Professional Documents
Culture Documents
https://www.ncsbn.org/Professional_Boundaries_2007_Web.pdf
– http://www.icn.ch/icncode.pdf
Nurses Rights in Ethical Situations
• Nurse has the right to refuse to participate in
giving care to a client if they disagree with care
on ethical grounds.
– Upheld by ANA
– Assure client is not abandoned for care
– The Joint Commission (TJC) requires employers to
establish policies and mechanisms to address staff
requests not to participate in aspects of care that
conflict with cultural values or religious beliefs.
Nursing Practice Regulations
• TBON – Texas Board of Nursing
– Regulates nursing practice in Texas
– Creates Rules and Regulations to administer the
Nurse Practice Act (NPA)
– Describes rules of conduct for nurses
• Rule 213.27 – Good Professional Character
• Rule 217.11 – Standards of Practice
• Rule 217.12 – Unprofessional Conduct
– http://info.sos.state.tx.us/pls/pub/readtac$ext.View
TAC?tac_view=3&ti=22&pt=11
NCSBN Professional Boundaries
Concepts of Professional Boundaries
• Boundaries: Space between nurse’s power and
client’s vulnerability
• Crossings: Brief excursions across boundaries that
may be inadvertent, thoughtless, or even purposeful
if done to meet a specific therapeutic need
https://www.ncsbn.org/Professional_Boundaries_2007_Web.pdf
NCSBN Professional Boundaries
Concepts of Professional Boundaries
• Violations: results when there is confusion
between the needs of the nurse and those of the
client.
• Sexual misconduct: extreme form of violation that
is seductive, sexually demeaning, harassing or
interpreted as sexual by the client.
https://www.ncsbn.org/Professional_Boundaries_2007_Web.pdf
Identifying Boundary Crossings
• Excessive self-disclosure
– When the nurse discusses personal feelings or aspects of
their personal life in front of the pt
• Secretive behavior
– When the nurse keeps secrets with the client or when the
nurse becomes guarded when someone questions their
interactions
• “super nurse”
– When the nurse believes only he or she can meet the needs
of the client
• Selective communication
– When the nurse fails to explain actions or actions of care
Identifying Boundary Crossings
• Singled out client treatment/client attention to
the nurse
– Nurse spends inappropriate amts of time with the
client, client may give gifts to the nurse
• Flirtations
– Never, ever, appropriate, or ok, ever, ever…
• You and me against the world behavior
– Nurse views client in a protective manner
• Failure to protect the client
– Nurse doesn’t’ recognize sexual feelings towards the
client
Nurse’s Challenge
• Be aware
• Be cognizant of feelings and behaviors
• Be observant of the behavior of other
professionals
• Always act in the best interest of the client
https://www.ncsbn.org/Professional_Boundaries_2007_Web.pdf
Informed Consent
44
Learning Outcomes
• Describe sources of law that affect nursing
practice
• Professional negligence
• Avoiding Malpractice claims
• Causes for suspension/revocation of license
• Legal responsibilities of Nurse Leaders
45
Distinction between Law and Ethics
Concepts Law Ethics
50
Professional Negligence
Five components necessary for professional
negligence to occur:
1. Standard of care
3. Foreseeability of harm
http://www.nurseweek.com/features/00-05/malpract.html
Professional Negligence
Reducing the Risk cont.:
• Manage risks
• Don’t hurry through discharge
• Be discreet
• Use restraints wisely
• Be kind
http://www.nurseweek.com/features/00-05/malpract.html
Liability
• Liable: to be legally responsible by law
• Personal liability: every person is liable for
his/her own conduct
• Joint liability: nurse, physician, and
employing organization are liable
• Respondeat superior liability: “the master is
responsible for the acts of his servants”
54
Claims Against Nurses
• Inadequate charting.
55
Claims Against Nurses
• Unattended pt falls
56
Incident Reports
• Incident reports can’t be used in court, unless they (lawyers and
what not) find out that it exists. They are intended for internal
shit only, within the hospital, monitoring trends, prevention of
future occurrences, etc.
• Don’t put them in the chart! You can document the fall, what
you did to make it better, but not that you filled out the actual
incident report form.
• Don’t tell the pt or family that you’re filling one out! You’re not
keeping them from any information about the incident, you’re
just not telling them about the form…
• Don’t document on pt’s chart that you filled one out!
• Notify nurse management teams and what not when you fill it
out.
• Remember, there is no law about having to fill out an incident
report. It’s just the hospitals policy to keep tabs on all the shit
that goes wrong inside it’s walls
Incident Reports
• Unusual / unexpected incidents
Do
– Document incident information, treatment & follow up
on chart
– Notify Nsg Management & Risk Management
DO NOT
– Leave copy on chart
– Discuss with pt / family
– Document form completion in chart
58
Intentional Torts
• Assault & Battery
– Assault is the behavior that makes a person fearful of harm
– Battery is an intentional physical contact with a person that
causes injury
• False Imprisonment
– Any unlawful confinement within fixed boundaries, can be
physical, emotional, or chemical
• Defamation of character (slander)
– Communicating to a 3rd party information that can hurt
character, self esteem, blah blah blah. Being truthful reduces
risks of being charged with this
• Invasion of privacy
59
Types of Consent
• Informed consent
• Implied consent
– Pt unable to consent
– Treatment is in patients best interest
• Express consent
– Witness pt signature
– Assure pt received information
60
Informed Consent
• Language pt understands
• Patient competency
61
Medical Records
it
62
Causes of License Suspension
• Professional negligence
• Felony convictions
63
Causes of License Suspension
64
Legal Responsibilities of a
Nurse Leader
65
Legal Responsibilities
of the Nurse Leader
• Reporting dangerous understaffing
– Texas passed law saying you have to have rules and
policies set up and in place in case staffing issues arise
• Ensuring staff credentials and qualifications
• Quality Control of nursing practice
• Equipment operation by staff
• Reporting substandard care
• Responsibility to be fair and nondiscriminatory
66
Malpractice for Nurse Leader
• Assignments
– Pt assignments
• Delegation
• Supervision
• Orientation & Education
• Evaluation
• Staffing
67
The Patient
Self-Determination Act
68
Whistleblower Act
• To prevent employers from taking retaliatory
action against nurses such as suspension,
demotion, harassment or discharge for
reporting improper patient care or business
practices
Good Samaritan Act
70
Health Insurance Portability and
Accountability Act
• Privacy Rules
71
Diverse Workforce
• Title VII (Civil Rights Act-1964): Protects against
discrimination based on race, color, creed, national
origin, religion or sex
http://www.jointcommission.org/AboutUs/
Joint Commission
National Patient Safety Goals
• Improve accuracy of patient identification
• Improve the effectiveness of communication
among caregivers
• Improve the safety of using medications
• Reduce the risk of healthcare associated
infections
http://www.jointcommission.org/AboutUs/
Joint Commission
National Patient Safety Goals cont.:
• Accurately and completely reconcile medications
across the continuum of care
• Reduce the risk of patient harm resulting from falls
• Prevent healthcare associated pressure ulcers
• The organization identifies safety risks inherent in
its patient population
• Universal protocol
http://www.jointcommission.org/AboutUs/
Centers for Medicare & Medicaid
The Centers for Medicare & Medicaid Services
(CMS) is a branch of the U.S. Department of
Health and Human Services. CMS is the
federal agency that administers the Medicare
program and monitors the Medicaid programs
offered by each state.
http://www.cms.gov/
Centers for Medicare & Medicaid
• Works closely with TJC to maintain patient
safety
• Reimburses according to meeting standards of
care
• Healthcare-associated infections
• Hospital-acquired conditions
http://www.cms.gov/
References
Potter, P. A., & Perry, A.G. (2009) Fundamentals of Nursing (7th ed.).
Canada: Mosby.
Smeltzer, S. C., & Bare, B. G. (2008). Brunner & Suddarth's textbook of
medical-surgical nursing (11th ed.). Philadelphia, PA: Lippincott
Markkula Center for Applied Bioethics. http://www.scu.edu/ethics
Texas Engineering Extension Service (TEEX), Center for Disease Control
and Prevention (CDC), The Texas A&M University System (TAMUS), &
National Emergency Response and Rescue Training Center (NERRTC).
(2003). Integrated Health and Medical WMD Training Program.
(Original work published 2001, Texas Engineering Extension Service
(TEEX), College Station, TX.
Marquis, B. & Huston,C. (2009) Leadership roles and management
functions in nursing (6th ed). Philadelphia, PA: LIppincott