Leadership & Management 2

8/14/2019 Leadership & Management 2

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Leadership &Management 2


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Basis of Nursing PracticeNurse Practice Acts (NPAs)

Laws in each state that are instrumental indefining the scope of nursing practice

Provide protection of the general public

Common Law

Consists of broad, interpretative principles basedon reason, traditional justice and common sense


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When can a license be denied, revoked or suspended?When can a license be denied, revoked or suspended?

.Unprofessional conductUnprofessional conduct

.Fraudulent practiceFraudulent practice .Practicing nursing beyond the scope of licensePracticing nursing beyond the scope of license .Directing others to practice beyond their authorized scopeDirecting others to practice beyond their authorized scope .Failing to take appropriate action in safeguarding patient from incompetentFailing to take appropriate action in safeguarding patient from incompetent

health care practicehealth care practice .Practicing the profession while under the influence of alcohol or other moodPracticing the profession while under the influence of alcohol or other mood

altering substancesaltering substances .Practicing the profession while the ability to practice is impaired by physicalPracticing the profession while the ability to practice is impaired by physical

or emotional disabilityor emotional disability .Misappropriation of drugs, supplies or equipmentMisappropriation of drugs, supplies or equipment .Practicing nursing in the state without a licensePracticing nursing in the state without a license .Permitting, aiding or abetting an unlicensed person to perform activitiesPermitting, aiding or abetting an unlicensed person to perform activities

without a licensewithout a license .Violating confidentialityViolating confidentiality .Willful alteration of medicationsWillful alteration of medications .Obtaining or attempting to control controlled substances by unauthorizedObtaining or attempting to control controlled substances by unauthorized

meansmeans .Forging a prescription of medicationsForging a prescription of medications .Selling or attempting to sell a controlled substanceSelling or attempting to sell a controlled substance .Failure to report to the boards facts known regarding incompetent or illegalFailure to report to the boards facts known regarding incompetent or illegal

practice of any RN or LPN.practice of any RN or LPN. .Practicing an expanded role without certification of the boardPracticing an expanded role without certification of the board .Failure to adhere to the standards of practice for nurses in the expanded roleFailure to adhere to the standards of practice for nurses in the expanded role

When can a license be denied, revoked or suspended?When can a license be denied, revoked or suspended?

.Unprofessional conductUnprofessional conduct .Fraudulent practiceFraudulent practice .Practicing nursing beyond the scope of licensePracticing nursing beyond the scope of license .Directing others to practice beyond their authorized scopeDirecting others to practice beyond their authorized scope .Failing to take appropriate action in safeguarding patient from incompetentFailing to take appropriate action in safeguarding patient from incompetent

health care practicehealth care practice .Practicing the profession while under the influence of alcohol or other moodPracticing the profession while under the influence of alcohol or other mood

altering substancesaltering substances .Practicing the profession while the ability to practice is impaired by physicalPracticing the profession while the ability to practice is impaired by physical

or emotional disabilityor emotional disability .Misappropriation of drugs, supplies or equipmentMisappropriation of drugs, supplies or equipment .Practicing nursing in the state without a licensePracticing nursing in the state without a license .Permitting, aiding or abetting an unlicensed person to perform activitiesPermitting, aiding or abetting an unlicensed person to perform activities

without a licensewithout a license .Violating confidentialityViolating confidentiality .Willful alteration of medicationsWillful alteration of medications .Obtaining or attempting to control controlled substances by unauthorizedObtaining or attempting to control controlled substances by unauthorized

meansmeans .Forging a prescription of medicationsForging a prescription of medications .Selling or attempting to sell a controlled substanceSelling or attempting to sell a controlled substance .Failure to report to the boards facts known regarding incompetent or illegalFailure to report to the boards facts known regarding incompetent or illegal

practice of any RN or LPN.practice of any RN or LPN. .Practicing an expanded role without certification of the boardPracticing an expanded role without certification of the board .Failure to adhere to the standards of practice for nurses in the expanded roleFailure to adhere to the standards of practice for nurses in the expanded role


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Legal Aspects of Nursing Care

LawSum total of rules and regulations by which asociety is governed.

Functions of law in nursing

-Provides a framework for establishing whichnursing actions of the care of clients are legal

-Differentiates the nurses responsibilities fromthose of other health professionals

-Helps establish boundaries of independentnursing action

-Assists in maintaining a standard of nursingpractice by making nurses accountable under thelaw


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Sources of Law

Constitution

- Creates legal rights and responsibilities and isthe foundation for a system of justice

Legislation (Statutory law)- Laws enacted by any legislative body

Administrative Law

- e.g. boards of nursing

Common Law- Laws evolving from court decision


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ExpressedExpressedUnintentionalUnintentional IntentionalIntentional

Negligence/

MalpracticeNegligence/

Malpractice

Assault/ BatteryAssault/ Battery

False

ImprisonmentFalse

Imprisonment

Invasion of PrivacyInvasion of Privacy

Defamation of CharacterDefamation of Character

LibelLibel SlanderSlander

Types of LawTypes of Law

Private/ CivilPrivate/ Civil

Contract LawContract Law

ImpliedImplied

FelonyFelony

Criminal

LawCriminal

Law

PublicPublic

MisdemeanorMisdemeanor

TortsTorts


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Types of Law Public Law

- Body of law that deals with relationships amongindividual, government and the governmentalagencies

- Criminal Law: important segment of the public and dealswith actions against the safety and welfare of the public

- Felonies and Misdemeanor

Private law or Civil law

Body of law deals with relationships among privateindividuals

2 Categories:Contract Law and Tort Law


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Areas of Potential Liability in Nursing

Crimes and TortsTypes of Crimes:a. Felonies

Serious nature = Prison

b. MisdemeanorsLess serious nature = Fine or suspension

practicing nursingwithout a license


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TortsIntentional

Unintentional

Intentional Tort

4 Elements in a Tort action:

a. A duty to one person

b. The breach of that duty (either by doing something orfailing to do something)

c. The breach must proximately cause the plaintiffs

injuryd. An injury to the plaintiff


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Torts1. Assault

2. Battery

-Exists when there is no consent

3. Defamation of character

4. False Imprisonment5. Invasion of Privacy

4 Types

a. Use of the clients name or likeness for

profit without consentb. Unreasonable intrusion

c. Public disclosure of private facts

d. Putting a person in a false light


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TortsUnintentional tort1. Negligence

Gross Negligence/Reckless ImprudenceSimple Negligence

2. Malpractice6 Elements:a. Dutyb. Breach of Dutyc. Forseeabiltyd. Causatione. Harm and Injuryf. Damages


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Legal Doctrines related to Negligence

Respondeat superiorLet the master answer

Res ipsa loquitorLet the thing speak for itself

Statue limitations Time limitation set for nurses toprove that one or more of the elements were notmet


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Contracts

4 Elements of a Valid Contract

a. Agreement

b. Consideration

c. Legal subject matterd. Contractual capacity

2 Types of Contract

Expressed

Implied


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Contracts

Termination of ContractMost nurse-patient contracts end when:

treatment is complete

bill has been paid

A health care provider may terminate contract ifpatient:

fails to pay for services

fails to keep scheduled appointments

fails to follow health care providers instructions

transfers to another ward/unit hospital


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Contract

To terminate health care provider-patientrelationship, the following should be done:

1. Send notice by certified mail, return receiptrequested

2. Place copy in patients file3. Allow patient adequate time to find newprovider


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Laws that RN should be concernedwith:

Good Samaritan Acts California Board

A person licensed under this chapter who in goodfaith renders emergency care at the scene of an

emergency which occurs outside both the placeand the course of that persons employment shallnot be liable for any civil damages as the result ofacts or omissions by that person in rendering theemergency care.

This section shall not grant immunity from civildamages when the person is grossly negligent


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Missouri Board

This legislation applies to physicians, surgeons,registered professional nurses, licensed practicalnurses, and licensed mobile emergency medicaltechnicians in situations when aid is given in anemergency or accident and occur outside of ahealth care setting. When any of the above healthcare providers render, in good faith, emergencycare or assistance at the scene of an emergency oraccident, no liability may be imposed for any civildamages arising from acts or omissions inrendering such emergency care. There is noprotection, however for gross negligence andwillful or wanton acts or omissions. Thus, it shouldbe noted that this legislation is only applicable ifthe care is rendered without compensation.


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Guidelines for Emergency Care

Limit actions to first aid, if possible Not perform actions with which they are

unfamiliar

Offer help, but do not insist

Stay at the scene until the injured party leaves oruntil relieved by another qualified person

Do not accept any compensation


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Patient Self-Determination Law

Advance Directives

Types:

Durable Power of Attorney

-also known as health care proxyLiving Will

-provides specific instructions about health caredecision

The health care proxy will make decision for thepatient after his physician has decided that he isnot anle to make his own health care decision.


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Who can decide for Organ Donation?

According to Priority:

Spouse

Son or daughter 18 years of age; or either of your

parents Brother or sister 18 years of age or older

Guardian appointed by a court prior to thedonors death or any other legally authorized

person


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Informed Consent

A document attesting that the patient has beeninformed and understands the nature of theprocedure, the risks, possible outcome andalternatives of the said procedure

Implies that:

-consent was voluntary and free of coercion

-client was competent and of legal age-client had enough information

-Intentional tort may result if not obtained properly


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Informed Consent

Roles

Role of the physician: To explain the nature of theprocedure

Role of the witnessing nurse: Verify that the clientunderstands the procedure

If the client does not understand, refer the client back to the physician.

The physician should explain.


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Informed Consent

4 Exception to the Rule

Life- or limb-threatening emergency

Information could threaten the patient

Patient chooses not to hear all the information

Patient has prior knowledge


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Nurses and Legal Issues

Warning signs of Impairment

Alcoholism

Irritability Mood Swings

Elaborate excuse for behavior Unkempt appearance

Blackouts

Impaired motor coordination,

slurred speech, flushed face,bloodshot eyes

Numerous injuries with vagueexplanation


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Drug Addiction

Rapid changes in mood and or performance

Absenteeism

May work a lot of time Increased somatic complains

Increased isolation from others

Often volunteers to medicate other nurses clients

Excessive discrepancies in signing anddocumentation procedures of controlledsubstances


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Reporting a crime, tort or unsafe practiceWrite a clear description of the situation you believe

you should report

Make sure that your statements are factual andcomplete

Make sure you are credible

Obtain support from at least one trustworthy personbefore filing the report

Report the matter starting at the lowest possible level

in the agency hierarchyAssume responsibility for reporting the individual by

being open about it. Sign your name on the letter.

See the problem through once you have reported it.


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RestraintsReminders Regarding the Use of Restrains Informed consent is needed to use restrains. Restraint of patients without informed consent or sufficient

justification is false imprisonment. Never use restraints for discipline or staff convenience. Use the least restrictive method of restraint. Use restraints only in accordance with the written order of a

licensed independent practitioner (LIP) or as part of an establishedhospital clinical protocol.

No one can order restraints to be used PRN. Monitor patient closely, and periodically reassess for continued

need for restraints and document findings. Remove restraints for 10 mins. every 2 hrs. for Range of Motion

exercises, repositioning/ambulation, toileting and preventive skincare

Time Limitations Should not exceed 24 hours. Primary behavioral health needs: not exceed 4 hours for adults, 2 hours

for children aged 9-17 years and 1 hour for children younger than 9 years.


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Restraints Who can give orders for Restrains? Depending on state laws governing the scope of practice, LIPs

could include physicians' assistants or nurse practitioners. Furthermore, situations may occur in which appropriately trained

supervisory/professional licensed personnel, such as a clinicalnurse manager, may initiate restraints in an emergency situationbefore obtaining the written order.

Written orders for restraints should include: the time limitation Time started, Time Ended Type of restraint Frequency of monitoring

Revaluation if it differs from hospital policy. Clinical justification of the necessity for restraints A written order that complies with hospital policy Measures taken to protect the patients rights, dignity, and well-

being


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Incidence Report

Purpose: For management and documentationpurposes

Types of Incident:

Events or circumstance that might result inlitigation or accusations by a regulatory agency

Events or circumstances observed in thecourse of acting with medical providers orinstitutions in which the nurse was a DIRECTOBSERVER or substandard or harmful practices


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Incidence ReportWhat an incident report should contain

The date The place The position of the individual reporting (Not necessarily the name) A description of the incident or issue Whom it is reported to What should be done to correct it What has been done to correct it A space for follow up reporting The signature of the individual reporting The date and time the report is received by the Risk Manager Action of the Risk ManagerCOMMON SITUATIONS THAT REQUIRE INCIDENT REPORT Complication from diagnostic or treatment procedures (e.g. blood sample

stick, biopsy, x-ray, invasive procedure, bronchoscopy) Failure to report change in patients condition. Falls Patient is burned


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Ethical Issues in Nursing Practice

MoralityPrivate, personal standards of what is right and wrong.Moral issues involve important social values and norms

Ethics

Method of inquiry about the rightness or wrongness ofhuman actions

Bioethics

Ethics as applied to life situations

Nursing Ethics

Ethical issues that occur in the context of nursing practice


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Ethical Issues in Nursing Practice

Values

Freely chosen, long-lasting beliefs or attitudesabout the worth of something

Value System

Personal set of beliefs on a continuum from mostto least important, thus providing the basis fordecisions and choices


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Moral Frameworks (Theories)

Consequence based

The end justifies the means

Utilitarianism

Choose the lesser evil Principle Based

Emphasizes individual rights, duties andobligations

Relationship BasedPromote the common good


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Common Ethical Principles

Autonomy

Refers to self law

Beneficence

Duty to do goodConfidentiality

Relates the concept of privacy

Double Effect

There is proportionate or favorable balance ofgood and evil


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Ethical Principles

FidelityPromise keeping

Justice

Like cases should be treated alike

Each person receive equally according to:-need

-societal contribution

-merit

-legal entitlementRetributive justice

Concerned with the distribution of punishment


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Ethical Principles

Nonmaleficence

The duty not to inflict harm

Paternalism

The intentional limitation of anothers autonomy

Respect for persons

Sanctity of Life

The perspective that life is the highest good

VeracityThe obligation to tell the truth and not to lie ordeceive others


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Ethical Codes

Provide broad principles for determining andevaluating client care

Specific Ethical codes:

The Code of Nurses International Council of

Nurses American Nurses Association Code of Ethics

Ethical Reasoning Process:

-Recognize a moral issue

-Analyze facts and identify the dilemma-Decide on possible alternative actions

-Select specific action

-Evaluate the effectiveness of the action


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Documents

Leadership & Management 2