Legal Issues in Nursing

Nataliya Lishchenko

Terms and Definitions

• Ethics - standards of conduct.  Includes personal behavior and issues of character.

• Law - codification of values common to a community

• Ethical code and legal code

• Patient’s rights and responsibilities. Informed Consent

Codes of Ethics

• Definition: a collective statement about the groups expectations and standards of behavior.

• It includes:         Responsibility - reliable and dependable to carry out the duties of the nurses particular role.         Accountability - able to answer to self, client, the profession, employer and society for actions.         Competence - possess skills and knowledge to perform tasks as assigned.         Judgment - ability to form an opinion or to draw sound conclusions.         Advocacy - giving clients the information they need to make decisions and then supporting those decisions.

Patient’s Bill of Rights

• 1. The patient has the right to considerate and respectful care.• 2. The patient has the right to obtain from his physician

complete current information concerning his diagnosis, treatment, and prognosis in terms the patient can be reasonably expected to understand.

• 3. The patient has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and/or treatment…. Where medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information (and) to know the name of the person responsible for the procedures and/or treatment.

Patient’s Bill of Rights

• 4. The patient has the right to refuse treatment to the extent permitted by law, and to be informed of the medical consequences of his action.

• 5. The patient has the right to every consideration of his privacy concerning his own medical care program.

• 6. The patient has the right to expect that all communication and records pertaining to his care should be treated as confidential.

• 7. The patient has the right to expect that within its capacity a hospital must make reasonable response to the request of a patient for services.

Patient’s Bill of Rights

• 8. The patient has the right to obtain information as to any relationship of his hospital to other health care and educational institutions insofar as his care is concerned (and) any professional relationships among individuals, by name, who are treating him.

• 9. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment (and) has the right to refuse to participate.

• 10. The patient has the right to expect reasonable continuity of care.

Patient’s Bill of Rights

• The patient has the right to examine and receive an explanation of his bill regardless of source of payment.

• 12. The patient has the right to know what hospital rules and regulations apply to his conduct as a patient.

What is Informed Consent?

In 1914, Justice Benjamin Cardozo stated, “ Every human being of adult years and sound mind has a right to determine what shell be done with his own body…” (Schloendorff v. Society of N.Y. Hospital)

More about IC:http://www.ama-assn.org/ama/pub/category/4608.html

Definition

• Informed Consent (IC) is the duty of a health care provider to discuss the risks and benefits of a treatment or procedure with a client prior to giving care

IC must include the following:

1.The nature of the procedure

2.The risks and hazards of the procedure

3.The alternatives to the procedure

4.The benefits of the procedure

Obtaining IC under Special Circumstances

• Consent for donation of tissues or organs

• Consent for genetic testing

• Consent for medical experimentation with children

Nurses’ Legal Responsibilities

• Standards of Care (SC)–guidelines that establish expectations for the provision of safe and appropriate nursing care

• SC in each state are represented in the form of Nurse Practice Acts, the State Board of Nursing Rules and Regulations, Federal and State Laws regulating hospitals and other health care institutions, by professional and specialty nursing organizations, and by the written policies and procedures of employing institutions

Standard of Nursing Practice (ANA)

• The American Nurses Association (ANA) is responsible for defining the scope and standards of generic nursing practice.

• In 1991, ANA revised the standards of clinical nursing practice, broadening professional role expectations.

Components of Credentialing

1. Licensure

2. Registration

3. Certification

4. Accreditation

Licensure

Licensure

• Must be licensed by the Board of Nursing of the State in which you practice

• All states require RN to have a passing score on the National Council Licensure Examination (NCLEX) to obtain an initial license

• A nursing license can be suspended or revoked by the state board of nursing if a nurse’s conduct violates provision of the licensing statute

The Purpose of and Qualifications for Nurse Licensure and Registration

• The purpose: to determine and maintain the competence in nursing practice

• Main standards for every state

Registration

• The main goals: to check nursing background (credentials), certifications, etc.

• Temporary Registration

• Registration exams

Certification

• Different from Licensure: Licensure establishes minimal level of practice vs. Certification that recognize excellence in practice

• Certification was not legally required, it was voluntary

• Licensure is granted and governed by legislation and administered through the State Boards of Nursing vs. Certification is awarded by non-governmental agencies

Accreditation

• All nursing programs must meet the rules and regulations of the state board of nursing for the particular state involved

• All colleges and universities must meet additional regulations and standards established by regional accrediting bodies

• Professional schools usually seek an additional voluntary accreditation by a professional association

• NLN (National League for Nursing)• AACN (American Association of Colleges of Nurses)

Legal Consideration

• The same legal problem may be solved different in different states

• Different Sources of Law

Sources of Law & Nursing Practice

• Statutory law• From the federal and state legislatures• Violations are criminal offenses and punishable by

fines or imprisonment

• Common law• From judicial decisions (“res judicata”- the thing is

decided, “stare decisis” – let the decision stand)

• Administrative law• Prescribed by administrative agencies

Federal Statutes Related to Nursing & Health Care• Mandate a minimum standard of care in all settings that

receive federal funds (Medicare, Medicaid)• Emergency Medical Treatment & Active Labor Law

(EMTALA) • Prohibits refusal of care for indigent & uninsured patients seeking

medical assistance in emergency departments

• Applicable to nonemergency facilities such as urgent care clinics•Americans With Disabilities Act

–Prohibits discrimination against persons with disabilities

•Patient Self-Determination Act of 1990

–Requires federally funded hospitals to inform adult patients in writing about their right to make treatment choices

Federal Statutes Related to Nursing & Health Care

• Health Insurance Portability & Accountability Act of 1996 (HIPAA)• Intent of this law is to ensure confidentiality of

the patient’s medical records; the statute sets guidelines for maintaining the privacy of health data

Statutory Law: State Statutes

• State Nursing Practice Act and Board of Nursing Rules & Regulations• Define the scope and limitations of professional

nursing practice• Vary from state to state but have common elements• Penalties for violations

• Formal reprimand• Period of probation• Fines• Limiting, suspending, or revoking license

Statutory Law: Reporting Statutes

• Child Abuse Prevention and Treatment Act and Reporting Statutes• Mandate reporting specific health problems and

suspected or confirmed abuse• Health professionals must report under penalty of fine or

imprisonment for failing to do so:• Infant and child abuse

• Dependent elder abuse

• Specified communicable diseases

Civil Law

• Negligence: Failure to act in a reasonable and prudent manner

• Malpractice: Failure of a person with specialized education and training to act in a reasonable and prudent manner

Confidentiality

• The right to confidential health care is protected by the US Constitution, federal and state laws, and the ethical codes of health care professionals.

• Confidentiality is an essential part of the relationship between client and health care provider

• Nurse has a duty of confidentiality (disciplined by both employer and state board of nursing)

When a Health Care Provider Can Breach Confidentiality

There are 4 exceptions:

1. Mandatory reporting laws for child abuse

2. Mandatory injury reporting laws that apply to all clients who are injured by a weapon or criminal act

3. Public health law that require reporting infectious diseases to the local health department

4. A duty to warn third parties

The End