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