Legal Aspects of Nursing
NUR101
FALL 2010
LECTURE #21
K. Burger, MSEd, MSN, RN,CNE
PPP by: Sharon Niggemeier RN MSN Revised kburger8/06
Legal Aspects
• Legal accountability for all nursing actions
rests with the nurse.
• Nurses and student nurses are legally
responsible for their actions
Regulation of Nursing Practice
• Regulated by laws
New York State Nurse Practice Act
Patient Self-determination Act (PSDA)
Health Insurance Portability and
Accountability Act ( HIPAA)
Americans with Disabilities Act ( ADA)
Medicaid Statutes / Resident’s Rights
Public Health Laws
Regulation of Nursing Practice
• Regulated by Standards of Care
guidelines developed by:
-nursing organizations such as ANA
-state boards of nursing
-health care institutions
-procedural textbooks
-written nursing policies/procedures
Mandated by the Joint Commission on
Accreditation of Healthcare Organizations
(JCAHO)
Licensure of Nursing Practice
• Licensure requirements are set by State
Board of Nursing
-educational requirements
-licensing exam (NCLEX)
-maintenance and renewal
-suspension and revocation
-professional misconduct proceedings
Take a look at
www.op.nysed.gov/nurse.htm
The State Board of Nursing may revoke or
suspend a nurses license for willfully violating
the nurse practice act:
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drug/ETOH abuse (most common)
fraud ( in obtaining license)
conviction of a felony
gross or ordinary negligence
previous disciplinary actions in other states
physical / mental impairments
practicing after your license expires
Types of Legal Action- Crimes
• Criminal Action
– a wrong against persons and society
– criminal court
– punishable by imprisonment
Felony
Misdemeanor
Types of Legal Actions- Torts
• Civil Action- Tort
– A wrong against an individuals rights or
property
– civil court
– punishment usually with monetary settlement
– tort may also be a crime and tried in both courts
Intentional
Unintentional
Torts
• Intentional:
fraud
invasion of privacy
defamation of
character
false imprisonment
assault and/or battery
• Unintentional:
negligence
Malpractice =
negligence as it
applies to a
profession
Elements of Malpractice
FOUR elements must be
met to prove guilty of
malpractice
• Duty- (relationship)
nurses responsibility to
provide care in an
acceptable manner
• Breach of Duty- failed
to provide care in
acceptable manner
• Injury(damages)nurses act caused harm
• Proximate causereasonable cause and
effect can be shown
between the omission
or commission and the
harm
Common Malpractice
Allegations
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Failure to maintain safety
Improper technique/treatment
Failure to monitor and report
Medication errors
Failure to follow policy/procedures
Poor documentation
Improper use of equipment
Protecting Yourself
• Practice safely & competently
Always follow standards of care!!
• Develop a caring relationship with your pt
• Communicate, communicate, communicate!
• Document, document, document!
Protecting Yourself
• Remember - the nurse enters into a
contractual obligation ( ethical AND legal)
when caring for a client.
• You are responsible for the actions of your
ancillary staff ( Respondent superior )
• Carry your own liability insurance
• You have increased responsibility in regards
to Good Samaritan Laws.
Patient’s Bill of Rights
• Every patient has rights under PUBLIC
HEALTH LAW
See handout and/or
NYS Department of Health Website
Informed Consent
INCLUDES:
• Explanation of procedure
• Explanation of risks, anticipated discomfort
• Explanation of alternatives
Client has right to refuse
Client must be competent and of legal age
It is the physician’s duty to obtain informed consent
It is the nurse’s duty to verify that client was informed
Ethics & Values
NUR101 FALL 2010
LECTURE #21
K Burger MSEd,MSN,RN,CNE
Ethics versus Laws
• Nurse Practice Act governs legal practice
• You govern ethical practice
• It is the ETHICS of nursing practice that
elevate it as the #1 most trusted profession
Source: Gallup Poll, Honesty and Ethical
Standards of Professions Survey, 2004.
Nursing Code of Ethics
• Written by professional organizations
American Nurses Association (ANA)
International Council of Nurses
Remember…one of the hallmark characteristics
of a “profession” is that it has a Code of Ethics.
Values versus Ethics
VALUES = personal belief about the worth of
a
given idea, attitude, custom
ETHICS = good character and conduct
Values Clarification
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Your first step in development of ethical behaviors
Recognize and understand your values
Critically examine your ethical thinking
Transformational learning
Critical reflection
Constructive discourse
Emotional intelligence
Democratic habits of heart
• Aids in the development of ethical agency
( the ability to “do the right thing”)
Essential Values for Nursing
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Altruism
Autonomy
Human dignity
Integrity
Social Justice
Cultural competence
All of above correlate to universal
principles of biomedical ethics.
Universal Ethical Principles
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Veracity
Autonomy
Beneficence
Nonmaleficence
Fidelity
Confidentiality
Justice
Ethical Behavior of the Professional Nurse
includes:
• Accountability
• Responsibility
• Advocacy
Ethical Stressors in Nursing
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Quality of life
Futile care
Euthanasia
Abortion
Allocation of scarce resources
Processing Ethical Dilemmas
• FIRST… ask yourself “is it really an ethical dilemma”
• THEN if yes:
- gather all relevant data
- do a values clarification process
- state the problem
- consider all possible courses of action
- negotiate an outcome
- evaluate
• Also consider use of institutional resources: