Transcript Legal considerations for nursing practice

Legal considerations
for nursing practice
Legal limits for nursing
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Nurse practice acts: describe and define the legal
boundaries of nursing practice within each state
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Vary from state to state, especially for advanced
practice nurses (family nurse practitioners, clinical
nurse specialists)
Standards of care: legal guidelines for nursing practice
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Defined by nurse practice acts, ANA, and state boards
of nursing
Standards of care
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In a malpractice lawsuit, nursing conduct/care is
compared to the nursing standards of care for that state
Court looks to see if the nurse acted as any reasonably
prudent nurse would act under the same or similar
circumstances
Breach of nursing standards: if care did not meet set
standards of care, must be proven in negligence or
malpractice lawsuits
Negligence & Malpractice
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Nursing care that falls below defined standards of care
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Malpractice: professional negligence
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Nursing malpractice: when nursing care falls below
defined standards of care
Malpractice
The following must be established in order for nurses to be
found guilty of malpractice:
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The nurse was responsible for caring for the patient
The nurse did not carry out that care
The patient was injured as a result
The patient’s injury was due to the nurse’s failure to
provide adequate care
Negligence
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Nurses may be held liable for negligence if their care
does not meet the standards of nursing care for that
state
Avoiding negligence:
 Carefully follow standards of care and providing
competent care
 Communicate with other healthcare professionals
 Develop caring relationships with patients and
families
 Carefully document assessments, care, and patient
outcomes
Avoiding negligence
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Stay aware of current nursing literature in areas of
clinical practice or specialty
Know and follow clinical policies and guidelines for
facilities
Be aware of common causes of patient injury and work
to prevent such
Communicate with patients and their families so that
they are aware of nursing care provided
Communicate patient changes to physicians promptly
and document carefully
Consent
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A signed consent form is required for procedures and
care
State laws designate who is legally able to give consent
for care
Caution must be taken with patients who are:
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Hard of hearing
Unable to speak English
Under 18 years of age
Sedated
Mentally ill
Informed consent
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Patient’s agreement to procedure or care after being
informed of risks, benefits, alternatives, and
consequences
Health care providers must present information so that
patient can understand it, in order to make an informed
choice
If no informed consent, patient may charge negligence
or battery
Nurses & informed consent
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In most cases, is not the nurses’ responsibility to obtain
consent
Nurses are often asked to witness patient signature on
consent form
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Means that patient voluntarily gave consent,
signature is authentic, and patient appears competent
to give consent
Student nurses
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Are liable if they cause harm to patients
 Do not do skills that you have not been taught!
Make sure that you are carefully supervised when you
perform procedures with patients
 Medication administration
 IV starts, catheterization, suctioning, etc
Prior to giving medications:
 Make sure that you check patient ID band FIRST!
 Look up each medication so that you know what you
are giving!
 Check for patient allergies FIRST!
Short staffing
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Legal problems may occur if there is insufficient staff to
provide patient care
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Staffing problems should be brought to the attention of
the nursing supervisor
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Written protests may be made to facility administration
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Nurses must not walk out or refuse assignment due to
short staffing
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May be considered insubordination and result in
disciplinary action
Will make patient care staffing problem even worse
Physician’s orders
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Sometimes physicians may give orders over the phone,
especially late at night.
Only RNs can take orders over the phone
 They cannot be taken by LPNs, nursing assistants,
unit secretaries, or other staff members.
 They may not be left in voice mail
Best bet- don’t let doctors give you verbal orders (unless
it is an emergency!)
 Hand the chart to the doctor and ask him to write the
order instead
Physician’s orders
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Nurses are obligated to follow physicians’ orders for
patient care
If a nurse believes that an order is wrong or may harm a
patient, the nurse must notify the physician to clarify the
order
If the physician insists, the nurse should notify the
nursing supervisor to address the problem
A nurse should not follow a doctor’s order that may
result in harm to the patient- may be legally responsible
for any harm suffered by the patient
Myths about student nurses
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MYTH: Nursing students don’t have to worry about
making mistakes with patients because they are working
under the RN’s license.
REALITY: If a client is harmed as a direct result of a
nursing student’s actions or lack of action, the liability for
the incorrect action is generally shared by the student,
instructor, hospital or health care facility, and the
university or educational institution. Student nurses may
be named in malpractice lawsuits!
Myths about student nurses
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MYTH: Nursing students are only glorified nursing
assistants.
REALITY: While in clinical, student nurses are expected
to perform as professional nurses (as an RN would in
providing safe client care). Nursing students are not
working in the same capacity as nursing assistants and
therefore are expected to provide a higher level of care
than nursing assistants.
Myths about student nurses
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MYTH: Nursing students don’t have to hear report about
their patients because all the decisions about care are
made by the RN
REALITY: Staff nurses may serve as preceptors, but that
does not excuse the student from performing at the level
of a RN. That includes planning care, implementing
interventions, and evaluating outcomes.
Myths about student nurses
MYTH: Nursing students will never be asked to perform
skills that they don’t know how to do.
REALITY: Nurse preceptors are not always aware of which
skills have been learned by the nursing students.
Students may be asked to perform skills that they have
not been taught yet.
When in clinical:
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If you are asked to perform a skill which you have not
been taught yet or which you do not feel comfortable
doing, let your instructor and the RN know!
They may:
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Perform the procedure and allow you to observe
Review the procedure with you and allow you to
assist
When in clinical:
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Do not perform a skill that you have not been taught or
you do not feel comfortable doing
Use your clinical instructor as a resource- if you are
unsure of something, ASK!
LOOK BEFORE YOU LEAP!
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Do not make rash decisions in clinical- take you time
and make decisions carefully.
Here are some other
suggestions for when you
are in clinical…
When in clinical:
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MAKE SURE THAT YOU HAVE THE RIGHT
PATIENT!!!
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Check the ID band BEFORE you do anything
with a patient!
Look up every medication before you give it!
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You need to know the drugs you are giving, in order
to make sure that is appropriate for the patient and
watch for side effects
Your clinical instructor WILL expect this!
When in clinical:
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The facility may require your instructor to sign your
medication sheets.
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Make sure this is done before you leave clinical for
the day
Sign your name with your first initial, last name, and
credentials (OUSN)
Document only in black ink!
When in clinical:
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Be on time, ready to go! Nurses are busy getting report
and don’t have time to deal with nursing students who
show up late.
Treat the nursing staff (RNs and nursing assistants) with
respect and thank them for their assistance.
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Nursing assistants are a huge help to nursing
students- they know where stuff is!
Stay on their good side!
When in clinical:
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Work with your classmates!
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Nursing school and clinicals are hard enough without
having to go it totally alone
If your patient is sleeping, see if one of your
classmates needs a hand with something
If you get to do something really cool or your patient
has an unusual wound or heart murmur, share it with
your classmates so that they can learn about it too!