Legal Implications in Nursing Practice Taylor ch 7

Legal Implications in Nursing Practice Taylor ch. 7

Definition of Law § Standard or rule of conduct established and enforced by government § Designed to protect the rights of the public

Types of Laws § Public law—government is directly involved; regulates relationships between individuals and government § Private law—civil law; regulates relationships among people § Criminal law—concerns state and federal criminal statutes; defines criminal actions

Sources of Law § Constitutions—serve as guides to legislative bodies § Statutory law—enacted by a legislative body § Administrative law—empowered by executive officers § Common law—judiciary system reconciles controversies, creates body of common law

Professional and Legal Regulation of Nursing Practice § Nurse practice acts § Standards § Credentialing § Accreditation § Licensure § Certification

Reasons for Suspending or Revoking a License § Drug or alcohol abuse § Fraud, deceptive practice § Criminal acts, previous disciplinary actions § Gross or ordinary negligence § Physical or mental impairments including age

Selected Laws Affecting Nursing Practice § Patient Self-Determination Act (Advance Directives) § Health Insurance Portability and Accountability Act (HIPAA) § Licensure § Nursing Practice Act § Informed Consent § Controlled Substances § Obligation to Report

Patient Self-Determination Act of 1991 § Requires health care institutions to provide written information concerning client rights to make their own decisions. § If patient chooses to have written documentation, the chart must contain Advance Directives (living will, Healthcare Power of Attorney) that the patient has completed. § If patient becomes incapacitated, decisions can be made by the person appointed as the HCPA.

Impact on Nursing Practice § Nurse or other hospital representative is required to ask the patient about ADs. § Nurses are impacted when pt is unable to make own decisions. § Nurse needs to know when pt has a DNR § Ethical issues can occur § Nurse may be asked to be a witness to signatures

HIPAA § Goal is to protect patient privacy. § Uniform electronic transfer of information. § Use of tax ID numbers of employers. § Security rule which provides uniform level of protection that applies to all HCPs. § Privacy rule that specifies what information can be disclosed and in which situations.

Impact on Nursing Practice § Name cannot be posted § Records in secure area § Printed material cannot be left unattended § Access to information is limited to those involved § Password to access client record § Privacy rights posted in full view § Oral communication volume kept low § HCPs must keep current with HIPAA

Nursing Practice Act (ncbon. org) § Main components of RN practice: § Assessing, planning, and implementing care § Documentation § Hand-off communication (SBAR, shift change, unit/facility transfer) § Teaching § Collaboration § Supervising and evaluating § Making sure safe and effective nursing care is practiced, whether by you or others

Standards of Care § Skills and learning commonly possessed by members of a profession § Used to evaluate the quality of care nurses provide § Have become the legal guidelines for nursing practice § General standards vs. specialty practice standards § Consider such situations as floating, short staffing, and following MD orders

Standards of Care § Nursing Practice Acts § Federal and state laws regulating health care agencies (JCAHA, Medicare) § Professional and specialty nursing organization (ANA, NOORN) § Written policies and procedures and job descriptions

Implications for Nursing Students § Same standard as for RN § Instructor’s responsibilities to student § Student responsibilities to instructor § Student’s demonstration of competency § Student may or may not be supervised § Do not confuse SN and CNA roles

Informed Consent § A nurse can witness the client’s signature. § Determine if client understands what has been told by surgeon. § Statutory guidelines include: § Adults of “sound mind” § Minors—under 18 unless emancipated § Client must be emotionally and mentally competent to sign a consent. Those given meds that affects cognition, should not sign a consent. Clients declared incompetent, unconscious, under the influence of alcohol/drugs, have chronic dementia or other mental deficiency should not sign. § Emergencies are special circumstances

Controlled Substances § Nurse is responsible for following federal guidelines for administering controlled substances § All meds are signed out on computerized med access system § If no computerized system is used, follow policy of agency. § Nurse is responsible knowing all info on drug and for patient/family teaching R/T med § Nurse is responsible for knowing classes and implications for specialty groups

Obligation to Report § Child/elder abuse, GSWs, suicides, infectious diseases reported to appropriate person. § Unsafe practices by colleagues reported to supervisor § Impaired nurses on the job reported to supervisor who will then report it to BON or police as required. § If nurse questions an order but the HCP can not be located, contact supervisor. Nurse should NOT carry out order without clarification. § Report all sexual harassments to supervisor stat.

Negligence § Negligence is the failure to act according to the standard of what a “reasonable, prudent nurse” would do. § Ignoring patient needs or requests for help can be negligence § Actions that put the patient at risk or that cause harm are negligent unless they are intentional; then it could be assault and battery. § Failure to do things that should be done such as carrying out orders, monitoring patient, or failing to call HCP for changes in patient’s condition is negligence. § Nurse must respond to patient needs or delegate the task.

Advocacy § Overall goal is to protect pt rights § An advocate informs pts about their rights § Also provides patient information needed to make informed decisions. § Requires accepting and respecting the patient’s right to decide even if the nurse believes the decision is wrong

Dimensions of Advocacy § Being on the patient’s side § Following through or following up § Providing resources § Going above and beyond

Values Basic to Advocacy § The client is a holistic, autonomous being who has the right to make choices and decisions § Clients have the right to expect a nurse-client relationship that is based on trust, mutual respect, and collaboration on health care issues and respect of feelings

The Nurse as Speaker § In managing care, it is important to remember that the patient is the reason you are here. His or her needs come first § Sometimes patients cannot assert themselves or speak for themselves and nurses need to intervene on their behalf § It is the nurse’s legal and ethical responsibility to protect the client’s human and legal rights.

Vulnerable Populations § Elderly § Children § Abused § Under the influence § Extremely ill—physically or mentally § Special needs § Different value system related to autonomy

Client Health and Safety § It is the nurse’s responsibility to follow policies and procedures of institution to report: § Incompetence § Unethical behavior § Illegal actions § Impaired colleagues