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Where do the legal guidelines that nurses follow come from? Be prepared to give examples of each.
- Sources of legal guidelines come from:
- Statutory law (Nurse Practice Act): describe and define the legal boundaries of nursing practice in each state. An example of federal statute enacted by US congress is Americans with Disabilities Act (ADA)
- Criminal law (felonies or misdemeanors)
- Civil law
- Regulatory law (administrative law): reflects decisions by administrative bodies like State Boards of Nursing. Example; requirement to report incompetent or unethical nursing conduct to the State Board of Nursing
- Common law (judicial decisions)Examples; informed consent, the pts right to refuse treatment, negligence and malpractice.
What are Standards of care?
- Legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care
- Best known comes from the American Nurses Association (ANA)
- Set by every state
- Set by state and federal laws that govern where nurses work
- Joint Commission requires policies and procedures (P&P).
How does the law define the standards of care for nursing?
- Legal guidelines for defining nursing practice and
- identifying the minimum acceptable nursing care
In what ways does the Americans with Disabilities Act Impact the practice of nursing?
The ADA impacts the practice of nursing in that it protects the rights of the physical or mentally disabled. Also, it is the most extensive law on how employers must treat health care workers and pts with HIV (not AIDS). It protects privacy of those with HIV even the nurse.
What does EMTALA stand for and how does it impact patient care?
Emergency Medical Treatment and Active Labor Act. When a pt comes to emergency department or hospital appropriate medical screening is done in hospital. If there is an emergency situation the hospital cannot discharge or transfer the pt until the condition is stabilized unless the pt requests transfer or discharge in writing after getting info on benefits and risks or if health care provider certifies that benefits outweigh risks.
What are the types of advance directives and how are they utilized?
- a. Living will: Written document that direct treatment in accordance with pts wishes. Pt can decide what medical treatment/procedures they want if terminally ill or in persistent vegetative state
- b. Health care proxy: legal document designates a person(s) the pt chooses to make health decisions when they cannot.
- c. Durable powers of attorney for health care: DPAHC is the same as a health care proxy
How does the nurse educate clients about advance directives?
What are the legal requirements for organ donation?
- At least 18 years old
- Donors must make gift in writing with their signature (many adults sign back of license)
- Who sets policies and guidelines for the procurement of organs?
- United Network for Organ Sharing (UNOS) sets policies and guidelines.
What does HIPAA stand for and how does it protect clients and nurses?
- Health Insurance Portability and Accountability Act
- a. It protects rights to pts and protects employees
- b. It protects individuals from losing their health insurance when changing jobs without losing coverage as a result of preexisting coverage exclusion as long as they have had 12 months of continuous group health insurance coverage
- c. Right to confidentiality
When can a health care provider use restraints?
- a. Only to ensure physical safely or pt or other pts
- b. When less restrictive interventions are not successful
- c. Only when ordered by health care provider
What should written orders include when the need for restraints arise?
A specific episode with start and end times.
If restraints are used incorrectly what is this an example of? Who is liable?
- The nurse AND health care institution.
Who provides licensure to nurses?
State Board of Nursing
What is the purpose of licensure?
It permits people to offer special skills to the public and also provides legal guidelines for protection of the public.
When can an RN license be revoked or suspended?
If the nurses conduct violates provisions in th licensing statute based on administrative law rules that implement and enforce the statute.
Be able to define torts and give examples of intentional torts, quasi-intentional torts, and unintentional torts as they apply to nursing.
- Torts: civil wrong made against a person or property
- Intentional tort: willful acts that violate someones rights eg assault, battery, and false imprisonment
- Quasi-intentional tort: intent is lacking but volitional action and direct causation occur such as:
- defamation of character
- Invasion of privacy
- Unintentional tort: includes negligence and malpractice
When is it appropriate for the nurse to obtain consent?
Because nurses do not perform surgery or direct medical procedures, in most situations getting consent does not fall within nursing duty. The person responsible for performing the procedure needs to get the informed consent. When a nurse provides consent form for patient to sign she must ask the patient if he understands the procedure he is signing for.
What are the statutory guidelines for legal consent for medical treatment?
- 1. Adults
- A. Any competent individual 18 years of age or older for himself or herself
- B. Any parent for his or her unemancipated minor
- C. Any guardian for his or her ward
- D. Any adult for the treatment of his or her minor brother or sister (if an emergency, and parents are not present)
- E. Any grandparent for a minor grandchild (if an emergency, and parents are not present)
- 2. Minors
- A. For his or her child and any child in his or her legal custody
- B. For himself or herself in the following situations:
- 1. Lawfully married or a parent (emancipated)
- 2. Pregnancy (excluding abortions)
- 3. Venereal disease
- 4. Drug or substance abuse
- C. Unemancipated minors may not consent to abortion without one of the following:
- 1. Consent of one parent
- 2. Self-consent granted by court order
- 3. Consent specifically given by a court
What does the nurses signature witnessing consent mean?
Means that the patient voluntarily gave consent, the signature is authentic and patient appears to be competent to give concent.
What should the nurse do if they suspect the client doesnt understand the treatment?
Notify health care provider or nurse supervisor
When are nursing students liable for their actions?
Always. If a patient is harmed not only the student nurse but the instructor, hospital and school as well, will be liable.
How are student nurses expected to perform?
As professional nurses would in providing safe patient care
What should the student nurse do if asked to perform a task they are not prepared to complete safely?
Bring to supervisors attention to get needed help
What are other legal factors affecting nursing students?
When would it be necessary for the nurse to obtain malpractice insurance?
When she plans to practice outside of her employing institution since her employers isurance will may for suits that happen at work but not when she is not at work.
What should the nurse do if asked to care for more clients than is reasonable?
Bring it to attention of nursing supervisor. If she has to accept unreasonable workload they need to made written protests to nursing administrators. Though the protests do not relieve responsibility if there is an accident or injury because of inattention it shows the nurse was trying to act reasonably. Nurse should always keep a copy of the written protest.
What constitutes client abandonment?
Walking out on a patient constitutes abandonmnt
What must the nurse do if asked to float to a unit where they do not regularly work?
The nurse should inform the supervisor of any lack of experience in caring for the type of patient in that unit and they should request and receive an orientation to that unit.
What should the nurse do if they find a physicians order for their client to be erroneous or harmful?
Nurses follow orders unless they believe an order is given in error or is harmful. In this case the nurse needs to clarify with the health care provider. If the doctor confirms the order and you still believe it is inappropriate, inform the supervising nurse or follow te established chain of command.
If a nurse carries out an erroneous or harmful order written by the physician, what are the consequences?
The nurse will be liable for any ham the patient suffers.
How does the nurse inform a physician or health care provider properly regarding a clients condition?
To inform properly you perform a competent nursing assessment of the patient to determine the signs and symptoms that are significant in relation to the attending health care providers tasks of diagnosis and treatment. Document that you notified the health care provider and his response, your follow-up and the patients response.
What are the responsibilities of the nurse when taking a verbal order or an order over the phone?
The nurse must confirm orders by reading back to the doctor. The order must be signed by doctor as soon as possible (usually between within 24 hrs). Students NEVER take vebal orders.
What are the steps involved in risk management?
- Identify possible risks.
- Analyze risks.
- Act to reduce risks.
- Evaluate steps taken.
Why is it important to file an occurrence report?
- Aka incident report.
- One tool used in risk management is the incident report or occurrence report.
- a. It serves as a database for further investigation
- b. Alerts risk management to a potential claim situation.
What are elements of good documentation?
The health care provider contacted, nurses assessment, information communicated to the health care provider and the health care prviders response.
When using electrical equipment what is important to verify?
The nurse should always verify that the machine is giving the correct assessment of the patient.
Nurses need to be involved in their professional organizations for what reasons?
Nurses need to be involved so that current laws, rules and regulations reflect reality. Nurses should represent nursing and the pts perspective in the community.