The Nurse & The Law

Legal Implications in Nursing

Practice

Society expects safe health care

delivery

Nurses should not fear the law

Nurses should practice using

judgment skill that are the outcome
of informed critical thinking

Nursing Practice

Nursing practice includes

understanding:

the law
the legal boundaries
the implications of the law

Nurse Practice Act

Describes

and defines the

legal boundaries of nursing
practice within each state.

Nurse Practice Act

Violations

Stealing

Use controlled substances

License by fraud

Conviction of a felony

LIABILITY

legal

responsibility for the

outcome of an action.

Liability
Nurse

Charged in Death of
Patient

Sources of Law
Regulatory
Common
Statutory
Criminal
Civil

/administrative

Regulatory / Administrative Law

Reflects decisions made by an
administrative body such as the
state board of nursing
e.g. the duty to report
incompetent or unethical nursing
conduct

Common Law
Results from decisions made by a
court when individual legal cases
are decided
e.g. informed consent and the
patients
right to refuse
treatment

Criminal Law
Prevents harm to society and
provides punishment for crimes
Two classification of crimes:
Felony

A crime of a serous nature that has a penalty

of imprisonment greater than one year or
death

Misdemeanor

A less serous crime of imprisonment of less

than one year or a fine

Civil Laws
Protects the rights of individual
persons within our society and
encourage fair and equitable
treatment among people
e.g. causing harm to an individual or
property. Punishment involves
payment of money.

Standard of Care
Legal guidelines for nursing practice
and provides the minimum
acceptable nursing care.
Developed by the American Nurses
Association (ANA) and set out in the
Nurse Practice Act of each state

Standard of Care

All nurses are responsible for knowing

the provisions of the Nurse Practice
Act of the state in which they work
In law suit a nurses action would be
compared to the standard of care to
determine what a prudent nurse
would do under same or similar
circumstances.

Standard of Care

The Joint Commission (TJC)

Require that accredited hospitals have

written nursing policies and procedures
to guide nursing practice

The internal standards of care must be

specific and accessible on all nursing
units

Standard of Care

In a lawsuit for malpractice a nursing

expert testifies to the jury about the
standards of care as applied to the
facts of the case

A breach of the nursing standard of

care is one element that must be
proven in the tort of nursing
negligence or malpractice

Nursing & the Legal Process

Plaintif

Defendant

Factual witness

Expert witness

Federal Statutory Issues in

Nursing Practice

Americans Disabilities Act

Emergency Medical Treatment and
Active Labor Act
Mental Health Parity Act
Advance Directives
Living Wills

Federal Statutory Issues in

Nursing Practice

Durable Power of Attorney for Health care

Uniform Anatomical Gift Act

Health Insurance Portability and

Accountability Act

Restraints

State Statutory Issues in

Nursing Practice

Defines nursing
standards of
practice/care.
Enforces Nurse
Practice Act.
Licensure.
Disciplines
accordingly.

Licensure

N-Clex RN
Examination
license
grants nurses
the right to
provide
service, care
for others

Licensure

process by which
a governing
agency
grants a person
the right to
provide
certain defined
services.
Identifies
minimum safe
practice.

Nurse Practice Act

1. Defines scope
of
nursing practice
2. Educational
requirements
3. Separate
practice

State Statutory Issues in

Nursing Practice
Good

Samarita
n
Law

State Statutory Issues in

Nursing Practice

Public Health Laws

The Uniform Determination of Death

Act

Autopsy

Physician-Assisted Suicide

Torts

A tort is a civil wrong made against a

person or property.

Torts are classified as intentional,

quasi-intentional, or uninterntional

Intentional Torts

Willful acts that violate anothers

rights

Intentional Torts:
1. Assault
2. Battery
3. False imprisonment

Quasi-intentional Torts

Acts in which intent is lacking but

volitional action and direct causation
occur

Quasi- Intentional Torts

4. Invasion of privacy
5. Defamation of character

Unintentional Tort

Unintentional
torts:
Negligence

Malpractice

Common Acts of Negligence:

Medication errors
IV therapy
Burns
Falls
Surgery counts
Failure to monitor
Failure to notify

Avoiding Negligence:
Follow
Standards of
Care
Competence
Communicatio
n
Documentation
Empathetic
rapport

Malpractice 4 Ds

Elements to determine
malpractice:
1. Duty

2. Derelict - breach of duty

3. Direct cause
4. Damages

Malpractice cont.

Responsibilit
y:
1. Nurse
2. Agency

Malpractice cont.
Malpractic

e
insurance

Abandonment & Assignment

Issues

Short Staffing

Floating

Health Care Providers Orders

Risk Management
System of ensuring appropriate
nursing care that attempts to identify
potential hazards and eliminates
them before harm occurs.
Incident report or occurrence report

Professional Involvement

As a nurse stay involved in

professional organizations and on
committees that define the standards
of care for nursing practice.

Be willing to represent nursing and

the patients perspectives in the
community

Professional Involvement
The

voice of the nurse is

powerful and efective when
the organizing focus is the
protection and welfare of the
public entrusted to nurses
care

Ethics in Professional Nursing

Ethics

The study of conduct and character

Determines what is good or valuable for

individuals, groups and society at large

Conflicts occur when ethics, values and

perception about health care collide.

Basic Terms in Health Ethics

Autonomy

Beneficence

Freedom from external control

To take positive actions to help other

Nonmaleficence

Avoidance of harm or hurt

Basic Terms in Health Ethics

Justice

Refers to fairness

Fidelity

Agreement to keep promises

Professional Nursing Code of

Ethics

Code of Ethics

A set of guiding principles that all

members of a profession accept

Advocacy

The support of a particular cause, as a

nurse you advocate for the health,
safety, and rights of patients including
their right to privacy

Professional Nursing Code of Ethics

Responsibility

Accountability

A willingness to respect ones professional

obligations and follow through on
promises.

The ability to answer for ones action

Confidentiality

Protection of patients personal health

information (HIPAA)

Value

Value

A personal belief about the worth of a

given idea, attitude, custom or object that
sets the standard that influence behaviors

Value Formation

Value Clarification

Nursing Point of View

Ethical Dilemma

Institutional Resources

Issues in Health Care Ethics

Quality of Life

Genetic Screening

Care at the end of Life

Access to Care

Allocation of Scarce Resources

Access to care

The Nursing Shortage