NCM 119-A  person giving necessary details .

BSN 121571
Nursing Leadership & Management Nurses as witness:
Prof. Leila D. Benito  Could not divulge PRIVILEGED COMMUNICATION in
September 23 & 30, October 1, 2021 (Thursday-Friday) civil case , means that the nurse is
incompetent to testify on the communications
NURSING LAWS made to him by the patient, all the advice given
Nursing Jurisprudence and all information gathered by observation.
 department of law which comprise all legal rules
and principles affecting the practice of nursing. Duration of seal of secrecy except:
Nursing Legislation 1. Criminal case
 the making laws or the body of laws already 2. With patient’s consent
enacted affecting the practice of nursing. 3. Patient sued doctor for damages
Law
 a rule of civil conduct prescribed by the supreme  Testimonies of fact - factual information, no
power in a state commanding what is right and opinion unless an expert witness
prohibiting what is wrong.  Perjury - is the willful telling of a lie under oath.
Legal right  Hearsay evidence - rumors not admissible in
 a claim which can be enforced by legal means evidence
against a person whose duty is to respect it.  Dying declaration - considered hearsay unless the
Court Mechanism: drying person is a victim of crime
 Lawsuit - proceeding in court for a purpose
1. to enforce a right Nurses and Criminal Liability
2. to enforce a wrong  Felonies – acts or omissions punishable by law.
 Civil case – complainant /defendant
 Criminal case - Plaintiff / accused Elements:
 Statute of Limitations – the length of time 1. Deceit (dolo) – deliberate intent
following the event during which the plaintiff may 2. Fault (culpa) – results from imprudence, negligence,
file a lawsuit. lack of foresight
Example:
 Negligence - filed within 2-3 years from occurrence. Stages of Crimes :
1) Consummated – all elements executed and there is
Due Process successful result.
 is fair and orderly process which aims to 2) Frustrated – all elements executed, no successful
protect and enforce a person’s right. result.
3) Attempted – attempts to start commission of
Fundamentals Requirements of Due Process offense but no successful result .
1. Right to be informed.
2. Right to remain silent. Degree of Crimes:
3. Right to have competent counsel. 1. Grave – capital punishment or penalty of above 6
4. No use of violence, threat torture. years and one day, or fine of more than 6 thousand
pesos.
Trial 2. Less grave – penalty of 1 month and 1 day -6
 facts are presented and determined; Law is applied years ,or fine of not more than thousand but not
at the end. less than 200 pesos.
Summon 3. Light - penalty of 1 day to 30 days, or fine of not
 is a writ commanding an authorized person to more than 200 pesos.
notify a party to appear court to answer a
complaint made against him. CLASSIFICATION OF PERSONS CRIMINALLY LIABLE
Subpoena 1) Principal
 is an order that requires a person to attend at a a) by direct participation – doer of the act
specific time and place testify as a witness. b) by inducement – induces or pays another to
Subpoena Tecum commit the crime
 is a subpoena that requires a witness to bring c) by indispensable cooperation – participation
documents is necessary for the commission of the crime
/ papers in his possession. 2) Accomplice “ accessory before the fact”
Witness 3) Accessory “ accessory after the fact “

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 a. profiting themselves or assisting others to 3) Murder - the killing of another person with any of
profit. the enumerated aggravating circumstances provide
b. concealing destroying the evidence of the by law.
crime 4) Infanticide – the killing of an infant less than three
c. harboring or assisting the escape of the days old from delivery.
principal. 5) Abortion – termination of pregnancy
6) Illegal detention/false imprisonment – deprive
CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY another of freedom of movement or space.
7) Simulation of birth – preventing that a
1) Justifying circumstance – deemed to have acted in woman gave birth when in truth and in fact she did
accordance with law. not.
a) Lawful self-defense 8) Misdemeanor – an act less than a felony
Elements: 9) Robbery – taking of the personal property of
1. unlawful aggression another by means of force violence or intimidation.
2. reasonable necessity of the means employed by 10) Theft - taking the personal property of another
3. lack of sufficient provocation without his/her consent .
b) Obedience to an lawful order of superior 11) Assault – threat to cause bodily harm.
12) Battery – actual body contact without consent of
2) Exempting circumstance – exempted from criminal patient
liability. 13) Invasion of privacy
a. Imbecile/insane , except lucid interval 14) Defamation – character assassination
b. Person below 9 years old a) Slander – oral
c. Person above 9 and below 15 unless acted b) Libel – written
with discernment.
d. Performance of a lawful act GUIDELINES TO PREVENT CRIMINAL LIABILITY
1. Be familiar with Philippines Nursing law
3) Mitigating circumstance – reduces penalty 2. Be familiar with laws affecting the nursing practice
a. below 18 y/o. or over 70 y/o. 3. Known agency rules, regulations, policies
b. does not meet all requisite circumstances 4. Upgrade skills and competence
under justifying and exempting 5. Develop good IPR
c. offender is deaf, dumb, blind or with physical 6. Consult superior as needed
defect 7. Verify vague/erroneous orders
d. voluntary surrender 8. Always keep doctor updated regarding patient
e. illness diminishing exercise of the will power 9. Ensure accurate recording and reporting
10. Check informed consent
4) Aggravating circumstance – increase liability
a. Take advantage of public position Legal consideration in charting:
b. Committed with abuse of confidence 1) Don’t tamper with medical records
c. on occasion of earthquake, epidemic, calamity 2) Observe agency’s standards on documentation
d. For price or reward  Complete, concise, specific, use standard
e. fire, poison, explosion abbreviations
f. Evident premeditation  Telephone orders
g. craft, fraud or disguise
h. treachery Tips for avoid in legal pitfalls:
1. Patient falls
5) Alternative circumstances – either aggravating or  do proper assessment
mitigating  appropriate assistance is given
a. Relationship  use protective measures
b. Intoxication  document all nursing interventions
c. Degree of instruction/education 2. Medication error
 observe R’s of drug administration
CRIMES CONCERNING NURSES  check dr’s order
1) Parricide - the offender or victim is the father,  consult drug handbook/pharmacy
mother, brothers or sisters legitimate or  not exempt from liability for following dr’s
illegitimate, ascendant, descendant or the spouse. order
2) Homicide - the killing of another person 3. Equipment Injuries
 report adverse events to superiors

2
  monitor patient regularly
 refuse to use a device not know how to
operate
Nurses and Contracts/Wills
 Contract – Agreement between at least two
parties which create an obligation recognized by
law. There must be acceptance of the obligation.
Elements of validcontract:
1. given freely
2. competent parties
3. lawful object
4. valid consideration
Types of contracts :
1) Implied – terms are inferred from the actions of
the parties
2) Expressed – Verbal / written , terms are specified
BREACH OF CONTRACT : FAILURE WITHOUT LEGAL
EXCUSE TO PERFORM ANY PROMISE WHICH FORMS
THE WHOLE OR PART OF THE CONTRACT.
 Will - an act whereby a person is permitted with
formalities of law to control to a certain degree the
disposition of a state to take effect after his death.
 Decedent – person whose property is
transmitted through succession
 Testator – a decedent who left a will
Two kinds of wills:
1. Notarial will – done before a lawyer , requires at
least three witnesses
2. Holographic will - entirely dated, written and
signed by the testator himself.
Nurse’s obligation in the execution of will:
1) Note the soundness of clients mind
2) That the wall is signed by the testator
3) That the witnesses shall be present at the time and
sign by the presence of the testator.
Gifts mortis Causa – Disposing of gifts by a person in
anticipation of death / belief in approaching death.
 Limited to personal properties
 Acceptance by the recipient
 Gifts are revocable and subject to the claims of
creditor’s without proof of intent of defrauding
them.
NEGLIGENCE AND MALPRACTICE
 Negligence - doing of that which a reasonably
prudent person would not have done : or the
failure to do that thing which a reasonably prudent
person would have done in like or similar
circumstances .
Three Essential Conditions for actionable Negligence :
1. Existence of a duty on the part of the person
charged to protect the complaining
party from the injury received.
2. Failure to perform that such failure
3. Injury resulting form such failure
 Burden of Proof : complaining or injured
party.
Doctrines under Negligence:
1. Doctrine of ‘Res ipsa Liquitor “the thing speaks for
itself”
Three conditions :
A. Accident must be of a kind which ordinarily does
not occur in the absence of someone’s negligence :
B. The accident must be caused by an agency or
instrumentality within the exclusive control of
defendant ;
C. Not have been due to any voluntary action or
contribution on the party.
1. Doctrine of “Respondeat Superior”: Let the
principal answer for the acts of his agent.
2. Effect of “force majeure”: It is an irresistible force,
one that cannot be foreseen or prevented; a
event, and “ act of God”. fortuitous
Not answerable unless:
A. Expressly specified by the law
B. Declared by stipulation
C. Nature of obligation requires assumption of risk
The and the doctor’s orders
 it is expected that nurses exercise reasonable
judgment / sound discretion in carrying out
doctor’s orders.
 it life of patient is endangered, liable for criminal
negligence or reckless imprudence.
 Somera Case
 Malpractice - Any professional misconduct, or any
unreasonable or fiduciary duties:
 Objectionable practice / Contrary to
established rules.
 Example: Nurse giving out prescription of
drugs PHILIPPINE NURSING ACT( RA 9173 ),
BR # 425, Series of 2003
NURSING LAW
What is the scope of practice in the Philippines ?
A person id deemed to be practicing nursing:
 When he/she singly or in collaboration with
another, initiates an performs nursing services to
individuals, families and communities in any health
car setting .
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 When he/she provide nursing care during
conception, labor, delivery infancy, childhood,
toddler, pre-school, school age, adolescence,
adulthood and old age.
 When as independent practitioner, the nurse is
primarily responsible for the promotion of health
and prevention of illness.
 When as a member of the health team, the nurse
collaborates with other care provides for the
curative , preventive and rehabilitative as aspects
of care, restoration of health, alleviation of
suffering , and when recovery is not possible ,
towards a peaceful death.
Duties of the Nurse:
 Provide nursing care through the utilization of the
nursing process.
 Establish linkages with community resources and
coordination with the health team.
 Provide health education to individuals, families
and communities.
 Teach, guide and supervise students in nursing
education programs including the administration of
nursing services in varied settings such as hospitals
and clinics; undertake consultation services;
engage inn such activities that require the
utilization of knowledge and decision-making skills
of a registered nurse.
 Undertake nursing and health human resource
development training and research, which shall
include but not limited to the development of
advance nursing practice.
In addition to the above, what are expected of nurses
in the practice of their profession?
 Observe Code of Ethics and Code of Technical
Standards for Nurses
 Uphold the standards for safe nursing practice
 Maintain competence by continual learning through
professional continuing education .
How can one practice nursing in the country?
A person can practice nursing in the Philippines if he/she:
 Passed the written exams given by the Board of
Nursing (section 12)
 Registered by reciprocity (section 20)
 Has a special or temporary permit (section 21)
What is registration by reciprocity?
Nurses who are registered I a foreign country may be
issued a certificate of registration/professional license if
these conditions are met:
1. The requirements for registration in their country of
origin are substantially the same as those in or
country .
2. Under their laws, Filipino nurses are granted the
same privileges and on the same basis as their
citizens.
Who may be issued a special/temporary permit?
 Licensed nurses from foreign countries/states
whose service are either for a fee or fee if they are
internationally well-known specialists or
outstanding experts in any branch or specialty of
nursing:
 Licensed nurses fromforeign countries, states on
medical mission whose services shall be free in a
particular hospital , center or clinic
 Licensed nurses from foreign countries/states
employed by schools/colleges of nursing as
exchange professors in a branch or specialty
of nursing.
What does the PRC issue to nurses who passed the
board exams ?
 Certificate of registration/professional license
 Professional identification card
What are the qualifications of the members of the
Board of Nursing ?
 Be a natural born citizen and resident of the
Philippines;
 Be a member of good standing of the accredited
professional organization of nurses:
 Be a registered nurse and holder of master’s degree
in nursing education or other allied medical
profession conferred by a college or university,
duly recognized by the Government.
 Have at least ten (10) years of continuous practice
of the profession prior to appointment, the least
five (5) years of which is in the Philippines
 Not have been convicted of any offense involving
moral turpitude.
Who appoints, removes and suspends the members of
the BON ?
 The President of the Republic of the Philippines
What are the powers, function and duties of the Board
of Nursing?
 Conduct the licensure examination for nurses
 Issue, suspend or revoke certificates of registration
for the practice of nursing
 Monitor and enforce quality standards of nursing
practice in the Philippines and exercise the powers
necessary to ensure the maintenance of efficient,
ethical and technical, moral and professional
standards in the practice of nursing taking into
account the health needs of the nation;
 Ensure quality nursing education by examining the
prescribed facilities of universities or colleges of
nursing or departments of nursing education and
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 those seeking permission to open nursing courses
to ensure the standards of nursing education are
properly complied with and maintained at all times.
 Conduct hearings and investigations to resolve
complaints against nurse practitioners for unethical
and unprofessional conduct and violations of this
Act, or its rules and regulations and in connection
therewith, issue subpoena ad testificandum and
subpoena duces tecum to secure the appearance of
respondents and witnesses and the of respondents
and punish with contempt persons obstructing,
impeding and /pr otherwise interfering with the
conduct of such proceedings, upon application with
the Court.
 Promulgate a Code of Ethics in coordination and
consultation with the accredited professional
organization of nurses;
 Recognize nursing specially organizations in
coordination with the accredited professional
organization
 Prescribe, adopt, issue and promulgate guidelines,
regulations, measures and decisions as maybe
necessary for the improvement of the nursing
practice advancement of the profession and for the
proper and full enforcement of RA 9173 subject to
the review and approval by the PRC.
What are the grounds for the removal or suspension of
the members of the BON?
 Continued neglect of duty or incompetence
 Commission or tolerance of irregularities in the
licensure examinations
 Unprofessional, immoral and dishonorable conduct.
What are the qualifications of nursing administrators?
 A person occupying supervisory or managerial
positions requiring knowledge of nursing must:
 Be a registered nurse in the Philippines
 Have at least two (2) years experience in general
nursing service administration;
What are the qualifications of nursing administrators?
 A person occupying supervisory or managerial
positions requiring knowledge of nursing must:
(Contd…)
 Possess a degree of Bachelor of Science in Nursing ,
with at least nine(9) units in management and
administration courses at the graduate level.
 Be a member of god standing of the accredited
professional organization of nurses;
 Provided, that person occupying the position of
chief nurse or director of nursing service shall , in
addition to the foregoing qualifications possess;
 At least five (5) years of experience in a supervisory
or managerial position in nursing :
 A master’s degree major in nursing
For primary hospitals, the maximum academic
qualifications and experiences for a chief nurse are:
 Be a registered nurse in the Philippines
 Have at least two (2) years experience in general
nursing service administration
 Possess a degree of Bachelor of Science in Nursing ,
with at least nine (9) units in management and
administration courses at the graduate level
What are the qualifications of faculty of nursing ?
 A member of the faculty in College of nursing
teaching professional courses must;
 Be a registered nurse in the Philippines
 Have at least one (1) year of clinical practice in a
field of specialization
 Be a member of good standing in the accredited
professional organization
 Be a holder of a master’s degree in nursing ,
education, or other allied medical and health
sciences conferred by a college or university duly
recognized by the Government of the Republic of
the Philippines.
What are the qualification of deans of colleges of
nursing?
 Have at least 5 years of supervisory or managerial
experience master’s degree in nursing
 Have at least five yrs. of experience in nursing
What are the grounds for the revocation and
suspension of certificate of registration / professional
license and cancellation of special / temporary permit?
 Conviction by final judgment of any criminal offense
involving moral turpitude: immoral or dishonorable
conduct, or having unsound mind.
 For unprofessional and unethical conduct
 For gross incompetence or serious ignorance
 For malpractice or negligence in the practice of
nursing
 For the use of fraud and deceit or false statements
in obtaining a certificate of registration and/or
professional license o temporary /special permit.
 For violation of RA 9173 , the rules and regulations ,
Code of Ethics for nurses and technical standards
for nursing practice , policies of the Board and the
Commission, or the conditions and limitations for
the issuance of the temporary /special permit;
 For practicing his/her profession during his/her
suspension from such practice.
What are the requirements for the re-issuance of
revoked certificates and replacement of lost certificate?
 Expiration of a maximum of four years from the
date of revocation of a certificate
 The cause for revocation has disappeared or has
been cured and corrected
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 Proper application
 Payment of the required fees
Can inactive nurses return to practice ?
 Yes. Nurses who have not actively practiced the
profession for five (5) consecutive years can return
to practice if they undergo one month of didactic
training and three months of practicum. The Board
of Nursing shall accredit hospitals to conduct the
said training program.
What are the prohibitions in the practice of nursing in
the country ?
The following may be punished with a fine
(PhP50,000.00 – Php 100,000) or imprisonment (1-6
years or both:
 Those without a certificate of registration /
professional license and professional
identification card or special temporary permit or
without having been declared exempt from
examination.
 Anybody who uses as his/her own the certificate of
registration, professional license and professional
identification card or special temporary permit of
another.
 Anybody who uses an invalid certificate of
registration / professional license, a suspended or
revoked certificate of registration /professional
license, or an expired or cancelled special
/temporary.
 Anybody who gives any false evidence to the Board
in order to obtain a certificate or registration
/professional license, a professional identification
card or special permit or special permit.
 Anybody with falsely poses or advertises as a
registered and licensed nurse or uses any other
means that tend to convey the impression that
he/she is a registered and licensed nurse.
 Anybody who appendage B.S.N. /R.N. ( Bachelor of
Science in Nursing/Registered) or any similar
appended age to his/her name without having
been conferred said degree orregistration.
 Anybody who, as a registered and licensed nurse,
abets or assists the illegal practice of a person who
is not lawfully qualified to practice nursing.
 Any person or the chief executive officer of a
juridical entity who undertakes in-service
educational programs or who conducts review
classes for both local and foreign examination
without permit/clearance for the Board and the
Commission.
 Any person or employer of nurses who violate the
minimum base pay of nurses and the incentives and
benefits that should be accorded be accorded
them.
 Any person or the chief executive officer of a
juridical entity violating any provision of this Act
and its rules and regulations.
What are the provisions on continuing professional
education?
 Nurses are to maintain competence by continual
learning through continuing professional
education to be provided by the accredited
professional organization or any recognized
professional nursing organization.
 The law also mandates the creation of
comprehensive specialty program by the Board of
nursing, the Philippine Nurses Association and the
Department of Heath to upgrade the level of
skill and competence of specialty nurse clinicians in
the country .
LEGAL CONCEPTS AND ISSUES IN NURSING
What is the significance of citizenship in the practice of
nursing in the Philippines ?
 Philippine citizenship is a requirement for members
of the Board of Nursing (in fact they should be
natural born Filipinos) and for those who will take
the licensure examinations. It is also a qualification
(though implicit) for nursing administrators and
educators. One can be a Filipino citizen by birth or
naturalization.
What is a contract ?
 A contract is meeting of minds between two
persons where they bind themselves to give
something or to render some services. Practically
anything could be subjective to a contract as long as
these are not contrary to law, morals, customs,
public order and public policy .
What should a nurse remember about will?
 A nurse, particularly those care of well-to-do
patients should remember that the main requisite
for making a will is testamentary capacity or sanity.
The person who makes a will should at least be 18
years old and is not prohibited by law.
What is informed consent?
 the basic principle of all consents - the patient‘s
right to consent to being and effect of the touched
– is captured by this classic legal statement, “Every
human being of adult years and sound mind has a
right to determine what shall be done with his own.
 Mental capacity or competence – is the ability to
understand the nature and effect of the act in
which a person is engaged and the business he is
transacting.
Essential elements of an informed consent :
1. Complete information
2. Competence
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3. Voluntaries
The nurse’s responsibility in witnessing the giving of
informed consent involves :
1) Witnessing the exchange between the client a and
the physician.
2) Witnessing the client affix his signature
3) Establishing that the client really affix his signature ;
and three establishing that the client understood.
When can restraints be used ?
 Restraints should be used with caution and
discretion. All patients have right to
independence and freedom of movement.
Restraints require a physician’s order. If patient or
his legal guardian refuses to be restrained, this
should be documented in the patient’s medical
record.
When can a nurse accept telephone orders?
Should be accepted by the nurse only in extreme
emergency. If the nurse is to receive a telephone order,
the following should be done:
1. read back the order to the doctor to ensure that
the order has been correctly received.
2. write the physician’s name and one’s name and
sign; note the time;
3. Make sure that the ordering physician signs his
name as soon as he arrives.
What should a nurse remember about abortion?
 Is illegal according to the Revised Penal Code the
patient should assume responsibility for her
abortion. She should be made to sign a statement
relieving the hospital and its personnel from
liability .
What is a medical record ?
 A medical record is a document which should
describe the patient’s medical event in a
systematic, organized manner including patient
problems, reactions and responses to procedures,
medications, diet and treatment. It was created as a
means of communicating among health care
providers. Today medical records serve two
important functions to provide legal
documentation and obtain third party payments.
What should be done when a patient leaves the
hospital without the order of his physician ?
 Patient should sign a statement that he assumes
full responsibility for leaving the hospital without
the consent of the physician and releases the
hospital personnel from any responsibility for such
discharge.
What are intentional torts?
a) Assault and battery
b) Defamation
c) Invasion of privacy
d) False imprisonment
e) Fraud
What is the difference between negligence and
malpractice?
 The terms malpractice and negligence are often
used interchangeably. However, negligence is a
more specific type of negligence. Malpractice is a
deviation form a professional standard of care.
The Components of professional negligence are:
1. Duty to use due care
2. Failure to meet standard of care
3. Foresee ability of harm
4. Injury
5. A direct relationship between failure to meet the
standard of care and injury can be proved.
 Due care – Reasonable care under the
circumstances or, that degree of care or concern
that would or should be exercised by an ordinary
person in the same situation.
 Reasonable care – That degree of skill and
knowledge customarily used by a competent
health practitioner or student of similar education
and experience in treating and caring for the sick
and injured in the community in which the
individual is practicing.
 Standard of care - Skill and learning commonly
possess by members of the profession .
What is res ipsa Ioquitur?
 The thing speaks for itself. When the harm that
resulted from negligence and the responsibility for
the harm are clear that anyone would agree on it,
the term res ipsa Ioquitor is used.
What is Good Samaritan Law ?
 This law provides immunity from civil liability when
a person provides assistance in an emergency. Its
main purpose was to encourage citizens to assist
their men by rendering emergency medical aid to
them when they are injured .
What is an advance directive ?
 It is a document made by a competent individual to
establish desired health care for the future or give
someone else the right to make health care if the
individual becomes incompetent.
a) Living will
b) Durable power of attorney
What is liability ?
 It is the fundamental rule of law that every person
is liable for his own negligent conduct .
 Is an obligation or dept that can be enforced by
law.
 A person who is liable for malpractice
is usually required to pay for damages. Damages
refer to compensation in money
recoverable for a loss of damage.
a) Personal liability
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 b) Respondeat superior can monitor quality of patient care and institute
c) Captain-of –the-doctrine some measures to prevent similar incidents in
d) Corporate liability the future.
What is force majeure?
 It is an irresistible force, one that cannot be What are some of the common legal termsthat nurses
foreseen or prevented; a fortuitous event, and should know?
“ act of God”. No person shall be held liable  Affidavit
for nonperformance of what was expected of  Civil law
him/her if the cause of the nonperformance was a  Contempt of court
force majeure devastating typhoons, earthquakes  Criminal law
and other calamities .  Day in court
What are examples of cases filed against nurses  Defendant
involving allegations of negligence ?  Deposition
 Failure to count or incorrectly counting the number  Due process
of sponges or instruments where a duty exists to  Expert witness
account for them  False testimony
 Improper exercise of judgment that bed rails should  Hearsay evidence
have been used to safeguard clients.  Injunction
 Lack of supervision of clients at regular and  Inquest
appropriate intervals  Perjury
 Failure to contact or notify physician of changes in  Plaintiff
the client’s condition  Power of attorney
 Failure to recognize an emergency and give  Prima facie evidence
emergency treatment to client  Privileged communication
 Failure to recognize adverse signs and symptoms,  Right to appeal
discontinue treatments and contact physician  Statute of limitations
 Lack of judgment in evaluating physician’s orders  Subpoena duces tecum
 Failure to administer medications properly  Summons
 Failure to apply appropriate principles of hot and  Warrant
cold
 Failure to assist client with ambulation What is a DNR order ?
 Failure to evaluate client complaints and follow up  DNR means “do not resuscitate .” is a medical not
with MD to do a cardiopulmonary resuscitation (CPR) on a
 Failure to monitor vital signs patient . According to the American Medical
 Improper identification of patient for surgery Association , a DNR order must be formally
 Lack of sterile technique entered in the patient's progress. In the US,
 Failure to remove foley catheter lawsuits involving the termination of life support
with the Karen Quinlan case. She was in coma fora
Who is responsible for a delegated task ? year and kept alive by a respirator. Her father went
 the nurse who delegates a task to an to court and was permitted by the New Jersey
unlicensed worker remains personally liable. She Supreme Court to seek physician who would agree
should remember that. to remove the respirator
1. Task should be properly assigned to a worker
competent to safetyperform it; How can nurse protect themselves for malpractice suits?
2. Worker should be properly supervised 1. Practice within the scope of the nurse practice act
3. Appropriate follow-up and evaluation of the task 2. Follow established practice standards
should be done. 3. Observe agency policies and procedure
 Some nursing responsibilities should not be 4. Always put patient rights and welfare first
delegated to an unlicensed staff. 5. Be aware of relevant laws and legal
 E.g. assessment, nursing diagnosis, some portions concepts/principles
of planning, evaluation and documentation. 6. Upgrade technical skills consistently

What is an incident report? What is a standard?

 An incident report is an administrative that is  A standard is the desired and achievable level of
required of nurses if there are violations of performance against which actual practice is
standards and policies whether or not injury occurs. concerned. Standards are necessary to demonstrate
Through incident reports, hospital administration to the public, government and other stakeholders

8
 that the nursing profession is dedicated to
maintaining public trust and in upholding its
professional values.
7. Observe proper documentation
 Observe your agency’s standards on
documentation Some tips
 Use appropriate form
 Document in ink
 Write or print legibly
 Record the patient’s name and ID/case
number in every page of the chart
 Chart the exact times the patient receives
treatment medications , goes to OR.
 Record the complete date and time of each
entry
 Sign every entry
 Chart facts perceived through the senses ; try
not to make assumptions if possible
 Be specific; avoid general terms and vague
expressions
 Be concise yet descriptive
 Be complete
 Use standard abbreviation only
 Never erase an erroneous entry
 Write on every line. Don’t insert notes
between lines. Don’t leave spaces.
 Chart an Omission as a new entry
 Document symptoms using the patient’s. Use
medical terms only if you are sure of their
meaning
 Never document for someone else .
Why should we not erase anything on the
patient’s record?
 We should never erase anything on a patient’s
record because erasures raises questions and
doubts and can be interpreted as hiding something.
If an entry is erroneous, clearly draw a line through
the error write“ error: to the side in parentheses,
enter the correction, add your signature and the
date. In risky situations, it is prudent to have the
corrected notation witnessed by a co-worker .
 Examples of specific preventive actions for
the most reasons for lawsuits;
Patients falls
 Carefully assess all patients for risks of falling
 Take necessary precautions when caring for any
patient with an increased risk of falling
Failure to follow physician’s orders or established
protocols
 If you don’t understand a physician’s order ,
ask questions until you do.
 If you question the wisdom of an orderor protocol,
bring it to the attention of the physician or your
supervisor.
Improper use of equipment
 Know how to operate a devices before you use it.
 If you have misgivings about using a device, refuse
to do so unless the situation is extraordinary
 Report all equipment-related adverse effects to
your supervisor
 Document and report all equipment – related
injuries
Failure to monitor sufficiently
 Adhere to the frequency of monitoring specified in
physician’s orders and agency policies and
procedures , and by the patient’s condition.
 Document the frequency of monitoring and the
patient’s status.
Failure to communicate
 Promptly report changes in the patient’s symptoms
and signs of distress to the physician
 Document all assessments and telephone
conversations with the physician .
Medication Errors
 Obtain a patient's drug history including allergies at
the start of care.
 Routinely review all of the patient’s drugs to
identify possible ineffective drug therapy, adverse
reactions, allergies or contraindications
 If you’re unfamiliar with a drug or an
administration route , consult a reputable text or a
pharmacist
 If you don’t understand the physician ‘s order, ask
questions until you do.
 If you make an error or the patient has a drug
reaction, complete an incident report within 24
hours (or within the time specified in your agency’s
policies.)
 Preserve the drug supplies and IV bag as is for
possible investigation.