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Legal Responsibilities of the Nurse Administrator A nurse administrator will work in a variety of health care environments.

They often manage a team of nurses, or a specific nursing unit or shift. They are fully trained in the implementation of nursing procedure and must hold their team of nurses accountable for their actions. Nurse administrators can interact directly with patients but often are assigned to a more managerial role. Nurse Administrator responsibilities may include: Overall responsibility for nursing patient care Establishing and documenting administrative procedure for the nursing team Promoting the development of nursing staff Budgeting and maintaining practice and standard guidelines Communication between practice and nursing staff Scheduling and supervising of nursing staff Analyzing nursing treatment and diagnosis decisions Troubleshooting and patient consultation Team building exercises and employee counseling.

A Nurse Administrator is highly trained and has knowledge of nursing procedure and protocol. They work as pivotal leaders in an organization and may aspire to chief executive positions. People drawn to this specialty want to be leaders in health care. They enjoy managing processes and people. Nurse Administrators are qualified to work in a variety of positions in the health care environment. In summary this is administrative nursing work responsible for the overall management and direction of the nursing services at a major treatment facility. Work involves the responsibility for organizing, supervising, and coordinating the work of nursing care services; maintaining professional, legal and ethical standards of performance, and the development of agency policies. Standard Classification Factors Supervision Received LEVEL E: "Under administrative direction. . ." At this level, employees are free to plan, develop and organize all phases of the work necessary for its completion within program guidance. Generally, they can develop and utilize any procedures and methods which do not conflict with major policies. Supervision is generally exercised over them through staff conference-type discussions and a review of progress reports. Difficulty - LEVEL C: Considerable. . . Duties which require a high degree of concentration because of the many factors which must be considered and weighed before a decision can be reached. Usually positions that require planning, developing, and coordinating programs and directing fairly large groups of people fall into this category. Complexity - LEVEL D: Work is of a diversified nature that usually involves multiple unrelated steps. Analytical thought is necessary for dealing with complex data and situations. Work often involves a variety of unrelated processes and may require planning or carrying out a sequence of actions or both. Several alternatives usually exist at this level for approaching problems or situations. Workers at this level exercise a considerable amount of independent judgment. Work is controlled by occasional review and by reporting to or consultation with supervisors or superiors. When guidelines exist at this level, they are usually broadly defined or technical requiring careful analysis and interpretation. Consequence of Actions or Decisions - LEVEL E: Consequences of actions or decisions at this level are highly significant. Work is rarely if ever reviewed. Errors may result in serious disruption in the operation of a major agency. Contacts - LEVEL D: The purpose of the contact is to justify, defend, negotiate, persuade or interrogate to settle matters, maintain good will, gain cooperation or reach compromises when the information is controversial or the individuals or groups have strong differences of opinions or diverse viewpoints. Extensive use of communication techniques and well developed communication skills are required for dealing with others. Physical Demands - LEVEL A: The work is predominantly sedentary and requires minimal or negligible physical exertion. The employee is normally seated; however, the nature of the work allows for periods of standing or walking at will. Environmental Conditions - LEVEL A: The work environment involves normal everyday hazards or discomforts typical of offices, meeting and training rooms, or libraries. Comfortable levels of temperature, ventilation, lighting and sound are inherent in the work environment. Exposure to deviations from pleasant environmental conditions is only occasional. The likelihood of injury is remote. Supervision/Leadership - LEVEL D: Involves administrative supervision responsibility. As a "first line supervisor", the primary responsibility involves scheduling, supervising and evaluating employees who perform the same or similar work. Responsible for recommending hiring and disciplinary actions to a higher level of authority. As a "project manager" may direct the activities of project leaders to develop plans and criteria and to evaluate progress and results for one or more projects. Nursing administrators are expected to be aware of legal restrictions affecting personnel appointment and assignment. The Manager who departs from agencys hiring policies can be held negligent if she or he appoints an employee without appropriate screening and that employee later injures a patient. The nurse administrators have responsibility for staffing and supervising nursing units to ensure safe, effective patient care. Therefore they have the authority to temporarily reassign a nursing employee from one unit to another to compensate for emergency staff storages. In shifting the employee to compensate for personnel storage, a supervisor or a manager must take into consideration the nurses capability to discharge duties of the temporary position. In floating nurses to an intensive care unit to compensate for understaffing, the manager should only reassign only those nurses whose education and experience have prepared them to perform all of the nursing function common to an intensive care unit. Each nurse has legal responsibility to make full disclosure of her or his background knowledge and skills and notify the nurse manager when given an assignment for which she or he is not qualified. The manager is also obliged to adjust the amount and type of supervision to fit and employees level of maturity a nd experience. Less experienced or less skilled employees need more professional support and advice from the manager. Responsibility in Quality Control The nurse administrator and the authority of the agency at all levels have a legal obligation to ensure nursing care quality. A nurse managers legal responsibility for quality control of nursing service imposes a duty t observe, report and correct the incompetence of any patient care provider. Usually the head nurse or ward in charge is responsible for quality of patient care given by all personnel including medical on the nurse unit, whether or not these individuals have direct reporting responsibility to the head nurse

Responsibility for Equipment To protect patients and employees from injury, a nurse manager must ensure that all patient care equipment are fully functional and that detective equipment is promptly repaired or replaced. He or she must ensure that nursing personnel know how to operate sophisticated equipment, so that he or she is expected to provide instructions in proper care and storage. Legal Considerations of Managing a Diverse Workforce The variety of experiences and perspective which arise from differences in race, culture, region, mental or physical abiliti es, heritage, age, gender, sexual orientation, gender identity and other charac teristics. So why is it when many people think of diversity, they think first of ethnicity and race, and then gender? Diversity is much broader. Diversity is otherness or those human qualities that are different from our own and outside the group to which we belong, yet present in other individuals and groups. As this suggests, workplace diversity can provide tremendous benefits in terms of improved morale, outside-the-box thinking, greater teamwork, and an atmosphere of mutual understanding and respect. Guiding Principles Managing diversity is defined as planning and implementing organizational systems and practices to manage people so that the potential advantages of diversity are maximized while its potential disadvantages are minimized, according to Taylor Cox in Cultural Diversity in Organizations. Managing diversity well provides a distinct advantage in an era when flexibility and creativity are keys to c ompetitiveness. An organization needs to be flexible and adaptable to meet new customer needs. How Well Do You Manage Diversity? Do you test your assumptions before acting on them. Do you believe there is only one right way of doing things, or that there are a number of valid ways that accomplish the same goal? Do you convey that to staff? Do you have honest relationships with each staff member you supervise? Are you comfortable with each of them? Do you know what motivates them, what their goals are, how they like to be recognized? Are you able to give negative feedback to someone who is culturally different from you? When you have open positions, do you insist on a diverse screening committee and make additional outreach efforts to ensure that a diverse pool of candidates had applied? Managing Diversity To address diversity issues, consider these questions: what policies, practices, and ways of thinking and within our organizational culture have differential impact on different groups? Mast people believe in the golden rule: treat others as you want to be treated. The implicit assumption is that how you want to be treated is how others want to be treated. But when you look at this proverb through a diversity perspective, you begin to ask the question: what does respect look like; does it look the same for everyone? Does it mean saying hello in the morning, or leaving someone alone, or making eye contact when you speak? It depends on the individual. We may share similar values, such as respect or need for recognition, but how we show those values through behaviour may be different for different groups or individuals. How do we know what different groups or individual need? Perhaps instead of using the golden rule, we could use the platinum rule which states: treat others as they want to be treated. Moving our frame of reference from what may be our default view (our way is best way) to a diversity -sensitive perspective (lets take the best of a variety of ways) will help us to manage more effectively in a diverse work environmen t. Your Role You have a key role in transforming the organizational culture so that it more closely reflects the values of our diverse workforce. Some of the skills needed are: an understanding and acceptance of managing diversity concepts, recognition that diversity is threaded through every aspects of management self-awareness, in terms of understanding your own culture, identity, biases, prejudices, and stereotypes willingness to challenge and change institutional practices that present barriers to different groups. Professional Licensure Versus Institutional Licensure Professional Licensure means a restricted practice requiring a license, which gives a "permission to practice." Such licenses are usually issued in order to regulate some activity that is deemed to be dangerous or a threat to the person or the public or which involves a high level of specialized skill. The danger and skill elements inspire governments not to allow a free-for-all, but to regulate the activity, and licensing is a well-established and convenient method of regulation. Licensing includes such things as pilot and driving licenses, licenses to play professional sports, etc. In the case of certain occupations and professions, licensing is often granted through a professional body or a licensing board composed of advanced practitioners who oversee the applications for licenses. This often involves accredited training and examinations, but varies a great deal for different activities and in different countries. Practicing without a license may carry civil or criminal penalties. Institutional Licensure is a procedure in which individual licensure for health professions would be abandoned and the responsibility for assessing professional competence would fall to the health care facility where the health professional is used. Proponents of the procedure maintain that health needs would be better and more flexibly served. Opponents maintain that knowledge, judgment, and competency are the products of a good basic education in the profession and that educators cannot teach the profession without a set of standardized expectations, as are now provided by government-controlled licensing procedures and certifying examinations. In addition, health care facilities may not have the expertise or resources necessary to evaluate the various kinds of health care providers. License is a privilege and not a right as quoted. In nursing, all nurses must safe guard the privilege of licensure by knowing the standards of care applicable to their work setting. Deviation from standard should be undertaken only when nurses are prepared to accept the consequences of their actions, both in liability and loss of licensure. Nurses who violate specific norms of conduct such as fraud, performing specific actions prohibited by the nursing practice act, exhibiting unprofessional and illegal conduct, malpractice and abusing alcohol or drugs may have their licenses suspended or revoked by the licensing boards in all states and countries. Common Grounds or Causes of Revocation and Suspension of License

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health care practitioner as a nurse practitioner Typically, suspension and revocation preceding are administrative. Following a complaint, the BON completes an investigation. Most of the cases reveal no grounds for discipline. If the investigation supports the need of discipline, nurses are notifies of the charges and are allowed to prepare a defense.

At the hearing, which is more likely similar to trail they are allowed to present evidence. Some professionals have advocated shifting the burden of licensure and thus accountability from individual practitioners to an institution or agency. Proponents for this move believe that institutional licensure would provide more effective use of personnel and greater flexibility. Integrating Leadership Roles and Management Functions in Legal and Legislative Issues The medical malpractice crisis doesnt have to be permanent. Between legislation and nurse leader advocacy, the focus can re turn to patient care rather than defensive practice. -Kathleen White (2005) Legislative and legal controls for nursing practice have been established to clarify the boundaries of nursing practice and to protect the clients. The leader uses established legal guidelines to role model nursing practice that meets or exceeds accepted standards of care. Leaders also are role models in their efforts to expand expertise in their field and to achieve specialty certification. Perhaps the most important leadership roles in law and legislation are those of vision, risk taking and energy. The leader is active in professional organizations and groups that define what nursing is and what it should be in the future. This is an internalized responsibility that must be adopted by many more nurses if the profession is to be a recognized and vital force in the political arena. Management functions in legal and legislative issues are more directive. Managers are responsible for seeing that their practice and the practice of their subordinates are in accord with current legal guidelines. This requires that managers have a working knowledge of current laws and legal doctrines that affect nursing practice. Because laws are not static, this is an active and ongoing function. The manager has a legal obligation to uphold the laws, rules, and regulations affecting the organization, the patient, and nursing practice. Managers have a responsibility to be fair and nondiscriminatory in dealing with all members of the workforce, including those whose culture differs from their own. The effective leader goes beyond merely preventing discriminatory charges and instead strives to develop sensitivity to the needs of a culturally diverse staff. The integrated leader-manager reduces the personal risks of legal liability by creating an environment that prioritizes patient needs and welfare. In addition, caring, respect, and honesty as part of nurse-patient relationships are emphasized. If these functions and roles are truly integrated, the risks of patient harm and nursing liability are greatly reduced. Revised Implementing Rules and Regulations of Republic Act No. 9184, Otherwise Known as The Government Procurement Reform Act RA 9184, better known as the Government Procurement Reform Act (GPRA), was signed into law on July 22, 2002. GPRA was enacted primarily to eliminate all forms of corrupt practices in the government procurement system and likewise seek efficient utilization of the government s resources. The GPRA is governed by five (5) core principles, To promote: (1) transparency in the procurement process; (2) competitiveness by extending equal opportunities thereby allowing eligible private contracting parties to participate in public bidding; (3) streamlined procurement process that will uniformly apply to all government procurements; (4) system of accountability; and, (5) public monitoring of the procurement processes and implementation. R.A. 9184 Section 3. Governing Principles on Government Procurement The procurement of the GOP shall be governed by these principles: a) Transparency in the procurement process and in the implementation of procurement contracts through wide dissemination of bid opportunities and participation of pertinent non-government organizations. b) Competitiveness by extending equal opportunity to enable private contracting parties who are eligible and qualified to participate in public bidding. c) Streamlined procurement process that will uniformly apply to all government procurement. The procurement process shall be simple and made adaptable to advances in modern technology in order to ensure an effective and efficient method. d) System of accountability where both the public officials directly or indirectly involved in the procurement process as well as in the implementation of procurement contracts and the private parties that deal with GOP are, when warranted by circumstances, investigated and held liable for their actions relative thereto. e) Public monitoring of the procurement process and the implementation of awarded contracts with the end in view of guaranteeing that these contracts are awarded pursuant to the provisions of the Act and this IRR, and that all these contracts are performed strictly according to specifications Conclusion Philippine public procurement has a long way to go. The Government Procurement Reform Act and its associated regulations enshrined the appropriate and significant principles of transparency, civil sector involvement and the use of ICTs. However, the promises of this legislation remain largely unmet. The PhilGEPS system limits outside oversight by CSOs and journalist by restricting access to data. The platforms features and affo rdances place real constraints on data use, impose barriers to entry for engaging with the data and, ultimately decrease the scale and scope of outside investigation, analysis and oversight. For transparency to enable public oversight and change the incentives of internal actors, the data needs to be easily accessible and usable. Procurement information should be available in bulk, machine-readable, open formats. Civil society observers are not able to cope with the scale of procurement proceedings that occur everyday. Data-backed and ICT enabled oversight presents an opportunity to move beyond oversight founded on the notion of physical co-presence. Updates on Legal Issues in Nursing Administration What is Law? Law is a system of rules and guidelines which are enforced through social institutions to govern behavior. A description of a direct link between cause and effect of a phenomenon deduced from experiments and/or observations. The binding rules of conduct meant to enforce justice and prescribe duty or obligation, and derived largely from custom or formal enactment by a ruler or legislature. These laws carry with them the power and authority of the enactor, and associated penalties for failure or refusal to obey. Law derives its legitimacy ultimately from universally accepted principles such as the essential justness of the rules, or the sovereign power of a parliament to enact them. Sources of Law 1. Constitution a system of fundamental laws or principles that govern a nation, society, corporation, or other aggregate of individuals. The purpose of a constitution is to establish the basis of a governing system for the future and the present. Each state also has a constitution that establishes the general organization of the state government and grants and limits its power. 2. Statutes laws that govern. Legislative bodies, such as Congress, state legislatures, and city councils make these laws. Statutes are officially enacted (vote on and passed) by the legislative body and are compiled into codes, collections of statutes, and ordinances.

3. Administrative Agencies are given authority to act by the legislative bodies and create rules and regulations that enforce statutory laws. Administrative laws are valid only to the extent that they are within the scope of the authority granted to them by the legislative body. 4. Court Decisions judicial or decisional laws are made by the courts to interpret legal issues that are in dispute. Depending on the type of court involved, judicial or decisional law may be made b a single justice, with or without a jury, or by a panel of justices. Generally, initial trial courts have a single judge or magistrate, intermediary appeal courts have three justices, and the highest appeal courts have nine justices. Sources of Law Use Involvement with Nursing Practice The Constitution The highest law; interpreted by the Little direct involvement in the Supreme Court; gives authority to area of malpractice. other three sources of law. Statutes Also called statutory law or Before 1970s, very few state or legislative law; laws that are federal laws are dealt with passed by the state or federal malpractice. Since the malpractice legislators and that must be signed crisis, many statutes affect by the president or governor. malpractice. Administrative Agencies The rules and regulations Some of these agencies, such as established by appointed agencies the National Labor Relations Board of the executive branch of the or health and safety boards, can government (governor or affect nursing practice. president). Court Decisions Also called tort law; this is court Most malpractice law is addressed mode law and the courts interpret by the courts. the statutes and set precedents. Types of Laws and Courts 1. Criminal Case the individual faces charges generally filed by the state or federal attorney general for crimes committed against an individual or society. In criminal cases, the individual is always presumed to be innocent unless the state can prove his or her guilt beyond reasonable doubt. Incarceration and even death are possible consequences for being found guilty in criminal matters. Nurses found guilty of intentionally administering fatal doses of drugs to patients would be charged in a criminal court. 2. Civil Case one individual sues another for money to compensate for a perceived loss. The burden of proof required to be found guilty in a civil case is described as a preponderance of the evidence. In other words, the judge or jury must believe that it was more likely than not that the accused individual was responsible for the injuries of the complainant. Consequences of being found guilty in a civil suit are monetary. Most malpractice cases are tried in civil court. 3. Administrative Cases an individual is sued by a state or federal governmental agency assigned the responsibility of implementing governmental programs. State boards of nursing are on such governmental agency. When an individual violates the states nurse practice act, the board of nursing may seek to revoke licensure or institute some form of discipline. The burden of proof in these cases varies from state to state. When the clear and convincing standard is not used, the preponderance of the evidence standard may be used. Clear and convincing involves higher burdens of proof than preponderance of evidence but significantly lower burdens of proof than beyond a reasonable doubt. Type Burden of Proof Required for Likely Consequences of a Guilty Guilty Verdict Verdict Criminal Beyond a reasonable doubt Incarceration; probation; fines Civil Based on a preponderance of Monetary damages the evidence Administrative Clear and convincing standard Suspension or loss of licensure ** All liability suits involve a plaintiff and a defendant. In malpractice cases, the plaintiff is the injured party and the defendant is the professional who is alleged to have caused the injury. What is Torts? The word tort comes from the Latin term torquere, which means "twisted or wrong." Torts are legal wrongs committed against a person or property, independent of a contract that render the person who commits them liable for damages in a civil action. Whereas professional negligence is considered to be an unintentional tort; assault, battery, false imprisonment, invasion of privacy, defamation and slander are intentional torts. Unintentional Tort a) Negligence is the omission to do something that a reasonable person, guided by the considerations that ordinarily regulate human affairs, would do - or as doing something that a reasonable and prudent person would not do. b) Malpractice the failure of a person with professional training to act in a reasonable and prudent manner also is called professional negligence. **Reasonable and prudent generally means the average judgment, foresight, intelligence, and skill that would be expected of a person with similar training and experience. Five elements must be present for a professional to be held liable for malpractice. 1. Standard of Care - must have been established that outlines the level or degree of quality considered adequate by a given profession. Standards of care outline the duties a defendant has to a plaintiff or a nurse to a client. These standards represent the skills and learning commonly possessed by members of the profession and generally is the minimal requirements that define an acceptable level of care. Standards of acre, which guarantee clients safe nursing care, include organizational policy and procedure statements, job descriptions, and student guidelines. 2. Breach of Duty after the standard care has been established, it must be shown that the standard was violated there must be a breach of duty. This breach is shown by calling other nurses who practice in the same specialty area as the defendant to testify as expert witnesses. 3. Forseeability of Harm the nurse must have had the knowledge or availability of information that not meeting the standard of care could result in harm. If the average, reasonable person in the defendants position could have anticipated the plaintiffs injury as a result of his or her actions, then the plaintiffs injury was forseeable. Ignorance is not an excuse but lack of information may have a negative e ffect on the liability to forsee harm.

4. Failure to meet the standard of care must have potential injure the patient there must be a provable correlation between improper care and injury to the patient. 5. Actual Patient Injury this injury must be more than transitory. The plaintiff must show the defendant directly caused the injury and that the injury would not have occurred without the defendants actions. It is important to remember here, however, that not taking ac tion is an action. Nurses can be held liable even if the patient injures him or herself because the nurse did not appropriately safeguard the patient from harm. Components of Professional Negligence Elements of Liability 1. Duty to use due care (defined by the standard of care) Explanation The care that should be given under the circumstances (what the reasonably prudent nurse would have done). Not giving care that should be ,given under the circumstances The nurse must have reasonable access to information about whether the possibility of harm exists. Patient is harmed because proper care is not given. Actual harm results to patient. Example: Giving Medications A nurse should give medications accurately, completely, and on time. A nurse fails to give medications accurately, completely, or on time. The drug handbook specifies that the wrong dosage or route may cause injury. Wrong dosage causes patient to have a convulsion. Convulsion or other serious complication occurs.

2. Failure to meet standard of care (breach of duty) 3. Forseeability of harm

4. A direct relationship between failure to meet the standard of care (breach) and injury can be proved 5. Injury

Intentional Tort An intentional tort is any deliberate interference with a legally recognized interest, such as the rights to bodily integrity, emotional tranquility, dominion over property, seclusion from public scrutiny, and freedom from confinement or deception. a) Assault and Battery Assault is the imminent threat of a harmful or offensive bodily threat. Battery is an intentional and wrongful physical contact with a person that entails an injury or offensive touching. b) Fixed Imprisonment or Illegal Detention False imprisonment describes any unlawful confinement within fixed boundaries, and this confinement can be produced by physical, emotional, or chemical means. C) Defamation is communicating to third party false information that injures a persons reputation; or causes adverse, derogatory, or unpleasant opinions of him. Slander is oral defamation of a person by speaking unprivileged or false words by which his reputation is damaged. Libel is defamation by written words, cartoons or such representations that cause a person to be avoided, ridiculed or held in contempt or to tend to injure him on his work. Five Legal Issues in Nursing 1. Signatures Are Golden When a physician or other health care provider orders a procedure be done to a patient, it is the nurses responsibility to obtain an informed consent signature. This means that the patient: Understands the procedure and the alternative options Has had a chance to ask the provider any questions about the procedure Understands the risks and benefits of the procedure Chooses to sign or not sign to have the procedure performed. If the nurse does not obtain signatures, both the nurse and the operating provider can be held liable for damages incurred. 2. Document It is the nurses responsibility to make sure everything that is done in regards to a patients care (vital signs, specimen c ollections, noting what the patient is seen doing in the room, medication administration, etc.), is documented in the chart. If it is not documented with the proper time and what was done, the nurse can be held liable for negative outcomes. A note of caution: if there was an error made on the chart, cross it out with one line (so it is still legible) and note the correction and the cause of the error. 3. Report It or Tort It Allegations of abuse are serious matters. It is the duty of the nurse to report to the proper authority when any allegations are made in regards to abuse (emotional, sexual, physical, and mental) towards a vulnerable population (children, elderly, or domestic). If no report is made, the nurse is liable for negligence or wrongdoing towards the victimized patient. 4. Rights to Privacy The nurse is responsible for keeping all patient records and personal information private and only accessible to the immediate care providers, according to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If records get out or a patients priva cy is breached, the liability usually lies on the nurse because the nurse has immediate access to the chart. 5. Youre Dosing WHAT?! Medication errors account for 7,000 deaths and 770,000 patients injured each year in the US. It is the nurses responsibility to follow the five rights of medication administration: right dose, right drug, right route, right time, and right patient. If a nurse pays attention to those details, the likelihood of a medication error is greatly reduced, thereby saving the nurse and health care institution from liability for damages.