Nurse Practice Acts and Legal Frameworks

Nurse Practice Acts

• Each state has laws (nurse practice acts) that define the scope of nursing practice.
• These acts set minimum standards for nursing practice.
• California's nurse practice act for LVNs specifies direct patient care, medication administration, wound care, and reporting patient changes.

Criminal vs. Civil Law

• Criminal law concerns public matters, prosecuted by government agents, and results in guilt/innocence findings. Penalties can include fines, imprisonment, or both.
• Civil law concerns disputes between individuals/entities, initiated by individuals, and results in a determination of accountability/innocence. Settlements are based on assessed liability.
• Statutory law is created by governments (federal, state, local).
• Common law (case law) develops from court decisions, often following precedent.

Civil Law Establishment

• Civil law comes from statutes, regulations, and case law that outline responsibility and accountability.
• It governs disputes between parties and addresses non-criminal issues (negligence, malpractice).

Negligence and Malpractice

• Negligence is the lack of due care, arising from carelessness.
• Malpractice is specific professional negligence, a failure to meet professional standards.

Malpractice Criteria

• Duty: established patient-nurse relationship
• Breach of duty: failure to act reasonably
• Harm: occurred (not necessarily physical)
• Causation: the breach of duty directly caused the harm.

Accountability vs. Liability

• Accountability is responsibility for actions
• Liability is legal responsibility for actions.

Advocate

• An advocate pleads a cause or issue on another's behalf.

Legal Test of Practice Regulation

• LVNs follow practice regulation by passing the NCLEX exam.

Joint Commission

• The Joint Commission accredits and certifies healthcare facilities.

Healthcare Institution Obligations

• Healthcare institutions must uphold patients' rights to care without bias, respect, privacy, confidentiality, safety, and condition/treatment information.

Informed Consent and Minors

• Informed consent is a patient's right to healthcare decisions.
• Minors have consent rights for treatment if criteria like marriage, emancipation, military service, or specific health situations are met.

Confidentiality

• Nurses must protect patient information, accessed only on a "need-to-know" basis.
• Social media use should be restrained, adhering to facility policies and respecting anonymity. Destruction of patient materials is essential before leaving a work site.

Elder Abuse/Abuse Reporting

• Reporting suspected abuse or neglect, even if uncertain, is mandatory.
• Nurses are protected from liability when acting in good faith to report mandated information.
• Withholding mandatory information is considered passive euthanasia.

Informed Consent - Legal Responsibilities

• Healthcare providers are primarily responsible for ensuring informed consent procedures are followed.

Unanswerable Questions

• Avoid questions about prognosis or procedure details, as this is beyond nurses' scope.

Avoiding Lawsuits

• Stay within scope of practice and provide compassionate care.

Ethics

• Ethics are values influencing behavior, feelings, and beliefs about right/wrong.
• Medical ethics involves respecting patients and their advance directives.
• Advance directives are written instructions for care when a person can't make decisions.
• Living will specifies treatment during terminal illness.
• Durable power of attorney for healthcare appoints someone to make decisions based on patient wishes.
• NFLPN has a code of ethics for Licensed Vocational Nurses that dictates practicing within scope, maintaining confidences, providing non-bias care, and maintaining high professional/personal behavior.