Legal aspects in nursing

   The legal aspects of nursing have an impact on the manner in which care is delivered to patients by nurses. Legal concerns shape the environment in which nursing is practiced and determine how documents are kept or shared. Ultimately, nurses and the nursing care they provide are judged based on a legal definition for the standard of care for nurses.

–  Written “standards of care” and “guidelines” are available as resources for determining how nursing care is to be delivered and the quality of care. However, the legal definition of the standard of care for nurses is not a “guideline” or a “policy” set by any one individual or institution. Rather, it is the embodiment of collective knowledge for what is required of the average nurse and sets the minimum criteria for proficiency.

–   Legal accountability for all nursing actions rests with the nurse.

–   Nurses and student nurses are legally responsible for their actions.

Laws that Govern Nursing

Nursing practice act  

•           Each state regulates the practice of nursing.
•      Sets educational requirements for nurses and define the scope of nursing practice.
•          Requirements of licensing for protection of public.

Standard of Care 

•          Guidelines by which the nurse should practice. 
•          Guidelines determine whether nurses have performed duties appropriately, If not the nurses place themselves in jeopardy for legal action.

Employee guidelines

·         Respondent superior-your employer will be held liable for any negligent act, if any alleged negligence occur during your employment.

Contracts

·         Nurses are responsible for carrying out all terms and agreements in the contract (obligations, rights, duties, institutional policies)  

Hospital staffing

·         Nurses cannot walk out when staffing is short, you can be charged with abandonment.

Nurses must report short staffing to the nursing administration

Floating

•          Is acceptable to solve hospital understaffing problems.
•      Legally, a nurse cannot refuse to float, unless you contract guarantees that you can work in one specific area or you can prove a lack of knowledge of the assigned tasks.
•    Nurses who float should inform the supervisor of any lack of experience in the new task to care for the client on the unit.
• The nurse should request and be given orientation to the new unit

Disciplinary action

Board of nursing may deny, revoke, or suspend license to practice as a Registered Nurse as follows:

•          Unprofessional conduct.
•         Breach of client confidentiality.
•       Failure to use sufficient knowledge, skills or nursing judgment.
•          Physical or verbal abuse.
•          Delegating to unlicensed personnel nursing care that can place the client in risk for injury.
•          Failure to maintain an accurate medical records for each client

        

Legal Liability

Types of Law :

Contract law

• Agreement between private individuals

Civil law

·        Relationship among persons and the protection of person’s right and property.

Criminal law

•          Are concerned with offenses against the public and society in general.
•          An act of violation of criminal law is called a crime

Good Samaritan Laws

•   Encourage health care professionals to assist in medical emergency situations without fear of being sued
• This law providing legal immunity for helping in an emergency, providing they give reasonable care

                                             Tort Law

A civil wrong doing, other than a breach of contract, in which the law allows an injured person to seek damages from a person who caused the injury.

                      

                                               Unintentional tort

            Negligence

·        Performing an act that a reasonable and prudent person would not perform.

   

       Malpractice

• It is also negligence by professional person.
• Professional misconduct or unreasonable lack of skills in carrying out professional duties. 

Examples of Negligence or Malpractice

•   Burning the client with hot water bottle or heating pad.
•   Leaving sponges or instruments in a client’s body after surgery
•   Failing to recognize warning signs of shock or impending MI (myocardial infarction)
•   Ignoring signs and symptoms of bleeding
•  Forgetting to give medication or give the wrong medication. 

                                                                     

                                         Intentional tort

Assault

·         Mental or physical; (without touching) forcing a client to take medication or treatment.

Battery

·         Touching, with or without the intend to do harm.

·        Hitting or striking a client. 

·         If a mentally competent adult is forced to have a treatment he or she has refused; battery occurs.

Defamation/Divulgence

·         Injuring a person’s name and reputation by making false statements to a third party. 

Slander

·         Making false statements orally

Libel

·        Making false statements in print, writing, or pictures

Fraud

•           Presenting false credentials
•      Describing a myth regarding treatment

Four Elements to prove negligence or malpractice

Duty

•   Obligation to use due care. 
•   Failure to care for or to protect others against unreasonable risk. 
•   Nurse must anticipate foreseeable risk.
•   Example:  wet floor, side rails –risk for client’s falling.

Breach of duty

•        Failure to perform according to established standard of care
•        Example: turn client every 2 hours to prevent decubitus (bed sores)

Injury/Damages

•   Failure to meet standard of care that cause actual injury or damage to the client, either physical or mental
•   Example: older client falling of the bed, because side rails were not up, result of the fracture of the hip.

Causation

•      A connection between conduct and the resulting injury

Invasion of privacy

HIPPA Law

·         Health Insurance Portability and Accountability Act 1996.Protect the privacy and security of a person’s health information.

·        Patient has the right to be left alone, without any risk for injury.

·        Patient has right to make personal choices without interference such as:

•        Contraception
•         Abortion
•        Right to refuse treatment

False Imprisonment 

·         Confinement without authorization

·         Threatening to restrain a person

·         Applying restrains without MD order

·         Preventing a person from leaving a room

·         Leaving side rails of the bed up, preventing the  client to leave a bed.  

Psychiatric Nursing Law

Voluntary admission

·         Client admits him or herself to an institution for treatment and retains all civil rights

Involuntary admission

·         Someone other than client applies for the admission to the institution.

·         Usually certified by two medical providers.

·         Client has the right to the legal hearing

• Most states limit commitment for 90 days

Emergency admission

·         Any adults may apply for emergency admission of another.

·         Medical or court approval is required to detain anyone beyond 24 hours.  

Legal and civil rights of hospitalized clients

•        Right to wear their own clothes
•        Right to see visitors
•        Right to have phone and TV
•        Right to have private conversation by phone
•        Right to send and receive mail (unopened)
•        Right to refuse shock therapy (ECT)  and lobotomy (incision in a frontal lobe to severing nerve tract)  
•     c   Right for competency hearing (by court)

                                        Patient’s consents

Surgical consent

·         Must be obtained prior surgery

·         Written

·         Obtained voluntarily

·         Physician must explain the procedure and nurse has witness the patient signature.

·         Adult and emancipated minors may sign consent, if they are mentally competent.

·         If minor child or an incompetent or unconscious adult, consent must be obtained from family members or guardian

·         Minors 14 years of age and older must agree to treatment along with their parents or guardian   

Informed consent

·         Adult client is competent and understand consequences

·         Voluntary

·         Information must be given in understandable form (no medical terminology)

·         Cannot sign informed consent if client has been drinking alcohol or has been pre-medicated.

·         Minors who can give consent:

•        Married minors
•        Minors for STD’s, HIV testing, AIDS treatment, drug and alcohol treatment
•       Emancipated minors

•      Minors seeking psychiatric services
•        Pregnant minors.     

 

Rx and healthcare providers

·         Nurse requires obtaining Rx order

·         Verbal /phone Rx should be avoided (follow protocol). 

·         Always read back order and dosage to physician.

·         Write order to chart or computer

·         Failure to follow rules can be considered negligence

·         If a nurse questions a physician’s order, because he or she believes that it is wrong do the following:

•        Inform the physician
•         Record that MD was notified
•        Record the response
•        Inform the nursing supervisor
•        Refuse to carry out the order   

Restrains

·         Client may be restrained only under the following circumstances:

•         In an emergency
•        For a limited time
•         For the purpose of protecting the client from injury 

Nursing Responsibility

·         Notify the MD immediately that the client has been restrained

·        Document the facts and rational for restraining the client

·        Nurse should do the following:

•         Use a restrains as last alternative
•         Apply restrains properly
•         Check restrains to see that circulation not impair or cause pressure sores, or other injury.
•         Remove restrains as soon as possible. If restrains continue, update order from the physician       

Incident Reports

Also Read : Crisis Intervention and Techniques