Legal and Ethical Concepts
Nancy Pares RN, MSN
Metro Community College


Laws define and limit relationships
Sources of public law
◦ Constitutional
◦ Administrative
◦ Criminal
 Felony vs misdemeanor

Civil Law
◦ Contract
 Involves compensation, mutual understanding
 Implied contract
 Employer policies, fulfill terms, respect others
◦ Tort
 Wrongful act against another
◦ Protective/reporting
 HIPPA
 Good Samaritan

Adequate assistance

Reasonable conduct from clients

Compensation

Reasonable treatment by co workers

State
◦ Unintentional torts
 Negligence




Duty
Breach of Duty
Injury
Causation
 Malpractice
 Assault
 Battery
 False imprisonment
 Restraints (OBRA)
 Invasion of privacy
 Right to be left alone; consent for no treatment
 Defamation
 fraud

Intent is lacking, but a willfull action is
evident
◦ Defamation of character
◦ Invasion of privacy
◦ Breech of confidentiality



Defined by Practice Acts and Standards of
Care
RN is legally responsible to ensure that the
client receives competent, safe and holistic
care.
Best Defense
◦
◦
◦
◦
Actively participate in NNA
Attend continuing ed on legal issues
Call State Board with any questions about practice
Stay current in hospital policies and procedures

Unprofessional conduct
◦ Delegation, HIPPA, lack of knowledge; abuse, false
documentation, leaving assignment

Impaired Nurse
◦ Duty to report

Safety
◦ Understaffing
◦ Mandatory overtime
◦ Reassignment

Executing prescribed orders

Whistle blowing

Nursing students

Professional liability insurance

Advance Directives







DNR orders
Euthanasia
Wills
Pronouncement of Death
Care of the deceased
Organ donation
autopsies

Ethics
◦ Study of rightness of conduct
◦ Vs. morality?

Relationship between ethics and legal
◦ Ethical opinions reflect individual differences
◦ Human behavior and motivation are too complex to
be accurately reflected in law
◦ The legal system judges action rather than intention
◦ Laws change according to social and political
influences




Working in a clinic that performs abortions
Honoring a terminally ill client request for no
heroic actions
d/c a comotose client life support at the
request of the family
Diverting meds from a client for your own use










Autonomy
Beneficience
Confidentiality
Double effect
Fidelity
Justice
Nonmaleficence
Paternalism
Sanctity of life
veracity

M ….. Massage the dilemma

O…outline options

R…resolve

A…act by applying options

L…look back and evaluate






Maximize client well being
Balance client needs with family
responsibilities
Support family and enhance support system
Carry out hospital policies
Protect other client well being
Protect nursing standards

Is the action good or neutral?

Is the intent good?

Good effect cannot be achieved by bad action

Balance of good/bad


Human caring should guide the practice
Confidentiality
◦ Privacy, misuse of information




Restraints
Trust
Refusing to provide care
Food and fluid

Nancy Cruzan

Terri Shiavo







Practice with compassion and respect
Nurses primary commitment is to the patient
Nurse advocates, protects the patient
Nurse is responsible and accountable for
actions
Nurse must maintain competence and
professional growth
Nurse participates in improving health
Nurse contributes to profession thru
community, educational and social situations




Dx: missed abortion—client hospitalized, D&C
was scheduled—client discussed with MD
Nurse administered preop meds then noted that
there was no consent signed. Surgery was
postponed awaiting MD. MD arrived and had pt
sign and husband also-witnessed by RN.
Procedure resulted in perforation, OB attempted
to repair—called in general surgeon-- required
removal of 1 ft of bowel
Result: likely to have higher incidence of SBO

Was the hospital liable to obtain informed
consent?




1985- Nurse Midwife advertised ‘Family Birth’
Hospital Chief of Staff – OB wrote a letter to
the administration of two hospitals stating
that home deliveries were being done without
qualified supervision.
Same MD confronted nurse midwife at L&D
Nurse midwife was prohibited from the
hospital.

Was the slander actionable?



Client with fx leg—cast applied; orders to
have nursing check hourly and call with
concerns
Charting notes gap from 4am to 830 am.
MD examines at 830—compartment
syndrome and identification of tissue death—
leg amputated

Was documentation considered substandard
and cause for patient to suffer injury?


Female patient admitted to LTC—noted large
diamond ring and informed that she should
not keep in her room. Pt kept the ring.
Ring disappeared—investigation proved
fruitless—thru a ‘tip’ a nurse aid was
implecated—arrested and pled guilty

Was the nursing home responsible for the
property damage sustained by the resident?
Male was admitted to psych unit on Nov 21due
to being a threat to himself and others.
Meeting held on Nov 23 determined that he
was able to be released. (Thanksgiving
holiday)
Male entered house on Dec 5 and killed one
individual and wounded two others, then shot
himself.

Was the institution liable for discharging the
patient and the subsequent deaths?

What are they?

What about gossip amongst peers?

What about behaviors of student nurses?


How do we apply these standards in the
classroom?
What should be done if




student cheats?
Lies to instructor?
Copies from other’s work
Instructor or student ‘bullies’