Legal Aspect
of Nursing
Objectives

1.
By the end of the lectures students should be
able to explain and discuss:
Standards that govern nursing care
2. The Law and how it governs
nursing/midwifery
3. Conduct of students
Standards of Care
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Guidelines for nursing/midwifery practice
Average degree of skill, care and diligence
exercised by members of the same profession
under the same or similar circumstances
If standards does not met this level is
negligence-incompetence or gross
negligence
Yard stick by which the legal system measures
the actions of a nurse in a malpractice suit
Protects patients from inferior care
Standards CONT’D
 If
nurse /midwives do not perform their
duties within accepted standards of care
they place themselves in jeopardy of
legal action and also place their client’s
at risk for harm or injury
Definitions
 Standards
of professional performanceactivities such as continuous quality
improvement, education, research,ethics
and peer review
 Standard is an authoritative statement
 Guidelines suggest or recommend
practices by which standards of care can
be met-do not mandate compliance
Definitions CONT’D
 By
laws are rules that are adopted to
regulate practice and privilegesmed/surg nursing
 Policy-overall
goals
 Procedures
policies
plan to accomplish general
–tools used to implement the
Sources of Standards
Joint Commission on Accreditation of Healthcare
Organizations
 State laws and regulations
 American Nurses association
 Bylaws, Facility procedures
Ghana
 NMC
 Constitution
 GRNA/GRMA
 MOH/GHS
 Facility procedures and protocols

Developing Standards
 State
board of nursing
 Nursing associations
 Specialty nursing associations
 Standards vary-general or specific
Legal Implications
Standard serves as evidence- prove 4 elements
1. Duty
2. Breech of duty
3. Proximate cause
4. Damages

Expert-relevance
Hearsay evidence

Standards in disciplinary Proceedings
Standard of Care Defenses
 Nurses
in Training
 Error-in-Judgement-
standard met even
though error occurred
 Two-schools-
of Thought Doctrine-more
than one method of doing a procedure
Legal Responsibilities
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Law is the body of rules and regulations that
governs people’s behaviour and their
relationships with others in the society and
with the state
Rules made by a society for the purpose of
preserving orders and promoting the safety of
that society
Standard of human conduct established and
enforced by authority of an organized society
through its government
Responsibilities CONT’D
 Law
promote order by resolving conflicts
and disputes non-violently
 Nurses/midwives
must understand the
legal aspect of the profession
 Protect the rights of the client's and
reduce the risk of liability
Responsibilities CONT’D
 When
we practice within the confines of
the law, we are able to
 Shield yourself from liability
 Advocate for clients rights
 Provide care that is within the scope of
practice
 Discern the responsibilities of nursing in
relationship to the responsibilities of other
members of the health team
Responsibilities CONT’D
 Provide
safe competent care that is
consistent with standards of care
Types of law
 Coded
or written- laws formally enacted
or approved by parliament
 Uncoded
or unwritten – un-enacted i.e.
judicial precedents
Categories of Law
2 Main Categories
1. Public laws Constitutional Law-regulate functions of
government and the relationship of
individuals to them
 Criminal
laws- prevent and punish people
who do wrong in the state
Categories CONT’D
2. Private and Civil Laws- rights and duties of
individuals
Bill
Act
Decree
Nurse/Midwife and the Law
-Laws have dual purpose in
nursing/midwifery:
1. To regulate practice
2. To protect client/patient
-All professions are subject to legal control
-Each state has it s own laws pertaining to
nursing called ’’ Nurses Practice Act”
Administration is by NMC in Ghana
Nurse/Midwife and the Law
CONT’D
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The midwives ordinance was established in
1931 which gave way to the formulation of
their board
The nurses ordinance empowered the
formulation of the nurses board of the Gold
coast in 1948
Regulation on education, examination and
registration of nurses
It was merged with the Midwives board on
27th September 1972 to form the NMC
Proclaim under NRC Decree 117
Tort Law
 Is
a wrongful act committed by one part
against another part or property
 Purpose is to make the injured party
whole again usually through monetary
compensation
 Tort is divided into two main parts
 Negligence or unintentional tort
 Intentional tort
Unintentional Tort
 Negligence-
occurs when an
unreasonable or careless act or
ommission of an act causes injury to
another
 Ordinary-failure to exercise the care that
an ordinary prudent party exercises under
similar circumstances- aid fails to clean a
spill and patient falls
Unintentional CONT’D
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Malpractice- specific type of professional
negligence that occurs when the standard of
care that can be reasonably expected from
such professional is not met
Only professionals can be sue for malpractice
Breaching standard of care
The nurse is responsible for her actions-know
the consequences off your actions
Unintentional CONT’D
 Personal
liability-you are responsible for
your own conscious conduct
 Respondent superior-employer may be
responsible for the legal consequences of
the employee’s action within the scope of
his or her employment
 Right to control, direct and superviseemployer
Unintentional CONT’D
 Gross
negligence- if the nurse/midwife is
careless in her duties to the extent that
human life is jorpardized then is viewed as
a crime rather than a tort
Examples of Acts of
Negligence
 Leaving
side rails down-patient fall out
 Burning patient from hot water bottle,
enemas, heating pads, sitz baths
 Giving wrong medication
 Using faulty apparatus
 Misuse of patient personal belongings
 Failure to count sponges accurately
 Patient abandonment in urgent situations
Intentional Torts
Willfully or intentional act or wrong doing that
violates another person’s rights or property;
e.g.
 Assault
 Battery
 False imprisonment
 Trespass
 Defamation
 Infliction of emotional distress
Civil/criminal law
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Assault
 Treat
or an attempt to contact the body
of another person without the privilege of
doing so and without consent
 Treat to use force
 E.g. shaking a stick at a person close
enough to be hit
Battery
 Act
of making an unauthorized contact
 Actual employment of force or merely
touching someone against their will
 No treatment can be done without the
patient’s consent or relative’s
 In rear cases- mentally ill or in
emergencies
 Nurse is responsible for reporting cases of
child abuse
False Imprisonment
 Unwarranted
restriction of the freedom of
another. It includes:
 Unlawful
detention of a patient- for failure
to pay bills
 Misuse
of restraints by hospital personnelneed an order to use restriants
Defamation
 Wrongful
act meaning to injured the
reputation of another person
 Very careful in personal remarks in daily
activities
 If defamation is oral- slander
 Written defamation –libel
 Statement is considered libel or slander
when another person either hears or sees
it
Crime
Any offence perpetuated against the
public interest
Two categories
 Misdemeanors- misbehaviors
 Felony- more serious crimes carrying
penalties ranging from imprisonment to
death
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Nursing/Midwives Activities
that Borders on the Law
Patient Consent- patient or parent (minor) or
significant signs for it
 Its to protect the hospital or physician
 Do not obtain consent after the patient is
medicated or
 If patient is physically or mentally
challenged
 Its your responsibility to let them know the
procedure -witness
Consent CONT’D
 If
the patient refused to sign a consent
form its your responsibility to inform the
surgeon so that unauthorized procedure is
not performed
 In emergency situation the consent may
be obtain from the next of king
 When underage (below 21) the parent
signs the consent
Invasion of Privacy
 Every
patient has the right to privacy
 Do
not make unauthorized disclosures
about the patient
 If
patient is unconscious next of kin should
be consulted to grant permission
Privacy CONT’D
In police and accident cases the only facts that
can be released without patient consent are:
 Name,
 Address,
 Sex,
 Marital Status,
 Approximate age,
 Occupation,
 Employer,
 Name and address of nearest relative
Privacy CONT’D
 The
condition of the patient may be
stated as good, fair, serious, critical or
dead on arrival
 The name of the physician can be
disclosed with permission
 Photographs must not be takenpermission
 No shop talk-gossip
Privacy CONT’D
Certain cases that nurses can give
information
 Communicable disease,
 child abuse,
 criminal abortions,
 gunshot wounds,
 attempted suicide
 drug abuse
Abortion
If you are called to take care of a critically ill
patient with criminal abortion;
 Stay with the patient till legal or medical
aid is obtain
 Give your best and refrain from making
moral judgments
Narcotics and other drugs
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Drug abuse prevention and control actprescription storage, administration of poisons
and dangerous drugs
Poison and dangerous drug act- prescription,
sales, storage and administration of narcoticsopium and cocaine. E.g.
Morphine sulphate,pethidine,barbiturates
Kept in a double lock cupboard( box-in a
box)
Narcotics CONT’D
 Nurse
may give narcotics if supplied by
the institutions
 License to dispense it
 Carefully record on legal records which
indicates patients name, physician, name
of drug, dosage and the time give as well
as the nurses signature
 These records are checked and a
narcotic count done on each shift
Euthanasia(Mercy Killing)
 From
a Greek word- easy death
 Practice of painless putting to death
persons who have incurable, painful or
distressing handicaps or diseases
 Opposed by various religious bodies
 It could be called suicide or murder
Unlawful Death
 Homicide-
to cause the death of another
person unlawfully
 If death is due to negligence- involuntary
manslaughter
 E.g. nurse involved in illegal abortion and
the person dies- will be charge with the
above
Wills
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Legal declaration of a person’s wishes as to the
deposition of his property after death
Patience may ask the nurse/midwife to help in
making a will You have help the patience in securing the
services of a lawyer by referring the patient to a list
of lawyer in your locality
You can serve as a witness
The patient should be of a sound mind too
Not under the influence of drugs or persons
Nurse should record this as a fact in the patient’s
record
Living Wills
 Documents
instructing physicians to
withhold or withdraw life sustaining
procedures when death is imminent
 Prolonging the dying process and nor
promoting health
 Needs two witness neither should be a
doctor or relative
Living Wills CONT’D
 Advance
directives- gives directions to
healthcare providers on client’s desires in
specific critical situations
 Durable power of attorney- health care
surrogate –client appoint someone to
make health care decisions if and when
they are no longer able to make decisions
on their own behalf
Patient’s Chart
 Is
considered a legal document
 Patient is safe guarded through the chart
 It can also protect the doctor,nurse and
hospital in cases of law suits
 Provides a written account of patient
hospitalization- it should be up to date
and accurate to the last minute
 Patients physical condition from admission
to discharge
Chart CONT’D
 All
recorded information must be legible,
complete, spelt correctly and standard
abbreviations used
 Pertinent observations should be
recorded and signed, dated and patients
name must appear on every chart, page
on which notation is being made.
Effective Documentation
 Careful,
complete
and objective
documentation should be done
 Timely and truthful
 Keeps other health care providers p to
date
 Institutions has a duty to maintain nursing
records
 If records are incomplete it can be term
negligent
Documentation CONT’D
 If
errors are made in documentation,
follow the facility’s protocol to correct itdon’t erase
Suit Prone Patient
 Patient
who is usually unhappy, resentful
and dissatisfied with all phases of his life
 Because of his psychological make is
more likely to sue for malpractice when
something goes wrong
Health Care Fraud and Abuse
 Intentional
misrepresentation that one
knows is false and makes anyway,
knowing that the deception could result
in an unauthorised or illegal benefit to self
or others such as monetary gain
 The most common forms of fraud involve
insurance or payment
It includes:
 Receiving ,offering or soliciting kick back
Fraud CONT’D
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Billing for services not rendered
Misrepresenting a patient’s diagnosis to justify
payment
Falsification of documents to justify payments
“Upcoding” -billing for a service not provided
Billing for patients visits not done
Billing for medical unnecessary testing
Inflating bills
Student Nurses/Midwifes
 Practice
nursing and midwifery in
reasonable and safe manner
 Liability of a student is usually shared by
the student, instructor, hospital and
educational institution
 Never accept a procedure you are not
familiar with- ask for supervision
 Questions
 Summary
 Thank
you.