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Chapter 4
Legal and Ethical Aspects of Nursing
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LEGAL ISSUES OF NURSING PRACTICE
• Types of Laws
– Constitutional
– Statutory
– Administrative
– Criminal
– Civil
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Legal Terminology
• Crime
– Deliberate commission of a forbidden act or omission
of an act required by law
• Felony
– Serious crime
– Ex. Practicing without a license*
• Misdemeanor
– Crime that is considered not as serious as a felony
but is still serious and may be cause for revocation of
a nursing license
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Legal Terminology (cont’d)
• Liability
– Legal responsibility for one’s actions or failure to act
appropriately
• Tort
– Injury that occurred because of another person’s
intentional or unintentional actions or failure to act
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Legal Terminology (cont’d)
• **Negligence
– Harm done to a client as a result of neglecting
duties, procedures, or ordinary precautions such as:
• Performing nursing procedures not taught
• Failing to follow standard protocols as defined by
the facilities policy and procedure manuals
• Failing to report defective or malfunctioning
equipment
• Failing to meet established standards of safe care
for clients
• Failing to question a physicians order that seems
incorrect
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Legal Terminology (cont’d)
• Malpractice
– Professional negligence
– Improper, injurious, or faulty treatment of a client
that results in illness or injury
– Harm that results from a licensed persons actions or
lack of actions**
• Assault
– Threat or an attempt to do bodily harm, and includes
physical or verbal intimidation
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Legal Terminology (cont’d)
• *Battery
– Physical contact with another person without that
person’s consent
• *Informed consent
– Tests, treatments, and medications are to be
explained, documented, and signed by client
• *Libel
– Written statement or photograph that is false or
damaging
• *Slander
– Malicious verbal statements that are false or
injurious
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Legal Issues of Nursing Practice
• False imprisonment
• *Abandonment of care
– Implies that a healthcare professional has
prematurely stopped caring for a client
• Invasion of privacy and confidentiality
– Trespassing
– Illegal search and seizure
– Releasing private information
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HIPPA and privacy
• HIPPA
– Privacy regulation
Security Rule
electronic PHI
Release of Information
When giving any information regarding a client,
whether in person or by telephone, be sure you
cannot be overheard by other clients or visitors.
Protect the computer screen so no one can see the
information
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Nurse Practice Act
• The law that defines and regulates the practice of nursing
in the United States is called the Nurse Practice Act.
• These laws define the title of “nursing” and regulate the
many aspects of the field of nursing.
• The law or Nurse Practice Act in each state, province, or
territory defines regulations for practical and registered
nursing.
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Components of a Nurse Practice Act
• Definition of practical and registered nursing
• Nursing functions protected by the law
• Requirements for an approved school of nursing
• Establishment of requirements for licensure
• Process and procedures for becoming licensed
• Procedures for maintaining licensure and continuing
education
• Issue and renewal of nursing licenses
• Suspension, revocation, and reinstatement of license
• Interstate endorsement
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Functions of the State Board of Nursing
• The legislative power to initiate, regulate, and enforce
the provisions of the Nurse Practice Act is delegated to a
specific state agency often known as the State Board of
Nursing.
• Boards are subject to legal parameters, but usually they
have some leeway in interpreting aspects of the Nurse
Practice Act.
• In the recent past, the State Boards of Nursing were
responsible for the creation of the licensing examination.
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Precautions Against Lawsuits
• Follow accepted procedures .
• *Be competent in your practice
• Ask for assistance.
• Document well.
• Do not give legal advice to clients.
• Do not accept gifts.
• Do not help a client prepare a will.
• Consider a malpractice insurance policy.
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The Good Samaritan Act
• *A law called the Good Samaritan Act is in effect in
most states, and protects a person from liability if they
give emergency care within the limits of first aid and if
they act in a “reasonable and prudent manner.”
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Professional Boundaries
• Power versus vulnerability
– Do not exploit the power to access private client
information
• Boundary crossings
– Questionable behavior
• Boundary violations
– Excessive personal disclosures
• Professional sexual misconduct
– Seductive, sexually demeaning, or harassing
behavior
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Advance Directives
• An advance directive is a legal document in which a
person either states choices for medical treatment or
names someone to make treatment choices if he or she
loses decision-making ability.
– Living will
• Written and legally witnessed document that
requests no extraordinary measures be taken to
save a life in the event of terminal illness
– Directive to physicians
• Type of written document used for terminally ill
adults who have no other person to name as their
agent for making healthcare decisions
– Durable power of attorney for healthcare-decision
makers
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Deficient or Harmful Care
• People who are vulnerable to deficient or harmful care
include:
– Children and some adults
– Mentally incompetent or confused persons
– Elderly people
– People living in isolation
• The law protects vulnerable persons from injury, abuse,
or neglect while receiving care in a healthcare facility,
nursing home, school, or their own home.
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Brain Death*
• Cessation of breathing after artificial ventilation is
discontinued
• Cessation of heartbeat without external stimuli
• Unresponsiveness to external stimuli
• Complete absence of cephalic reflexes
• Pupils fixed and dilated
• Irreversible cessation of all functions of the brain
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Biological Death
• Absence of respirations
• Absence of a heartbeat
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Ethical Issues in Treatment
• Organ transplantation
• Criteria and questions
• Refusal of treatment
• Withholding treatment
• Termination of treatment
• Euthanasia
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Rights and Responsibilities of Healthcare
Clients
• Clients’ Rights
– A Patient’s Bill of Rights
– Developed by the American Hospital Association
• Clients’ Responsibilities
– Clients are active participants in formulating their
care plan and making healthcare decisions, and have
a responsibility to participate in and cooperate with
care given.
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Provisions and Goals of the HIPAA
Legislation
• In 1996, the Health Insurance Portability and
Accountability Act (HIPAA), Title II, was passed and
serves as federal privacy regulation.
• The HIPAA, Title II act:
– Regulates who can have access to client information
– Sets standards for storage and transmission of client
information
– Requires that healthcare facilities write policies
allowing clients access to their own personal health
information. (The client has the right to request
correction of any errors.)
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Impact of HIPPA on Nursing Care
• Nursing students or staff nurses will most likely be asked
to sign a HIPAA confidentiality statement each year
which certifies that they are familiar with HIPAA
regulations and will follow their guidelines.
• Violation of HIPAA privacy practices is cause for
termination of employment or of student status in most
facilities.
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