Legal Aspects of Nursing

NUR101FALL 2010LECTURE #21K. Burger, MSEd, MSN, RN,CNEPPP by: Sharon Niggemeier RN MSN Revised kburger8/06

Legal Aspects

• Legal accountability for all nursing actions rests with the nurse.

• Nurses and student nurses are legally responsible for their actions

• Regulated by lawsNew York State Nurse Practice ActPatient Self-determination Act (PSDA)Health Insurance Portability and Accountability Act ( HIPAA)Americans with Disabilities Act ( ADA)Medicaid Statutes / Resident’s RightsPublic Health Laws

Regulation of Nursing Practice

Regulation of Nursing Practice• Regulated by Standards of Care

guidelines developed by:-nursing organizations such as ANA-state boards of nursing-health care institutions-procedural textbooks-written nursing policies/proceduresMandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Licensure of Nursing Practice

• Licensure requirements are set by State Board of Nursing

-educational requirements-licensing exam (NCLEX)-maintenance and renewal-suspension and revocation-professional misconduct proceedings

Take a look at www.op.nysed.gov/nurse.htm

The State Board of Nursing may revoke or suspend a nurses license for willfully

violating the nurse practice act:

• drug/ETOH abuse (most common)• fraud ( in obtaining license)• conviction of a felony • gross or ordinary negligence• previous disciplinary actions in other states• physical / mental impairments• practicing after your license expires

Types of Legal Action- Crimes

• Criminal Action– a wrong against persons and society– criminal court– punishable by imprisonment

Felony

Misdemeanor

Types of Legal Actions- Torts

• Civil Action- Tort– A wrong against an individuals rights or

property– civil court– punishment usually with monetary settlement– tort may also be a crime and tried in both courts

IntentionalUnintentional

Torts

• Intentional:fraud

invasion of privacy

defamation of character

false imprisonment

assault and/or battery

• Unintentional:negligence

Malpractice = negligence as it applies to a profession

Elements of Malpractice

FOUR elements must be met to prove guilty of malpractice

• Duty- (relationship) nurses responsibility to provide care in an acceptable manner

• Breach of Duty- failed to provide care in acceptable manner

• Injury(damages)- nurses act caused harm

• Proximate cause-reasonable cause and effect can be shown between the omission or commission and the harm

Common Malpractice Allegations

• Failure to maintain safety

• Improper technique/treatment

• Failure to monitor and report

• Medication errors

• Failure to follow policy/procedures

• Poor documentation

• Improper use of equipment

Protecting Yourself

• Practice safely & competentlyAlways follow standards of care!!

• Develop a caring relationship with your pt

• Communicate, communicate, communicate!

• Document, document, document!

Protecting Yourself

• Remember - the nurse enters into a contractual obligation ( ethical AND legal) when caring for a client.

• You are responsible for the actions of your ancillary staff ( Respondent superior )

• Carry your own liability insurance• You have increased responsibility in

regards to Good Samaritan Laws.

Patient’s Bill of Rights

• Every patient has rights under PUBLIC HEALTH LAW

See handout and/or

NYS Department of Health Website

Informed Consent

INCLUDES:

• Explanation of procedure

• Explanation of risks, anticipated discomfort

• Explanation of alternatives

Client has right to refuse

Client must be competent and of legal age

It is the physician’s duty to obtain informed consent

It is the nurse’s duty to verify that client was informed

Ethics & Values

NUR101 FALL 2010

LECTURE #21K Burger MSEd,MSN,RN,CNE

Ethics versus Laws

• Nurse Practice Act governs legal practice

• You govern ethical practice

• It is the ETHICS of nursing practice that elevate it as the #1 most trusted profession

Source: Gallup Poll, Honesty and Ethical Standards of Professions Survey, 2004.

Nursing Code of Ethics

• Written by professional organizations American Nurses Association (ANA)

International Council of Nurses

Remember…one of the hallmark characteristics of a “profession” is that it has a Code of Ethics.

Values versus Ethics

VALUES = personal belief about the worth of a

given idea, attitude, custom

ETHICS = good character and conduct

Values Clarification

• Your first step in development of ethical behaviors

• Recognize and understand your values

• Critically examine your ethical thinking

• Transformational learningCritical reflectionConstructive discourseEmotional intelligenceDemocratic habits of heart

• Aids in the development of ethical agency ( the ability to “do the right thing”)

Essential Values for Nursing

• Altruism

• Autonomy

• Human dignity

• Integrity

• Social Justice

• Cultural competence

All of above correlate to universal principles of biomedical ethics.

Universal Ethical Principles

• Veracity

• Autonomy

• Beneficence

• Nonmaleficence

• Fidelity

• Confidentiality

• Justice

Ethical Behavior of the Professional Nurse includes:

• Accountability

• Responsibility

• Advocacy

Ethical Stressors in Nursing

• Quality of life

• Futile care

• Euthanasia

• Abortion

• Allocation of scarce resources

Processing Ethical Dilemmas

• FIRST… ask yourself “is it really an ethical dilemma”

• THEN if yes:- gather all relevant data- do a values clarification process- state the problem- consider all possible courses of action- negotiate an outcome- evaluate

• Also consider use of institutional resources:Ethics Committee