Informed Consent in Nursing

Patient Rights and Refusal of Treatment

• A patient has the right to refuse a procedure or treatment without discontinuing other supportive care.
• A patient may refuse a procedure or treatment even after it has begun.
• A patient has the right to receive an explanation of alternative therapies and the risks of doing nothing.

Good Samaritan Laws and Public Health Laws

• Good Samaritan laws limit liability and offer legal immunity if a nurse helps at the scene of an accident.
• Public health laws affect individuals, populations, and communities, and are intended to improve the health of people.

State Statutes Affecting Nursing Practice

• Termination of pregnancy laws vary by state.
• Physician-assisted suicide laws vary by state, and nurses should know their state's laws.
• The Uniform Determination of Death Act determines actual death.

Nursing Workforce Guidelines

• Guidelines cover staffing and nurse-to-patient ratios, nursing assignments, patient abandonment, nurse delegation, and nursing students.

Legal Implications and Reducing Your Legal Risks

• Torts are civil wrongful acts or omissions of care made against a person or property.
• Quasi-intentional torts are acts in which a person may not intend to cause harm to another but does.
• Unintentional torts arise when a person is harmed and the person inflicting the harm knew, or should have known, that their actions were less than the accepted scope and standard of practice.

Negligence and Malpractice

• Negligence is conduct that falls below the generally accepted standard of care of a reasonably prudent person.
• Malpractice is a type of negligence, and the person being held liable for malpractice must be a professional.
• The standard of proof is what a reasonably prudent nurse would do under similar circumstances in the geographical area in which the alleged breach occurred.

Malpractice Insurance and Nurse Experts

• Malpractice insurance is a contract between an insurance company and a nurse or employer that is intended to cover costs incurred when a patient sues the employer and/or the nurse.
• Nurse experts testify about the standards of nursing care as applied to the facts of a case.

Reducing Legal Risks

• Nurses should remain involved in the nursing profession to reduce their personal legal risk.

Federal Statutes Affecting Nursing Practice

• The Patient Protection and Affordable Care Act (PPACA) provides consumer rights and protections, affordable health care coverage, increased access to care, and quality of care that meets the needs of patients.
• The Emergency Medical Treatment and Active Labor Act prohibits the transfer of patients from private to public hospitals without appropriate screening and stabilization.
• The Health Insurance Portability and Accountability Act (HIPAA) provides rights to patients and protects employees.
• The Health Information Technology Act requires nurses to ensure protected health information (PHI) is protected.
• The Americans with Disabilities Act (ADA) protects the rights of people with physical or mental disabilities.
• The Mental Health Parity and Addiction Equity Act requires health insurance companies to provide coverage for mental health and substance use disorder treatment.
• The Patient Self-Determination Act requires health care institutions to provide written information to patients concerning their rights to make decisions about their care, including the right to refuse treatment and to formulate an advance directive.
• The Uniform Anatomical Gift Act provides the foundation for the national organ donation system.
• The Omnibus Budget Reconciliation Act (1986) altered the way in which health care is provided to older adults.