VISIBILITY OF NURSES

INTRODUCTION
“Although nurses comprise the majority of health care professionals, they are largely
invisible.Their competence, skill, knowledge are as a word image that suggest only a reflection, not
reality”. (Sullivan E J 2004). The public of nursing and nurses are typically based on personal
experienced with the nurses which can lead to narrow view of nurses are often based on brief
personal experience. This experience may not provide an accurate picture of all that nurses can do
provide in the healthcare delivery system. The truth is that most often the nurse is invisible. When in
the hospital, the patients interact with many staff and there is little to distinguish from one another,
so the patient may refer to most staff as nurse.
This does not mean that people does not value nurses, they do. However many people do not know
about the education required to become nurse or about the variety of educational entry points into the
nursing that lead to RN qualification. Nurses need to present themselves as profession through all
with whom they come in contact.

Visibility of nurses
Meaning
• A quality or fact of, degree of being visible.
• Degree of exposure to public notice
• Capacity of providing a clear un obstructed view.

Strategies to improve the visibility of nursing

1. Collective bargaining
Collective bargaining is the process by which unions participate in administrative division
involving the terms of employment and the price of labor. Labor union tries to expand and strengthen
the position of the nurse as a large, potentially strong and powerful group of professional people.
Nurses must continue to foster a positive powerful image and continue to organize.
2. Computer technology
The visibility of nurses can be influenced by the increase in computer technology. The
development and implementation of computer technology enhances the management and delivery of
healthcare, and will continue to do so in the future. Documentation, care planning, laboratory values,
quality management and administrative records can be computerized. Nurses save time by assessing
a computerized system.to acquire the necessary skill; nurses must become educated and proficient in
computer technology.
3. Elimination of external sexism
Sexism continues to harm and disrupt the professional visibility of nursing. Nursing is not limited
to one gender; nursing is genderless and its potential is equally as limitless. It is suggested that
increasing the number of male nurse will make the profession a different one. The nursing profession
and practice will also take on an improved public visibility of nurses by having more balance
between men and women.
4. Development of internal media committee
Internal media, in the form of catalogs, brochures, newsletters, annual reports, advertisements,
films and educational materials are important to any health care institutions relations but should be
viewed as having equal importance to the image of nursing. It is suggested that the health care
facilities should have an internal media committee. Nurses must become active in such committee
and actively review all materials, paying special attention to the effect these materials have on the
visibility of nurse. Nurses must work with the public relation committee to ensure that nursing is
represented in a positive professional manner to people.
5. External media committee
The mass media, print and broadcast are the most pervasive influences on public attitudes and
opinions in contemporary life. Numerous nurses and group of nurses suggest that external nursing
media committees be organization. These media watch groups must take responsibility for
monitoring the media for all references to nursing. The groups must respond to the media for positive
and negative referrals to nursing
6. Education
The visibility of nurses is changing due to the elevated efforts of our nursing leader to attain the
highest level of competency possible for our profession. The expectation for nursing today call
educated and motivated individual, so education strategies has become one of the important
strategies for improving visibility for nurses.
7. Marketing
As the nursing profession works to upgrade its visibility, marketing strategies are important. It is
crucial that nursing services, nursing programs and the nursing profession be strategically marketed
to a wide range of audience to promote nursing excellence and to project an achievement oriented,
professional visibility of nursing.

Nursing responsibilities for improving its own visibility

 Recognize that an image problem does exist and that each nurse has a responsibility to
improve the professions visibility.
 Strengthen involvement in professional organization, collectively, nursing is extremely
powerful.
 Provide all nurses including staff nurses to become salaried staff members rather than hourly
wage earners.
 Become politically active and politically knowledgeable, nurses should run for office.
 Document activities, it shifts the balance of power and allows nurses to state their case on a
rational basis.
 Demand that nurse authors be considered for editing health columns.
 Provide technical assistance to the media.
 Improve the community image volunteer for community sponsored activities.
 Revise and update nursing career literature, especially books in schools and public libraries
that introduce the profession to projective nurses.
 Establish school of nursing as research and information centers for people experiencing,
critical health care issues e.g. AIDS, homelessness.
 Be self-confident, self-confident behavior commends respect.
 Share the positive aspects of the nursing profession with others.
 Learn to describe nursing responsibilities in clear, non-technical terms.
  Continue to develop alterative nursing education programs designed for adult nurses needing
to advance their education.
 Increase visibility makes service that client and their families know that nursing staff is
responsible for 24hour care.

Visibility of nurse in cyberspace.

“Healthcare professionals have been quick to ride the wave of the Internet revolution by
learning to use various kinds of internet tools that allow them to interact with each other,
unrestrained by national and geographical boundaries, time, and distance. They develop collaborative
research ideas and exchange information through the use of electronic mails, subscribe to electronic
newsgroups and participate in discussion lists”.

New forms of visibility of nursing

Nursing work is made visible by its own definition, measurements’ and enumeration;
similarity, these are key elements in the governing process, as they allow for evaluation, judgment
and review. Initially, embryonic technologies produced nursing knowledge by recording the type,
number and outcomes of various patients (Winch 2001). These early conceptions of nursing work
have been extended and refined through medical record keeping, and the production of quantitative
and qualitative nursing research continuing until the present. The evaluation of nursing work through
evidence based reviews provides detailed information that may enable governments to target and
instruct nurses regarding their work.

CONCLUSION
In short, the major responsibility for improving the visibility of nurses lies in the nursing
profession itself. Black and Germaine Warner suggested a variety of things nurses can do including
recognizing that each nurse should work to improve nursing’s image, participating in professional
organization becoming politically active, writing for local media, providing technical assistance to
the media, taking advantage of public speaking opportunities and sharing positive aspects of nursing
with others.
 LEGAL CONSIDERATION

INTRODUCTION:
Safe nursing practice includes an understanding of the legal boundaries within which nurses
must function. As with all aspects of nursing today an understanding of the implications of the law
supports critical thinking on the nurse` s part. Nurses must understand the law to protect themselves
from liability and to protect their clients` rights. Nurses need not fear the law be rather should view
the information that follows as the foundation for understanding what is expected by our society
from professional nursing care providers.

CONCEPT OF LAW

MEANING OF LAW
“Law is a rule or a body of rules of conduct inherent in human nature and essential to or
binding upon human society and to guide human functions”.
“ Law is the body of principles recognized and applied by the state and the
administration of justice”.

PURPOSE OF LAW
 To define relationships among the members of a society and between individuals and groups
as they arise
 To define which activities are permitted and which are not.
 To allocate authority.
 To dispose of troubled cases as they arise.
 Functions of law in nursing

Terminologies related to law

Malpractice is defined as professional misconduct, unreasonable lack of skill or fidelity in
professional duties, evil practice, or illegal or immoral conduct.
Assault is any willful attempt or threat to harm another, coupled with the ability to actually harm the
other person.
Battery is any intentional touching of another` s body or anything the person is touching or holding
without consent.
Contract is a written or oral agreement between two people in which goods or services are
exchanged.
Tort is a civil wrong for which remedy is common law action for liquidated damages and which is
not exclusively the breach of contract or breach of trust or other merely equitable obligation.
Negligence is the failure of an individual to do something that reasonably prudent person would do
or the commission of an act in particular circumstances in standard of care to which a nurse is legally
bound, would not do under similar circumstances.
Informed consent is a person` s agreement to allow something to happen (such as surgery) based on
a full disclosure of facts needed to make an intelligent decision (i.e., knowledge of risks involved,
benefits, alternatives, or consequences of refusal).
Crime is an offense against society that violates a law.
Felony is a crime of a serious nature that has a penalty of imprisonment for greater than 1 year or
even death.
Misdemeanor is a less serious crime that has a penalty of a fine or imprisonment for less than 1
year.
Fidelity refers to the agreement to keep promises.

TYPES OF LAW
Two types of laws are public law and civil law;
1. Public law governs the relationship between individual and the government and
governmental agencies.
2. Private law is the body of law deals with relationships among private individuals.
3. Contract law involves the enforcement of agreements among private individuals or the
payment of compensation for failure to fulfill the agreements.
4. Tort law defines and enforces duties and rights among private individuals that are based on
contractual agreements.

SOURCES OF LAW
Constitutional law: Constitutional law deals with the relationship between the state and the
individual and the relationships between different branches of the state, such as executive, the
legislative and the judiciary.
Administrative law: Administrative law refers to the body of law which regulates bureaucratic
managerial procedures and defines the powers of administrative agencies.
Criminal law: Criminal law involves the state imposing sanctions for crimes committed by
individuals so that society can achieve justice and a peaceful social order.

IMPORTANCE OF LAW IN NURSING

 It provides patients against deliberate and inadvertent injury by a nurse.
 It protects the nurses against the suits if she renders right care.
 It provides a framework for establishing which nursing actions in the care of clients are legal.
 It assists in maintaining a standard of nursing practice by making nurses accountable under
law.
 It differentiates the nurse’s responsibilities from those of other health professional.

LEGAL LIMITS OF NURSING

Licensure Standard of care

Drug maintenance

Student nurses
LEGAL LIMITS
Documentation

Standing orders
Correct identity Informed consent
Licensure:
All registered nurses and licensed practical nurses are licensed by the board of nursing of the
state or province in which they practice. The requirements for licensure vary, but requirements for
education are in most licensing acts, and the nurse must pass an examination. Licensure permits
persons to offer special skills and knowledge to the public, but it also provides legal guidelines for
protection of the public. All states use the National Council Licensure Examinations (NCLEX) for
registered and licensed practical nurse examinations.
A nurse`s license can be suspended or revoked by the board of nursing if conduct violates
provisions of the licensing statue. For example, nurses who perform illegal acts such as selling or
taking controlled substances jeopardize their license status. Before licenses are revoked, nurses must
be notified of the charges and permitted to attend a hearing to present evidence on their own behalf.
These hearings are not court proceedings but are usually conducted by the state or provincial board
of nursing. Some states are provinces provide for judicial review of such cases if the nurse has
exhausted all other forms of appeal.
Standards of Care:
One of the functions of law is to define the standards of care the nurse must provide. All U.S.
state legislatures and Canadian provincial parliaments have passed nursing practice acts that define
the scope of nursing practice.
Professional organizations are another source for defining the standards of care. The
American Nurses Association (ANA) and Canadian Nurses Association (CNA) have developed
standards for nursing practice, policy statements, and similar resolutions. These standards are very
general and include such recommendations as the obligation to provide continuing education
programs.
The written policies and procedures of the employing institution detail ways in which the
nurse is to perform duties. Such policies are usually quite specific and are set forth in procedure
manuals found in most nursing units. For example, a procedure and policy outlining the steps that
should be taken when changing a dressing or administering medication gives specific information for
nurses to perform these tasks. These policies provide another definition of standards of care.
Policies and procedures of institutions may be more restrictive than nurse practice acts, but they can
never request a nurse to act beyond the standards of practice allowed by law.
Student Nurses:
If clients suffer harm as a direct result of nursing students` actions, the liability for the
incorrect action is generally shared by the student, instructor, and hospital or health care facility.
Student nurses should never be assigned to tasks for which they are unprepared and should be
carefully supervised by instructors as they learn new procedures. Although student nurses are not
considered employees of the hospital, the institution has a responsibility to monitor the acts of
nursing students. Student nurses are expected to perform as a professional nurse would; the law does
not provide for a difference in quality of care rendered to clients (Ulys, 1988).
Sometimes, student nurses are employed as nursing assistants or nurse` s aides when they are
not attending classes. If student nurses are so employed, they should not perform tasks that do not
appear in a job description for a nurse` s aide or assistant. For example, even if a student has learned
to administer intramuscular medications in class, this task may not be performed by a nurse`s aide.
Standing orders
Nurses are requested to execute prescribed orders. In case of emergency or the doctor/
medical personnel is not available, each nursing service area should have standing instructions or
orders for the nurses to carry out.
Informed Consent
Informed consent is a person` s agreement to allow something to happen (such as surgery)
based on a full disclosure of facts needed to make an intelligent decision (i.e., knowledge of risks
involved, benefits, alternatives, or consequences of refusal) (Black 1979). The law has long
recognized that individuals have the right to be free from bodily intrusion. The doctrine of informed
consent not only requires that a person be given all relevant information required to reach a decision
regarding treatment, but also that the person be capable of understanding the relevant information
and does, in fact, give consent. One who performs a procedure on a client without informed consent
may be found civilly liable for committing battery.
A signed consent form is required for all routine treatment, hazardous procedures such as
surgery, some treatment programs such as chemotherapy, and research involving clients (JCAHO,
1993). A client signs general consent forms when admitted to the hospital or other health care
facility. Separate special consent forms must be signed by the client or a representative before
specialized procedures are performed. The following factors must be verified for consent to be valid
(Fiesta, 1988; Prosser and Keeton, 1988):
1. The person giving consent must be mentally and physically competent and be legally an
adult.
2. The consent must be given voluntarily. No forceful measures may be used to obtain it.
3. The person giving consent must thoroughly understand the procedure, its risks and benefits,
as well as alternative procedures.
4. The person giving consent has a right to have all questions answered satisfactorily.
If a client is deaf, illiterate, or has some other impediment of communication (such as
speaking a foreign language), an interpreter should be available to explain the terms of consent.
Correct identity
All babies born in the hospital are correctly labeled at birth and to ensure that at no time
they are placed in the wrong cot or handled to the wrong mothers. All people in the hospital should
wear identity card. Every patient before being given premedication for any operation should be
labeled in the manner approved by the hospital.
Documentation
Keeping accurate and comprehensive records are essential in any health care facility.
Records provide a legal and business document. Regardless of the format used to record the data, it
should be accurate, concise and up to date. Verbal orders if carried out, then it should be documented
or written as “told over phone or verbal orders carried”, etc. if a proper documentation is done by for
the activities done by the nurse, then she is safe in the hands of law.
Drug maintenance
Checking the unlawful use of narcotic drugs is liable to drug dependence. These drugs should
be kept under lock and key.
LEGAL LIABILITY IN NURSING
When the nurse fail to meet the legal expectation of care, the client can initiate action if harm
or injury incurred by the client. These are mostly unintentional and intentional tort.
1. Unintentional tort
These types of tort are accidents that cause injury to another person or property.
Negligence and Malpractice are the examples of unintentional tort.
Negligence :
Negligence is conduct that falls below the standard of care. It is established by law for the
protection of others against unreasonable risk of harm, and it is characterized chiefly by
inadvertence, thoughtlessness, or inattention (Black 1979).
If nurses give care that does not meet appropriate standards, they may be held liable for
negligence. Negligence may involve carelessness, such as failing to check a client` s arm band and
then administering the wrong drug. Another example of negligence may be administering a
medication even when it has been documented that the client has an allergy to that medication.
However, carelessness is not always the cause. If nurses attempt a procedure for which they have not
been trained and does it carefully but still harm the client, a claim of negligence could be made.
Nurses have been involved in several common negligent acts including the following.
 Intravenous therapy errors resulting in infiltrations or phlebitis.
 Burns to clients
 Falls resulting in injury to clients.
 Failure to use aseptic technique where required.
 Errors in sponge, instrument, or needle counts in surgical cases.
 Failure to give a report, or to give an incomplete report, to an oncoming shift.
Nurses are responsible for performing all procedures correctly and for exercising professional
judgment as they carry out the orders of physicians and duties not ordered but for which they have
authority: And nurse who does not meet accepted standards of care while discharging duties or who
performs duties carelessly runs a risk of being found negligent.
Malpractice
Malpractice is one type of negligence. It is defined as professional misconduct, unreasonable
lack of skill or fidelity in professional duties, evil practice, or illegal or immoral conduct (Black
1979). In a malpractice lawsuit against a nurse, the following criteria must be established.
 The nurse (defendant) owned a duty to the client (plaintiff).
 The nurse did not carry out that duty.
 The client was injured
 The client` s injury was a result of the nurse` s failure to carry out his or her duty.
 These are the criteria for every type of tort, not only malpractice (Prosser and Keeton, 1988).
The best way for nurses to avoid being named in law suits is to follow standards of care, give
competent health care, document assessments, interventions and evaluations fully, and develop
empathetic rapport with the client. Poor client relations are leading causes of lawsuits. A client who
believes that the nurse performed duties correctly and was concerned with his or her welfare is
unlikely to initiate a lawsuit. In addition, careful, complete, and objective documentation are keys to
avoiding malpractice.
 Assault is any willful attempt or threat to harm another, coupled with the ability to actually
harm the other person. The victim believes harm will come as a result of the threat (Black 1979).
Assault may be subtle; for example, a nurse might attempt to coerce a client into taking a drug he or
she does not wish to take. A more blatant example might involve a nurse handing an uncooperative
client in the emergency room. If the exasperated nurse yells. “If you don` t take off those filthy
clothes, I` m going to rip them off you!” and moves toward the client, a claim of assault could be
made.
Intentional tort
These types of torts are deliberate actions in which the intent is to cause injury to a person or
property these are more likely to be assessed against nurses and some intentional torts fall under the
criminal law, if there is gross violation of the standards of care. The following are some of the
intentional torts.
Battery
Battery is any intentional touching of another` s body or anything the person is touching or
holding without consent. Injury is not a requirement (Black 1979). There have been instances of
battery of confined clients by personnel in mental institutions (J. Health and Hospital Law, 1989). In
a less drastic case, if a nurse attaches fetal electrodes during labor without the consent of the mother,
a claim of battery could be made. The important issue is the client` s informed consent, which will
be addressed later in the chapter.
In some situations consent is implied (Prosser and Keeton, 1988). For example, if a nurse
says, “I have your injection, Mr. Jones,” and the client holds out his arm, he is giving implied
consent to the injection.
Whether the procedure that constitutes battery helps the client is unimportant. In a classic case from
1905, Mohr V Williams, the client gave written consent for surgery on his right ear. After the client
was anesthetized, the physician discovered that the left ear was more seriously affected, and he
operated on the left ear. The client sued because surgery was performed on the “wrong” ear.
Invasion of Privacy
Clients have claims for invasion of privacy when their private affairs, with which the public
has no concern, have been publicized (Prosser and Keeton, 1988). A client is entitled to confidential
health care. All aspects of care should be free from unwanted publicity or exposure to public
scrutiny (Calloway, 1986). An example of invasion of privacy occurs when clients are unnecessarily
exposed in the room or in the corridors.
Another form of invasion of privacy is the release of information to an unauthorized person
such as a member of the press or the client` s employer. Gossiping about a client` s activities is
another form of invasion of privacy and could lead to a charge of slander against the nurse. Another
example is a nurse ` s unwanted intrusion in private family matters. A nurse has no right to intrude
in matters not directly related to the client` s well-being. For example, a nurse should respect a wish
not to inform the client` s family of a terminal illness.
Defamation of Character
Defamation of character is the holding up of a person to ridicule, scorn, or contempt within the
community (Black 1979). There are two types of defamation: slander and libel (Prosser and Keeton,
1988). For example, if a nurse tells a client that his physician is incompetent; the nurse could be held
liable for slander. If the nurse writes such a comment, the charge would be libel. The important
issues in a claim of defamation of character are whether the information was shared with third
persons (other than the client) and if harm has been done to the reputation of the plaintiff (Prosser
and Keeton, 1988).

LEGAL ISSUES IN NURSING

Legal issues in nursing practice reflect the changing trends in technology, medical
advancements and increased awareness among the patients.
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 and 1967. The misuse of drug act aims at checking the unlawfully use of the drugs
liable to produce dependence or cause harm if misused. A drug affected by this act is referred to as
controlled drugs. The common controlled drugs under the dangerous drug act involves cocaine,
heroin, methadone, morphine, opium, pethidine, hallucinogens,etc.
Controlled substances should be kept securely locked, and only authorized personnel should
have access to them. Criminal penalties for misuse of controlled substances exist. There have been
cases in which physicians have illegally prescribed and dispensed controlled substances, and if
nurses employed by such physicians fail to report these activities, they may be legally accountable
for aiding and abetting the physicians.
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 referred to care for
an AIDS patients.
Death and Dying
There are many issues regarding definition of death. The law identifies that death occur
when there is a greatly diminished brain function, despite function of other body organ. Even though
the client may be legally the brain death, the actual pronouncement of death is usually the legal
responsibility of the physician, nurses must be aware of legal definition of death.
Autopsy and Organ donation
Legally competent persons are free to donate their bodies or organs for medical use. Consent
forms are available for the purpose. The nurse must be aware of the policies and procedures of
institutions and the laws in the state where they are asked to serve as a witness for a person who
wishes to give consent for a donation
Living Wills and Health care Surrogates
Living wills are documents instructing physician to hold or withdraw life –sustaining
procedures whose death is imminent. Each state providing for providing living will need two
witness, either of whom can be a relative or doctor are needed when the client sign the documents,
medical special directives also must be legally prepared with the appropriate witness of the client’s
signature. Client executes these documents to appoint someone to make health care decisions if and
when they are no longer able to make decision on their own behalf.
E.g. In terminally ill state and persistently vegetative state. Nurse should be aware of institutional
policies with the patient’s self-determination act.
Patient’s property
 Many of the unconscious patients admitted in emergency their belonging should be listed,
checked by two nurses and put in safe keeping. While a patient is in hospital, the nurse has no right
to go through his locker or personal property without his consent unless it is suspected that the
patient intent to injure him or others and has the means to do so. When the patient has died in
hospital, his possessions must be recorded in the property book, but money and valuable should be
listed and packed separately. Also write the color of ornaments and also inform to administrative
officers. Preoperatively and during delivery, these things should be taken care of.

LEGAL CONCEPTS AND NURSING PRACTICE:

In addition to encountering legal problems in the care of clients, nurses may share liability for
errors made by physicians and other health care personnel or for inadequate care provided by their
employing institutions.
Physician Orders:
The physician is responsible for directing the medical treatment of a client. The nurse is
obligated to follow the physician` s order unless he or she believes the order is in error or would be
determined to clients. Therefore all orders must be assessed, and if one is determined to be
erroneous or harmful, further clarification from the physician is necessary (Cushing, 1990;
Cournoyer, 1989). If the physician confirms the order, but the nurse still believes it is inappropriate,
the supervising nurse is informed. A written memorandum to the supervisor detailing the events in
chronological order and the reasons for refusing to carry out the order should protect the nurse from
disciplinary action. The supervising nurse should help resolve the questionable order. A nurse who
carries out an inaccurate order may be legally responsible for harm suffered by the client (Cushing,
1990).
The physician should write all orders, and the nurse should be sure they are transcribed
correctly. Verbal orders are not recommended because they leave possibilities for error. If a verbal
order is necessary as in an emergency, it should be written and signed by the physician as soon as
possible, usually within 24 hours (JCAHO, 1933).
A difficult area regarding physician orders involves an order of “no code” or “do not
resuscitate” (DNR) for a terminally ill client. In the past many physicians were reluctant to write
such an order because they feared legal repercussions for “abandoning” a client (Younger, 1987). If
a physician has documented in his progress notes that the client` s condition is deteriorating and that
the decision not to administer cardiopulmonary resuscitation has been made, the physician us
perfectly justified in writing a no code order. Unless the physician decides that such a discussion
would be detrimental to the client` s condition, the order should be discussed with the client. In such
cases, the physician should also discuss the order with the family. A no code order should be
written, not given verbally. Physicians should regularly review DNR orders in case the client` s
condition warrants a change. The nurse should be familiar with the institution` s policies and
procedures concerning DNR orders. Physicians can list all specifics of DNR orders. For example, a
physician may order vasopressors and fluid management to maintain a client` s blood pressure. But
also state DNR in the presence of cardiac standstill, lethal dysrhythmias, or respiratory arrest.

Short Staffing
During nursing shortages, the issue of inadequate staffing may arise (Horsley, 1981). The
JCAHO has established guidelines for institutions to determine the level of staff needed. These are
referred to as staffing rations. Legal problems may arise if there are not enough nurses to provide
competent care (Rosen, 1990). If assigned to care of more clients than is reasonable, nurses should
attempt to reject assignments by informing the nursing supervisor that they are inappropriate. If
nurses are required to accept the assignments, they should make written protests to nursing
administrators. Although these protests would not relieve nurses of responsibility if clients suffered
because of inattention, it would show that the nurse was attempting to act in good faith. Nurses
should not walk out when staffing is inadequate because a charge of abandonment could be made.
Nurses are sometimes required to “float” from the area in which they normally practice to
other nursing units. In one case, a nurse in obstetrics was assigned to an emergency room. A client
entered the emergency room and complained of chest pain. He was given a markedly increased
dosage of lidocaine by the obstetrical nurse and died after suffering cardiac arrest and subsequent
irreversible brain damage. The nurse lost the malpractice lawsuit brought against her (Goff, 1989).
Nurses who float should inform the supervisor of any lack of experience in caring for the
types of clients on the new nursing unit. They should also request and be given orientation to the
unit. Nurses floated to a unit are held to the same standards of care as nurses who regularly work in
that area (Murphy, 1988).
Incident:
An incident report is filed when something arises that could or did cause injury and that was
not consistent with good care. For example, if a nurse administers an incorrect dose of medication, a
client falls out of bed, or an intravenous solution infiltrates the skin causing sloughing and scar
formation, the nurse should complete an incident report (Orlikoff and Vanagunas, 1988). Most
institutions provide specific forms for this purpose. The nurse objectively records the details of the
incident, and the physician examines the client and reports any untoward effects caused by the error
(Figure 6-2). Subjective assumptions should not be included on the incident report nor should
statements assigning blame be included.
Reporting Obligations:
Nurses are required to make a report in such situations as child abuse, rape, gunshot wounds,
attempted suicide, or certain communicable diseases to the appropriate authorities (Kreitzer, 1981).
The nurse may also be required to report unsafe or impaired professionals. Because information that
must be reported varies among states and provinces, the nurse should become familiar with the
appropriate statutes.
Good Samaritan Laws:
Good Samaritan Laws have been enacted in almost every state and province to encourage
health care professionals to assist in emergency situations. These laws limit liability and offer legal
immunity for people who help in an emergency, providing they give the best possible care under the
conditions (Northrop, 1990). If a nurse stops at the scene of an automobile accident and gives
appropriate emergency care such as using caution when moving the injured person in case of a spinal
injury or applying pressure to stop hemorrhage, the nurse is acting within accepted standards, even
though proper equipment was not available.
Contracts:
A contract is a written or oral agreement between two people in which goods or services are
exchanged (Black, 1979). An oral contract is as legally binding as a written one, but it may be more
difficult to prove. A breach of contract occurs if either party fails to carry out agreed obligations.
 By accepting a job, a nurse enters into an agreement with an employer. The nurse will
perform professional duties competently, adhering to the policies and procedures of the institution.
In return the employer not only pays for services but also furnishes the facilities and equipment in
proper working order to enable the nurse to provide efficient and competent care.
Nurses also enter into contractual agreements with clients (Cushing, 1988). Nurses agree to
give competent care, and clients agree to pay for the services. When clients sign admission forms
upon entering the hospital or agree to nursing care in any health care agency; they initiated the
contract. Private duty nurses have specific written contracts with their clients. It is from such
contracts that the duty to perform competently arises and the failure to follow through leads to the
concept of negligence.

LEGAL RESPONSIBILITIES OF NURSE

 Responsibility of appointing and assigning
Nursing administrators are expected to be aware of legal restrictions affecting personnel appointment
and assignment. The nurse administrators have the responsibility for staffing and supervising nursing
units to ensure safe effective patient care.
Each nurse have the legal responsibility to make full disclosure of her or his background knowledge
and skills and notify the nurse manager who given an assignment for which he or she is not qualified
 Responsibility in quality control
The nursing administrator and the authority of the agency at all levels have the legal obligation to
ensure nursing care quality. A nurse manager’s legal responsibility for quality control of nursing
service imposes a duty to observe report and correct the incompetence of any patient care provider.
 Responsibility for equipment
To protect patients and employees from injury a nurse manger must ensure that all patient care
equipment is fully functional and that the defective equipment is promptly repaired or replaced.
Nurses have the duty to refuse the equipment if it is faulty.
 Responsibility for observation and reporting
Nursing personnel have more frequent and prolonged patient contact than other care giver. Nurses
are trained to detect significant symptoms and reactions. Nurses have a legal duty to observe patients
frequently and report findings. The nurse is expected to observe a patient more closely when his or
her condition implies increased health risk.
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 health care
needs.
 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 discharges or escapes from the health care agency.
 Responsibility for record keeping and reporting
Nurses have legal; responsibility for accurately reporting and recording patient’s conditions,
treatment and responses to care. The medical record is a written or computerized account of a
patients illness and treatment that includes the information submitted by all members of health care
tea. The medical record is an information source document should be used to plan care, evaluate
care, allocate cost, educate personnel etc.
 Responsibility for death and dying
Nurses must be aware of legal definition of death because they must document all events that when
the patient is in care. Sometimes there will be issues of euthanasia either active or passive.

LEGAL ISSUES IN SPECIALTY PRACTICE AREAS

MATERNAL AND INFANT NURSING
Many legal issues are involved in the care of mother and her infant. Alike 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 cesarean section
 Improper vaginal delivery or failure to perform a cesarean section
 Improper use of forceps
 Incidence surrounding inducting labor and use of Oxytocin
 Delay in arriving at the hospital
 Nonattendance at the delivery
The common causes for lawsuits against nurses will include the following
 Problems of medication
 Failure inadequate client monitoring
 Failure to adequately assess the client
 Failure to report changes in the patient
 Abortions
 Nursing care of newborn
PEDIATRIC NURSING
As in all areas of nursing practice, negligence involving pediatric clients is possible. Pediatric nurses
are responsible for preventing children, and their care, from accidently harming themselves.
MEDICAL SURGICAL NURSING
As in the case of pediatric clients, disoriented adults may require some form of restraints. Some
common acts of negligence in medical surgical nursing are as follows
 Overlooked sponges, instruments needles: in the operation theater it is a responsibility of the
nurse to count the sponges, instruments, needles before the closure of the abdomen or any
cavity.
 Burns: the professional nurse is requires knowing the cause and effect of any heat application
so as to avoid burns. The nurse could be held liable if she/he neglects to take proper safety
measure prior to application of such measures.
 Falls: the nurse could be held liable if a patient falls from the bed 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. Injury due to the administration of wrong medicine,
wrong dosage and wrong concentration: administration of medicine without prescription by
any 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.
 Loss or damage: the nurse is held liable if a patient’s property is lost when it has been
entrusted to her/ his care.
 Assault and battery: failure to take the informed consent of the patient prior to any procedure,
treatment, investigation or operation the nurse is held liable.
 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.
 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. The possible problem occurs in critical care nurses is associated with the use of
electronic monitoring device.
PSYCHIATRIC NURSING
The practice of psychiatric nursing is associated and influenced by the right of patients and quality of
care they are receiving.
In psychiatric setting the process of hospitalization can be traumatic or supportive for the individual
depending on the institution, attitude of the family and friends. At present three types of admission
are being used that is voluntary and involuntary
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 without formal or written application
Voluntary admission
Under this procedure any citizen of lawful age any apply in writing admission to a public or private
psychiatric hospital. This is preferred type of admission because it is similar to that of any medical
hospitalization. When admitted as voluntary the patient remains all civil rights
Involuntary admission
Involuntary commitments are continuously recognized by the court on the basis of two theories; first
under its police power the state has the authority to protect the community from the dangerous acts
of the mentally ill. Most laws justify commitments of the mentally ill on these grounds
1. Dangerous to others
2. Dangerous to self
3. Need for treatment
State laws on commitment vary, but they attempt to protect the individual who is not mentally ill
from being detained in the psychiatric hospital against his will, for political, economic family or
other non-medical reason. Action is begun with sworn petition by a relative, friend, public official,
physician or any interested citizen stating the person is mentally ill and as in need of treatment. Some
states allow only specific individuals to file such petition
The decision as to whether the patient requires hospitalization is then made. Precisely who
makes this decision determines the nature of the commitment.
Legal roles of nurses
  Nurse as provider of services, if any malpractice claims are filed under the law of negligent
tort, and should prove the following
a. a legal duty of care existed.
b. the nurse performed the duty negligently.
c. damage was suffered by the plaintiff as a result.
d. the damage was substantial.
 provide standard nursing care.
 know the laws.
 keep record and reports.
 consult a lawyer if any question arises.
 Nurse as an employee, accurate supervision and evaluation of her responsibility.
 Nurse as a citizen,
Community health nursing. It is the combination of nursing practice and public health practice. two
legal aspects apply to most practice situation, such as;
a. professional negligence or malpractice.
b. scope of practice
 examining the usual and customary practice of profession.
 taking into account how legislation defines the practice of profession in a
jurisdiction.

Medico legal aspects of death
 Be with the patient during death.
 Reassure the patient relatives.
 Do not whisper in the patient and relatives presence.
 Death declaration should be the responsibility of the doctor.
 Proper recording of the death should be done in the hospital record.
 Respect the body and conduct all the last offices of mummification of the body.
 Body should be kept for observation for at least 3 hours to prevent misconception in case of
cadaver spasm.
 Take signature of the party, before handing over the body in death register and case paper.
 In case of unknown patient; intimate nursing superintend and sent to mortuary with proper
labeling.
 In the case of MLC intimate the police.

CONCLUSION
The nurse in the modern era has multifunction in their work setting. In spite of having
in the job description, these job activities are not explicitly defined. There is job ambiguity , so in
that situation they need to know about the law and legal issues that can have positive impact on them
in day to day functioning and on their clients who are the recipient of their care nursing practice is
governed by many legal concepts. It is important to know the basics of legal concepts, because nurse
is accountable for their professional judgments and actions.
BIBLIOGRAPHY
Book references
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Journals
 Regulatory Model on Transitioning Nurses From Education to practice, Nancy Spector,
Sulling Li, Joan’s Health Care Law, ethics and Regulation / volume 9 No.1 January – March,
2007, p.no.19 – 22.