client care. Additionally, the nurse cannot warn the client that the client will not be allowed to come back to the hospital because it is the client's right to access health care whenever required.

A client was admitted to a postoperative nursing unit after undergoing abdominal surgery. During this time, the nurse failed to recognize the significance of abdominal swelling, which significantly increased during the next 6 hours. Later, the client had to undergo emergency surgery. The lack of action on the nurse's part is liable for action. Which legal term describes the case?

Tort A tort is a litigation in which one person asserts that a physical, emotional, or financial injury was a consequence of another person's actions or failure to act. The lack of action on the nurse's part indicates unintentional tort. A misdemeanor or felony would be an offense under criminal law, and neither is applicable in this case. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property.

While riding in the elevator, a nurse discusses the HIV-positive status of a client with other colleagues. The nurse's action reflects:

invasion of privacy. The nurse's action reflects an invasion of the client's privacy. Disclosing confidential information to an unauthorized third party subjects the nurse to liability for invasion of privacy, even if the information is true. Defamation of character includes false communication that results in injury to a person's reputation. Negligence is an act of omission or commission. Prevention of movement or unjustified retention of a person without consent may be false imprisonment.

Which is an example of an unintentional tort?

A nurse gives the client a medication, and the client has an adverse reaction to it. An unintentional tort occurs when the nurse does not intend harm, but harm occurs (e.g., the nurse administers a medication and the client has an adverse reaction to it). The other three responses are intentional torts.

While walking down the hall, a nurse manager overhears a staff member telling a client, "If you don't stay in this chair and stop wandering, I'm going to tie you to it." The nurse manager pulls the staff member aside and discusses what was said. The nurse manager intervenes because the staff member's statement is which type of tort?

Assault The staff member's statement reflects a threat of contact with another person without the person's consent. This is considered assault. Battery is an assault that is carried out and includes willful, angry, and violent or negligent touching of another's body or clothes (or anything attached to or held by that person). False imprisonment is the unjustified retention or prevention of the movement of another person without proper consent. This would apply if the staff member did in fact tie the client to the chair. Invasion of privacy involves the disclosure of information without the person's consent.

A student nurse is assisting an older adult client to ambulate following hip replacement surgery when the client falls and reinjures the hip. Who is potentially responsible for the injury to this client?

The student nurse, the nurse instructor, and the hospital As a student nurse, you are responsible for your own acts, including any negligence that may result in client injury. A hospital may also be held liable for the negligence of a student nurse enrolled in a hospital-controlled program because the student is considered an employee of the hospital. The status of students enrolled in college and university programs is less clear, as is the liability of the educational institution in which they are enrolled and the health care agency offering a site for clinical practice. Nursing instructors may share responsibility for damages in the event of client injury if an assignment called for clinical skills beyond a student's competency, or the instructor failed to provide reasonable and prudent clinical supervision.

A legal document that states a client's health-related wishes — such as a preference for pain management if the client becomes terminally ill — and also allows the client's adult child to direct the client's care, is:

an advance directive. Clients communicate their wishes to health care providers by verbally participating in health care decision making and by employing written documents called advance directives. A will is a legal document where one communicates wishes of how to dispose of personal effects and belongings upon one's death. The terms license and standard of care have no application in this scenario.