Professional Nursing Today Legal Implications for Nursing Practice

Professional Nursing Today Legal Implications for Nursing Practice Healthcare Delivery System Entry into Professional Nursing NRS 101

What is a Nurse?

How are nurse’s portrayed in the media?

What makes a nurse a professional? http: //www. youtube. com/watch? v=z 1 -u. MKg 86 Ck

Nursing as a Profession n Extended education n Theoretical body of knowledge n Provides a specific service n Autonomy in decision making and practice n Code of ethics

Scope & Standards of Practice n Standards of Professional Performance n Code of Ethics

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

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

Historical Perspective n Florence Nightingale n Dorothea Dix n Clara Barton n Isabel Hampton Robb n Dr Mildred Montag

Nursing Today n Registered Nurse n Licensed Practical Nurse n Nurse Practitioner n Clinical Nurse Specialist n Nurse Midwife n CRNA

Current Trends & Issues in Healthcare n n n Nursing Shortage Patient Satisfaction Managed Care Transcultural Nursing National Patient Safety Initiatives Evidence-Based Practice Information Age Genetics Globalization of Health Aging Population Legal & Ethical Issues Terrorism/Bioterrorism/Disaster Nursing

Nursing Shortage n National problem which is growing n Critical shortage in specialty areas n Avg age of nurse is 45 n Resurgence of enticements for recruitment

Reasons for Shortage n Work environment n Recruitment n Retention n Aging workforce n Compensation n Aging Baby Boomers n Shortage of nursing faculty

Patient Satisfaction n Press ganey surveys n Good customer service n Patient Bill of Rights n Treat patients like family n Healthcare is a business

Managed Care n Goal is to keep length of stay (LOS) down n Capitation n Patients are discharged sooner n Patient acuity higher n Health Care Plans n Case manager work closely with physicians and insurance companies

Transcultural nursing n Nursing has become a melting pot n Nurses are challenged to be more culturally aware n Cultural sensitivity

National Patient Safety Initiatives n Joint Commission National Patient Safety Goals n Institute for Healthcare Improvement “ 5 Million Lives” Campaign n The Leapfrog Group

Joint Commission National Patient Safety Goals n Improve the accuracy of patient identification n Improve the effectiveness of communication among n n n n caregivers Improve the safety of using medications Reduce the risk of health care-associated infections Accurately and completely reconcile medications Reduce the risk of patient harm from falls Encourage patients’ active involvement in their own care as a patient safety strategy The organization identifies safety risks inherent in its population Improve recognition and responses to changes in a patient’s condition

The Leapfrog Group n Reduce preventable medical mistakes and improve the quality and affordability of health care n Encourage health providers to publicly report their quality outcomes so consumers can make informed choices

IHI “ 5 Million” Lives Campaign” n Deploy rapid response teams n Deliver reliable evidence-based care for acute MI n Prevent adverse drug events n Prevent central line infections n Prevent surgical-site infections n Preventilator-associated pneumonia

Evidence Based Practice n Goal is to achieve cost-effective, high quality patient care based on scientific inquiry n Nurses need to understand research process involved n Nursing care should not be based on opinions, past practices, but on the results of scientific research n Clinical journals n Practice guidelines n Nursing research

Information Age n Consumers today are more computer savvy regarding healthcare n More info on internet n Consumers could possibly be more informed than health care worker n Joint Commission 2014 all medical records have to be EMR

Genetics n Many major developments in the field of genetic research n Stem Cell n Human Genome Project n Cloning n Legal & Ethical issues

Globalization of Health n Healthcare has become a global issue n People are mobile, diseases can travel n Nurses need to have an understanding of the issues pertaining to global health

Legal Limits of Nursing Sources of Law n Statutory law: Nurse Practice Acts n Regulatory law/Administrative law n Common law n Criminal law: felony & misdemeanor n Civil law: negligence & malpractice :

Legal Issues in Nursing n Nurse Practice Act n Standards of n n n n Professional Practice EMTALA Advanced Directives HIPAA Licensure Good Samaritan Laws Public Health Laws Physician-Assisted Suicide Americans With Disabilities Act

Civil & Common Law Issues in Nursing Practice n Intentional Tort n Unintentional Tort n Negligence n Malpractice n Consent n Informed Consent n Malpractice Insurance n Abandonment & Assignment Issues

Aging Population n Population is aging n Growing concerns regarding the unique needs of the elderly n Gerontological nursing

Terrorism/Bioterrorism/Disaster Nursing n The 9 -11 terrorist attacks have heightened attention to the growing threats of terrorism n Nurses need to be aware to the health consequences of terrorism and use of biological agents

Practice Settings for Nurses n Hospital n Community Based Practice Settings

Hospital Based Nursing n Acute care is where largest group of nurses practice n Different Staffing Patterns n Skill Mix Changing n Increase in skilled nursing facilities due to aging population and increase in chronic disease

Community Based Nursing n Focus on health promotion, maintenance, education n Community Health Centers, Clinics n School Nursing n Occupational Health n Home Health n Physicians Office n Managed Care Organizations n Forensics Nursing

Nursing Education n Diploma n ADN n BSN n Master’s n Doctorate n Continuing education n In-service education

Nursing Roles n Caregiver n Clinical Decision Maker n Client Advocate n Rehabilitator n Comforter n Communicator n Collaborator n Teacher

Professional Roles & Responsibilities n Autonomy & Accountability n Caregiver n Client Advocate n Educator n Manager/Clinical Decision Maker n Communicator n Collaborator n Career Development

Autonomy & Accountability n Autonomy is the essential element of professional nursing n Person is reasonably independent and selfgoverning in decision making & practice n Increased autonomy=Increased responsibility n Accountability- nurse is responsible professionally & legally for type & quality of care provided n Regulated through Standards of Practice and Nurse Practice Act

Clinical Decision Maker n Utilizes critical thinking skills and the nursing process n Nursing Process: Assessment, Diagnosis, Planning, Implementation, Evaluation

Client Advocate n Nurse protects the clients human and legal rights n Providing information to assist in decision making n Patient Bill of Rights

Rehabilitator Role n Assist client to return to optimal level of functioning n Nurse helps client to adapt physically and emotionally to changes in lifestyle, body image

Comforter Role n Caring for client as a human being n Role is traditional to nursing n Care is directed to whole person, not just a body part n Demonstration of care and concern

Communicator Role n Role is central to all other roles n Involves communication with client, family, healthcare team members, resource people, and the community n Without clear, concise communication it will be difficult to give effective care

Teacher/Educator Role n Explains concepts and facts about health, demonstrates procedures, reinforces learning, determines understanding, and evaluates progress of learning n Unplanned or informal education n Planned or formal education

Nursing Career Roles n Clinician n Nurse Educator n Advanced Practice Nurse n Nurse Administrator n Nurse Researcher n Military Nurse n Forensic Nursing

Healthcare Team Members n n n Nurses Physician Assistant Therapists and Technicians Pharmacist Nutritionist/Dietitian Case Manager/Social Worker Pastoral Care Nursing Assistant Unit Secretary Ancillary Staff

Professional Nursing Organizations n Created to deal with issues of concern within profession n American Nurses Association n National League of Nursing n State Nurses Association n National Student Nurse Association n Organizations specific to specialty

Health Care Delivery System n Prospective Payment System n Diagnosis-related Groups n Capitation n Utilization Review

Health Care Plans n Managed care organization (MCO) n Medicare n Preferred provider organization (PPO) n Medicaid n Private insurance n Long term care insurance

Health Care Services n Primary Care n Preventive Care n Secondary Acute Care n Tertiary Care n Restorative care n Continuing Care