Legal Implications in Nursing Practice

Safe Nursing Practice: Mindfulness

Patient centered Quality safe practice Monitoring the environment Application of Knowledge

Safe Nursing Practice: Nursing Students

Patient safety top priority Know policies before undertaking a clinical assignment Must be knowledgeable about the client's condition, interventions, medications, and treatments Let instructor know if you are unprepared Seek help if unsure

Torts

Torts may be intentional or unintentional acts of wrongdoing.

Malpractice Insurance

A contract between the nurse and the insurance company Provides a defense when a nurse is in a lawsuit involving negligence or malpractice insurance Nurses covered by institution's insurance while working

Intentional Torts

A person committing an intentional tort is considered to have knowledge of the permitted legal limits of his or her words or acts. Intentional Assault Battery False Imprisonment Invasion of Privacy Defamation of Character

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

Nursing Practice and HIPPA

Cannot post name near/on patient's door Secure chart/computer screen Don't leave printed information unattended Must have password to access patient information in computer Notice of patient right to privacy provided upon admission Use low voice when discussing patient information

Risk Management

A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs Steps involved: Identify possible risks. Analyze risks. Act to reduce risks. Evaluate steps taken. One tool used in risk management is the incident report or occurrence report. Occurrence reporting Serves as a database for further investigation Alerts risk management to a potential claim situation.

Reportable Events

Abandonment Breech of Confidentiality Exceeding Scope of Practice Failure to Supervise Inappropriate Delegation &/or Assignment Failure to Maintain Accurate Documentation Failure to Maintain Standards of Care Inappropriate Interaction with Client (verbal/physical) Neglect - includes sleeping on duty Failure to Report Crucial Healthcare Information

Statutory Guidelines for Legal Consent for Medical Treatment Adults

Adults A. Any competent individual 18 years of age or older for himself or herself B. Any parent for his or her unemancipated minor C. Any guardian for his or her ward D. Any adult for the treatment of his or her minor brother or sister (if an emergency, and parents are not present) E. Any grandparent for a minor grandchild (if an emergency, and parents are not present)

Informed Consent

Agreement to procedure based on full disclosure of risks, benefits, alternatives, and consequences of refusal. Without informed consent a patient may bring a lawsuit against the health care provider for negligence. Informed consent is usually responsibility of the person responsible for procedure/surgery. Elements of responsibility must include: Description and explanation of procedure Names & qualifications of persons performing procedure or assisting Risks and benefits Info regarding alternatives Right to refuse without discontinuation of other treatment; right to refuse before or during procedure Voluntarily given: Capacity to consent *Checklist to ensure Informed Consent: Disclosure Comprehension Competence Voluntariness

Nursing Students

Are liable if actions cause harm to patients, as is the instructor, hospital, and college/university. Are expected to perform as a professional when rendering care. Must separate student nurse role from their work as a certified nursing assistant (CNA). Nursing students are held to the same standards as a registered nurse

Living Wills

Document in the event of terminal illness or condition Patient declares what he or she wants Difficult to interpret at times due to not always clinically specific If health care workers follow, should be immune from liability

Reportable Drug Related Issues

Drug abuse Impairment on duty Drug diversion Positive drug screen Fraudulent prescription for controlled substances

HIPPA

Health Insurance Portability and Accountability Act Right to keep personal information from being disclosed Right to inspect and copy ones medical record Limits who can access client's record Privacy: Right to keep personal info from being disclosed Confidentiality: protects private client info once it is disclosed in health care settings. *Nurses sign a document about their responsibility to maintain HIPPA when caring for patients Notice of privacy practices Opportunity for confidential communications Limits medical information sharing among health care providers directly involved in care Protected health information Name Address Date of birth Social security number Obtaining information Only access information pertinent to health status of assigned patients Disclosing information Only to those directly involved in care HIPPA violations have civil and criminal sanctions

Professional Nursing Practice

Is regulated by the states; nurses must hold a state-issued license to practice nursing. Details of the practice of nursing are found in the scope of practice for each state. Practice can vary from state to state; for this reason, nurses should be familiar with the nursing practice act and scope of practice in the state in which they work.

Red Flags in the Record

Lack of treatment Lack of patient teaching or discharge instructions Charting inconsistencies such as lapses in time References to an incident report Patient abandonment Battles between health care providers Fraudulent or improper alterations of the record Destruction of records or missing records

Emergency Medical Treatment and Active Labor Act

Law that requires anyone that comes into the ER to be stabilized and treated

Health Care Power of Attorney

Legal document that designates a person to make health care decisions when cannot make on their own behalf

Advanced Directives

Legal document that expresses an individual's desires regarding medical treatment used when that individual cannot communicate their wishes. Living will Health care power of attorney Patient Self-Determination Act gives the patient the ability to make their own decisions using these documents

Standards of Care

Legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care Best known comes from the American Nurses Association (ANA) Set by every state Set by state and federal laws that govern where nurses work Joint Commission requires policies and procedures (P&P).

Public Health Laws: Mandatory Reporting

Legal requirement to report Abuse or neglect of minors and older adults Nurses who violate the Nurse Practice Act Nurses have a legal obligation to report conduct which is incompetent, unethical, and illegal Violence, abuse or neglect by other nurses Certain injuries and illnesses Gunshot wounds Poisoning Stabbing Any suspected criminal act or violence Communicable Diseases Suspected child abuse or neglect Knowledge of a crime on school property Indecent liberties with a minor Possession of a firearm on school property Assault Sexual assault Rape Kidnapping

Federal Statutory Issues in Nursing Practice

Living Wills, Durable Power of Attorney Advance Directives Health Insurance Portability and Accountability Act The Nursing Home Reform Act: Restraints Nursing home- residents have the right to be free from physical or chemical restraints that are unnecessary. Be familiar with your facility's policies about restraints

Documentation

Medical Record is a Legal Document! Should provide a complete and accurate account of patient condition and care received. Any signature on the medical record makes you legally responsible for the content of which you are signing. Falsification of a medical record is grounds for termination, reportable to the board of nursing, and could lead to legal action. Because legal actions may be initiated years after care was provided, you may not remember the incident in question - until you review your careful documentation

Statutory Guidelines for Legal Consent for Medical Treatment Minors

Minors A. For his or her child and any child in his or her legal custody B. For himself or herself in the following situations: 1. Lawfully married or a parent (emancipated) 2. Pregnancy (excluding abortions) 3. Venereal disease 4. Drug or substance abuse Minors (cont'd) C. Unemancipated minors may not consent to abortion without one of the following: 1. Consent of one parent 2. Self-consent granted by court order 3. Consent specifically given by a court

Unintentional Torts

Negligence: performing an act that a reasonably prudent person under similar circumstances would not do or, conversely, failing to perform an act that a reasonably prudent person under similar circumstances would do. Malpractice: negligence by professional personnel Failure to follow standards of care Improper administration of insulin Failure to use equipment in a responsible manner Improper use of lift and pt falls Failure to assess and monitor Post-op patient Failure to communicate Concerned about elderly pt being discharged home and then pt rehospitilazed Failure to document Document notifying physician

Elements of Advanced Directives

Patients have rights: May refuse medical treatment for self Children: Courts may intervene to protect innocent third parties when parents/guardians refuse medical treatment May have DNR/DNI orders "Do not resuscitate" "Do not Intubate" Documentation must reflect conversation of Health Care Provider with client and/or family Must be signed and dated by Health Care Provider *Patient can be a partial DNR when do not want to be intubated but want medications

Just Culture

Promotes a learning culture that supports patient safety while assigning accountability for behavioral choices. Review practice events Identify appropriate resolutions Promote practice enhancement and patient safety.

Consents

Required of all routine treatment, hazardous procedures, research, & some treatment programs Official interpreter must be present to explain the terms of consent if client is deaf, illiterate, or speaks foreign language. States can define who is considered "designated" individual to legally give consent for others

Abandonment and Assignment Issues

Short staffing Legal problems occur if inadequate number of nurses will provide care. Floating Based on census load and patient acuities Physician's orders Nurses follow orders unless they believe an order is given in error or is harmful.

Legal Limits of Nursing

Sources of legal guidelines come from: Statutory law (Nurse Practice Act) Criminal law (felonies or misdemeanors) Civil law Regulatory law (administrative law) Duty to report Common law (judicial decisions) Informed consent Right to refuse treatment Negligence and malpractice 4 sources of laws exist at both the federal and state level: constitutions, statutory law, administrative law, and common law. Your state's Nurse Practice Act is the most important law affecting your nursing practice. (statutory law) Criminal law: a type of public law, concerns state and federal criminal statutes, which define criminal actions such as murder, manslaughter, criminal negligence, theft, and illegal possession of drugs. Civil law: (private law) regulates relationships among people; includes laws relating to contracts; ownership of property; and the practice of nursing, medicine, pharmacy, and dentistry.

Assault

a threat or attempt to make bodily contact with another person without that person's consent. Threatening to do any of these actions if the patient does not cooperate is assault.

Battery

an assault that is carried out and includes willful, angry, and violent or negligent touching of another person's body or clothes or anything attached to or held by that other person. Forcibly removing a patient's clothing, administered an injection after the patient has refused it, and pushing a patient into a chair are all examples of battery.

Americans With Disabilities Act

covers any person who has a physical or mental impairment that substantially limits one or more major life activities or who has a record of such impairment. Protects people who have communicable diseases, such as AIDS or HIV; recovering alcoholics and drug addicts

The Occupational Safety and Health Act

ensure safe and healthful working conditions for men and women; reduce work-related injuries and illnesses Electrical equipment; isolation techniques. Must be tested for functioning

The Health Care Quality Improvement Act

identification and discipline of health care practitioners who engage in unprofessional conduct and to restrict their ability to move from state to state without a disclosure of their previous performance. Cannot move to a new state without record following them

Public health lab

legal issues; people have the right to autonomy

Licensure

license for the state being worked in

Defamation of Character

one party makes derogatory remarks about another that diminish the other party's reputation; False or exaggerated statements Slander: spoken; Libel: written

Good Samaritan Law-

protect you from liability if you're helping someone; every state has this lab but it does vary

False imprisonment

unjustified retention or prevention of the movement of another person without proper consent