Legal of nursing

1. LEGAL OF NURSING
Edith O Perez

2. Ethical principles:
Codes that direct or govern nursing
actions
 Code of Ethics for Nurses, developed by the
International Council of Nurses
 American Nurses Association Code of Ethics
 American Hospital Association: Issued
Client’s Bill of Rights
 Mental Health Systems Act: Developed
rights for mentally ill clients
 The Joint Commission: Developed policy
statements on the rights of mentally ill
individuals

3. Question
 A nurse observes unsafe practice by a
physician and reports it to the risk
management department of the hospital.
Which ethical principle does this represent?
 1-Autonomy
 2-Beneficence
 3-Justice
 4-Veracity

4. Question
 The nurse is caring for a patient with heart
failure resulting in irreversible kidney damage
who decides to go home to die rather than
accept hemodialysis. The nurse understands
that the patient is practicing which ethical
principle?
 1-Autonomy
 2-Beneficence
 3-Justice
 4-Veracity

5. Ethical principles
 Justice: The equitable distribution of potential benefits and
tasks determining the order in which clients should be cared
for
 Veracity: The obligation to tell the truth
 Fidelity: The duty to do what one has promised
 Beneficence: The duty to do good to others and to maintain a
balance between benefits and harms. Irrigating a wound,
administering a medication, turning and positioning an
immobile patient.
 Autonomy: Respect for an individual’s right to self-
determination
 Non maleficence: The obligation to do or cause no harm to
another. Medicating a postoperative patient for pain and them
ambulating the pt using 2 person assist address the need to
improve circulation

6. In attempting to decide which services should be
offered to a community, the public health nurse
decides to implement hypertension screening and
treatment because most of the residents are
hypertensive. This decision is based on the
principle of:
 A. veracity.
 b. values.
 c. utilitarianism.
 d. autonomy.

7. Ethical dilemma
 1. An ethical dilemma occurs when there is a
conflict between two or more ethical principles.
 2. No correct decision exists, and the nurse
must make a choice between two alternatives
that are equally unsatisfactory.
 3. Such dilemmas may occur as a result of
differences in cultural or religious beliefs.

8. Advocacy
 An advocate is a person who speaks up for or
acts on the behalf of the client, protects the
client’s right to make his or her own decisions,
and upholds the principle of fidelity.
 An important nursing responsibility is to act as
a client advocate and protect the client’s rights.
 The nurse must represent the client’s
viewpoint to others and take advantage of
such advocacy resources as the ethics
committee, an interpreter, and social services.

9. Standards of care
 Standards of care are guidelines that identify
what the client can expect to receive in terms
of nursing care.
 The guidelines determine whether nurses
have performed duties in an appropriate
manner.
 If the nurse does not perform duties within
accepted standards of care, the nurse places
himself or herself in jeopardy of legal action.

10. Floating
 Legally, the nurse cannot refuse to float unless a
union contract guarantees that nurses can work
only in a specified area or the nurse can prove
lack of knowledge for the performance of
assigned tasks.
 Nurses in a floating situation must not assume
responsibility beyond their level of experience or
qualification.
 Nurses who float should inform the supervisor of
any lack of experience in caring for the type of
clients on the new nursing unit.
 The nurse should request and be given
orientation to the new unit.

11. Constitutional Law
 1. Based on the U.S. Constitution, a group of
laws that establish the powers and limits of
each of the three branches of government
(executive, legislative, and judicial).
 2. Grants broad individual rights and
responsibilities.
 3. Is the foundation of the U.S. justice system.
 Clients’ rights to equal treatment

12. Statutory Law (Legislative)
 Based on the laws enacted by federal and
state legislative bodies, which are made up of
elected individuals who represent the interests
of voters.
 Examples of federal and state laws are
presented in the section “Specific Laws and
Regulations that Guide Nursing Practice

13. Administrative Law (Regulatory)
 Based on rules and regulations designed to
enforce the laws passed by legislative bodies.
 Nurse practice acts and authority for
administrative functions of the state boards of
nursing.
 The state board of nursing in each state is
entrusted with the task of creating the rules
and regulations detailing how the profession of
nursing is practiced in the state.

14. Common Law
 Evolves from court decisions, not through
legislation.
 Based on judges’ interpretation and
application of constitutional and statutory laws
to a set of facts presented in a court case.

15. Criminal Law
 With the rights of individuals and society as
defined by legislative laws.
 Involve jeopardize the safety and welfare of
the public
 Assault, Battery, Murder, Manslaughter

16. Civil Law
 Civil law seeks to resolve a disagreement
between a private individual and another
individual or group
 Two types of civil law that influence standards
for nursing practice are contract law and tort
law.
 Contract Law : Based on legally enforceable
agreements (contracts) between individuals.
 Unintentional Tort, Intentional Tort, Negligence

17. Respondeat Superior
(“let the master answer)
 When a hospital hires a nurse, the nurse functions as a representative of the
institution and must perform within its policies and procedures; the hospital is
responsible for the actions of the nurse.
 This doctrine does not support acts of gross negligence or acts that are outside the
scope of employment.
 Gross negligence is the intentional failure to perform a duty in reckless disregard of
the consequences affecting the client a gross lack of care to such a level as to be
considered willful and wanton
 I mean a course of action which [shows actual or deliberate intention to harm] [or
which, if not intentional,] [shows an utter indifference to or conscious disregard for (a
person's own safety) (and) (the safety of others)]
 Captain of the ship: A healthcare provider may be held liable for a nurse who is
working under the direction of the healthcare provider, the nurse is also still liable for
his or her own actions.
 Borrowed servant: When an employer directs a nurse to work for a second
employer, the second employer is held accountable for the nurse’s actions (e.g.,
agency nurse); however, the nurse is also still liable for his or her own actions.
 Nurses need their own liability insurance for protection against malpractice lawsuits
 NSO
 http://www.nso.com/Individuals/Professional-liability/nurse-malpractice-insurance-
coverage?refID=iiWW2PPi

18. Tort law
 A tort is a civil wrong inflicted or imposed on
another person or their belongings.
 Intentional tort: Commission of a deliberate
improper act (actual or threatened) that is
beyond the legal limits of what is considered
acceptable. It must be executed on purpose
and with intent; however, no harm has to occur
for liability to exist.
 Examples:
 Battery,Assault,Fraud,False imprisionment,
invasion of privacy

19. Intentional tort
 An assault occurs when a person puts another person in
fear of a harmful or offensive act.
 Stating, “If you don’t behave, you can’t have your pain
medication
 Battery is an intentional touching of another’s body without
the other’s consent.
 Forcefully undressing a patient.
 Resuscitating a patient who has a do-not-attempt-
resuscitation order.
 Administering a medication refused by a patient.
 Invasion of privacy: violating confidentiality, intruding on
private client or family matters, and sharing client information
with unauthorized persons.
 Discussing confidential information on an elevator used by
visitors

20. Intentional tort
 False imprisonment occurs when a client is
not allowed to leave a health care facility
 Refusing to discharge a patient from the
hospital until he or she pays the bill.
 Fraud Engaging in purposeful
misrepresentation or reckless disregard of the
truth to produce unlawful gain.
 “You should not feel any pain with this
procedure,” when it is commonly know that the
procedure is painful.

21. Quasi-intentional tort
 Making false statements, verbally (slander) or
in writing (libel), about another person that
harms the person’s reputation, holds the person
up to ridicule or contempt, or causes the person
to be avoided.
 Defamation: Takes place when a falsehood is
said (slander) or written (libel) about a person
that results in injury to that person's good name
and reputation

22. Unintentional tort
 Commission or omission of an act that results
in harm to another.
 However, there is no intent to do harm by the
per- son committing or omitting the act.
 Negligence and malpractice are considered
unintentional

23. Negligence
 Occurs when a nurse fails to implement reasonable
care as dictated by standards of care by omission or
commission of an act and/or fails to act how a
reasonable and prudent layperson would in similar
circumstances.
 Negligence is conduct that falls below the standard of
care.
 Failure to exercise the proper degree of care required
 Careless act of of commission and acts of omission.
 Failure to use sterile technique when indicated
 Failure to check equipment for proper functioning
 Burns sustained by the client as a result of failure to
monitor bath temperature or equipment
 Failure to monitor a client’s condition

24. Malpractice
 Is determined if the nurse owed a duty to the
client and did not carry out the duty and the
client was injured because the nurse failed to
perform the duty.
 Professional form of negligence.
 Duty
 Breach of duty
 Causation
 Damages

25. Examples
 Failure to assess the patient and make
appropriate nursing diagnoses.
 Failure to plan appropriate nursing care.
 Failure to implement a plan of care
appropriately.
 Failure to evaluate patient responses to
interventions.

26. Federal Law: Client’s Bill of
Rights
 Right to know the names and roles of the persons
who are involved in care
 Right to consent or refuse a treatment
 Right to have an advance directive
 Right to privacy
 Right to expect that medical records are
confidential
 Right to review the medical record and to have
information explained
 Right to expect that the hospital will provide
necessary health services

27. Americans With Disabilities Act
 Established a mandate for eliminating
discrimination against people with disabilities.
 Requires reasonable accommodation for
individuals to perform their job and for patients
(e.g., buildings must be wheelchair accessible,
providers of care cannot discriminate against
patients who have acquired immunodeficiency

28. Comprehensive Drug Abuse
Prevention and Control Act.
 Controls distribution and use of drugs that
have a high potential for abuse or addiction,
such as opioids, depressants, stimulants, and
hallucinogens.
 Controlled drugs must be stored, handled,
disposed of, and administered according to
regulations established by the U.S. Drug
Enforcement Administration (DEA).

29. Emergency Medical Treatment and
Active Labor Act.
 Ensures access to emergency services despite an
inability to pay for services.
 When transferred, a patient must be attended to by
competent personnel and with appropriate equipment.
 All hospitals that offer emergency services to provide
a medical screening examination (MSE) when a
request is made for examination or treatment for an
emergency medical condition (EMC), including active
labor, regardless of an individual's ability to pay.
 Was enacted in 1986 to prohibit the refusal of care for
indigent and uninsured clients who seek medical
assistance in the emergency department and the
transfer of unstable clients, including women in labor,
from one facility to another

30. Occupational Safety and Health Act
(OSHA).
 Established the Occupational Safety and
Health Administration (an agency of the U.S.
Department of Labor), which identifies and
enforces regulations that protect individuals
from work- related injury.

31. Health Care Quality Improvement
Act.
 Provides public identification of primary health-
care providers who are disciplined or
penalized for failure to meet legal standards of
care.
 Established the National Practitioner Data
Bank, which tabulates data about medical
malpractice payments, unfavorable actions
taken against clinical privileges, and measures
taken by professional organizations that
negatively affect membership.

32. National Labor Relations Act.
 Gives individuals the legal right to bargain with
an employer as a group to improve working
conditions and salaries (collective bargaining).
 The American Nurses Association (ANA) in
1944 stated that each state’s nurses
association can perform collective bargaining
for nurses.

33. Newborns’ and Mothers’ Health Protection
Act.
 Increased the length of stay in a hospital or
birthing center for a mother and infant to no
less than 48 hours after a vaginal birth and no
less than 96 hours after a cesarean birth.
 Attempts to limit maternal and neonatal
morbidity and mortality.

34. HIPAA
 The Health Insurance Portability and
Accountability Act (HIPAA) describes how
personal health information (PHI) may be used
and how the client can obtain access to the
information.
 PHI includes individually identifiable
information that relates to the client’s past,
present, or future health; treatment; and
payment for health care services.

35. HIPPA Disclosure
 To a family member or significant other in a medical emergency
 To a personal representative appointed by the client or designated by law
 To a coroner, medical examiner, or funeral director about a deceased
person
 To an organ procurement organization in limited circumstances
 To a governmental agency authorized to oversee the health care system or
government programs
 To the Department of Health and Human Services for the investigation of
compliance with the Health Insurance Portability and Accountability Act or
to fulfill another lawful request
 To federal officials for lawful intelligence or national security purposes
 To protect health authorities for public health purposes
 To appropriate military authorities if a client is a member of the armed
forces
 In accordance with a valid authorization signed by the client

36. Patient Self-Determination Act.
 Requires health-care agencies to provide
patients written information about their rights
when making decisions regarding health care.
 Inform the different advance directives

37. Examples of State Laws
 Mandatory reporting laws.
 Require reporting of communicable diseases
and suspected abuse (e.g., physical, sexual,
emotional, or verbal abuse; financial
exploitation; neglect) of children, elders, and
mentally disabled people by health-care
providers or family members to authorities
(e.g., Child Protective Services)

38. Good Samaritan laws
 These laws encourage health care
professionals to assist in emergency situations
and limit liability and offer legal immunity for
persons helping in an emergency, provided
that they give reasonable care without any
kind of payment

39. The NCLEX® examination is created and administered
by the:
 a. American Association of Colleges of
Nursing (AACN).
 b. American Nurses Association (ANA).
 c. National Council of State Boards of Nursing
(NCSBN).
 d. National League for Nursing (NLN).

40. Nurse Practice Act
 A nurse practice act is a series of statutes that
have been enacted by each state legislature to
regulate the practice of nursing in that state.
 Nurse practice acts set educational
requirements for the nurse, distinguish
between nursing practice and medical
practice, and define the scope of nursing
practice.

41. Organ donation and
transplantation
 An individual who is at least 18 years old may
indicate a wish to become a donor on his or her
driver’s license (state-specific) or in an advance
directive.
 The federal Omnibus Reconciliation Act: all
hospital establish protocol for identification of
potentials donors
 The Uniform Anatomical Gift Act provides a list
of individuals who can provide informed
consent for the donation of a deceased
individual’s organs.
 The United Network for Organ Sharing sets the

42. Rights for the Mentally III
 Right to education
 Right to habeas corpus (written request for release from the
hospital)
Right to an independent psychiatric examination
 Right to civil service status, including the right to vote
 Right to retain licenses, privileges, or permits
 Right to marry or divorce
 Right to treatment in the least restrictive setting
 Right not to be subject to unnecessary restraints
 Right to privacy and confidentiality
 Right to informed consent
 Right to treatment and to refuse treatment

43. Religion
 Catholic Church: Organ donation and transplants are
acceptable.
 Orthodox Church: Church discourages organ donation.
 Islam (Muslim) beliefs: Body parts may not be removed or
donated for transplantation.
 Jehovah’s Witness: An organ transplant may be accepted,
but the organ must be cleansed with a nonblood solution
before transplantation.
 Orthodox Judaism: All body parts removed during autopsy
must be buried with the body because it is believed that the
entire body must be returned to the earth; organ donation may
not be considered by family members.
 Organ transplantation may be allowed with the rabbi’s
approval.

44. Safeguarding of Valuables
 Many healthcare agencies require a client to
sign a release to free the agency of
responsibility for lost valuables.
 A client’s wedding band may be taped in place,
unless swelling of the hands or fingers is a
risk.
 Religious items (e.g., medals, scapulars) may
be pinned to the client’s gown if this is
permitted by agency policy.

45. Reporting
 Nurses are required to report certain
communicable diseases, dog or other animal
bites, and criminal activities (e.g., abuse or
neglect, gunshot or stab wound, assault,
homicide, suicide) to the appropriate authorities in
accordance with state or federal guidelines.
 The Impaired Nurse
 If a nurse suspects that a coworker is abusing
alcohol or drugs, the nurse must report the
individual to nursing administration in a
confidential manner, with the client’s safety and
treatment for the impaired nurse being the priority
issues.

46. The Joint Commission
 Is a national organization that offer peer
evaluations for accreditation every 3 years for
all types of US health care agency.
 To focus on priority safety practice
 Safety of the client, families and employee

47. Nurse’s responsibility
 Nurses are bound to protect client
confidentiality by most nurse practice acts, by
ethical principles and standards, and by
institutional and agency policies and
procedures.
 Disclosure of confidential information exposes
the nurse to liability for invasion of the client’s
privacy.

48. Medical records are confidential
 The client has the right to read the medical
record and have copies of the record.
 Only staff members directly involved in care
have legitimate access to a client’s record;
 HCPs and nurses caring for the client,
technicians, therapists, social workers, unit
secretaries, client advocates, administrators
(e.g., for statistical analysis, staffing, quality
care review).
 Others must ask permission from the client to
review a record.

49. Information
technology/computerized medical
records
 Health care employees should have access
only to the client’s records in the nursing unit
or work area.
 The use of a password or identification code is
needed to enter and sign off a computer
system and not share .