About Legal IssuesRights, responsibilities, scope of nursing

practiceAs defined by state nursing practice acts

Sources of lawsSum total of rules and regulations by which a

society is governedLaw made at federal, state, and local levels

Figure 47-1 Overview of the sources of law.

About Legal Issues, continuedCriminal and civil laws

Address conduct harmful to another individual or society

May be punishable by fines or imprisonmentCrime

Act prohibited by statute, common law principles

Civil law Deals with rights and duties of private persons

Tort LawTort civil wrong committed against a

person or person’s propertyUnintentional torts

NegligenceProfessional negligenceMalpractice

Professional Negligence or MalpracticeFive elements:

DutyBreach of dutyForseeabilityCausationInjury or harm

Professional Negligence or Malpractice, continued

Related doctrines:Respondeat superiorRes ipsa loquitur

Statute of limitations

Intentional TortsAssaultBattery False imprisonmentInvasion of privacy

Strategies to Prevent IncidentsMaintain client safetyFallsMistaken identity

Minimize risk of medication errorsApply the Five Rights

Right drug Right dose Right client Right route Right time

Strategies to Prevent Incidents, continuedUse effective communication

Helps decrease risk of bad outcomesAttentive listening Accurate documentation and reporting

Professional liability insuranceNurses should carry to manage personal

financial risk

Standards of CareBased on

Nurse Practice Act (NPA)Administrative rulesJob descriptionsPolicies and procedures

ANA

Selected LawsInformed consent

Client’s legal and ethical rights to be informed of, give permission for procedure, treatment

Client must not be coercedClient understanding essentialFollow agency’s specific protocolsCompetency for consentConsent in an emergencyChild participation in decision

Selected Laws, continuedControlled Substance Act

Federal lawGood Samaritan laws

Encourage health care providers to help victims in an emergency

Protects health care workers from potential liability

Nurse responsible for following through with emergency care

Nurse Practice ActsNurse Practice Acts (NPAs)

Defines: Scope of practice Standards for education programs Licensure requirements Grounds for disciplinary actions

Enforced by state boards of nursing (BON)

Figure 47-3 Relationship among the Nursing Practice Act, Administrative Rules, and position/advisory statements.

LicensureAllows nurses legal privilege to practice

nursing as defined by NPAEach BON oversees administration of a

licensure examinationNational Council of State Boards of Nursing

NCLEX-RN®

NCLEX-PN ®

BONsResponsibilitiesActions against nurses found guilty

Giving false informationNolo contendereConduct that endangers public healthUnfit or incompetent to practiceEngaging in conduct that deceives, defrauds,

or harms the public2009 NCSBN report www.NCSBN.org.

National Council of State Boards of NursingMembershipFunctionsNurse Licensure Compact

Mutual recognition model

NPAsCertificationFederal organizations

Joint CommissionCenters for Medicare and Medicaid Services

Nursing studentsStandards of Practice

Standards of Nursing PracticeANA Standards of Nursing PracticeStandards are authoritative statements by which the

nursing profession describes the responsibilities for which its practitioners are accountable. Standards reflect the values and priorities of the profession and provide direction for professional nursing practice and a framework for the evaluation of this practice. They also define the nursing profession’s accountability to the public and the outcomes for which registered nurses are responsible.

http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingStandards.aspx

ANAStandards of Professional PerformanceQuality of practiceProfessional Practice EvaluationEducationCollegialityEthicsCollaborationResearchResource UtilizationLeadership

Professional Nursing PracticeNurse Practice Acts

Licensure and Certification

Science and Art of Nursing practice

Figure 47-4 Impact of laws and standards on the nurse.

Advance DirectivesLegal document Expresses an individual’s desires regarding

medical treatmentPatient Self-Determination ActTypes of advance directives

Living willDurable power of attorney for health care

Elements of Advance DirectivesSurrogate decision maker authority to:

Consent to or refuse medical treatment or diagnostic procedure

Hire or discharge medical providersAuthorize admission to medical and long-term

care facilitiesHave access to all medical recordsConsent to comfort care, pain relief measuresAny measures to carry out wishes

Role of NurseReassure clients and families that they have

option to change their decisionAssess whether clients, families have

accurate understanding of life-sustaining measures

Be supportive of clients’ decisions

Health Information and Portability and Accountability Act

HIPAAPurposes

Minimizes exclusion of preexisting conditionsDesignates special rights for those who lose other

health coverageEliminates medical underwriting in group plansIncludes Privacy Rule

Protected Health InformationProtected by Privacy Rule:

Individually identifiable health informationInformation that identifies individualAccess to medical recordsRequired notice of privacy practices and

opportunity for confidential communicationsLimits on use of medical informationProhibition of use of personal information for

marketing

Privacy vs. Confidentiality

Privacy right of individuals to keep their personal information from being disclosed

Confidentiality the assurance client has that private information will not be disclosed without client’s consent

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