Legal Issues in Public Health and Management

Legal Issues in Public Health and Management

• Law is defined as rules made by humans to regulate social conduct in a formally prescribed and legally binding manner.
• Laws are based on fairness and justice.

Learning Objectives

• Define law.
• List functions of law in nursing.
• Identify sources of law.
• Differentiate between common types of law (e.g., criminal, civil, administrative).
• Identify legal issues in nursing.
• List common malpractice situations.
• Explain health-related legal issues.
• Apply guidelines for reporting a crime, tort, or unsafe practice.

Functions of Law in Nursing

• Provides a framework for establishing which nursing actions in client care are legal.
• Differentiates nurses' responsibilities from those of other health professionals.
• Establishes the boundaries of independent nursing action.
• Maintains a standard of nursing practice by holding nurses accountable.

Sources of Law

• Constitutions, statutes, administrative agencies, and court decisions.

Constitution

• A constitution outlines fundamental laws or principles governing a nation, society, corporation, or aggregate of individuals.
• It establishes the basis of a governing system for the present and future.

Statutes

• Laws created by legislative bodies.
• Officially enacted by a legislative body and compiled into codes, collections of statutes, and ordinances.

Administrative Agencies

• Agencies authorized to act by legislative bodies.
• Create rules and regulations to enforce statutory laws.
• Administrative laws are valid within the scope of authority granted by the legislative body.

Court Decisions

• Judicial or decisional laws are made by courts to interpret legal issues in dispute.
• Decisions can be made by a single justice, with or without a jury, or by a panel of justices.
• Different court levels (trial, intermediary appeal, highest appeal) have varying justice numbers.

Types of Laws and Courts

• Nurses may face criminal, civil, or administrative court cases.
• Each type of case has a different court procedure, burden of proof, and punishment.

Criminal Cases

• Charges are filed by the state/attorney general for crimes against individuals or society.
• Individuals are presumed innocent unless proven guilty beyond a reasonable doubt.
• Consequences can include incarceration and/or death.
• Intentional administration of fatal doses by nurses can lead to criminal charges.

Civil Cases

• One individual sues another for monetary compensation for perceived loss.
• Burden of proof is "preponderance of the evidence" (more likely than not).
• Consequences are typically monetary.
• Most malpractice cases are tried in civil court.

Administrative Cases

• An individual is sued by a governmental agency responsible for implementing governmental programs.

Types of Law

• Public Law: deals with relationships between individuals and governmental agencies.
• Private Law: deals with relationships between individuals.
• Criminal Law (part of private law): is categorized as contract law and tort law.

Contract Law

• Enforces agreements among private individuals or compensation for failing to fulfill agreements.

Tort Law

• Defines and enforces duties and rights among private individuals not based on contractual agreements.
• Examples applicable to nursing: negligence, malpractice, invasion of privacy, assault.

Legal Issues in Nursing

• Nursing Practice Act
• Standard of Practice

Nursing Practice Act

• Regulates nursing practice by legally defining and describing the scope of practice, protecting the public.
• Protects nurses' professional capacity.
• Each country has its act with a common purpose of protecting the public.
• Establishes minimum entry standards and distinguishes qualified from unqualified practitioners.

Standard of Practice

• Ensures competent and safe nursing practice by establishing standard practice.
• Professional organizations implement and establish standards.
• Describes responsibilities for which nurses are accountable.
• Reflects nursing profession values and practices, provides direction in professional practice, and offers frameworks for evaluating nursing practice.
• Defines accountability to the public and client outcomes.
• Standards are used in licensure, certification, accreditations, peer reviews, and public policy.
• Standards are maintained through appropriate entry to the profession.

Credentialing

• Determines and maintains competence in nursing practice.
• Credentials include licensure, registration, certification, and accreditation.

Licensure

• Legal permit granted by a government agency for professional practice and particular titles.
• Contains three criteria: need to protect public safety, clearly defined occupation with a separate area of work, and proper authority to license.

Registration

• Listing of an individual's name and information on an official governmental agency roster.
• Registered nurses can use the title "Registered Nurses."

Certification

• Validating that an individual nurse has met minimum standards of nursing competence in specialty areas (pediatrics, mental health, gerontology, school health).

Accreditation

• Process where a voluntary or governmental agency appraises institutions or programs to grant accredited status.

Common Malpractice Situations

• Medication errors: misreading labels, incorrect dosing, identifying the wrong patient, improper administration routes (IV instead of IM).
• Leaving objects inside a patient during surgery.
• Burning a patient.
• Patient falls due to improper rail use or unattended care.
• Ignoring patient complaints.
• Incorrectly identifying clients.
• Loss of client property (jewelry, money, eyeglasses, dentures).

Health-Related Legal Issues

• Abortion: nurse assistance for saving life/health of mother, does not perform independent abortion, treats patient's effects when no physician available. Reports criminal abortion in physician absence.
• Euthanasia: active or passive ending of life is not permissible for the nurse. Nurses should not assist, not collaborate with patient or relatives' requests.
• Organ Transplantation: nurse involves in procedure with clear agreement, donor's informed consent, and absence of mental illness. Advocates for human rights.
• Suicide: nurse removes items facilitating suicide (e.g., sharp objects, ropes, drugs). Nurse does not leave patient unattended.

Guidelines for Reporting Crimes, Torts, or Unsafe Practices

• Write clear descriptions and truthful statements.
• Get support from a trustworthy person before filing a report.
• Report through agency hierarchy beginning with the lowest level.
• Take accountability for reporting, signing reports.
• Follow through on the reporting process after reporting it.