Transcript Legal Foundations of Professional Nursing

Professional Nursing Practice
Concepts and Perspectives
Seventh Edition
Chapter 5
Legal Foundations of
Professional Nursing
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Learning Objectives
5.1 Identify primary sources of law and types of legal actions.
5.2 Describe the nurse practice act as the legal boundary of nursing.
5.3 Discuss essential legal aspects of malpractice, informed consent, adverse
event reports, DNR orders, euthanasia, and death-related issues.
5.4 Examine the nurse’s role in identifying and assisting the impaired nurse.
5.5 Examine the problem of sexual harassment in nursing.
5.6 Consider how the collective bargaining process is used to improve nursing
practice.
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Hallmark Features
• A focus on foundational knowledge related to
professional nursing
– Includes nursing history, nursing theory, ethics, and
legal aspects, etc.
• An overview of professional nursing roles, issues,
and changes in the profession
– Discusses nurses as healthcare providers, learners
and teachers, and leaders
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Challenges and Opportunities
• Scientific development and new technological
advances led to development of advance
healthcare directives
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Critical care units
Surgical techniques
Development of medications
Life support
Gene manipulation
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Challenges and Opportunities
• Changes in the healthcare system
– Providing new roles for nursing
– Nurses act as client advocates
• Advanced practice nurse (APN), clinical specialist,
and clinical nurse leader (CNL)
– Expanded roles
– Added responsibilities and legal issues
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Learning Objective 5.1
Identify primary sources of law and types of legal
actions.
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The Legal System
• Four primary sources of law
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Constitutions
Statutes
Administrative laws
Decisions of court (common law)
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Constitutions
• Establish general organization of federal
government
– Executive
– Legislative
– Judicial
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Statutory Law
• Laws enacted by any legislative body
– Federal law supersedes state or provincial laws
– Patient Self-Determination Act of 1990
 Enables clients to participate in decisions about their care
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Administrative Law
• Enacted by specific governing bodies with
expertise in a given area
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Judicial or Decisional Law
• Body of principles that evolves from court
decisions
• Continually adapted and expanded
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Types of Legal Actions
• Civil (private)
– Between individuals
• Criminal
– Disputes between an individual and society
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Learning Objective 5.2
Describe the nurse practice act as the legal
boundary of nursing.
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Safeguarding the Public
• Permissive laws, first laws applicable to nursing in
the United States
– No restrictions on nursing practice
• By 1923 all states had nurse registration laws
• State board of nursing is the governing authority
responsible for regulating nursing practice within
the state
• National Council of State Boards of Nursing
(NCSBN) comprises all state boards of nursing
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Nurse Practice Acts
• ANA published guide for states in developing and
revising their nurse practice acts
• State boards of nursing and state nurses’
associations collaborate on nurse practice acts
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Nurse Practice Acts
• Nurse practice acts include
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Definitions
Authority of board of nursing
Educational program standards
Standards and scope of nursing practice
Types of titles and licenses
Protections of titles
Grounds for disciplinary action
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Credentialing
• Process of determining and maintaining
competence
• Includes
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Licensure
Registration
Certification
Accreditation
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Credentialing
• Licensure
– Process by which state government agency grants
permission to an individual to engage in a given
profession who has proven competency
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Credentialing
• Licenses may be revoked for just cause
– Nurse may appeal decision
• One state licensure versus practices across state
lines
– Nurse Licensure Compact Model Legislation
• Advanced practice
– Many states require different licenses
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Credentialing
• Registration
– Listing an individual’s name and other information on
an official roster
• Certification
– Validation that a nurse has met minimum standards of
competence
• Accreditation
– Accredited status given by an organization to
institutions, programs, or services that meet
predetermined standards and criteria
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Credentialing
• Standards of care
– Used to evaluate quality of care
– Developed from ANA standards of nursing practice
• The Joint Commission developed accreditation
standards for hospitals and healthcare
organizations
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Learning Objective 5.3
Discuss essential legal aspects of malpractice,
informed consent, adverse event reports, DNR
orders, euthanasia, and death-related issues.
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Negligence and Malpractice
• Negligence
– Conduct lacking in due care
– Failure to perform duty, which causes injury
• Malpractice
– Professional negligence
– Harm caused by wrongful or unskillful act or omission
• May be intentional or unintentional
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Negligence and Malpractice
• Elements of proof for nursing malpractice
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Duty of nurse to provide care to client
Nurse failed to carry out duty
Foreseeability of an injury
Client was injured
Causal relationship between client’s injury and nurse’s
breach of duty
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Negligence and Malpractice
• Nursing negligent actions may occur with
– Medication errors
– Client falls
– Operating room errors
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Documentation
• Medical record is legal source of information about
client
• Credible document must be
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Contemporaneous
Accurate
Truthful
Appropriate
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Delegation
• Process of a nurse to direct another person to
perform nursing task
• Nurse is accountable and responsible for the care
given to her or his clients
• Decision Tree for Delegation
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Delegation
• AACN five factors affecting delegation
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Potential for harm
Complexity of task
Predictability of outcome
Adequate supervision available
Level of interaction with client required
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Restraints
• Protective devices used to limit activity of client
– Chemical
– Physical
• Should only be used when less restrictive
interventions have been determined ineffective
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Informed Consent
• An agreement in which client accepts
treatment/procedure
• Nurse’s role
– Witness exchange between client and physician
– Establish that client understands
– Witness client signature
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Informed Consent
• Three major elements of informed consent
– Voluntarily given
– Client must be competent and capable of
understanding
– Client receives adequate information to be informed
decision maker
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Informed Consent
• Three groups who cannot provide consent
– Minors
– Unconscious or injured
– Mentally ill who have been judged as incompetent
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Advance Healthcare Directives
• Advance directive
– Statement client makes specifying his or her wishes
regarding healthcare decisions
• Advance healthcare directive types
– Living will
– Natural death acts
– Durable power of attorney for health care/medical
durable power of attorney
– Medical or physician directive
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Advance Healthcare Directives
• ANA recommended questions to ask on admission
– Does the client have basic information about advance
healthcare directives?
– Does the client wish to initiate an advance healthcare
directive?
– Did the client bring one that was prepared in advance?
– Has the client discussed end-of-life choices?
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Do-Not-Resuscitate Orders
• Do-not-resuscitate (DNR) orders or “no-code”
– Require that no effort be made to resuscitate client in
event of a respiratory or cardiac arrest
• Physicians may order for clients in a stage of
terminal, irreversible illness or expected death
• Must be documented in client’s medical record
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Adverse Events and Risk Management
• Adverse event, unusual occurrence, or incident
report
– Agency record, required by The Joint Commission
– Must be completed as soon as possible, once client
has been assessed and necessary interventions have
been taken to prevent injury
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Adverse Events and Risk Management
• Risk-management department
– Reviews all adverse event reports
– Identifies hazards
– Determines need for further investigation
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Death and Related Issues
• Legal issues surrounding death
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Death certificate
Labeling of deceased
Autopsy
Organ donation
Inquest into the cause or manner of a death
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Death and Related Issues
• Will
– A declaration by a person about how the person’s
property is to be disposed after death
• A valid will must
– Be made by a person of sound mind
– Not be unduly influenced by anyone else
• Nurse may act as witness
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Death and Related Issues
• Euthanasia
– Deliberate ending of a person’s life for medical
reasons
– The act of painlessly putting to death persons
suffering
• Legally wrong in Canada and most of the United
States
• Voluntary euthanasia/assisted suicide
– Dying individual desires control over time and manner
of death
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Learning Objective 5.4
Examine the nurse’s role in identifying and
assisting the impaired nurse.
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The Impaired Nurse
• One whose practice is negatively affected
because of substance abuse
• Three victims of the impaired nurse
– Client
– Colleagues
– Impaired nurse
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The Impaired Nurse
• Actions to take when a nurse suspects an
impaired colleague
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Do not let her or him care for clients
Report unsafe practices
Document suspicious behaviors or incidents
Confront individual with supervisor and witnesses
Respect nurse’s right to confidentiality and privacy
Avoid being judgmental
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Learning Objective 5.5
Examine the problem of sexual harassment in
nursing.
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Sexual Harassment
• Unwelcome sexual advances, requests for sexual
favors and other verbal or physical conduct of a
sexual nature in the following circumstances
– As a condition of employment
– As the basis for employment decisions
– At a workplace where work is interfered with or creates
an intimidating, hostile, or offensive working
environment
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Nurses as Witnesses
• Nurses may be called to testify in legal action
– Act as a defendant in a malpractice or negligence
action
– Provide testimony about care provided to the plaintiff
– Provide testimony as an expert witness
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Learning Objective 5.6
Consider how the collective bargaining process
is used to improve nursing practice.
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Collective Bargaining
• Formalized decision-making process between
management and labor to negotiate
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Wages
Conditions of employment
Work hours
Work environment
Fringe benefits of employment
• Written contract
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Collective Bargaining
• Controversial among nurses
– Necessary to obtain control of nursing practice and
economic security
– Moral dilemma in the event of a strike
• Process includes
– Recognition of a certified bargaining agent
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Collective Bargaining
• Collective bargaining agents
– Union
– Trade association
– Professional organization
 United American Nurses
 National Nurses United
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Collective Bargaining
• Strike
– Organized work stoppage by group of employees
• Grievances
– Any dispute, difference, controversy, or disagreement
arising out of the terms and conditions of employment
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