NRS 101
About Legal Issues
 Rights, responsibilities, scope of nursing practice
 As defined by state nursing practice acts
 Sources of laws
 Sum total of rules and regulations by which a society is
governed
 Law made at federal, state, and local levels
Figure 47-1 Overview of the sources of law.
About Legal Issues, continued
 Criminal and civil laws
 Address conduct harmful to another individual or
society
 May be punishable by fines or imprisonment
 Crime
 Act prohibited by statute, common law principles
 Civil law
 Deals with rights and duties of private persons
Tort Law
 Tort  civil wrong committed against a person or
person’s property
 Unintentional torts
 Negligence
 Professional negligence
 Malpractice
Professional Negligence or
Malpractice
 Five elements:
 Duty
 Breach of duty
 Forseeability
 Causation
 Injury or harm
Professional Negligence or
Malpractice, continued
 Related doctrines:
 Respondeat superior
 Res ipsa loquitur
 Statute of limitations
Intentional Torts
 Assault
 Battery
 False imprisonment
 Invasion of privacy
Strategies
to
Prevent
Incidents
 Maintain client safety
 Falls
 Mistaken identity
 Minimize risk of medication errors
 Apply the Five Rights
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Right drug
Right dose
Right client
Right route
Right time
Strategies to Prevent Incidents,
continued
 Use effective communication
 Helps decrease risk of bad outcomes
 Attentive listening
 Accurate documentation and reporting
 Professional liability insurance
 Nurses should carry to manage personal financial risk
Standards of Care
 Based on
 Nurse Practice Act (NPA)
 Administrative rules
 Job descriptions
 Policies and procedures
 ANA
Selected Laws
 Informed consent
 Client’s legal and ethical rights to be informed of, give
permission for procedure, treatment
 Client must not be coerced
 Client understanding essential
 Follow agency’s specific protocols
 Competency for consent
 Consent in an emergency
 Child participation in decision
Selected Laws, continued
 Controlled Substance Act
 Federal law
 Good Samaritan laws
 Encourage health care providers to help victims in an
emergency
 Protects health care workers from potential liability
 Nurse responsible for following through with emergency
care
Nurse Practice Acts
 Nurse Practice Acts (NPAs)
 Defines:
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Scope of practice
Standards for education programs
Licensure requirements
Grounds for disciplinary actions
 Enforced by state boards of nursing (BON)
Figure 47-3 Relationship among the Nursing Practice Act, Administrative Rules, and position/advisory statements.
Licensure
 Allows nurses legal privilege to practice nursing as
defined by NPA
 Each BON oversees administration of a licensure
examination
 National Council of State Boards of Nursing
 NCLEX-RN®
 NCLEX-PN ®
BONs
 Responsibilities
 Actions against nurses found guilty
 Giving false information
 Nolo contendere
 Conduct that endangers public health
 Unfit or incompetent to practice
 Engaging in conduct that deceives, defrauds, or harms
the public
 2009 NCSBN report www.NCSBN.org.
National Council of State
Boards of Nursing
 Membership
 Functions
 Nurse Licensure Compact
 Mutual recognition model
NPAs
 Certification
 Federal organizations
 Joint Commission
 Centers for Medicare and Medicaid Services
 Nursing students
 Standards of Practice
Standards of Nursing Practice
 ANA Standards of Nursing Practice
 Standards are authoritative statements by which the
nursing profession describes the responsibilities for which
its practitioners are accountable. Standards reflect the
values and priorities of the profession and provide
direction for professional nursing practice and a framework
for the evaluation of this practice. They also define the
nursing profession’s accountability to the public and the
outcomes for which registered nurses are responsible.

http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingStan
dards.aspx
ANA
Standards of Professional Performance
 Quality of practice
 Professional Practice Evaluation
 Education
 Collegiality
 Ethics
 Collaboration
 Research
 Resource Utilization
 Leadership
Professional Nursing Practice
 Nurse Practice Acts
 Licensure and Certification
 Science and Art of Nursing practice
Figure 47-4 Impact of laws and standards on the nurse.
Advance Directives
 Legal document
 Expresses an individual’s desires regarding medical
treatment
 Patient Self-Determination Act
 Types of advance directives
 Living will
 Durable power of attorney for health care
Elements of Advance
Directives
 Surrogate decision maker authority to:
 Consent to or refuse medical treatment or diagnostic
procedure
 Hire or discharge medical providers
 Authorize admission to medical and long-term care
facilities
 Have access to all medical records
 Consent to comfort care, pain relief measures
 Any measures to carry out wishes
Role of Nurse
 Reassure clients and families that they have option to
change their decision
 Assess whether clients, families have accurate
understanding of life-sustaining measures
 Be supportive of clients’ decisions
Health Information and Portability and
Accountability Act
 HIPAA
 Purposes
 Minimizes exclusion of preexisting conditions
 Designates special rights for those who lose other health
coverage
 Eliminates medical underwriting in group plans
 Includes Privacy Rule
Protected Health Information
 Protected by Privacy Rule:
 Individually identifiable health information
 Information that identifies individual
 Access to medical records
 Required notice of privacy practices and opportunity for
confidential communications
 Limits on use of medical information
 Prohibition of use of personal information for
marketing
Privacy vs. Confidentiality
 Privacy  right of individuals to keep their personal
information from being disclosed
 Confidentiality  the assurance client has that private
information will not be disclosed without client’s
consent