Chapter 4

Legal Aspects
of Nursing
 Learning Outcomes

1. List sources of law and types of law.

2. Describe ways nurse practice acts,
standards of care, and agency policies
and procedures affect the scope of
nursing practice.
3. Compare and contrast the state-based
licensure model and the mutual
recognition model for multistate licensure.
 Learning Outcomes (cont'd)

4. Describe the purpose and essential

elements of informed consent.
5. Discuss the impaired nurse and available
diversion or peer assistance programs.
6. Recognize the nurse’s legal
responsibilities with selected aspects of
nursing practice.
 Learning Outcomes

8. Discriminate between negligence and

malpractice.
9. Delineate the elements of malpractice.
10.Compare and contrast intentional torts
(assault/battery, false imprisonment,
invasion of privacy, defamation) and
unintentional torts (negligence,
malpractice).
 Learning Outcomes

11.Describe the four specific areas of the

Health Insurance Portability and
Accountability Act and their impact on
nursing practice.
12.Describe the laws and strategies that
protect the nurse from litigation.
13.Discuss the legal responsibilities of
nursing students.
 Nurse Practice Acts (NPA)

• Define and describe scope of nursing

practice
• Control practice through licensing

Where can you find our country

Nurse Practice Act?
 Credentialing

• Maintaining competence in nursing

practice
– Licensure
– Certification
– Accreditation
 Licensure Models

• State-based
– Separate license required for each state
– Challenged by changes in health care delivery
 Certification

• A voluntary practice validating an

individual has met minimum standards of
competence in a specialty area
• Conducted by the Saudi council
association
 Standards of Care

• Internal Standards
– Job description
– Education
– Expertise
– Institutional policies and procedures
 Standards of Care (cont'd)

• External Standards
– Nurse practice acts
– Professional organizations
– Nursing specialty-practice organizations
– Federal organizations and federal guidelines
(MOH, Ministry of Higher Education)
 Selected Nursing Legal
Responsibilities
• Informed consent
• Delegation
• Violence, abuse, neglect
• Controlled substances
• Impaired nurse
• Death and related issues
 Informed Consent

• Purpose
– Provides client with complete information prior
to obtaining agreement by client to accept a
course of treatment or procedure
– The informed consent is the record of the
informed consent, not the informed consent
itself
 Informed Consent

• Express Consent
– Oral or written agreement
• Implied Consent
– Individual’s nonverbal behavior indicates
agreement
– Medical emergency when a person cannot
express content because of physical condition
 Informed Consent

• Essential elements
– Consent must be voluntary
– Consent must be given by client or individual
with capacity to understand
– Must be given enough information to be the
ultimate decision maker
 Informed Consent

• Except in specific circumstances, the

following individuals cannot provide
informed consent
– a minor, person 18 years or younger
– the unconscious or person injured in such as
way that they are unable to consent
– a mentally ill person judged by professionals
to be incompetent
 Informed Consent (cont'd)

• a parent, legal guardian, or representative

provides or refuses consent for these
individuals
 Informed Consent

• Important to consider the problem of

illiteracy and other language barriers
• The consent must be read to the client or
an interpreter appropriately used to be
certain client understands
 Informed Consent (cont'd)

• Nurses Role
– Client gave consent voluntarily
– Signature is authentic
– Client appears competent to give consent
– Remind client they have the right to refuse
after signature on form continues after signing
consent
 Delegation

“The transfer of responsibility for the

performance of an activity from one person
to another while retaining accountability for
the outcome.”
– (American Nurses Association, 1997)
 The Impaired Nurse

• Inability to perform essential job functions

due to
– Chemical dependency on drugs
– Alcoholism
– Mental illness
Advanced Health Care Directives

• Allow persons to specify aspects of care

they wish to receive if unable to make
decisions
• Patient Self-Determination Act
– Recognize advance directives
– Ask clients if they have advance directives
– Providing educational material
 Do-Not-Resuscitate
• Order is generally written when client
wishes for no resuscitation
• Values and choices given highest priority
• DNR explicitly discussed with client, family,
and designated decision maker, and health
care team
• DNR clearly documented, reviewed, and
updated
• Other care should not be withdrawn
 Crimes

• An act committed in violation of public

(criminal) law
• Punishable by a fine or imprisonment
• Does not have to be intended in order to
be a crime
– Example: accidentally administering an
additional and lethal dose of a narcotic to
relieve discomfort
 Negligence

• Misconduct or practice that is below the

standard expected of an ordinary,
reasonable, and prudent person
• Places another person at risk for harm
• Applies to anyone
 Negligence (cont'd)

• Gross negligence
– Extreme lack of knowledge, decision making,
or skill that should have been known that put
others at risk for harm
 Malpractice

• Negligence that occurred while the person

was performing as a professional
– Applies to physicians, dentists, lawyers, and
generally includes nurses
 Measures to Take to Prevent
Malpractice
• Check and recheck medications-
medication error
• Check side rails before leaving a client-
client safety
• Do not ignore a clients complaint-failure to
observe and take appropriate action
• Right client-mistaken identity
 Intentional Torts

• Assault and battery

• False imprisonment
• Invasion of privacy
 Intentional Torts

• Assault
– attempt or threat to touch unjustifiably
• Battery
– willful touching that may or may not cause
harm
 Health Insurance Portability &
Accountability Act of 1996 (HIPAA)
• Includes four specific areas
– Electronic transfer of information among
organizations
– Standardized numbers for identifying
providers, employers, and health plans
– Security rule
– Privacy rule
 Unprofessional Conduct

• Incompetence or gross negligence

• Conviction for practicing without a license
• Falsification of client’s records
• Illegally obtaining, using, or possessing
controlled substances
• Need to retain professional boundaries
Unprofessional Conduct (cont'd)

• Violation of professional ethical codes

• Breach of confidentiality
• Fraud
• Refusing to care for clients of specific
socioeconomic or cultural origins
Carrying Out a Physicians Order

• Nurses expected to analyze procedures

and medications ordered by the physician
• Seek clarification for ambiguous or
seemingly erroneous orders
• Categories nurses should question
– Question any order a client questions
– Question any order if the client’s condition
changed
Carrying Out a Physicians Order
(cont'd)
• Categories nurses should question
– Question and record verbal orders to avoid
miscommunication
– Question any order that is illegible, unclear, or
incomplete
Providing Competent Nursing Care

• Provide care within the legal boundaries

• Nurses need to be familiar with various
jobs
• Care to protect clients from harm
• Anticipate sources for injury
• Educate clients about hazards
• Implement measures to prevent injury
• Client’s need to be assessed and
monitored appropriately
• Communicate with client’s with sincere
concern
 Documentation
• Medical chart is a legal document
• Nurses need to provide accurate and
complete documentation of the nursing care
provided
• Failure to document can constitute
negligence
• Insufficient or inaccurate assessments can
hinder proper diagnosis and treatment
causing harm to client
 Incident Reports

• Agency record of an incident or unusual

occurrence (also called unusual
occurrence report)
• Make all the facts available to agency
personnel
• Contribute to statistical data about
incidents
 Incident Reports (cont'd)

• Help health personnel prevent future

incidents
• Filed according to agency policy
Information Included on Incident
Reports
• Identify the client by name, initials, and
hospital or identification number
• Date, time, and place of the incident
• Description of the facts of the incident (no
conclusions or blame)
• Incorporation of the client’s account of the
incident in quotes
Information Included on Incident
Reports
• Identification of all witnesses
• Identification of any equipment by number
and any medication by name and dosage
Legal Responsibilities of Students

• Responsible for own action and liable for

their own acts of negligence
• Lower standards are not applied to nursing
students
• Function within scope of education, job
description and nurse practice act
Legal Responsibilities of Students
(cont’d)
• Follow procedures and policies
• Ask for additional help or supervision in
situations they feel inadequately prepared
• If working as an aide, can only perform
tasks in job description, not from nursing
school