VALDEZ, EDMARK MOISES

BSN-4

1) LEGAL RESPONSIBILITIES OF NURSES

Nurses have to abide by laws and regulations when practicing nursing. All of the
regulations and legal aspects of nursing are taught and explained to nurses throughout
nursing school. Not abiding by the code of ethics could cost the nurse his or her nursing
license and result in a malpractice suit.

Nurse Practice Act

Every state has a Nurse Practice Act, which states all the guidelines and laws for the
nurses who are licensed to practice in the state. The act includes the limitations and
training specifications of each nurse. This means that each nurse has been trained in a
specific area of nursing; therefore, the nurse must practice in that area only. If a nurse is
not trained to administer medication or treatment to a patient, the nurse is not permitted to
do so. The nurse must consult with a physician or other nursing authority when a
situation arises that the nurse is not certified to handle. Any wrongdoing is a violation of
this act, and the nurse may lose his or her nursing license, as well as having a suit filed
against him or her or the health care agency or hospital.

Patient Advocate
A nurse has the legal responsibility to be the advocate for the patient in all health care
instances, including emergencies. The nurse will be the liaison between the physician and
the patient. The nurse has the legal duty to monitor the patient and watch for any
abnormalities or complications that may occur. If any occur, the nurse must access a
physician to provide immediate care for the patient.

Administering Medication
Any nurse who is certified to administer medication to a patient must do so accurately
and timely. The nurse has the legal responsibility to interpret the charts and files of a
patient and to understand what allergic reactions patients may or may not have to a
certain medication. If a nurse does not administer the correct dosage or medication to a
patient, the patient could suffer major health risks or even death. This is grounds for a
malpractice suit against the nurse and health care facility.

Patient Neglect
The nurse will provide care for the patient he or she is monitoring at all times. If the
patient needs assistance with any issues, such as hygiene, the nurse has the legal
responsibility to assist the patient. If a nurse does not monitor and provide care to the
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patient, this can be considered patient neglect, which is unethical and illegal. The patient
may try to move and use the restroom on his or her own and may be physically injured in
the process. Some patients may harm themselves while under the influence of
medication, which should not happen if the nurse is paying proper attention to his or her
patient.

Consent Forms
Nurses have the legal responsibility to explain all treatment, medications and lab results
to patients or authorized family members of patients. Before a patient may undergo
surgery, he or she will need to sign a consent form. If the nurse is administering the
treatment, such as anesthesia, it is the nurse’s legal obligation to explain the negatives
and positives of the anesthesia. The patient or family member must then sign a consent
form acknowledging that the patient understands the procedure. If this form is not signed
and complications occur, the nurse may face legal consequences.

2) Role of the Nurse in Record Management such as:

PATIENT’S CHARTS AND RECORD

Documenting the care and treatment each patient receives is a primary duty for a nurse. Although
some might argue that documentation is not as important as direct care for the patient, proper
documentation actually helps the rest of the medical team provide effective treatment. This
information is used to plan and adjust a patient's course of treatment and to accurately bill for
services. In addition, documentation protects the nurse from malpractice suits. Proper charting is
critical to protect the medical facility and nurses from legal action and to provide the best care
possible for patients.

Relevant Information
Nurses document basic health information, such as the patient's vital signs, complaints, medical
tests ordered and their results. In addition, nurses can record symptoms or behaviors they
personally witness. These should be objective observations relevant to the patient's health, rather
than subjective opinions on the patient's feelings or attitudes. Nurses also record when they
administer treatments and medication; physicians orders; and any changes in the patient's status.
While a patient's medical diagnosis is an important part of a complete chart, nurses do not make
a diagnosis; this is the responsibility of the physician.
Clear and Accurate Entries
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Nurses must complete entries using legible handwriting. Charts should include only factual
information and not a nurse's opinions. Abbreviations should only be used if approved by the
medical facility's policies and must be used consistently. Nurses should document care as soon as
possible after treatment, and charts should include the time that care was given.
Correcting Errors
It is illegal to alter a patient's medical record. If a nurse makes a mistake while writing an entry,
the proper way to correct the mistake is to draw a line through the error and sign or initial the
change. Do not use correction fluid to erase mistakes. Additionally, nurses must not destroy
medical records or make back-dated entries.
Legal Considerations
Proper charting not only facilitates quality care, but patient charts are also a primary piece of
evidence in medical malpractice suits against nurses. Each state has a statute of limitations, or a
limited time period during which the patient may file a lawsuit. In Pennsylvania, for example, the
statute of limitations is two years. Reviewing the chart allows nurses to recall the case and the
actions they took, and also allows attorneys to review the treatment provided to patients. If a
nurse fails to accurately complete a chart, she may be found negligent in her duties.
Electronic Medical Records
Some medical facilities use electronic medical records, which require the same proper charting
steps as paper records. Nurses must ensure that records are accurate and contain all of the
required information. In addition, nurses must protect their access password so that records may
not be tampered with. After entering their notes and documentation, nurses must save their work
and close the screen to protect patient privacy.

KARDEX
The nursing kardex is a vital tool used to communicate primary patient care issues between
shifts. Details such as code status, medical history, family dynamics, mobility assistance,
nutritional needs, etc. are communicated via the nursing kardex. Changes in patient status are
updated during each shift so that the oncoming shift receives an accurate summary of critical
patient information.

INCIDENT REPORT
As a nurse, you have a duty to report any incident about which you have firsthand knowledge.
Failure to do so could lead to termination. It could also expose you to liability, especially in
cases of patient injury. Protect yourself and your patients by filing incident reports anytime
unexpected events occur.  

If you’re the one who discovers the incident, or you have been involved in the situation leading
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up to it and know more about it than your colleagues, filling out an incident report is your
responsibility. You’re expected to complete it before the end of the shift during which the
incident occurred or was discovered. 

SENTINEL EVENT
A sentinel event is a patient safety event that results in death, permanent harm, or severe temporary
harm. Sentinel events are debilitating to both patients and health care providers involved in the event.

3) Nurses Role in Establishing Collaborative Relationship in the Delivery of Health

Care 
      
Programs and Systems
Nurses are the only clinical professionals who are specially trained to understand the roles of
other healthcare providers, this training provides a strong foundation for successful
collaboration.

Effective communication is critical for a collaborative care plan to work; nurses are trained to
have adaptability, empathy, and communication skills, which allows for them to be excellent
leaders and members of a care team.

Nurses’ ability to understand and assess a patient’s clinical, emotional, and social needs can help
them to call upon available resources and create a patient-focused care plan. As nurses are
offering direct patient care around the clock, they have a unique and focused view of how that
care should be provided.

Nurses can be role models in their honest and open communication with team members about the
quality of patient care which is being provided and the work environment.

4) STAFFING
Process of assigning competent people to fulfill the roles designated for the organizational
structure through recruitment, selection and development, induction and orientation of the new
staff of the goals, vision, mission, philosophy etc.

PRINCIPLES
Definition of Appropriate Nurse Staffing
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Appropriate nurse staffing is a match of registered nurse expertise with the needs of the recipient
of nursing care services in the context of the practice setting and situation. The provision of
appropriate nurse staffing is necessary to reach safe, quality outcomes; it is achieved by dynamic,
multifaceted decisionmaking processes that must take into account a wide range of variables.
Core Components of Nurse Staffing
• Appropriate nurse staffing is critical to the delivery of quality, cost-effective health care.
• All settings should have well-developed staffing guidelines with measurable nurse sensitive
outcomes specific to that setting and healthcare consumer population that are used as evidence to
guide daily staffing.
• Registered nurses are full partners working with other healthcare professionals in collaborative,
interdisciplinary partnerships.
• Registered nurses, including direct care nurses, must have a substantive and active role in
staffing decisions to assure the necessary time with patients to meet care needs and overall
nursing responsibilities.
• Staffing needs must be determined based on an analysis of healthcare consumer status (e.g.,
degree of stability, intensity, and acuity), and the environment in which the care is provided.
Other considerations to be included are: professional characteristics, skill set, and mix of the
staff, and previous staffing patterns that have been shown to improve outcomes.
• Appropriate nurse staffing should be based on allocating the appropriate number of competent
practitioners to a care situation; pursuing quality of care indices; meeting consumer-centered and
organizational outcomes; meeting federal and state laws and regulations; and attending to a safe,
quality work environment.
• Cost effectiveness is an important consideration in delivery of safe, quality care.
• Reimbursement structure should not influence nurse staffing patterns or the level of care
provided.

Needs
The scope of nursing practice must be considered when determining staffing needs. According to
the American Nurses Association, the scope of nursing practice includes:

 assessment
 nursing diagnosis
 outcomes identification
 planning
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 implementation
 coordination of care
 health teaching and health promotion
 consultation
 prescriptive authority and treatment (for advanced practice registered nurses)
 evaluation

Procedure
 Determine the number and types of personnel needed to fulfil the philosophy, meet fiscal
planning responsibilities, and carryout the chosen patient care management organization
 Recruit, interview, select, and assign personnel based on established job description
performance standards.
 Use organizational resources for induction and orientation
 Ascertain that each employee is adequately socialized to organizational values and unit
norms.
 Use creative and flexible scheduling based on patient care needs to increase productivity
and retention
 Develop a program of staff education that will assist employees meeting the goals of the
organization.

Scheduling
Scheduling
 Timetable showing planned work days and shifts for nursing personnel.
Issues to consider in scheduling staff:
1. Patient type and acuity
2. Number of patients
3. Experience of Staff
4. Support available to the staff
Shifting Variations
 Traditional Shifting Patterns
 3 shift (8 hr shift)
 12 hr shift
 10 hr shift
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 Weekend option
 Rotating work shift
 Self-scheduling – staff makes their own schedule
 Permanent work shift
 Floaters – “on-call”
Forty Hour Week Law – based on RA5901
 No work, no pay
 Entitled to 2-week sick leave and off duty for 2 days
 Special Holidays – with pa

5. Filipino Management Styles

Today, nursing management is viewed as a profession of its own, requiring special training,
skills, and characteristics (which typically come more naturally to some than others). As a
fundamental component to drive a team’s motivation, performance, and job satisfaction,
effective nurse management is of the utmost importance to hospitals and health systems.
Building upon this logic, nurse managers with a solid understanding of their own nursing
leadership style will be more successful in managing their team/unit, ultimately driving better
patient care.

The most effective leadership styles in nursing management understand that both nursing staff
and patients benefit from the unit acting as a team. Realizing that the success of the unit heavily
relies on the strength of the nursing leader should implore nursing leaders to understand the
different types of leadership styles in nursing management. Once a foundational understanding
of the leadership styles in healthcare is established, nursing leaders can take personal inventory
of how they fall into current styles, while also assessing which styles they might be more
successful with in the future. The American Association of Nurse Assessment Coordination
(AANAC) recognizes the following five nursing leadership styles as:

 Transformational
 Democratic
 Laissez-Faire
 Autocratic
 Servant