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How does the Nurse Practice Act affect the scope of nursing practice?
- Regulates the practice of nursing
- Legally defines the scope of practice: different in each state
- Protects the public: indirectly by defining the scope of practice; ability to prescribe and what can be delegated by the RN
- Creates a State Board of Nursing: has the authority to make and enforce rules for nursing practice
- Establishes criteria for Education and Licensure
What are the INTERNAL STANDARDS OF CARE and how do they affect the scope of nursing practice?
- Job Description: What you can or cannot do.
- Institution policies and procedures: Ex: policy for inserting Foley catheters may vary from place to place. RN responsibility to know the policy for their institution.
What are the EXTERNAL STANDARDS OF CARE?
- State Nurse Practice Act
- Professional Organizations: ANA, NLN
- Nursing Specialty Organizations: ONS, CCRN
- Federal: OSHA, HIPPA
What is the PATIENT'S BILL OF RIGHTS?
- What patients can expect during their hospital stay:
- High Quality Care
- A clean and safe environment
- Involvement in their care
- Protection of privacy
- Help preparing them and their family for when they leave the hospital
- Help with their bill and filling insurance claims
What is TORT LIABILITY?
- Tort: A civil wrong by one person against the person or property of another.
- Type of civil action most often encountered by nurses
- Person harmed by tort may: Sue the wrongdoer and seek compensation (or apology) for the harm in money damages for both past and future noneconomic (pain) and economic (medical bills, loss of income) damages.
What are some examples of INTENTIONAL TORTS?
- Assault and Battery: Threats and physical contact
- Defamation of Character: Slander; giving report that a patient is "difficult"
- Invasion of Privacy: Looking at something unnecessary
- False Imprisonment: Restraints; having all 4 side rails up
- Fraud: Misdocumentation
What are some examples of UNINTENTIONAL TORTS?
- Unintentional Torts: form of negligence that addresses the negligent conduct of professionals, including nurses.
- Malpractice: Violation of a professional standard of care that results in injury to a patient.
What must be proved for someone to have a MALPRACTICE suit?
- Duty: The patient had a relationship with the nurse. Ex: It is the nurse's responsibility to provide a safe environment for their patient (Patient's Bill of Rights).
- Breach of Duty: The nurse failed to comply with the Standards of Care. Ex: Nurse left the side rails down.
- Causation: Relationship btwn the breach of duty and the injury. Ex: b/c the side rail was down, the patient fell out of bed.
- Damages: Injury occurred to the patient. Ex: Fractured hip, pain, etc...
How does delegation by nurses contribute to the increase in MALPRACTICE?
Nurses are delegating more due to the fact that patients in the hospital are "sicker". Same patient load, more work per patient.
How does early discharge contribute to the increase in MALPRACTICE?
There are more likely to be complications which would have been noticed if the patient spent more time in the hospital.
How does THE NURSING SHORTAGE AND HOSPITAL DOWNSIZING contribute to the increase in MALPRACTICE?
Retired nurses are returning to work. Budget cuts reduce staffing which creates more hours worked by employed personnel which creates TIRED nurses.
How do advances in technology contribute to the increase in MALPRACTICE?
Nurses rely more on technology to notify when a patient is in danger. Ex: machine will beep when there is air in the line.
How does increased autonomy and responsibility of hospital nurses contribute to the increase in MALPRACTICE?
Nurses have more duties. Ex: ICU nurses can have as many as 3 patients
How are the Standards of Care followed?
- Perform a complete admission assessment (head to toe) or design a plan of care.
- Adhere to standardized protocols or institutional policies and procedures.
- Follow a health care provider's verbal or written orders - Do not follow blindly. Know who is and isn't allowed to write prescriptions according to the state's Nurse Practice Act.
How can using equipment in a responsible manner prevent a nurse from being sued for MALPRACTICE?
- Learn how the equipment functions. Go to in-service training for new equipment.
- Follow the manufacturer's recommendations for operating equipment.
- Check for safety prior to use.
- Place equipment properly during treatment.
How can proper communication prevent a nurse from being sued for MALPRACTICE?
- Notify a physician in a timely manner when conditions warrant it. Do not wait until 0700 physician rounds to report a patient is not urinating and has a full bladder at 0300.
- Listen to the patient complaints and act on them. Find out more about complaints of pain, etc...
- Communicate effectively with patients.
- Seek higher medical authorization for a treatment. Go to the person you can get it from.
- A problem is not completely resolved by telling the charge nurse. It is the nurse's responsibility to make sure a problem is resolved!
What should always be documented in order protect yourself in the event you are sued?
- Patient progress and response to treatment.
- Patient injuries.
- Pertinent nursing assessment information, i.e. drug allergies.
- Information on telephone conversations with physicians including time, content of communication and actions taken.
- Education methods and patient understanding.
- Nursing plan of care.
How can assessment and monitoring of a patient protect a nurse from being sued?
- Complete a shift assessment (head to toe)
- Implement a plan of care
- Observe the patient's ongoing progress.
- Interpret a patient's signs and symptoms.
What are actions nurses can take as a patient advocate which will protect them from being sued?
- Question a discharge order when a patient's condition warrants it. Goal is to keep the patient safe and prevent re-entry into the hospital.
- Question incomplete or illegible medical orders. Important to know information regarding medications being administered to patient. Call the person who wrote the order with any questions on legibility or accuracy.
- Provide a safe environment.
What is the nurse's responsibility in regards to informed consent?
- Make sure the patient understand what they are signing. If they do not understand get the person performing the procedure to explain it again.
- Witness signing of informed consent. Anyone can witness, not critical.
What is the Good Samaritan Acts?
State law which provides civil immunity from negligence for individuals who render care in an emergency. Encourages healthcare providers and citizens trained in first aid to deliver medical care at accident sites and roadside emergencies without fear of incurring liability.
What information should be included in an INCIDENT REPORT?
- Complete name of person or people involved.
- Names of all witnesses.
- Complete factual account of incident. Avoid any conclusions of blame.
- Date, time and place.
- ID any medications or equipment by name and number.
- Document any circumstances surrounding the incident.
What is the federally mandated responsibility of the nurse in regards to CONTROLLED SUBSTANCES?
- Keep a record of each narcotic administered.
- Immediately report incorrect count.
- Have a 2nd person witness and sign discarded controlled substances. Actually watch fellow nurses discard before signing.
- Verify ordering physician is registered with DEA and Department of Justice.
- Making sure law is observed.
When can a student nurse be sued for negligence?
- When they fail to follow course objectives and student guidelines.
- When they fail to request appropriate supervision.
- When they violate patient/client confidentiality.
What is ALTRUISM?
- A professional value of nurses.
- Concern for the welfare and well-being of others.
- Example Actions: Demonstrating the understanding of the culture of a patient, becoming a mentor to a student nurse working on the floor or respecting the right of a Native American to call in a shaman for a consultation.
How do the professional values of nurses relate to AUTONOMY?
- It is the nurse's responsibility to give patients the right to self-determination and realize that patients have the right to determine what they want in life.
- Example actions: Reading the patient's Bill of Rights to a visually impaired patient or collaboration with other health care team members ro ensure the best possible treatment.
How do the professional values of nurses relate to HUMAN DIGNITY?
- It is the nurse's responsibility to have respect for the inherent worth and uniqueness of individuals and populations.
- Example Actions: Provide privacy for an elderly patient, planning individualized care for a patient or refusing to discuss a patient with a curious friend.
How do the professional values of nurses relate to INTEGRITY?
- It is the nurse's responsibility to act in accordance with an appropriate code of ethics and accepted standards of practice.
How do the professional values of nurses relate to SOCIAL JUSTICE?
It is the responsibility of the nurse to uphold moral, legal and humanistic principles.
How do the ethical principles of nurses relate to AUTONOMY?
It is the responsibility of the nurse to respect the rights of patients to make healthcare decisions.
How do the ethical principles of nurses relate to NONMALEFICENCE?
- Is it the responsibility of the nurse to avoid causing harm.
- Make sure the patient stays safe.
How do the ethical principles of nurses relate to BENEFICENCE?
- It is the responsibility of the nurse to make decisions which benefit the patient and balance benefits against risks and harms.
- Ultimately the decision is up to the patient.
How do the ethical principles of nurses relate to JUSTICE?
- It is the responsibility of the nurse to give each his or her due and act fairly.
- Every patient is a VIP.
How do the ethical principles of nurses relate to FIDELITY?
- It is the responsibility of the nurse to keep promises.
- If you tell the patient you will be back, GO BACK!
What is Standard V in the ANA Standards of Professional Performance?
Ethics: the nurse's decisions and actions on behalf of clients are determined in an ethical manner.
What is an example of nursing actions that are both ethical and legal?
A nurse gives the right drug by the right route in the right amount to the right patient at the right time - as the doctor ordered.
What is an example of nursing actions that may be considered ethical but are not legal?
What is an example of nursing actions that may be considered legal but are not ethical?
A nurse administers a large dose of pain-relieving drug to a patient as prescribed by the doctor's orders, even though she fears it may compromise respiration.
What is an example of nursing actions that are neither legal or ethical?
A nurse gives the wrong medical to a patient, does not inform the doctor and does not complete an incident report.