Legal Issues in Nursing Practice NRS 101 About

Legal Issues in Nursing Practice NRS 101

About Legal Issues Rights, responsibilities, scope of nursing practice As defined by state nursing practice acts Sources of laws Sum total of rules and regulations by which a society is governed Law made at federal, state, and local levels

Figure 47 -1 Overview of the sources of law.

About Legal Issues, continued Criminal and civil laws Address conduct harmful to another individual or society May be punishable by fines or imprisonment Crime Act prohibited by statute, common law principles Civil law Deals with rights and duties of private persons

Tort Law Tort civil wrong committed against a person or person’s property Unintentional torts Negligence Professional negligence Malpractice

Professional Negligence or Malpractice Five elements: Duty Breach of duty Forseeability Causation Injury or harm

Professional Negligence or Malpractice, continued Related doctrines: Respondeat superior Res ipsa loquitur Statute of limitations

Intentional Torts Assault Battery False imprisonment Invasion of privacy

Strategies to Prevent Incidents Maintain client safety Falls Mistaken identity Minimize risk of medication errors Apply the Five Rights Right drug Right dose Right client Right route Right time

Strategies to Prevent Incidents, continued Use effective communication Helps decrease risk of bad outcomes Attentive listening Accurate documentation and reporting Professional liability insurance Nurses should carry to manage personal financial risk

Standards of Care Based on Nurse Practice Act (NPA) Administrative rules Job descriptions Policies and procedures ANA

Selected Laws Informed consent Client’s legal and ethical rights to be informed of, give permission for procedure, treatment Client must not be coerced Client understanding essential Follow agency’s specific protocols Competency for consent Consent in an emergency Child participation in decision

Selected Laws, continued Controlled Substance Act Federal law Good Samaritan laws Encourage health care providers to help victims in an emergency Protects health care workers from potential liability Nurse responsible for following through with emergency care

Nurse Practice Acts (NPAs) Defines: Scope of practice Standards for education programs Licensure requirements Grounds for disciplinary actions Enforced by state boards of nursing (BON)

Figure 47 -3 Relationship among the Nursing Practice Act, Administrative Rules, and position/advisory statements.

Licensure Allows nurses legal privilege to practice nursing as defined by NPA Each BON oversees administration of a licensure examination National Council of State Boards of Nursing NCLEX-RN® NCLEX-PN ®

BONs Responsibilities Actions against nurses found guilty Giving false information Nolo contendere Conduct that endangers public health Unfit or incompetent to practice Engaging in conduct that deceives, defrauds, or harms the public 2009 NCSBN report www. NCSBN. org.

National Council of State Boards of Nursing Membership Functions Nurse Licensure Compact Mutual recognition model

NPAs Certification Federal organizations Joint Commission Centers for Medicare and Medicaid Services Nursing students Standards of Practice

Standards of Nursing Practice ANA Standards of Nursing Practice Standards are authoritative statements by which the nursing profession describes the responsibilities for which its practitioners are accountable. Standards reflect the values and priorities of the profession and provide direction for professional nursing practice and a framework for the evaluation of this practice. They also define the nursing profession’s accountability to the public and the outcomes for which registered nurses are responsible. http: //www. nursingworld. org/Main. Menu. Categories/The. Practiceof. Professional. Nursing/Nursing. Stan dards. aspx

ANA Standards of Professional Performance Quality of practice Professional Practice Evaluation Education Collegiality Ethics Collaboration Research Resource Utilization Leadership

Professional Nursing Practice Nurse Practice Acts Licensure and Certification Science and Art of Nursing practice

Figure 47 -4 Impact of laws and standards on the nurse.

Advance Directives Legal document Expresses an individual’s desires regarding medical treatment Patient Self-Determination Act Types of advance directives Living will Durable power of attorney for health care

Elements of Advance Directives Surrogate decision maker authority to: Consent to or refuse medical treatment or diagnostic procedure Hire or discharge medical providers Authorize admission to medical and long-term care facilities Have access to all medical records Consent to comfort care, pain relief measures Any measures to carry out wishes

Role of Nurse Reassure clients and families that they have option to change their decision Assess whether clients, families have accurate understanding of life-sustaining measures Be supportive of clients’ decisions

Health Information and Portability and Accountability Act HIPAA Purposes Minimizes exclusion of preexisting conditions Designates special rights for those who lose other health coverage Eliminates medical underwriting in group plans Includes Privacy Rule

Protected Health Information Protected by Privacy Rule: Individually identifiable health information Information that identifies individual Access to medical records Required notice of privacy practices and opportunity for confidential communications Limits on use of medical information Prohibition of use of personal information for marketing

Privacy vs. Confidentiality Privacy right of individuals to keep their personal information from being disclosed Confidentiality the assurance client has that private information will not be disclosed without client’s consent