legal dimensions of nursing

_________ remains the nurse's most important and best legal safeguard

Competent practice (Careful documentation ensures a record of competent practice.)

Whether negligence has occurred depends on a

standard of care: what a reasonably prudent person would or would not have done under similar circumstances.

Good Samaritan Laws

statutes that protect rescuers from being sued for giving emergency care

Criminal law is in most cases

statutory law

Nursing responsibilities for controlled substances include

storing them in special locked compartments and adhering to specific documentation responsibilities.

When in doubt about disclosing confidential information, consult the nursing

supervisor, ethics committee, or public relations department of the institution.

advance directive

that states your wishes about end-of-life care, give copies to your doctor, your family, and your care team

damages

the actual harm or injury resulting to the patient

Breach of duty

the failure to meet the standard of care.

Causation

the most difficult element of liability to prove, shows that the failure to meet the standard of care (breach) actually caused the injury.

A common problem reported by nurses is not knowing how to document a situation in which the nurse believes a patient needs medical attention but the responsible health care providers are not responding to calls for assistance. In this case, the best legal safeguard is to document

the time the health care provider was called, the time of response or lack of response, and the subsequent nursing response (e.g., nursing supervisor notified).

When documenting consent, assess whether patients

understand what they are signing and are acting voluntarily, and report any problems to the clinician doing the procedure.

incedent report

used by health care facilities to document the occurrence of anything out of the ordinary that results in, or has the potential to result in, harm to a patient, employee, or visitor

Nurses are discouraged from following any _________, except in an emergency. The nurse should never _______ an order on a health care provider's behalf because this is a wrong practice

verbal orders, write

certification

which is the process by which a person who has met certain criteria established by a nongovernmental association is granted recognition in a specified practice

lisencure

which is the process by which a state determines that a candidate meets certain minimum requirements to practice in the profession and grants a license to do so

accreditation

which is the process by which an educational program is evaluated and recognized as having met certain standards.

fraud

willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property.

as a nurse you sign the consent form as a _______ to having seen the patient sign the form, not as having__________

witness, obtained the consent yourself

contracts can be

writing or oral, although oral contracts may be more difficult to prove

Indications That a Nurse May Have a Substance Abuse Disorder (SUD) Narcotics Discrepancies

- Incorrect narcotic counts - Large amounts of narcotic wastage - Numerous corrections of medication records -Frequent reports of ineffective pain relief from patients -Offers to medicate coworkers' patients for pain -Altered verbal or phone medication orders -Variations in controlled substance discrepancies among shifts or days of the week

Indications That a Nurse May Have a Substance Abuse Disorder (SUD) Behavioral Changes

-Changes or shifts in job performance - Absences from the unit for extended periods - Frequent trips to the bathroom -Arriving late or leaving early -Making an excessive number of mistakes, including medication errors Behavioral changes may have physical manifestations: -Subtle changes in appearance that may escalate over time -Increasing isolation from colleagues -Inappropriate verbal or emotional responses -Diminished alertness, confusion, or memory lapses

what hospitals do when a never event occurs within their facility:

Apologize to the patient and family Waive all costs related to the event and follow-up care Report the event to an external facility Conduct a root cause analysis of how and why the event occurred

the nurse must________the client's claims and the events surrounding the alleged incident.

Document

[Areas of Potential Liability for Nurses] Standard II: Diagnosis

Failure to identify priority nursing diagnosis critical to the patient's care • Nursing diagnosis incorrectly developed and "labels" the patient negatively

examples of battery

Forcibly removing a patient's clothing, administering an injection after the patient has refused it, and pushing a patient into a chair

[Areas of Potential Liability for Nurses] Standard I: Assessment

Incomplete database obtained (occurs frequently when patient is too ill at admission to respond to questions) • Significant omissions or errors in recorded database • Failure to note in the patient's care plan (and to execute) the need for more frequent nursing assessments • Failure to recognize and to report significant changes in the patient's condition

[Areas of Potential Liability for Nurses] Standard VI: Evaluation

No evidence in care plan and nursing notes that nurses evaluated whether the patient achieved target goals Patient discharged before key goals are met and without follow-up instruction

[Areas of Potential Liability for Nurses] Standards III and IV: Outcome Identification and Planning

No indication in nursing care plan that nurses were aware of and sensitive to the patient's health care priorities

Comprehension

Patient/surrogate can correctly repeat in his or her own words that for which the patient/surrogate is giving consent.

Disclosure

Patient/surrogate has been informed of the (1) nature of the procedure, (2) risks and benefits, (3) alternatives , and (4) fact that no outcomes can be guaranteed.

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

The State Board of Nurse Examiners

comprehensive nursing note

This note should include the current nature of the problem, how you intervened, the patient's response, and, when appropriate, future priorities for care.

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 health care provider. 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.

Voluntariness

The patient is voluntarily consenting or refusing. Care has been taken to avoid manipulative and coercive influences.

Competence

The patient/surrogate understands the information needed to make this decision, is able to reason in accord with a relatively consistent set of values, and can communicate a preference.

HIPAA ensures that patients have the following rights:

To see and copy their health record To update their health record To request correction of any mistakes To get a list of the disclosures a health care institution has made independent of disclosures made for the purposes of treatment, payment, and health care operations To request a restriction on certain uses or disclosures To choose how to receive health information

Certain acts by nurses could constitute invasion of privacy, as the following examples

Unnecessary exposure of patients while moving them through a corridor or while caring for them in rooms they share with others Talking with patients in rooms that are not soundproof Discussing patient information with people not entitled to the information (e.g., with the patient's employer or the press, or even the patient's family if not authorized to do so) Pressing the patient for information not necessary for care planning Interacting with the patient's family in ways not authorized by the patient Using tape recorders, dictating machines, computers, and the like without taking precautions to ensure the patient's confidentiality Preparing written or oral class assignments about patients without concealing their identity Carrying out research without taking proper precautions to ensure the anonymity of patients

gross negligence

demonstrating that the offender is guilty of complete disregard for another's life may be tried as both a civil and criminal action. It is then prosecuted under both civil and criminal law.

Three processes are used for credentialing in nursing

accreditation, licensure and certification

sentinel event:

an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof

Threatening to do any of these actions if the patient does not cooperate is

assault

Some of the intentional torts for which nurses may be held liable include

assault and battery, defamation of character, invasion of privacy, false imprisonment, and fraud

although a policy specifies that a nurse may use restraints to protect an incompetent patient, restraining a competent patient to administer medications forcefully while the patient is refusing is

assault and battery.

battery

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

NURSE AS DEFENDANT

do not discuss the case with anyone at your facility Do not alter the patient's records. Cooperate fully with your attorney. Be courteous on the witness stand. Do not volunteer any information.

Consequences of not obtaining a valid consent include the possibility of charges of

battery against the nurse, the doctor, and the health care facility

Forcibly removing a patient's clothing, administering an injection after the patient has refused it, and pushing a patient into a chair are all examples of

battery.

is the most difficult component of malpractice to prove.

causation

in all instances, the nurse is responsible for answering any questions the patient may have and for making sure that the signed consent form is on the patient's ____

chart

A patient's refusal to sign a consent form should be________ and the patient should be informed of the ________

documented, possible consequences of the refusal

just culture

encourages open reporting of errors, recognizes that errors may be systemic rather than personal failures, and focuses on determining the root of the problem when events such as errors and near misses occur

never events

extremely rare medical errors that should never happen to a patient.

Nurses who report vital signs or other assessment data that they have not obtained are acting

fraudulently

People who are mentally ill may be committed to a psychiatric institution for treatment without their consent (involuntary commitment) only when it can be proved that they may be

harmful to themselves or others.

These reports are used for quality improvement and should not be used for disciplinary action against staff members.

incedent report

Documentation in the patient record, however, should not include the fact that an ________was filed.

incident report

In all health care facilities,________and________ is needed for admission, for each specialized diagnostic or treatment procedure, and for any experimental treatments or procedures.

informed and voluntary consent (except in an emergency )

Examples of common law are

informed consent and the right to refuse treatment

liability involves four elements that must be established to prove that malpractice or negligence has occurred:

involves four elements that must be established to prove that malpractice or negligence has occurred: duty, breach of duty, causation, and damages.

assault

is a threat or an attempt to make bodily contact with another person without that person's consent

near miss

is an error that would have happened except for someone's alertness and ability to identify and prevent the error.

The Good Samaritan law will provide

legal immunity to the nurse

A person cannot be________ to remain in a health facility, such as a hospital, if that person is of sound mind, even when health care providers believe that the person should remain for additional care

legally forced

Statutory laws

must be in keeping with both the federal constitution and the state constitution

Failure to conduct or document an assessment of a patient's learning needs and teaching may later be construed as

negligence

Unintentional torts are referred to as

negligence, malpractice, abandonment (A nurse who fails to initiate proper precautions to prevent patient harm (e.g., falls, skin breakdown) is subject to the charge of negligence. The nurse may not intend to cause harm, but harm results nevertheless.)

fact witness

nurse who has knowledge of the actual incident prompting a legal case; bases testimony on firsthand knowledge of the incident, not on assumptions

[Areas of Potential Liability for Nurses] Standard V: Implementation

patient's record contains no documentation of attempts to teach appropriate self-care measures to patient and family Nursing interventions deviate from usual standard of care (understaffing, indifference on part of nurse, inexperience of nurse, faulty or scarce equipment or resources)

Duty

refers to an obligation to use due care (what a reasonably prudent nurse would do) and is defined by the standard of care appropriate for the nurse-patient relationship.

The patient should sign a ______ indicating his or her refusal to consent and releasing the nurse, health care provider, and facility from responsibility for outcomes of this act. This statement should be______

release form, witnessed

The nurse_______for a potential or actual harmful incident or who witnesses an injury is the one who completes the incident form

responsible