I.

INTRODUCTION
The contribution of nursing to the alleviation of suffering and to protection
and promotion and restoration of health is a proud chapter in the history. The
image of any organization depends up on the behavior of people who
constitute it. So, there is great obligation on the part of employees to behave
in an ethical way at the work place. This is equally applicable to the nurse
who are working in different sectors of health care delivery system. The way
nurses behave, reflect the image of that organization. Today the nurses face a
variety of ethical problems than ever before. The consumers are patients
with complex needs. With increased awareness of health care, health care
facilities and consumer protection act, patients are getting aware about their
rights. Nurses also have now the expanded role. Issues which seem not
feasible, and ideal, many become practice with the change of time. These
issue are base for the future trends in care.

II. MEANING

Legal issues:
Law is standard or rules of conduct established and enforced by government.
Legal issues in nursing are those in which a person lead to face legal
problems in which nurse face problem when not meeting proper patient care
Legal:
Established by or founded upon law or official or accepted rules

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III. DEFINITION OF LAW

Laws are rules of conduct, established and established and

enforced by authority, which prohibit extremes in behaviour so that
one can live without fear for oneself or one’s property.
SULLIVAN AND DECKER, 2001
The law us a system of rights and obligations which the state
enforces.
GREEN

IV. PURPOSES OF LAW IN NURSING

1. To help the nurse to understand that they do have legal

responsibilities in nursing practice.
2. To make them understand by which authority these legal
responsibilities can be enforced.
3. To make them understand what areas of nursing practice can
mostly create legal problems.
4. To describe and protect the rights of clients and nurses
5. Law is there for the protection of nursing practice
6. Law is there for the identification of the risk of liability
7. Law is there to assist in the decision-making process involved in
nursing practice

2
8. Nurses have more responsibility
9. Safeguarding the nurse
a) Li censure
All nurses who are in nursing practice have to possess a valid
licensure, issued by the respective state nursing
council/indian nursing council
b) Good Samaritan laws:-
In response to health professionals, fear of malpractice
claims, most states enacted Good Samaritan Laws that
exempt doctors and nurses from liability when they render
first aid during emergency. These laws limit liability and
offer legal immunity for people helping in an emergency
c) Good rapport: -
Developing good rapport with the client is very important to
prevent malpractice. The ability to develop good rapport with
client is dependent on the nurse having good interpersonal
communication skills e.g. listening
d) Standards of care:-
Professional practicing in the medical field are held to certain
standards when administering care. It is always better to
follow standards of care to avoid malpractice and do not
attempt anything beyond the level of competence.

3
e) Standing orders:-
Although a nurse may not legally diagnose illness or
prescribe treatment, she or he may after assessing patients
condition apply standing orders or treatment guideline that
have been established the physician or doctor as appropriate
for certain problems and conditions
f) Consent for operation and other procedures:-
A patient coming in to hospital still retains his rights as a
citizen and his entry only denotes his willingness to undergo
an investigation or a course of treatment. Any investigation
or treatment of a serious nature, or an operation in which an
anesthetic is used, requires the written consent of the patient.
g) Correct identity:
The nurse or the midwife has the great responsibility to make
sure that all babies born in the hospital are correctly labelled
at birth and to ensure that at no time they are placed in the
wrong cot or handled to the wrong mother.
h) Counting of sponge instrument and needles:-
Nurses advocate that sponge, instrument and needle counts
be performed for all surgical procedures taking place in
operation theatre. When an instrument left in a patient body
the nurse will probably liable for any patient injury caused by
the presence of foreign body.

4
 i) Contracts:
Contract is a written or oral agreement between 2 people in
which goods or services are exchanged.
j) Documentation:-
Documentation is by far the best once a lawsuit field. The
medical record is a legal document admissible in court as
evidence.

V. LEGAL ISSUES IN NURSING

1. Controlled substances:
One of the legal issues that might arise for nurses involves the
use of controlled substances. The two acts that control the use of
poison in medicine is misuse of drug act 1971 and dangerous
drug act 1965, the misuse of drug act aims at checking cause
harm if misused. Drugs affected by this ct are reffered as
controlled drugs. The common controlled drugs under the
dangerous drug act include cocaine, heroine, methadone, opium,
pethidine, hallucinogen etc.
2. Patients property
Many of the unconscious patients admitted in emergency their
belongings should be listed, checked by two nurses and put in
safe keeping. When the patient dies in hospital, his possessions
must be recorded in the property book, but money and valuable
5
 should be listed and packed separately. Also write the colour of
ornaments, and inform to administrative officers. Preoperatively
and during delivery. These things should take care of.
3. Caring patient with AIDS
The care of AIDS and HIV patients has legal implications for
nurses. Confidential information must be protected of HIV
patients. An infected person cannot be discriminated against
based on contagiousness. The courts have upheld the employer’s
right to fire a nurse who refused to care for an AIDS patient.

4. Living wills and health care surrogates

Living wills are documents instructing physician to hold or
withdraw. Life sustaining procedure whose death is imminent.
Each state providing living will need two witnesses, neither
whom can be a relative or doctor are needed when the client sign
he document, medical special directives also must be legally
prepared with the appropriate witness of the clients signature.
5. Death and dying
There are many legal issues regarding definition of death. Even
though the client may be legally in brain dead, the actual
pronouncement of death is usually the legal responsibility of the
physician, nurses must be aware of legal definition of death.
6. Autopsy and organ donation

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 Legally competent are free to donate their bodies or organs for
medical use. Consent forms are available for the purpose

VI. LEGAL RESPONSIBILITY OFNURSE

1. Responsibility of Appointing and Assigning

Nursing administrators are expected to be aware of legal restrictions
affecting personnel appointment and assignment. A Manager who departs
from agency s 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 shortages. 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 and experience. Less experienced or less skilled employees need
more professional support and advise from the manager.

2. Responsibility in Quality Control

The nursing 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 to
observe report and correct the incompetence of any patient care provider.

7
 Usually the head nurse or ward incharge is responsible for quality of patient
care given by all personnel including medical on the nursing unit, whether or
not these individuals have direct reporting responsibility to the head nurse.

3. Responsibility for Equipment

To protect patients and employees from injury, a nurse manager must ensure
that all patient care equipments are fully functional and that defective
equipment is promptly repaired or replaced. He/she must ensure that nursing
personnel know how to operate sophisticated equipment, so that he/she is
expected to provide instructions in proper care and storage of patient care
equipment, even then, there is a service contract providing for maintenance
by an outside contractor. Nurse also has duty to refuse to use equipment
known to be faulty or that was not designed for use in the situation where it
was ordered.

4. Responsibility for Observation and Reporting

Nursing personnel have more frequent and prolonged patient contact than
other caregiver. Nurses are trained to detect significant symptoms and
reactions. Consequently nurses have a legal duty to observe patients
freque1ntly and report findings that have diagnostic or treatment value for
the patient, physician and other members of the patient’s treatment team.
The nurse is expected to observe a patient more closely when his or her
condition implies increased health risk. Infants, children, aged, disoriented.
Psychiatric and critically ill patients require more frequent observation than
other patients with no evidence of impending respiratory or cardiac
emergency.
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 The nurse has a duty to record and report observations of a patient ·condition
promptly, so that the physician can base treatment, decisions on up to date
information about the patient’s health needs. When the patient’s condition
deteriorates to the point that immediate action is needed to save life or limb,
the nurse must report observations of the patient’s worsening conditions to
the concerned doctor in person or any means. The nurse has a duty to report
improper medical care through appropriate channels in order to protect
patients from Doctor’s negligence.

5. Responsibility to Protect Public

The nurse has a legal duty to protect the public from injury by dangerous
patients. Each nurse manager or administrator should ensure that the agency
in which she or he is employed has a policy describing the procedure to be
followed when a patient with violent tendencies or who threatens violence to
others is discharged or escapes from the health care agency. The manager
must ensure that nursing personnel follow the procedures to alert community
members to the presence of a potentially dangerous patient in their midst

6. Responsibility for Record Keeping and Reporting

Nurses have legal responsibility for accurately reporting and recording
patient’s conditions, treatments and responses to care. The medical record is
a written or computerised account of a patient illness and treatment that
includes information submitted by all members of the patients health care
team. The medical record is an information source document that should be
used to plan care, evaluate care, allocate costs, educate personnel, research
care measure, and substantiate legal claim.

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 7. Responsibility for Death and Dying
Death occurs when there is an absence of brain function, despite functions of
other body organs. However, Nurses must be aware of legal definition of
death because they must document all that events, when the patient is in their
care. Sometime there will be issues of euthanasia, either active or passive.
Active euthanasia is defined as intentional homicide, e.g. intentionally
administering a lethal dose of morphine to a patient to cause death. An
example of passive euthanasia includes, removing breathing support or
withholding blood transfusion from a terminally ill patient with irreversible
brain damage, may raises legal questions.

VII. ETHICAL ISSUES

From we were very young we began to learn what was right and
what wrong behaviour was. We learned this from our parents,
relatives, friends and teachers. By the time we became adults, we
had a personal set of ethics to guide our behaviour in daily life.
We may believe, for example, that honesty is important and
necessary and important. We will try to be honest because we
believe it is right to do so. Being dishonest would then be wrong
for us. This is ethical behaviour.

VIII. MEANING
Ethics:

10
 The word ethics is derived from Greek word “Ethos” which means customs
or guiding beliefs (character)

IX. DEFINITION
Ethics are the rules or principles that govern right conduct and are designed
to protect the rights of human beings.
Sister Nancy

Ethics is the study of good conduct, character and motives.

Potter

Ethics refers to the moral code for nursing and is based on obligation to service
and respect for human life.
-Melanie and Evelyn.

X. NEED FOR NURSING ETHICS

1. Helps the students/RN to practice ethically
2. Helps the nurse to identify the ethical issues in her work place.
3. Protecting patients right and dignity.
4. Providing care with possible risk to the nurse health.
5. Staffing patterns that limit the patient’s access to nursing care.
6. Ethical reasoning helps the nurse to respond to ethical conflicts.
7. Helps to differentiate right / wrong behaviour.
8. Guide for a professional behaviour.
9. Help teachers plan education.

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 10.Prevent below standard practice

XI. ETHICAL PRINCIPLES IN NURSING ETHICS

1. AUTONOMY
It involves the right of self –determination or choice , independence and
freedom.
Eg: the purpose of the preoperative consent is to assure in writing that the
health care team respects the patients independence by obtaining permission
to proceed.

2. BENEFICENCE
This principle promotes taking positive, active steps to help others.
It dictates that a person is obliged to help others to advance their legitimate
and important interests; it requires the balancing of harms and benefits.
Benefits promote the client’s welfare and health, whereas harms or risks
detract from the client’s health and welfare.
Eg: a child immunization causes discomfort during administration but the
benefits of protection from disease both individual and for society, outweigh
the temporary discomforts.

3. NOMALEFICENCE
It refers to the fundamental agreement to do no harm. Nurse should interpret
the term ‘harm to mean emotional and social as well as physical injury.
Hann is thwarting, defeating, or setting back one person’s interest through
invasive action by another. Many nurses find it difficult to follow the

12
 principle when performing treatment and procedures that bring discomfort
and pain to patients. When the principle of sanctity of human life guides
healthcare decisions, the principle of nonmaleficence prohibits active and
passive enthusive by caregivers of terminally ill patients.

4. FIDELITY
It refers to the agreement to keep promises, commitments, responsibilities
that one has made one self and others. The principle of fidelity holds that a
person should faithfully fulfil his duties and obligations. Fidelity is
important in a nurse because a patient’s hope for relief and recovery rests on
evidence of caregivers conscientiousness.
Eg: Assess a patient for pain and then offer a plan to manage it , this
principle encourages to do best to keep the promise to improve the patients
comfort.

5. VERACITY
Telling the truth or intentionally deceiving or misleading patient. It concerns
truth telling an incorporates the concept that individuals should always tell
the truth. It requires professional caregivers to provide with accurate, reality-
based information about their health status and care or treatment prospect.
Truth telling is an ethical concern for nurse, because truth is the basis for
mutual trust between patient and nurse, and trust is the basis for patient’s
hope of benefit from nursing services.
Eg: should tell the truth when know that it might cause harm to the client?
Families go to great lengthens to protect a dying patient from the harsh
truth of his prognosis, and the patient himself may not wish to know.

13
6.JUSTICE
It implies equal treatment of all clients. Principle of justice requires treating
others fairly and giving persons their due. When there are resources to
distribute in healthcare, nurses should allocate them in such a way that equal
shares go to equal recipients.
Eg: a national multidisciplinary committee strives for fairness by ranking
recipients according to need, rather than resorting to selling organs.

7.RESPECT FOR PERSONS:

Respect for persons not only applies to clinical situations, but also to all life’s
situations. It directs individuals to treat themselves and others with a respect
inherent to man’s humanness. It requires recognition on a sense that all
mankind shared a common human destiny. The respect to persons needs to be
simplified as it affects nursing practice.
.
8.FREEDOM:
The principle of individual freedom decrease that patients be exempt from
control by others to select and pursue personal health goals. Nurses as a group
believe that patient should have greater freedom of choice within the nation’s
health care system. This principle should be observed by staff nurses when
planning patient care; by nurse manager when leading subordinates.

9.CONFIDENTIALITY:
It is the duty to respect privileged information. The principle of
confidentiality provides that caregivers should respect a patient need for
privacy and use personal information about him or her only to improve care.
Nurses should practice confidentiality to decrease patient vulnerability and
14
 share from widespread knowledge of personal information divulged during
care.

XII. ETHICAL ISSUES INVOLVED IN VARIOUS NURSING BRANCHES

IN NURSING
The branch/areas are:

a) Nursing research.
b) Nursing education.
c) Nursing administration.
d) Nursing management
e) Intensive care unit
f) Operation theatre/ surgical nursing.
g) Medical nursing.
h) Community health nursing.
i) Child health nursing.
j) Mental health nursing.
k) Maternity nursing.
l) Nursing procedures.

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 PATIENT CARE ISSUES, MANAGEMENT ISSUES,
EMPLOYMENT ISSUES AND MEDICO LEGAL
ISSUES

A. PATIENT CARE ISSUES

Nursing covers a wide range of disciplines and health-care issues that are
always changing and at the forefront of what guides this career path. Issues
such as health-care reform, nursing shortages, low salaries and ethics are
some of the issues being faced. With nursing being an integral part of
hospitals, nursing homes, home health agencies and colleges, the discipline
has to keep current of changing policies and be prepared to address whatever
may arise.

1. Nursing Shortage
The nursing shortage is a major issue facing the biggest licensed
profession in the health-care system. This shortage will affect health care
more each day, as it appears not much is being done to stop it. Many
emergency rooms have longer wait times due to less nursing staff, and
hospital floors are feeling the effects as well. This is affecting patient care
because the number of patients to one nurse is increasing, therefore
decreasing the quality of care. This shortage is being felt in hospitals,
nursing homes and home-health agencies. Nursing has been lobbying for
patients by seeking legislation to help with the nursing shortage and with
funding for nursing schools.

2. Health-Care Reform
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 Nurses have always been involved with health-care reform as
advocates for patients. The American Nursing Association (ANA) has been
working to have the voice of nurses heard. Nurses are in support of a public
plan, so Americans who are underinsured or uninsured will have access to
affordable, quality health insurance. The ANA has taken the stand that
health careis not a privilege but a right. It is lobbying for a reduction in cost
and an end to high out-of-pocket costs for services, as well as ending
discrimination pertaining to pre-existing conditions.

3. Low salaries
4. Standard Care
a) State Nurse Practice Act
b) ANA-Standards of Clinical Nursing Practice
c) National Association of School Nurses (NASN)
d) School policy and protocols

B. MANAGEMENT ISSUES

Nurses working in doctors' offices and hospitals have a difficult

job caring for patients and meeting the needs of both coworkers and
superiors within the institution. Nurse Managers who work in the medical
professional also have a complex and challenging role. It is a considerable
challenge to meet the needs of the organization, the needs of patients, and
the needs of the nurse employees.

1. Turnover
Maintaining adequate staffing levels is a major issue in nursing
management. Representatives working in nurse management and leadership

17
 are often faced with the responsibility of controlling turnover rates. Nurses
faced with long work hours for relatively little pay have few motivations to
remain in one position and often seek employment opportunities at
competing hospitals and neighboring clinics.

2. Funding
Lack of funding is an issue for many nurse managers who seek to provide
sufficient compensation to existing nurses as well as offer suitable
compensation in an attempt to recruit new nursing professionals for hire. An
underfunded institution cannot attract and provide for the right professionals,
and funding inadequacies can also become a detriment to the level of
training provided to medical staff, in addition to the needs for medical
equipment and supplies. When the medical institution's quality of staff and
training standards must be lowered because of budgetary concerns, the
overall level of patient care is unavoidably reduced.

3. Workload
Individual nurse manager workload and overall medical workload are issues
in leadership. The medical profession is one that never sleeps and has an
almost constant need for qualified professionals both in hiring and
scheduling. Not only do nurse professionals work long hours and many days
per week, but nurse managers and leaders are also faced with an ever-
increasing workload. Dealing with patient concerns, providing training and
support to nurses, and acting as a liaison between doctors, nurses and
medical administration members can be taxing and stressful. Many nurses

18
 are unwilling to enter into the nurse management field because of the added
stress and responsibility. When you add to all that the secondary stresses of
budgetary cutbacks and fewer nurse leadership roles, it means that existing
nurse managers are faced with enormous challenges when it comes to
balancing their leadership functions.

4. Issues regarding malpractice in nursing management

Issues of delegation and supervision

a) The failure to delegate and supervise within acceptable standards of

professional practice.

Issues related to staffing

b) Inadequate accreditation standards- adequate number of staff members in a

time of advancing patient activity and limited resources.
c) Inadequate staffing, i.e. short staffing.
d) Floating staff from unit to unit.

5. Ethics
Nurses are held to a high standard of ethics when it comes to patients, co-
workers and themselves. They provide care, promote human rights and
values, and help meet the needs of the less fortunate and vulnerable. A major
ethical goal is to also keep patients' information confidential, and this
includes not discussing patients in public places. Another ethical issue is
protecting patients from negligent co-workers who may endanger them. The
19
 individual nurse must not endanger the patient and has to be accountable to
the standards of the field.

6. Effect
Effects of reform, shortages, ethics and salaries are issues that keep nurses
constantly thinking, growing and changing..Nursing instructors make far less
money than nurses in the clinical setting. They also make less than other
educators in different fields. In order for nursing to succeed, there needs to
be qualified candidates educated, but with these low salaries nurses are not
flocking to this career path. Without these types of nurses being adequately
filled then qualified candidates will not have the opportunity to be taught.
These salaries need to be increased, and colleges and universities need to see
the value in these instructors.

C. ISSUES IN NURSING CURRICULUM DEVELOPMENT

a) Where are we now?

As nursing faculty we need to answer the question and analyze the present
situation whether or not we are on the road to relevant, which means the
validation of curriculum or judgemental process in which an attempts is to
be made to ascribe a degree of worth or value to a curriculum in the context
of professional education and preparation of participants for their
professional role.

Walker describes five types of validation

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 Academic validation
 Professional validation
 Economic validation
 Institutional validation
 Performance validation
Then identify the strengths of present system/situation before starting the
program.

b) Where we want to go?

This deals with the thinking and aspiration for future. Faculty must think
whether the educational program what is designed will help to meet the
expectations of individuals, families and communities in accordance far with
the developed countries or not.

c) What we want to achieve?

Nurse educators must be able to analyze and think critically that we are
preparing the students with the adequate skills to perform their expected
roles in all the three domains of professional tasks such as practical,
communication and intellectual skills according to the institutional goals and
educational objectives.

The three types of skills to be achieved:-

 Domain of attitudes (communication skills)

 For example, feelings, values and interpersonal relationships
 Domain of practical skills (imitation control and automatism)
 Domain of intellectual skills(knowledge and recall of facts)

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 For example, Interpretation of data and problem solving.

d) How can we achieve?

The faculty must think the ways by which the curriculum can be developed
to which is relevant to meet the needs of the country.

e) Collaboration issues
The nursing profession is faced with increasingly complex health care issues
driven by technological and medical advancements an ageing population,
increased numbers of people living with chronic disease, and spiraling costs.
Collaborative partnerships between educational institutions and service
agencies have been viewed as one way to provide research which ensures an
evolving health care system with comprehensive and coordinated services
that are evidence- based, cost – effective and improve health care outcomes.
These partnerships also ensure the continuing development of the
professional expertise necessary to meet these challenges.

D. EMPLOYMENT ISSUES

1. Issues related to Nursing Shortage

The nursing shortage is another international event. Why is there a
nursing shortage. There are many opinions regarding that question. I have
been a nurse long enough to recognize that nursing shortages wax and wane.
This shortage is more noticeable, however and it is lasting longer. The nurse
shortage itself is a contributing factor because the shortage creates staffing
problems, mandatory overtime, and constant calls for additional shift work.

22
 National nursing organizations are making strong efforts at stopping the
shortage by mandating better nurse- to-patient ratios, eliminating mandatory
overtime, and increasing salaries and benefits for nurses.

2. Issues in Nurse Migration

Nurse migration has attracted a great deal of political as well as
media attention in recent years. The rights to healthcare as well as workers’
rights are paramount to understanding the interests of health sector
stakeholders, including the consumer or patient, the government or
employer, and the worker or health professional. In this section a discussion
on the right to work and the right to practice is, by necessity, followed by a
warning that cases of exploitation and discrimination often occur when
dealing with a vulnerable migrant population. Additionally, international
migration policy issues addressing the somewhat conflicting sets of
stakeholders' rights are presented, and ethical questions related to nurse
migration are noted.

3. The Right to Work and the Right to Practice

Professionally active nurses are important players in an
increasingly competitive and global labor market. Unable to meet domestic
need and demand, many industrialized countries are looking abroad for a
solution to their workforce shortages; the magnitude of current international
recruitment is unprecedented (ICN, 2005).
For nurses to practice their profession internationally, they need to
meet both professional standards and migration criteria. The right to
practice, e.g., to hold a license or registration, a professional criteria, and the
right to work, e.g. to hold a work permit, a migration criteria, are sometimes

23
linked. Yet they often require a different set of procedures with a distinct set
of competent authorities.
In the interest of public safety, nurses' qualifications must be
screened in a systematic way to ensure they meet the minimum professional
standards of the country where they are to deliver care. This may be in the
form of a paper screen, for example automatic recognition of qualifications
received from a given country or school; tests, such as the NCLEX licensing
exam; supervised clinical practice, as seen in an adaptation period; and/or
successful completion of an orientation course/program.
Language is a crucial vehicle for the vital communication needed
both between the patient and care provider, and also between members of
the health team. It is not surprising that in many countries, a nurse's right to
practice is limited if the foreign-educated nurse's language skills do not
support safe care practices. Passing specific language tests are required in
certain countries. In others, the employer is held responsible for ascertaining
the language competence of the employees/health professionals. Clearly,
history has demonstrated a tendency for migrant flows to be the strongest
between source and destination countries that share a common language
(Kingma, 2006). For example, nurses wishing to migrate from Morocco will
tend to go to France while nurses from Ghana will be attracted by the United
Kingdom. As the pools of nurses willing to migrate change, and as language
competency becomes a professional advancement requirement, language
barriers may prove to be less of a constraint, and we may see Chinese nurses
working in Ireland and Korean nurses going to the US.
Foreign nurses also need to meet national security and
immigration criteria in-order-to enter the country and to stay on a permanent
or temporary basis, with or without access to employment. There is no doubt
24
 that nurse mobility will be affected by national security concerns and
decisions on how fluid the borders will be maintained. For example a
tightening of border restrictions after terrorism attacks or the opening of
borders with new economic agreements, such as the expansion of the
European Union, will continue to influence nurse migration patterns.

4. Exploitation and Discrimination

One of the most serious problems migrant nurses encounter in
their new community and workplace is that of racism and its resulting
discrimination (Chandra & amp; Willis, 2005). Incidents are, however, often
hidden by a blanket of silence and therefore difficult to quantify (Kingma,
1999). Migrant nurses are frequent victims of poorly enforced equal
opportunity policies and pervasive double standards. Some migrant nurses
are experiencing dramatic situations on the job where colleagues
purposefully misunderstand, undermine their professional skills, refuse to
help, and sometimes bully them, thus increasing their sense of isolation
(Allan & amp; Larsen, 2003; Hawthorne, 2001; Kingma, 2006). If we
recognize that international migration will continue and probably increase in
coming years, the protection of workers is a priority issue and should be
safeguarded in all policies and practices that affect migrant health
professionals.
5. Essential Terms and Conditions in an Employment contract
An employment relationship has traditionally been governed by
the terms and conditions of the employment contract. Previously, the
employer retained sole control in respect of the terms and conditions of
employment to be incorporated into the employment contract. However,
over the years there has been an increase in the implied terms and conditions
25
 which are also read into the contract. Additionally, then there are the
statutory terms and conditions which also apply. A badly drafted
employment contract which does not correctly express the intentions of the
employer on such matters as working hours, prolonged illness, bonus
payments, usage of office computer facilities, transfers, retirement age,
confidentiality, conflict of interest, disciplinary action and imposition of
punishment, etc or the omission to mention some of these items in an
employment contract can give rise to serious consequences for employers.
This talk will focus on what are considered as essential terms and conditions
which employers must incorporate into an employment contract and the
consequences of failure to do so.

6. Unsatisfactory work performance and termination of employment

The Courts have time and again reiterated that employees enjoy
security of tenure of employment. The maxim "easy to hire difficult to fire"
is a truism even in the case of probationers. No employer having hired a
person at considerable cost and having exposed the person to training,
formal or otherwise, will want to terminate the person. However, when an
employee has an attitude problem or whose work performance is not up to
the expectations he cannot be terminated by the employer simply by
invoking the termination clause in the employment contract. The employer
has to follow certain rules and procedures and only at the end of it can he
terminate the services of a non-performing employee. Even then, there are
no iron clad assurances that the termination will not be challenged by the
employee at the Industrial Court. How does an employer ensure that he
minimizes the risk of being challenged in Court over a termination of

26
 employment due to unsatisfactory work performance? This talk will attempt
to take you out of the labyrinth.

7. Misconduct and imposition of punishment

It has long been held that the employer has the inherent right to
discipline his workers. Should misconduct be committed, the employer after
a proper inquiry has been instituted can impose a suitable punishment,
including dismissal if the offence committed was of a serious nature. The
decision on the type of punishment to be imposed is under all circumstances
a subjective one. The Courts will interfere if, among others, the action taken
by the management was perverse, baseless or unnecessarily harsh or was not
just or fair. There have been occasions where employers have imposed the
punishment of dismissal for misconduct which they have assessed as serious
but these cases have been reviewed by the Industrial Court and the decision
of the employer substituted. Given that imposition of punishment is a
subjective matter, what factors or criteria should an employer apply in
determining appropriate punishment for misconduct committed in
employment. This talk, among others, will examine some of the issues to be
taken into account.

8. Sexual harassment at the workplace

Sometime ago this subject matter received a great deal of attention
especially with the launching of the Code of Practice on the Prevention and
Eradication of Sexual Harassment at the Workplace by the Ministry of
Human Resources. However, the response to the adoption of the Code by
employers was not encouraging. Some NGO's have called for the
introduction of statutory measures to deal with the problem. Some recent

27
 judicial pronouncements appear to make it difficult to prove sexual
harassment had indeed taken place. Regardless of all these what is the proper
attitude that ought to be taken by employers in this matter. Do employers
have a legal responsibility to safeguard their employees from sexual
harassment at the workplace? To what extent can employers dictate without
being accused of encroachment into a person's private life and social
interaction. How is an employer to deal with sexual harassment cases and
what standard of proof is called for when usually harassments are .private
and confidential incidents'.

9. Renewal of nursing registration

So that registration office is updated with nurses in practice. Of
course re- registration may qualify its periodicity and qualifications of nurses
e.g. clinical experience, attendance at continuing education etc.

10.Diploma vs degree in nursing for registration to practice nursing

This issue need indepth study of merits and demerits as well as its
feasibility before it could come on the surface.

11.Specialization in clinical area

It could be either through clinical experience or education.

Specialization in cure and specialized care required for patients demand that
nurses be highly skilled in the unit. Generalization of care seems remote and
unacceptable for patients under specialized treatment.

12.Nursing care standards

Standards must be laid down and followed so that clients
understand the quality of care expected from the nurses.

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E. MEDICO LEGAL ISSUES

Nurses face legal issues daily. Those issues may be in connection to

negligence, administering medication and advocating for the patient. The
Nurse Practice Act lists all of the duties and role of a nurse, except the legal
and ethical issues. If these duties and regulations are not followed, the nurse
is at risk of losing his license and facing a malpractice suit.

Legal Issues Specific to Nursing

1. Duty to seek Medical Care for the patient

It is the legal duty of the nurse to ensure that every patient
receives safe and competent care. The nurse cannot guarantee the patient
will receive medical care that the nurse be a strong advocate for the patient
and use every resource to ensure medical care is received. If you determine
that a patient in any setting needs medical care, and you do not do
everything within your power to obtain that care for the patient, you have
breached your duty as a nurse.

2. Confidentiality
It is a privilege to care for other people. At times, your patients
will relate to you in a personal way. One of the outcomes of your
relationship is that you may be told information of a personal nature.in
addition to what a patient may share with you, you have access to the
person’s hospital records. The law requires you to treat all such information
with strict confidentiality. This is also an ethical issue. Unless a patient has

29
 told you something that indicates danger to self or others, you are bound by
legal and ethical principles to keep that information confidential.

3. Permission to treat
When people are admitted to hospitals, nursing homes, and home
health services, they sign a document that gives the personnel in the
organization permission to treat them. Every time the nurse provides nursing
care to person, however, permission must be obtained. The courts have ruled
that people are expected to have some understanding of basic care, which
means the nurse should explain briefly what he or she is about to do. The
concept of permission to treat should be in your mind as you give nursing
care. For example, most personnel who pass food trays automatically ask,
“Are you ready to go for a walk now? These automatic questions actually
are permission to treat questions. When you are giving medication, you may
say, “Here are your pills,” Here is the new medication the doctor ordered for
you.” If the patient takes the medication, he or she has given you permission
to treat.

4. Informed consent
The concept of permission to treat is closely tied to the concept of
informed consent. The law states the persons receiving health care must give
permission to treat based on informed consent. The principle of informed
consent states that the person receiving the treatment fully understands the
possible outcomes, alternatives to treatment, and all possible consequences.

The physician is responsible for obtaining informed consent for

medical procedures, such as surgery, whereas the nurse is responsible for
obtaining informed consent for nursing procedures. Each institution has

30
 forms for informed consent for complex or serious procedures, such as
surgery, chemotherapy, or electroshock therapy. Check with your institution
and review the forms available for informed consent.

Surgical procedures commonly require informed consent.

Although the law states that either verbal or written consent is acceptable,
most institutions require written consent because it is the most legally
binding. It is the physician’s responsibility to give the surgical patient the
information necessary to meet the requirements for informed consent. It
often is the responsibility of the nurse to get the surgical consent from
signed.

5. Advance Directives
Although the Patient Self – Determination Act was passed by the
U.S. Congress in 1990, it was not implemented until 1992. The act states
that all the health care institutions are required to give clients or patients an
opportunity to determine what lifesaving measures or life-prolonging actions
they want implemented. This requirement applies to all hospitals, long term
care facilities, and home health agencies and is to be done at the time of
admission. The institution is required to give adequate information to the
person and assist in completing any forms. In most situations, the nurse is
responsible for educating patients if there is not enough information to make
an informed decision.

The purpose of advanced directives is to give the person an

opportunity to make decisions regarding healthcare before an illness or a
need for treatment that would prohibit making such critical decisions.

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6. Negligence
The law requires nurses to provide safe and competent care. The
measure of safe and competent care is the standards of care. A standard of
care is the level of care that would be given by a comparable nurse in a
similar situation. Negligence occurs when a person fails to perform
according to the standards of care or as a reasonably prudent person would
perform in the same situation.

It is the responsibility of the nurse to monitor the patient. If a

patient calls for a nurse to come and assist him in going to the restroom for
example, the nurse is to assist, or if the is busy with another patient, have
another nurse assist the patient. Ignoring the patient or responding after a
lengthy delay could be considered negligence, and if the patient is hurt from
trying to move himself, the nurse could face legal suits. Also, it could be
considered negligence if a physician orders the nurse to administer a
prescription, and the nurse did not do so.

Requirements to establish Negligence

There are four legal requirements that must be met for negligence to be
proved:-

a) A standard of care exists.

b) A breach of duty or failure to meet the standard of care has occurred.
c) Damages or injury has resulted from the breach of duty. (This could be
commission of an inappropriate action or omission of a necessary or
appropriate act).
d) The injury or damage must result from the nurse’s negligence.

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 I have never met a nurse whose goal was to be negligent, but it doesn’t
happen. Examples of negligent acts are:-

e) Leaving a patient’s bed in high position with the side rails down and the
patient gets confused during the night and falls out of bed.
f) Committing medications errors of either omission (not giving the drug) or
commission (giving the wrong drug).
g) Breaking sterile technique when changing a dressing, with a resultant
wound infection.
h) Mistakenly ambulating a patient who is on bed rest.
Nurses are not supposed to make mistakes, yet the best educated and well
intentioned nurse can. To avoid neglect, you need to pay attention to the
details of your assignment and focus on managing your workload efficiently.
It is important to practice such skills now while you are a student and have
an instructor to help you determine the most effective way to get your work
done.

7. Malpractice
Malpractice is a term used for negligence. Malpractice specifically
refers to negligence by a professional person with a license. You can be sued
for malpractice once you have your LPN license. If you are a nursing
assistant right now, you may be negligent, but it wouldn’t be malpractice
because you are not licensed.

8. Fraud
Few cases of fraud exist in nursing, but it does need to be
mentioned. Fraud is a deliberate deception for the purpose of personal gain
and usually is prosecuted as a crime. Most courts are harder on cases of

33
 fraud compared with cases of negligence or malpractice because fraud is
deliberate and results in personal gain.

9. Assault and Battery

It is found that most nurses do not understand the definitions for
assault and battery. It is important to your practice that you do understand
them.

Assault is the threat of unlawful touching of another, the willful attempt to

harm someone. Battery is the unlawful touching of another without consent,
justification, or exercise. In legal medicine battery occurs if a medical or
surgical procedure is performed without patient consent.

In both situations, it is not necessary for harm to occur. The events

simply need to happen. If you understand and practice the caring and
empowering concepts shared in this test, you should never have to be
concerned about assault and battery.

Assault can be verbally threatening a patient. Rather than threaten

a patient, you need to use your creative tactics to assist the patient in
whatever is his or her choice in the matter. You do not have to hurt the
person. If you practice transpersonal caring, however you should not have to
be concerned with these legal issues.

10.False Imprisonment
Preventing movement or making a person stay in a place without
obtaining consent is false imprisonment. This can be done through physical
or non physical means. Physical means include using restraints or locking a
person in a room.Insome unique situations, restraints and locking patients in
a room are acceptable behaviours.This is the case when a prisoner comes to
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 the hospital for treatment or when a patient is a danger to self or others. In
these situations, be sure you know the standards of care and the institution’s
policies regarding physical restraints. To restrain a person is a serious
decision. It requires a physician’s order and permission of the patient or the
patient’s family members.

It used to be common practice to use restraints on nursing home

residents who wandered or had other behaviours that were difficult to
manage. This is no longer an acceptable standard of care. The best approach
to avoiding a charge of false imprisonment is to work closely with patients
who seem at risk for confinement. Talk to them, do an ongoing assessment,
assign extra staff to assist the person, or implement some other creative way
to manage the problem. To resolve such complex issues is truly practicing
the art of nursing.

11.Invasion of privacy
Clients have claims for invasion of privacy’, e.g. their private
affairs, with which the public has no concern, have been publicized. Clients
are entitled to confidential health care. All aspects of care should be free
from unwanted publicity or exposure to public scrutiny. The precaution
should be taken sometimes an individual right to privacy may conflict with
public’s right to information for e.g. in case of poison case.

12. Nurse Practice Act

Each state has what is called a Nurse Practice Act. The guidelines
and laws outlined in the act pertain to all nurses who are licensed in that
particular state. Nurse limitation is one of those laws. Each nurse has a
limitation on what he is allowed and trained to do. He must follow the chain

35
 of command, especially with the care of a patient. If he does not have the
authority or knowledge to give a prescription, analyze a lab report, or advise
the patient on treatment, he may not legally do so. Any wrong information or
practice he commits is punishable by the law and the patient or family may
file a suit against him and the health agency or hospital he works for.

13.Patient's Advocate
A nurse has a legal obligation to act as the patient's advocate in
case of emergency. The nurse is to act as the liaison between the patient and
the health care provider, such as a physician. The nurse will monitor the
patient, ensuring that if any complications or abnormalities arise, a physician
notified immediately. The nurse is legally obligated to keep the personal data
and information of the patient private; not doing so is a violation of the code
of ethics for nurses.

14.Administering Medication
Nurses are responsible for administering the correct doses and
medications to patients. If the nurse gives a fatal dosage amount, she may
face legal malpractice suits. It is also the responsibility to research the
patient's records, or ask the patient and family members if there are any
allergies or complications that may pose a risk if a certain medication is
administered.

15.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

36
 population (children, elderly, or domestic). If no report is made, the nurse is
liable for negligence or wrongdoing towards the victimized patient.

Examples of legal torts

a) Invasion of Privacy example: a nursing student observing a procedure

without the client's consent or taking photos of the client.
b) False imprisonment example is telling the client that he/she may not leave
the hospital or the use of restraints.
c) Battery example: performing procedure without consent such as
resuscitation.

16. 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 patient's privacy is breached,
the liability usually lies on the nurse because the nurse has immediate access
to the chart.

17.Document, Document, Document

It is the nurse's responsibility to make sure everything that is done
in regards to a patient's care (vital signs, specimen collections, 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

37
 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.

F. LEGAL ISSUES IN SPECIALTY AND PRACTICE AREA

i. MATERNAL AND INFANT NURSING

Many legal issues are involved in the care of mother and her
infant. Generally the causes of lawsuits for malpractice in this area may be
divided into two categories who handling the mother and child. Lawsuits
brought against physicians/ doctors and nurses differ, reflecting the well-
recognized differences between these professions and their responsibilities.

A likely against a doctor who is in charge of looking after mother and infant
might be one of the following:-

 Failure to diagnose a high risk pregnancy.

 Delay in performing a caesarean section.
 Improper vaginal delivery or failure to perform a caesarean section.
 Improper use of forceps.
 Incidence surrounding including labour and the use of oxytocin.
 Delay in arriving at the hospital.
 Non attendance at the delivery.

THE COMMON CAUSES FOR LAW SUITS AGAINST NURSES WILL

INCLUDE THE FOLLOWING:-

1. Problems of medication

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 Nurses are authorized to administration of medication. So many allegations
against nurses with regard to medication dosage, route or time, and failure to
monitor side effects, for e.g. nurses are often involved in the administration
of oxytocin for the augmentation of labour.

2. Failure in adequate client monitoring.

Nurses are expected to monitor their clients at appropriate time intervals that
depend upon the client’s condition. Labour and delivery pose a unique
monitoring challenge, in that there are two clients to monitor, the mother and
baby. The delivering mother must be adequately monitored to prevent any
maternal complications during prenatal period. Nurses have legal
responsibilities regarding fetal monitoring during labour. And prompt
monitoring will be continued during natal period, postnatal period to prevent
complication related to mother and child in respective periods.

3. Failure to adequately assess the client.

Every nurse regardless of the area of practice is expected by virtue of his or
her licensure to be capable of performing assessment. The nurse is an
important member of the health care team who is the client constantly, and
responsible for the minute by minute evaluation of the client progress.
Nurses in all specialty areas must maintain the higher level of assessment
skills.

4. Failure to report changes in the patient

Whenever the nurses’ assessment indicates that the client’s condition has
changed, the nurse must notify the concerned physician. For example the
nurses failure in reporting changes in the child, denied the physician the
opportunity to intervene and possibly save the child’s life. When a nurse

39
 reports a client’s changed condition to the physician, the nurse feels that the
physician has not responded in a manner that is in the client’s best interest,
the nurse must proceed up the chain of command until proper medical care is
given to the client. As a patient advocate, nurses must understand that failing
to notify a doctor of a problem often leads to a delay in appropriate medical
care being implemented. This in turn can lead to an injury to the client and a
lawsuit.

5. Abortions
Abortion is one of the emotionally charged issues confronting nurses. Nurses
cannot be forced to participate in procedures they find morally offensive.
Nurses have right to refuse to assist with abortions. However, nurses cannot
attempt to stop an abortion being performed. She can assist with abortion if
it is performed under Medical Treatment of pregnancy Act.

6. Nursing care of new born.

There are certain legal requirements in providing nursing care for newborns,
such as properly identifying the infant- mother pair as soon as possible with
finger prints, foot prints and wrist bands. Standards of practice include
providing a clear airway, clamping the umbilical cord, applying antibiotics
or silver nitrate to the edges, and minimizing stress of dying and keeping
infant warm. Resuscitation equipment must be in the delivery room. When a
still born infant is delivered, the nurse must record all events about the
delivery. Although the atmosphere in a delivery room is disquieting, the
nurse must complete legal requirement by careful documentation.

7. Informed Consent

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a) Before treatment, diagnostic procedures, or experimental therapy, a patient
must be informed of the reasons for the treatment as well as possible adverse
effects and alternative treatments.
b) The physician must obtain signed consent.
c) The nurse must ensure that signed consent is in the patient’s chart before the
procedure is performed.
8. Prenatal Screening
a) Can detect inherited and congenital abnormalities long before birth.
b) Early diagnosis may allow repair of an abnormality in utero.
c) May force a patient to choose between having an abortion and assuming the
emotional and financial burden of raising a severly disabled child.
d) Some feel that the risk it poses to the fetus creates a conflict between the
rights of the fetus and the parents’ right to know the fetus’s health status.
e) Helps the patient fully understand the procedure.
f) Pretest and posttestcounseling are essential parts of an ethical prenatal-
screening program.
9. In vitro fertilization (IVF)
a) With IVF, the ovum is fertilized outside the body and then implanted into
the uterus.
b) Between 15 and 20 embryos may result from a single fertilization effort.
c) Only 3 to 5 of these embryos are implanted in the women’s uterus.
d) Ethical questions arise as to what to do with remaining embryos.
e) Although the procedure has allowed infertile couples to have children, some
are concerned that it is unnatural.

10.Surrogacy

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a) A surrogate mother carries a fetus for another couple, with the expectation
that the couple will adopt the neonate after he is born.
b) Questions have evolved over the surrogate mother’s legal rights to the infant.

11.Fetal tissue research

a) Fetal tissue has facilitated scientific research for Parkinson’s disease,
Alzheimer’s disease, diabetes, and other degenerative disorders.
b) Transplanted fetal nerve cells help to generate new cells in the patient that
somehow reduce symptoms.
c) Immaturity of the fetal immune system reduces the chances of the recipient
rejecting the tissue.
d) Some are concerned whether the number of abortions will increase in
response to the need for tissue and whether this is an ethical use of human
tissue.

12.Preterm and high risk neonate treatment

a) Medical advances have improved survival rates for high risk neonates.
b) Some are concerned about the physical, psychosocial and economic costs.
c) The nurse must present all available options in a compassionate, unbiased
manner using simple terms.
d) The nurse must help family members consider the pros and cons both
initiating and withholding treatment.

ii. PEDIATRIC NURSING

As in all areas of nursing practice, negligence involving pediatric
clients is possible. Paediatric nurses are responsible for preventing children,
in their care, from accidentally harming themselves. Cribs which sometimes
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 have a restraining device over the top are designed to keep infants and
toddlers from climbing out of bed and injuring themselves. All poisonous
substances and sharp objects should be kept out of the reach of children.
Children should be kept under constant surveillance to minimize
opportunities for accidental harm.It is advisable that the health care
professional including nurses should report to the concerned authority if they
come across the suspected cases may be liable for civil or criminal legal
action.

Every state and province with child abuse legislation requires that
suspected child abuse or neglect be reported. HealthCare professionals such
as nurses are mandated to report suspected cases. Healthcare professionals
who don’t report suspected child abuse or neglect may be liable for civil or
criminal legal action.

Pediatric nurses are responsible for protecting children from

accidently harming themselves. All poisonous substances and sharp objects
should be kept out of reach to the children. Children should be kept under
constant surveillance to minimize opportunities for accidental harm.

iii. Medical Surgical Nursing

As in the case of pediatric clients, disoriented adults may require
form of restraints to prevent accidental self injury. Standard care, laws and
regulations about the use of restraints and supervision apply to nursing
practice with medical surgical patient. Side rails are available on most
hospital beds for adult patients. Some disoriented older patients may also
require belt restraints to prevent them falling of the bed. If patients fall off
bed and injure themselves, they may bring a lawsuit against the nurses and

43
 hospital. Nurses are responsible for performing all procedures correctly and
exercising professional judgement. A nurse who does not meet the accepted
standards of practice or who perform duties in a careless fashion runs a risk
of being found negligence. Some common acts of negligence in medical
surgical nursing are as follows:-

a) Over looked sponges, instruments needles

In the operation theatre, it is a responsibility of the nurse to count the
sponges, instruments, needles before the closure of the abdomen or any
cavity. The nurse may be liable if she makes an error in their court.

b) Burns
The professional nurse is required to know the cause and effect of any heat
application so as to avoid burns. Some of the common heat applications are
applications, of hot water bags, heating pads, double sitz bath etc. The nurse
could be held liable if she/he neglects to take proper safety measure prior to
application of such measures.

c) Falls
The nurse could be held liable if a patient falls from the bed or due to
improper securing of patient on examination table or improper application of
restraint or provision of a proper bed for an unconscious patient or a child.

d) Injury due to the use of defective apparatus or supplies

The defective bed pans infect patients. The nurse could be held liable if she
uses equipment or supplies them which she or he knows to be faulty, e.g. the
use of unsterilized gauze of surgical dressings.

e) Injury due to administration of wrong medicine, wrong dosage and

wrong concentration.
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 Administration of medicine without prescription by the concerned authority,
mixing up of poisonous and non poisonous drug in cupboards leading to
errors, and failing to identify right medication for right patient, in right
dosage, at right time, considered as negligent act can be liable to be used.

f) Assault and battery

Failure to take the informed consent of the patient prior to any procedure,
treatment, investigation or operation, the nurse be held liable.

g) Failure to report accidents

The nurse has a moral and legal responsibility to report to the concerned
authority any accidents, losses or unusual occurrences. Failure to do this is
an act of negligence.

h) Maintenance of records and reports

Failure to maintain accurate record and reports or removing a position of
record may also make the nurse liable. Nurses working in critical care units
are also legally accountable for performing their duties. Critical care nurses
require additional training and ongoing intensive education to provide them
with information about advances in care methods to handle high- tech-
machines and electric and electronic apparatus in addition to other critical
care nursing measures. The possible legal problems for critical care nurses
are associated with use of electronic monitoring devices. No monitor can be
considered totally reliable and nurse must not completely depend on it.
These may be electrical hazards. The equipment should be checked routinely
by engineers to ensure that a patient will not receive any electrical shock.

i) Critical care units

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 Nurses working in critical care settings are legally accountable for
performing their duties. Critical care nurses require additional training and
ongoing in service education to provide them with information about
advances in methods of patient care. Possible legal problems for critical care
nurses are associated with the use of electronic monitoring devices. No
monitor can be considered totally reliable, and the nurse must not completely
depend on it. There may also be electrical hazards. The equipments should
be checked routinely.

iv. PSYCHIATRIC NURSING

The practice of psychiatric nursing is influenced by the law,
particularly in concern for the rights of patients and the quality of care they
are receiving. A psychiatric nurse should be sufficiently acquainted with the
legal aspects of psychiatry so that she/he can be aware of the patient’s rights
and can avoid giving poor advice or innocently involving herself/himself in
a legal entanglement.

1. Informal Admission
This type of admission to the psychiatric hospital occurs in the same way as
a person is admitted to a general medical hospital, i.e. without formal or
written application. The individual is then free to leave at any time, as he
would be in a general medical hospital.

2. Restraints
3. Discharge

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 v. COMMUNITY HEALTH NURSING
In olden days nurses were working under the control and
supervision of doctors. But in modern practice nurses are able to assess,
diagnose, plan, implement and evaluate nursing care independently.

As we begin professional practice, it is essential to understand the

law that defines the nurse’s responsibility and duties. Especially the
community health nurse must be very careful while doing services in the
community. Because there is team of people working in the hospital.
Whereas in the community the community health nurses are alone and most
of the time she is in a position to implement the services at home. So, she
must be more careful and she should have enough knowledge on legal
issues.

1. Intentional Torts

a) Assault: It is a threat or an attempt to make bodily contact with another

person without that person’s consent.
b) Battery: It is an assault that is carried out with willful angry and violent or
negligent touching of another person’s body or clothes.
Examples:-

 Forcibly removing patient’s cloth.

 Injection with force or when refused by patient.
 Pushing a patient in floor or the chair.

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 c) Defamation: It is an intentional tort makes derogatory remarks about
another.
Slander: oral defamation of character.

Libel: Written defamation (petition)

E.g. About patient or co workers.

d) Invasion of Privacy
All information should be confidential.
Interacting with the family members.
Avoid unnecessary exposure.
Checking of all graduates or machines.
Carryout research activities.
Using tape recorder, video or photos.

e) False Imprisonment: A person cannot be legally forced to remain in health

centers or hospital. (Unjustified intension)
f) Fraud: Willful and purposeful interpretation or misinterpreting the outcome
of procedure or a treatment. (License may be prosecuted under the NP Act.

2. Unintentional Torts

a) Negligence: An act of negligence may be enacting of omission or

commission.

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b) Malpractice or Negligence
c) Liability: It involves four elements that must be established to prove that
malpractice or negligence has occurred.
d) Duty: Execution of safety measures.
e) Breach of Duty: Failure to note and report to the higher authority about the
seriousness.
f) Causation: Failure to use appropriate safety measures.
g) Damages: Lengthened hospital stay and need for rehabilitation (Injection
abscess)

Nurses Responsibilities

a) Practice within the scope of nurse practice act.

b) Observe agency policies and procedures.
c) Establish standards by using evidence based practice.
d) Always prefer patient’s welfare.
e) Be aware of relevant law and understand the limits.
f) Practice within the area of individual competence.
g) Upgrade technical skills by attending continuing nursing education (CNE)
and seeking certification.
h) Following the standards of care and referral services.
i) Ensure patient safety.
j) Proper action for needs and problems and appropriate treatment.
k) Monitor the programme and proper reporting.
l) Verify the medication errors and reactions.

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 Legal Safe Guards of Community Health Nurses

a) Informed consent: Granted freedom, written or oral form (procedures,

expected outcome, complication, side effects, and alternative treatment.
b) Contracts: Exchange of promises between two parties. The agreement may
be written or oral. (E.g. patient and his family and health care team.)
c) Collective bargaining: Policies, legal procedures, up to date knowledge.
d) Competent practice: It is most important and best legal safeguard.

Respecting Legal Boundaries

a) Institutional policies/ procedures should be adopted.

b) Respecting individual rights.
c) Developing rapport and working relationship with the community.
d) Keeping careful documentation for all activities.

XIII. ROLES AND FUNCTIONS OF ADMINISTRATOR IN ETHICAL

ISSUES

1. He or she is self aware regarding own values and basic beliefs about the
rights , duties and goals of human beings
2. Accepts that some ambiguity and uncertainity be a part of all ethical decision
making
3. Accepts that negative outcomes occur in ethical decision making despite
high quality problem solving and decision making.

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 4. Demonstrate risk taking in ethical decision making.
5. Role models ethical decision making which are congruent with the code of
ethics and inter respective statements
6. Actively advocates for clients , subordinates and the profession
7. Clearly communicates expected ethical standards of behaviour
8. Uses a systematic approach to problem solving or decision making when
faced with management problems with ethical ramifications

XIV. ROLE AND FUNCTIONS OF NURSE MANAGER IN LEGAL ISSUES

1. Serves as a role model by providing nursing care that meets or exceeds

accepted standard of care
2. Reports substandard nursing care to appropriate authorities.
3. Practices nursing within the area of individual competence.
4. Prioritize patients right and welfare first in decision making.
5. Delegates to subordinates wisely, looking at the managers scope of
practice and that of those they supervise.

XV. SUMMARY
Certain issues lead o decreased standardization like patient care issues,
management and employement issues. Issued need deliberations and
common consensus. They need to be reviewed periodically. Issues which
seem not feasible, and ideal, may become practice with the change of time.
Nursing is defined as providing care to the healthy or sick individuals for
preventive, promotive, curative and rehabilitative needs. The Consumers are
patients with complex needs. With increased awareness of health care, health
care facilities and consumer protection patients/clients are getting awareness
51
 about their rights. nurses also have now the expanded role, with the result
the legal responsibility is increased. Hence, it is important for nursing
personnel working in hospital, community and educational field to develop
understanding of Legal and Ethical issues of Nursing.

XVI. CONCLUSION

Nursing ethics is a branch of applied ethics that concerns itself with

activities in the field of nursing. Nursing ethics shares many principles with
medical ethics, such as beneficence, nonmaleficence and respect for
autonomy. It can be distinguished by its emphasis on relationships, human
dignity and collaborative care. The need of nursing is universal. Inherent in
nursing is respect for life, dignity, and rights of man; it is unrestricted by
considerations of nationality, race, creed, color, age, sex, politics or social
status, Nurses render health services to the individual, the family, and the
community and coordinate their services with those of related groups.
Nurses play an integral role in the healthcare system. This is why they have
been correctly referred to as the heart of health care. Being a nurse is one of
the best demanding profession in the world and needs a lot of dedication and
commitment to the job. Nurses have to juggle various roles. It is a nurse’s
professional responsibility to remain safe and competent by being a lifelong
learner and provide effective care to patients to avoid medicolegal issues,
employement issues can be avoided by proper recruitment system, staffing
and keeping adequate salary. A number of legal issues are related to nursing
practice including licensing, nurse practice acts, and standards of care.
However in these litigious times, the issue that most concerns those
considering a career in nursing are negligence and malpractice.
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3. BT Basavanthappa.(2009). Nursing Administration. Jaypee Brothers

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