Chapter 4:

Legal and Ethical Aspects of Nursing

Types of Law and Examples

• Constitutional: Right to free speech

• Statutory: Nurse Practice Acts
• Administrative: State Boards of Nursing
• Criminal: Prosecution of malpractice
• Civil: HIPAA violations of privacy

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Legal Terminology

• Crime
– Deliberate commission of a forbidden act or omission
of an act required by law
• Felony
– Serious crime
• Misdemeanor
– Crime that is considered not as serious as a felony
but is still serious and may be cause for revocation of
a nursing license

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Legal Terminology (cont.)

• Liability
– Legal responsibility for one’s actions or failure to act
appropriately
• Tort
– Injury that occurred because of another person’s
intentional or unintentional actions or failure to act
• Negligence
– Harm done to a client as a result of neglecting duties,
procedures, or ordinary precautions

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Legal Terminology (cont.)

• Malpractice
– Professional negligence
• Assault
– Threat or an attempt to do bodily harm including
physical or verbal intimidation
• Battery
– Physical contact with another person without that
person’s consent

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Legal Terminology (cont.)

• Informed consent
– Tests, treatments, and medications are to be
explained, documented, and signed by client
• Libel
– Written statement or photograph that is false or
damaging
• Slander
– Malicious verbal statements that are false or injurious

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Question
Is the following statement true or false?
It is acceptable to give an injection to clients if they refuse,
and without their written consent.

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Answer
False
Giving an injection that the client refuses amounts to
battery, and hence is illegal. Moreover, the client or a legal
guardian must understand and sign the consent form for
care and treatment.

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Legal Issues of Nursing Practice

• False imprisonment
• Abandonment of care
• Invasion of privacy and confidentiality
– Trespassing
– Illegal search and seizure
– Releasing private information

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Nurse Practice Act

• The law that defines and regulates the practice of nursing

in the United States is called the Nurse Practice Act.
• These laws define the title of “nursing” and regulate the
many aspects of the field of nursing.
• The law or Nurse Practice Act in each state, province, or
territory defines regulations for practical and registered
nursing.

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Components of a Nurse Practice Act
• Definition of practical and registered nursing
• Nursing functions protected by the law
• Requirements for an approved school of nursing
• Establishment of requirements for licensure
• Process and procedures for becoming licensed
• Procedures for maintaining licensure and continuing
education
• Issue and renewal of nursing licenses
• Suspension, revocation, and reinstatement of license
• Interstate endorsement

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Functions of the State Board of Nursing

• The legislative power to initiate, regulate, and enforce

the provisions of the Nurse Practice Act is delegated to a
specific state agency often known as the State Board of
Nursing.
• Boards are subject to legal parameters, but usually they
have some leeway in interpreting aspects of the Nurse
Practice Act.
• In the recent past, the State Boards of Nursing were
responsible for the creation of the licensing examination,
however, now they are written by the National Council of
State Boards of Nursing.

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 Precautions Against Lawsuits

• Follow accepted procedures.

• Be competent in your practice.
• Ask for assistance.
• Document well.
• Do not give legal advice to clients.
• Do not accept gifts.
• Do not help a client prepare a will.
• Consider a malpractice insurance policy.

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Question
Is the following statement true or false?
In the case of a client who is terminally ill, has no relatives
present, and requests help, a nurse has the authority to
help the client prepare a will or other legal document.

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Answer

False
A nurse should never attempt to help a client prepare a will
or any other legal document. A graduate nurse may be
asked to witness the signing of a will.

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The Good Samaritan Act

• In effect in most states

• Protects a person from liability:
– if they give emergency care within the limits of first
aid
– if they act in a “reasonable and prudent manner”

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Professional Boundaries

• Power versus vulnerability

– Do not exploit the power to access private client
information
• Boundary crossings
– Questionable behavior
• Boundary violations
– Excessive personal disclosures
• Professional sexual misconduct
– Seductive, sexually demeaning, or harassing behavior

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Advance Directives

• Definition: a legal document in which a person either

states choices for medical treatment or names someone
to make treatment choices if he or she loses decision-
making ability
• Examples
– Living will
– Directive to healthcare providers
– Durable power of attorney for healthcare
– Mental health advance declaration

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Question
Is the following statement true or false?
If a client has a living will kept on file in the healthcare
facility, the nurse is forced to honor the will in the case of
the client being unable to make his own decisions regarding
care.

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Answer

True
A living will is a written and legally witnessed document
that requests no extraordinary measures to be taken to
save a person’s life in the event of terminal illness.
Healthcare providers and nurses are bound by the person’s
wishes.

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Deficient or Harmful Care

• People who are vulnerable to deficient or harmful care

include:
– Children and some adults
– Mentally incompetent or confused persons
– Elderly people
– People living in isolation
• The law protects vulnerable persons from injury, abuse,
or neglect while receiving care in a healthcare facility,
nursing home, school, or their own home.

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Brain Death
• Cessation of breathing after artificial ventilation is
discontinued
• Cessation of heartbeat without external stimuli
• Unresponsiveness to external stimuli
• Complete absence of cephalic reflexes
• Pupils fixed and dilated
• Irreversible cessation of all functions of the brain

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Biologic Death or Clinical Death

• Absence of respirations
• Absence of a heartbeat

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Ethical Issues in Treatment

• Organ transplantation
• Criteria and questions
• Refusal of treatment
• Withholding treatment
• Termination of treatment
• Euthanasia

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Rights and Responsibilities of Healthcare
Clients

• Clients’ Rights
– A Patient’s Bill of Rights
• Clients’ Responsibilities
– Clients are active participants in formulating their
care plan and making healthcare decisions, and have
a responsibility to participate in and cooperate with
care given.

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Provisions and Goals of the HIPAA
Legislation

• In 1996, the Health Insurance Portability and

Accountability Act (HIPAA), Title II, was passed and
serves as federal privacy regulation.
• The HIPAA, Title II act:
– Regulates who can have access to client information
– Sets standards for storage and transmission of client
information
– Requires that healthcare facilities write policies
allowing clients access to their own personal health
information. (The client has the right to request
correction of any errors.)

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Impact of HIPPA on Nursing Care

• Nursing students or staff nurses will most likely be asked

to sign a HIPAA confidentiality statement each year which
certifies that they are familiar with HIPAA regulations and
will follow their guidelines.
• Violation of HIPAA privacy practices is cause for
termination of employment or of student status in most
facilities.

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End of Presentation

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