Legal Issues and Safe Practices in Nursing

Legal Issues in Nursing

• Legal issues in nursing involve rights, responsibilities, and scope of practice.
• These are defined by state nurse practice acts and legislated through criminal/civil laws.
• All patients expect competent nursing services legally.
• Nursing students should be ready to provide safe, legally consistent care.
• They should also be aware of minimizing errors from accidents, carelessness, system failures, or malpractice.

Malpractice

• Malpractice is conduct deviating from professional standards.
• Nurses accounted for 795 of 11,810 malpractice payments in 2018, which is under 7%.
• Nursing malpractice cases are linked to liability risks and a more informed patient base.
• Further information is available on the National Practitioner Data Bank website.

Providing Safe Care

• Nurses need knowledge of anatomy, physiology, pathophysiology, medications, and therapies.
• Knowledge of healthcare provider regulations, institutions, payment systems, and laws is also essential.
• Nursing students learn about laws affecting practice upon enrollment.
• Legal and professional regulations address nursing practice and healthcare organizations.
• Healthcare agency policies ensure laws are followed to promote patient safety and protect staff/agencies.
• Policies on patient valuables ensure care, respect, and prevent theft or loss.
• Nurses must be aware of applicable regulations for safe, effective care and liability protection.
• Awareness begins with understanding general legal concepts and continues with learning laws affecting daily nursing activities.

Sources and Types of Laws

• Law is defined as the rules and regulations governing a society, made at federal, state, and local levels.
• Statutory laws are made by the legislative branches of government.
• The U.S. Constitution grants the federal government power to make laws.
• States can maintain health, public order, safety, and welfare unless restricted by the Constitution.

Nursing Laws

• Nursing laws are state statutory laws, and each state has a nurse practice act for nursing practice laws.
• Other statutory laws affecting nursing include statutes of limitation, protection/reporting laws, natural death acts, and informed consent laws.
• Legislative bodies delegate law administration and enforcement to administrative agencies.
• Administrative agencies can interpret laws and enact policies/procedures.
• State boards of nursing are examples of administrative agencies with delegated power.

Categories of Laws Affecting Nurses

• Constitutional: due process, equal protection
• Statutory (legislative): nurse practice acts, Good Samaritan acts, child and adult abuse laws, advance directives, sexual harassment laws, Americans with Disabilities Act
• Criminal (public): homicide, manslaughter, theft, arson, active euthanasia, sexual assault, illegal possession of controlled drugs
• Contracts (private/civil): nurse and patient, nurse and employer, nurse and insurance provider, patient and agency
• Torts (private/civil): negligence/malpractice, libel and slander, invasion of privacy, assault and battery, false imprisonment, abandonment

Criminal and Civil Laws

• Criminal law defines harmful conduct punishable by fines or imprisonment, with crimes against the state.
• Crimes are classified as felonies (serious) or misdemeanors (lesser).
• Criminal laws are enforced by law enforcement and prosecutors.
• Civil law deals with private rights/duties, often enforced through lawsuits relating to torts.
• A tort is a civil wrong against an individual or property, which may be intentional or unintentional.
• Compensation may be awarded to those injured by tort law violations.

Tort Law

• Tort law addresses intentional/unintentional actions or omissions resulting in harm.
• Unintentional torts are negligence and malpractice
• Intentional torts are assault, battery, false imprisonment, and invasion of privacy.
• Understanding negligence and malpractice here is essential.

Negligence

• Negligence deviates from reasonable person conduct under circumstances.
• It involves failure to exercise average care, skill, and judgment.
• A negligent act occurs when someone damages another's person or property without intent to injure.
• In legal actions, the injured party must prove the other party had a duty of reasonable care which they failed to maintain, causing injuries.

Malpractice Defined

• The standard of a "reasonable person" varies for specific occupations.
• The standard for professionals with special skills/licensure is the conduct of a reasonably skilled, competent, and experienced individual.
• Failure to meet this professional standard is professional negligence, or malpractice.

Categories & Examples of Negligence Resulting in Malpractice

• Failure to follow standards of care such as failure to:
  • Perform a complete admission assessment or design a plan of care
  • Adhere to standardized protocols or institutional policies and procedures
  • Follow a provider or prescriber’s verbal or written orders, if appropriate
  • Provide an environment that promotes safety.
  • Adequately monitor the patient's condition and take appropriate action to protect the patient
  • Notify the provider or prescriber of any changes in the patient's condition.
• Failure to Communicate and Document Accurately.
  • Failure to understand and use informatics to properly communicate knowledge of the patient's condition
  • Failure to document and communicate assessment findings, laboratory values, or any changes in patient status.
• Failure to Act as a Patient Advocate.
  • Failure to question orders when a patient's condition warrants it
  • Failure to question incomplete or illegible medical orders
  • Failure to report unsafe practice to the proper persons.
• Failure to Supervise Adequately.
  • Failure to Know the skill levels of supervised personnel
  • Failure to adequately monitor supervised personnel

Malpractice and Negligence

• Malpractice includes acts and omissions by a professional during professional duties.
• Negligent act/omission may rise to malpractice, jeopardizing license/patient safety.
• Anyone performing special skills is held to standards of qualified individuals.
• Nursing students are held to the same standard as licensed nurses.

Elements of Negligence or Malpractice Requirements

• Patient must be owed a duty, which is a legally enforceable standard of care
• A provider-patient relationship is the basis for finding duty.
• Nurse-patient relationship starts when the nurse accepts responsibility.
• Deviation of duty, aka breach, occurs via commission or omission.
• Forseeability must be present in the scenario.
• Injury must result from the professional's breach, called causation.
• Plaintiff must demonstrate harm from the breach.

Safety Alert for Nurses

• Nurses must know medication indications, dosage range, effects, toxicity, and contraindications.
• Malpractice lawsuits aim to restore the plaintiff's original position with damages.
• Damages cover medical fees, lost wages, and for physical harm, emotional damages too.
• Punitive damages punish malicious, willful, or wanton misconduct.

Related Doctrines

• Respondeat superior means the negligent nurse and employer get named in a lawsuit.
• Employers may be liable for insufficient resources, education, or orientation.
• Res ipsa loquitur applies when harm can't be traced, but negligence is suspected.
• An example of this is when a surgical instrument is left in a patient.

Statute of Limitations Defined

• Statute of limitations dictates time limits for bringing a suit.
• Plaintiffs typically have 1-2 years to file, but it varies by state and suit type.
• Statutes of limitations for minors also vary.

Intentional Torts Defined

• Intentional torts are actions taken with intent.
• The willfulness separates them from negligence and malpractice.

Assault, Battery & False Imprisonment

• Assault is creating apprehension of offensive, insulting, or injurious touching.
• Battery defined as willful touching that is unwanted, embarrassing, or unwarranted.
• Forcing a patient to ambulate against their will may be considered battery.
• False imprisonment is the unjustifiable detention of a person without legal warrant.
• Confining a patient, or restraining a patient seeking medical care, is false imprisonment.
• Standards of care disallow nurses from forcing patients into treatment or engaging action against the patient's will.

Invasion of Privacy

• Fourth Amendment grants the right to privacy and information is kept confidential and not disclosed without permission.
• Extends to use of name, photos, and control of belongings/space.
• Most agencies have patient info release policies as well as procedures for personal property.
• Failure to follow these policies could lead to a claim of invasion of privacy.
• HIPAA protects patient health information, including medical information, services provided, and payment data.
• State law/codes can further protect privacy.

Related Concepts to Legal Issues

• Safety & legal issues are very connected
• Ensuring safety and preventing errors have legal results
• A high number of adverse events involving medication errors occur at hospitals
• It is essential to reduce events through prevention strategies
• Proper reporting minimize impacts, provide insight, and there will be professional ramifications if failures do arise

Consent Issues

• Adhering to legal requirements related to safety + communication is important

Preventing Incidents of Professional Negligence

• Situations arise when malpractice/negligence is caused
• Medication errors require discussion + documentation with patient
• Understanding equipment + clear orders are other problems
• Mentoring, assesment, and care plans for patients are also important alongside safety issues

Concepts Related to:

• Cognition - Consent given must be voluntarily
• Comfort - Patients legally can have EOL care, while hospitals should provide advance directives/support/needs.
• Communication: Nurses ensure privacy and must follow HIPAA

Minimizing Risk of Medication Errors

• It has been defined that the administration of medication is a high-risk point for errors

Obtaining Professional Liability Insurance

• Nurses and physicians should carry professional liability insurance to manage financial risk
• There is occurrence-based coverage and claim-made.
• It is important to identify the policies regarding limit of injuries and covered injuries.

The Standard of Care Defined

• State nurse practice act /administrative rules form the basis of the level of care nurses are held
• The defined professional conduct and scope of practice are used for everyone in nursing care
• All nurses constantly need to be aware of changes
• Job descriptions contribute to defining the standard of care

Policies And Procedures

• Policies are implemented to define standard of care
• Nurses must review them
• If conflict with current policies arise, nurses solve conflict and improve processes

Laws that Affect Nursing Practice

• Informed consent and competency are included in laws
• Controlled substance act is also in nursing practice
• Good samaritan act

Informed Consent Factors

• Patients should be informed on healthcare procedure and treatment
• The information given should be of reasonable patient understanding
• Doctor needs to disclose alternatives + it’s treatment options + benefits and risk
• Reason for treatment
• Why it is needed
• How it benefits patient
• Possible side effects/ negative outcomes
• Alternatives to treatment
• Advantages/ disadvantages
• Information should be impartial

Patients with Impairments

• Cognitive impairments need consent
• Determination by court whether patient can make a decision + provide information

Informed Consent Types

• Expressed consent - agreement in writing or orally
• Implied consent - based action of patient
• Actions that are consistent with care

Medical Care for Minors

• For a minor, a legal guardian must give informed consent for treatment
• Emergency exception
• The law recognises minor has ability to consent treatment if they are the ones in need of it.
• NC allows contraceptive care for people 12 years and order

Controlled Substance Act

• CSA classifed on substances,use,potenetial abuse, and risk
• Enforced by Drug Enforcement Agency which has a closed system
• Traces route from point A to point B

Drug schedule

• Physical/psychological dependence/abuse potential
• Schedule I: Highest with illegal substances such as heroin and peyote. No therapeutic use
• Schedule II: High with cocaine and oxycodone
• Schedule III: Moderate with codein/ketamine at moderate potential
• ScheduleIV: Low with alprazolam/clonazepam.
• Schedule V: lowest with codiene, ezogabine

Good Samaritan Laws

• Most states encourage healthcare pros to help victims during an emergency.
• Meant to protect HC workers from liability.

Whistleblowing Law

• Disclosure of employers for unsafe/illegal things is called whistleblowing
• The employee who reports such practices is whistleblower
• Employers can’t retaliate but you must resolve it within org before getting outside authority
• Whistleblower must report discriminatory action before leaving the workplace.

Abuse Reporting

• Nurses are mandated reporters of child abuse
• Failing to report abuse you face charges
• Should be accurate/complete
• Report personally to authority
• Disclosure has exception confidentiality policy.
• Common signs of physical abuse is if there is non-matching injuries, unexplained findings, or sexually transmitted infections
• Follow mandatory report and be familiar with child statures.

Concerns for Adolescents

• Confidentiality is a concern for adolescents.
• Be familiar with laws related to adolescent confidentiality.
• Trust and honesty is essential.
• Confidentiality not guaranteed if in imminent danger, evidence of abuse, or diseases.

Issues for Pregnant Women

• It is unconstitutional for state to outlaw abortion during first trimester of pregnancy

Issues with Older Adults

• Nurses report elder mistreatment/abuse/exploitation
• Dehydration/malnutrition signal hygiene
• Agitation behaviour or financial situation may be indicative of other types of mistreatment
• Understand reporting laws in your state

EOL for older adults

• When an advances directive exist, nurses must provide care within guidelines

Learn about legal issues in nursing, including rights, responsibilities, and scope of practice, as defined by state nurse practice acts and laws. Furthermore, explore malpractice, its causes, and ways to provide safe, legally consistent care, minimizing errors and liability risks.