Nursing Law and Ethics Overview

Criminal Law In Nursing

• Criminal law in nursing involves actions against the state or public, such as theft, abuse, or practicing without a license.
• Criminal charges can lead to penalties like fines, imprisonment, or loss of nursing license.

Federal/Administrative Law in Nursing

• Federal law in nursing includes nationwide rules like patient privacy (HIPAA), anti-discrimination (ADA), and workplace safety (OSHA).
• These laws ensure nurses follow national standards and protect patient rights.

Medication Errors

• It is critical to increase both mandatory and voluntary reporting of medical errors.

Malpractice: 5 Elements

• Standard of care: the care that should be done
• Breach of duty: failure to meet the standard of care
• Foreseeability of harm: not meeting the standard of care could cause harm
• Injury to the patient: provable correlation between improper care and injury
• Actual injury: the injury occurred because of the defendant's actions

Nurses & Risk of Malpractice Suits

• Nurses have more authority and independence in decision making.
• They have increased legal accountability for decision making.
• They are performing more actions previously done by medical practitioners.
• More nurses are carrying malpractice insurance.

Avoiding/Reducing Risk of Malpractice Suits

• Practice within the scope of the nurse practice act.
• Observe and follow agency policies and procedures.
• Follow evidence-based practice.
• Always put patient's rights and welfare first.
• Be aware of relevant law and legal doctrines.
• Practice within the area of individual competence and upgrade technical skills constantly.

Torts

• Torts: legal wrongs committed against a person or property, independent of a contract, that render the person who commits them liable for damages in a civil action.
• Intentional tort: direct invasion of someone's legal rights.
• Unintentional tort: an accident that results in injury, property damage, or financial loss due to a person's careless or reckless behavior.

Types of Torts

• Negligence: considered an unintentional tort.
• Assault: threatening a person with the intention to carry out the threat, producing a reasonable apprehension of harm.
• Simple assault: a threat but no physical contact.
• Battery: intentional and wrongful physical contact that results in harm, no matter how minor.
• Assault & battery: a threat that's carried out resulting in harm.
• False imprisonment: restraint of a person's movement by another.
• Invasion of privacy:
• Defamation:
• Slander:

Criminal vs. Civil Act

• Criminal act: Offenses against the state or society (patients) as a whole. Examples: Theft, abuse, or practicing without a license.
• Civil act: Disputes between individuals or entities, typically seeking compensation for harm caused. Examples: Malpractice and negligence.

Time Management

• Priority setting is the most critical skill in good time management.
• "Do now" = setting priorities; may utilize delegation.

3 Steps to Time Management

• Allow for planning.
• Complete highest priority first.
• Finish one task before completing another.

Improving Productivity

• Start the day/morning by planning and updating the plan as needed.

Biggest Time Waster for Nurse Managers

• Paperwork overload.

Bran's 12 Time Management Habits

• Strive to be authentic.
• Favor trusting relationships.
• Maintain lifestyle that gives you maximum energy.
• Organize your day by your biorhythms.
• Set very few priorities and stick to them.
• Turn down things inconsistent with your priorities.
• Set aside time for focused effort.
• Always look for ways of doing things better and faster.
• Build solid processes.
• Spot trouble ahead and solve problems immediately.
• Break goals into small units of work and think only about one unit at a time.
• Finish what is important and stop doing what is no longer worthwhile.

Leadership Roles in Groups

• Aggresso: Expresses disapproval of others' values or feelings through jokes, verbal attacks, or envy.
• Blocker: Persists in expressing negative points of view and resurrects dead issues.
• Recognition seeker: Works to focus positive attention on himself or herself.
• Self-confessor: Uses the group setting as a forum for personal expression.
• Playboy: Remains uninvolved and demonstrates cynicism, nonchalance, or horseplay.
• Dominator: Attempts to control and manipulate the group.
• Help seeker: Uses expressions of personal insecurity, confusion, or self-deprecation to manipulate sympathy from members.
• Special interest pleader: Cloaks personal prejudices or biases by ostensibly speaking for others.

Stages of Conflict

• Latent conflict: Underlying issues exist but aren't yet visible.
• Perceived conflict: Awareness of the conflict begins, but it hasn't yet escalated.
• Felt conflict: Emotional responses to the conflict start to develop.
• Manifest conflict: The conflict becomes visible and may involve confrontations.
• Conflict aftermath: The conflict is resolved, and the outcome impacts future interactions.

Conflict Resolution Strategies

• Cooperative/Accommodating: The person cooperating gives for the other.

Nurse-Patient Communication

• Promote better communication among patients, family members, and healthcare professionals from the point of admission.
• Implement safe continuity of care by keeping the patient and family informed through nurse bedside change-of-shift reports.
• Engage patients and families in discharge planning throughout the hospital stay.

Total Quality Management (TQM)

• Also known as continuous quality improvement (CQI).
• Based on the individual being the focal element in production and service.
• Focus on doing the right things, the right way, the first time, and problem-prevention planning.

Benchmarking

• The process of measuring products, practices, or services against best-performing organizations.

Evidence-Based Practice (EBP)

• Integrates the best available research evidence with clinical expertise and patient values.
• Helps ensure patient care is based on the latest and most reliable evidence.

Clinical Practice Guidelines (CPGs)

• Provide diagnosis-based, step-by-step interventions for providers to follow.
• Promote high-quality care while controlling resource utilization and costs.

Standards

• A predetermined level of excellence that serves as a model to follow.
• Performance is measured against predetermined standards.
• Each organization and profession must set standards and objectives to guide individual practitioners.

Ethics

• Ethics: The study of right and wrong conduct, focusing on what a person's actions and relationships should be, not necessarily what they are.
• Characteristics of ethical dilemmas:
  • Being forced to choose between two undesirable options.
  • Moral distress: knowing the right thing to do but being unable to act due to constraints.
  • Moral uncertainty/conflict: being unsure which moral principles apply.
  • Moral outrage: witnessing immoral acts but feeling powerless to stop them.
• Ethical terms:
  • Autonomy: Freedom to make choices and accept responsibility for those choices.
    • Violations: Imposing choices on patients, not informing them before a procedure.
  • Utilitarianism: Making decisions based on what produces the greatest good for the most people.
  • Beneficence: Acting to promote good.
    • Violation: Refusing a procedure that promotes health violates beneficence and autonomy.

Legal Considerations

• Purpose of healthcare laws and legislations: To protect patients and nurses, define scope of practice, and protect individual rights.
• TN State Nurse Practice Act: Defines and limits the practice of nursing.
• Statutory law: Established by congress, legislatures, and city councils.
• Civil law: Deals with disputes between individuals, like malpractice, seeking compensation for harm.
  • Example: A nurse violates patient rights and must pay damages.
• Criminal law: Involves offenses against society, can lead to loss of license and imprisonment.
  • Example: Practicing without a license.

Torts

• Torts: Legal wrongs against a person or property, leading to civil actions for damages.
  • Intentional torts: Direct invasion of someone's rights.
    • Assault: Threat of harm, causing a reasonable apprehension.
    • Battery: Intentional and wrongful physical contact, causing harm.
    • False imprisonment: Restraining someone's movement.
    • Invasion of privacy: Violating someone's right to privacy.
    • Defamation: harming someone's reputation.
      • Slander: Defamation through spoken words.
  • Unintentional torts: Accidents caused by carelessness or recklessness.
    • Negligence: Failure to exercise the care expected of a reasonable person.

Time Management

• Good time management benefits: Positive outcomes, productivity, and effective communication.
• Planning as a nurse manager: Appropriately prioritize tasks to meet short-term and long-term unit goals.
  • Reprioritizing: Adjusting plans based on new information.
• Priority setting: Do now tasks, delegating when possible.
• 3 steps in time management:
  • Plan ahead.
  • Complete the highest priority tasks first.
  • Finish one task before starting another.
• Best time for productivity: Start the day/morning by planning and updating as needed.
• Largest time waster for nurse managers: Paperwork overload.
• ** Bran's 12 habits to master time management:**
  • Strive for authenticity.
  • Favor trusting relationships.
  • Maintain a high-energy lifestyle.
  • Organize your day based on your biorhythms.
  • Set and stick to a few priorities.
  • Turn down tasks inconsistent with your priorities.
  • Set aside focused time for important tasks.
  • Look for ways to improve efficiency.
  • Develop solid processes.
  • Spot problems early and solve them promptly.
  • Break down large goals into smaller units.
  • Finish what's important and stop doing what's not worthwhile.

Leadership and Management Roles for Effective Time Management

• Leadership Roles:
  • Self-awareness of personal time management obstacles.
  • Recognizing how personal values influence time use.
  • Role modeling prioritization and supportive resources.
  • Working cooperatively with others to maximize time.
  • Preventing distractions and interruptions.
  • Adapting to different time management styles.
  • Staying calm during high activity periods.
  • Prioritizing conflicting requests for time.
  • Determining the quality of work needed for each task.
• Management Functions:
  • Prioritizing daily plans to meet unit goals.
  • Scheduling time for planning.
  • Analyzing time management on the unit level.
  • Eliminating environmental barriers to time effectiveness.
  • Handling paperwork efficiently.
  • Breaking down large tasks into smaller, manageable ones.
  • Utilizing technology to facilitate communication.
  • Identifying the root of time issues.

Communication

• Increasing accurate interpretation: Use multiple communication methods.
• Nonverbal communication: Often more reliable than verbal communication.

Ethics

• Definition: Study of right and wrong conduct, including personal, societal, and environmental aspects.
• Characteristics of nursing ethical dilemmas:
  • Forced to choose between undesirable alternatives
  • Moral Distress: Knowing the right thing but unable to act due to constraints.
  • Moral Uncertainty/Conflict: Unsure of which moral principles apply.
  • Moral Outrage: Witnessing immoral acts but feeling powerless.

Patient Refusal of Consent

• Steps:
  • Address concerns.
  • Provide necessary information.
  • Maintain open communication, empathy, and respect for patient autonomy.
  • Explore alternative options.

Ethical Terms

• Autonomy: Freedom of choice, taking responsibility for one's decisions.
  • Example: Grandkids deciding not to tell grandma about her illness violates her autonomy.
  • Violation: Occurs when patients are not properly informed.
• Beneficence: Actions taken to promote good.
  • Example: Patient refusing a health-promoting procedure violates both autonomy and beneficence.
• Justice: Fairness and equal treatment.
  • Example: Lack of community resources for low-income families violates justice.
  • Example: Allocating organs based on a person's worth to society violates justice.
• Nonmaleficence: Actions taken to avoid harm.
• Confidentiality: Maintaining private information.
• Utilitarianism: Making decisions based on what benefits the greatest number of people.

ANA Code of Ethics with Interpretive Statements

• Outlines core values, duties, and responsibilities for nurses.
• A guide for ethical practice consistent with quality nursing care.
• Not legally binding but functions as a guide for ethical standards and moral thinking.

Healthcare Laws & Legislation

• Purpose:
  • Protects patients and nurses.
  • Defines acceptable practice and protects individual rights.
  • Enables nurses to understand their legal rights and obligations.

Tennessee State Nurse Practice Act

• A type of statutory law.
• Defines and limits the practice of nursing within the state.

Types of Law

• Civil Law: Deals with disputes between individuals.
  • Example: Malpractice or negligence lawsuits.
  • Consequence of guilty verdict: Monetary damages.
• Criminal Law: Involves offenses against the state or public.
  • Examples: Theft, abuse, practicing without a license.
  • Consequence of guilty verdict: Fines, imprisonment, loss of license.
• Federal/Administrative Law: Rules and regulations issued by local, state, and federal governments.
  • Examples: HIPAA (patient privacy), ADA (anti-discrimination), OSHA (workplace safety).
  • Consequence of guilty verdict: Suspension or loss of licensure.

Medication Error

• Increase in both mandatory and voluntary reporting is crucial for addressing errors.

Malpractice

• Elements:
  • Standard of care (what should have been done).
  • Breach of duty (failure to meet the standard of care).
  • Foreseeability of harm (not meeting the standard of care could have caused harm).
  • Injury to the patient (provable link between improper care and injury).
  • Actual injury (injury occurred due to the defendant's actions).

Nurse Risk of Malpractice Suits

• Increased authority and independence in decision making.
• Increased legal accountability for decisions.
• Performing more actions previously done by physicians.
• Higher salaries.
• Increased prevalence of malpractice insurance.

Reducing Risk of Malpractice Suits

• Practice within the scope of the Nurse Practice Act.
• Observe and follow agency policies and procedures.
• Utilize evidence-based practice.
• Maintain open communication and accurate documentation.

Organizational Communication

• Key Factors:
  • Assessing organizational communication.
  • Understanding organizational structure and who will be affected by decisions.
  • Clear, simple, and precise communication.
  • Two-way communication.
  • Seeking feedback.
  • Utilizing multiple communication modes for important messages.
  • Avoiding overwhelming subordinates with unnecessary information.

Types of Communication

• Passive: Avoiding conflict by suffering in silence.
  • Example: Nursing tech silently enduring task assignment issues.
• Passive-Aggressive: Aggressive messages presented passively.
  • Example: Saying yes when meaning no, sarcasm, complaining about others.
  • Considered the most dangerous coworker.
• Aggressive: Direct, threatening, and condescending.
  • Infringes on others' rights and personal space.

Stages of Conflict

• Latent Conflict: Underlying issues that haven't surfaced.
  • Example: Staffing crisis.
• Perceived Conflict: Awareness of the conflict, but not escalated, often without emotional response.
  • Example: Staff reporting a problem to management.
• Felt Conflict: Emotional responses to the conflict start developing.
  • Example: Staff anxiety when management doesn't address staffing concerns.
• Manifest Conflict: Visible conflict with confrontations.
  • Example: Manager's meeting with staff to discuss the problem.
• Conflict Aftermath: The outcome of the conflict, impacting future interactions.
  • Example: Increased staff or resignation of staff.

Conflict Resolution Strategies

• Accommodating/Cooperative: One person sacrifices their beliefs to allow the other person to "win."

Other Conflict Resolution Strategies

• Collaboration: Working together to find a solution that benefits both parties.
• Compromise: Both parties give something up to reach a mutual agreement.
• Conflict Smoothing: Trying to avoid conflict by downplaying the issue.
• Avoidance: Ignoring or withdrawing from the conflict.
• Competing: Trying to win at all costs, regardless of the other party.

This quiz explores essential legal concepts in nursing, including criminal law, federal regulations, medication errors, and malpractice. Understanding these legal frameworks is crucial for ensuring patient safety and adhering to ethical standards in nursing practice.