Transcript Chapter 23 Legal Implications in Nursing Practice

Chapter 23
Legal Implications in Nursing Practice
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
Legal Limits of Nursing

Sources of law:
◦ Statutory law (Nurse Practice Act)
 Criminal law (felonies or misdemeanors)
 Civil law
◦ Regulatory law (administrative law)
 EX: State Board of Nurses
◦ Common law (judicial decisions)
 Ex: informed consent, patient’s right to
refuse treatment…
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
2
Legal Limits of Nursing (Cont.)

Standards of care
◦ Legal guidelines for defining nursing
practice and identifying the minimum
acceptable nursing care
◦ Best known comes from the American
Nurses Association (ANA)
◦ Set by state and federal laws that
govern where nurses work
◦ Joint Commission requires policies and
procedures (P&Ps).
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
3
Case Study
Lynette Donovan, a 15-year-old female
African-American, was a passenger in a motor
vehicle collision and is now admitted to the
hospital with a fractured right femur. The
emergency department health care provider
applied a cast to the affected leg with
insufficient padding.
 Lynnette told the nurses that her right leg felt
numb, was swollen, and looked discolored.
 The nurses recognized that these symptoms
indicate impaired circulation in the extremity
with the cast.

Copyright © 2017, Elsevier Inc. All Rights
Reserved.
4
Case Study (Cont.)
The nurse has been unable to reach
Lynette’s health care provider despite
several calls. The nurse has not notified
the nursing supervisor of the patient’s
situation.
 David Ortiz is a 23-year-old nursing
student newly assigned to the nursing
division and to Miss Donovan. His initial
assessment notes that the patient’s right
leg is swollen, slightly blue, and slightly
malodorous. Lynette seems very anxious
and upset.

Copyright © 2017, Elsevier Inc. All Rights
Reserved.
5
Federal Statutory Issues
in Nursing Practice

Patient Protection and Affordable
Care Act (PPACA)
◦
◦
◦
◦
Consumer rights and protections
Affordable health care coverage
Increased access to care
Stronger Medicare to improve care for
those most vulnerable in our society
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
6
Federal Statutory Issues
in Nursing Practice (Cont.)

Americans with Disabilities Act (ADA)
◦ Protects rights of people with physical or
mental disabilities

Emergency Medical Treatment and
Active Labor Act
◦ When a patient presents to an
emergency department, they must be
treated

Mental Health Parity Act as Enacted
Under PPACA
◦ Strengthens mental health services
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
7
Federal Statutory Issues
in Nursing Practice (Cont.)

Advance directives
◦ Living wills
◦ Health care proxies or durable power
of attorney for health care
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
8
Federal Statutory Issues
in Nursing Practice (Cont.)
Uniform Anatomical Gift Act
 Health Insurance Portability and
Accountability Act (HIPAA)
 Health Information Technology Act
(HITECH)
 Restraints

Copyright © 2017, Elsevier Inc. All Rights
Reserved.
9
State Statutory Issues in
Nursing Practice
Licensure
Good Samaritan Laws
Public Health Laws
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
10
State Statutory Issues in
Nursing Practice (Cont.)
The Uniform Determination of Death
Act
Autopsy
Death with Dignity or
Physician-Assisted Suicide
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
11
Quick Quiz!
1. A nurse is caring for a patient who
states, “I just want to die.” For the
nurse to comply with this request,
the nurse should discuss:
A. living wills.
B. assisted suicide.
C. passive euthanasia.
D. advance directives.
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
12
Civil and Common Law Issues
in Nursing Practice
Torts
 Intentional

◦ Assault
◦ Battery
◦ False imprisonment
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
13
Civil and Common Law Issues
in Nursing Practice (Cont.)

Quasi-intentional torts
◦ Invasion of privacy
◦ Defamation of character
 Slander
 Libel

Unintentional torts
◦ Negligence
◦ Malpractice
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
14
Consent

Consent form
◦ Must be signed

Informed consent
◦ Agreement to allow care based on full
disclosure of risks, benefits, alternatives,
and consequences of refusal
◦ The nurse’s signature as a witness to the
consent means that the patient
voluntarily gave consent, the patient’s
signature is authentic, and the patient
appears to be competent to give
consent
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
15
Case Study (Cont.)
David remembers that Lynette
Donovan is legally a minor. She is
hurt and afraid and in an
unfamiliar setting.
 She may not be comfortable
speaking with the health care
providers who are present, and her
expressions of pain may be
modified by the circumstances she
is in.

Copyright © 2017, Elsevier Inc. All Rights
Reserved.
16
Termination of Pregnancy
or Abortion Issues

1973 Roe v. Wade
◦ U.S. Supreme Court ruled that there is
a fundamental right to privacy, which
includes a woman’s right to have an
abortion.

1989 Webster v. Reproductive
Health Services
◦ Some states require viability tests if the
fetus is more than 28 weeks’
gestational age.
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
17
Nursing Students
You are liable if your actions cause
harm to patients, as is your
instructor, hospital, and
college/university.
 You are expected to perform as a
professional when rendering care.
 You must separate your student
nurse role from your work as a
certified nursing assistant (CNA).

Copyright © 2017, Elsevier Inc. All Rights
Reserved.
18
Malpractice Insurance
A contract between the nurse and
the insurance company
 Provides a defense when a nurse is
in a lawsuit involving negligence or
malpractice
 Nurses covered by institution’s
insurance while working

Copyright © 2017, Elsevier Inc. All Rights
Reserved.
19
Quick Quiz!
2. A student nurse employed as a
nursing assistant may perform
care:
A. as learned in school.
B. expected of a nurse at that level.
C. C. identified in the hospital’s job
description.
D. requiring technical rather than
professional skills.
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
20
Abandonment and
Assignment Issues

Short staffing
◦ Legal problems occur if an inadequate
number of nurses will provide care.

Floating
◦ Based on census load and patient
acuities.

Health care providers’ orders
◦ Nurses follow orders unless they believe
an order is given in error or is harmful.
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
21
Case Study (Cont.)


Lynette Donovan developed
gangrene in the right leg. She
requires a right below-the-knee
amputation.
David Ortiz is returning from escorting
Miss Donovan to the operating room
for her procedure. He gets on the
elevator, where several visitors and
two nursing supervisors are talking
about the health care provider who
“made Donovan lose her leg.”
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
22
Quick Quiz!
3. A nurse is about to administer an
oral medication and question the
dosage. What should the nurse
do?
A. Administer the medication.
B. Notify the physician.
C. Withhold the medication.
D. Document that the dosage
appears incorrect.
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
23
Risk Management and
Quality Assurance
A system of ensuring appropriate
nursing care that attempts to
identify potential hazards and
eliminate them before harm
occurs
 Steps involved:

◦
◦
◦
◦
Identify possible risks
Analyze risks
Act to reduce risks
Evaluate steps taken
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
24
Risk Management and Quality
Assurance (Cont.)


One tool used in risk management is
the incident report or occurrence
report
Occurrence reporting
◦ Serves as a database for further
investigation
◦ Alerts risk management to a potential
claim situation



Documentation
TJC’s Universal Protocols
Professional involvement
Copyright © 2017, Elsevier Inc. All Rights
Reserved.
25
Question
The nursing assistant reports a
client’s blood pressure of 220/110
to the RN. What should the RN do?
A. Call the primary care provider.
B. Write an order for a blood
pressure medication.
C. Recheck the client’s blood
pressure.
D. Document the reported blood
pressure.
Answer
Rational: The nurse is ultimately
responsible
for the client – Cover your assets
A - It would be necessary to call the
primary care provider – after verifying
the BP
B - It is beyond the nurse’s scope of
practice write orders for medications
without a doctors' order
D - The nurse should document care that is
provided by self – not unverified results by
others
Group Activity





Distinguish between living will and health care
proxies
Define and provide an example of the
followings: intentional tort, quasi-intentional
tort, unintentional tort, assault, battery, false
imprisonment, defamation of character,
slander, libel, negligence, and malpractice
The nursing student’s role as an ADN student.
Explain how to handle staffing issues, floating,
and health care provider’s orders
The nurse’s role for obtaining consents