Nursing Legal Aspects

• Legal issues encompass the rights, responsibilities, and scope of nursing practice, defined by state nurse practice acts and legislated through criminal and civil laws.
• All patients have a legal right to expect competent nursing services.
• Nursing students must be equipped to provide safe nursing care consistent with legal requirements.
• Malpractice is conduct deviating from the standard of practice dictated by a profession, and nursing malpractice cases are associated with liability risks of nursing and increasingly well-informed patients.

Sources and Types of Laws

• Law is the sum total of rules and regulations by which a society is governed and is made at the federal, state, and local levels to reflect changing needs and expectations.
• Statutory laws are made by legislative branches at the federal, state, and local levels.
  • Nursing laws are state statutory laws, and each state has a nurse practice act.
• Administrative laws are made by administrative agencies.
  • State boards of nursing are administrative agencies given power by the legislature to interpret and enforce the law.

Criminal Law

• Criminal law defines conduct harmful to another individual or to society and may be punishable by fines or imprisonment
  • A crime is an act prohibited by statute or common law principles.
  • Felonies are more serious crimes, while misdemeanors are lesser offenses.
  • Criminal law is enforced by law enforcement and government prosecutors.

Civil Law

• Civil law deals with the rights and duties of private persons.
  • A tort is a civil wrong committed against an individual or their property.

Torts

• Torts define and address both unintentional and intentional actions, or omissions that result in harm to another person or property.
  • Civil actions occur when a plaintiff files a lawsuit to seek compensation for damages suffered from a perceived wrong

Unintentional Torts

• These include incidents or accidents.
• Negligence is conduct that deviates from what a reasonable person would do in a particular circumstance.
  • A negligent act occurs when an individual damages a person or property without intent to injure, possibly due to carelessness.
  • The injured party must prove that the other party had a duty of reasonable care, did not maintain reasonable care, and that failure to maintain reasonable care caused injuries to the aggrieved party.
• Malpractice involves acts and omissions committed by a professional in the course of performing their professional duties.
  • The reasonable person standard is different for specific professional occupations.
  • Failure to meet the standard of conduct for one's profession may be considered professional negligence or malpractice.
• Malpractice is a critical area of law for nurses, and any negligent act or omission, even unintentional ones, may jeopardize the nurse's license and patient safety.
• The public relies on the special expertise of the profession and nursing students are held to the same standard of conduct as licensed nurses.
• Elements of professional negligence or malpractice includes:
  • Duty
  • Breach of duty
  • Foreseeability
  • Causation
  • Injury or harm

Elements of a Malpractice Suit

• The purpose of a malpractice lawsuit is to award damages to restore the plaintiff to their original position as far as possible.
  • Damages are compensation for the plaintiff's loss or injury.
  • Punitive damages may be awarded if misconduct is deemed malicious, willful, or wanton.

DUTY

• A relationship must exist between the health care provider and the patient.
• Duty arises when the professional assumes responsibility for the care of the patient
• Once assumed skill must be exercised.

BREACH OF DUTY

• Consists of either an act or omission, and is a violation of the standard of care
• Examples:
  • Failure to follow a physician's order
  • Failure to assess & report changes in patient's condition
  • Giving the wrong medication
  • Following a physician's order improperly

Sources of Standards of Care

• Federal Law
  • The Constitution covers privacy and confidentiality
• State Law
  • Nurse Practice Act found in state Revised Code
• Association Standards
  • Position Papers
• Hospital Policy
  • Maintain competent and safe care

Standards of Care

• The law does not require a nurse to protect against every possible harm, but requires them to give care that other reasonably prudent nurses would.
  • Provision of high-quality care should be consistent with established nursing standards of care and professional performance.

Professional Standards

• Adhering to standards requires the nurse to be knowledgeable about them.
• One must attend continuing education that focuses on standards, participate in updating skills with new equipment, and update information about new developments in patient care.

FORESEEABILITY

• Certain events may reasonably be expected to cause specific results.
• Could one reasonably foresee a certain result based on the facts as they existed at the time of the event in question?

CAUSATION

• Breach of duty must be the direct and proximate cause of the injury.
• The injury type should be a foreseeable consequence of the negligent act.
• Causation is the most difficult element for the plaintiff to prove, making documentation critical to refute any claim of causation.

INJURY

• Once the plaintiff proves a duty existed and that the duty was breached, injury must be proven.
• A minor injury with a full recovery is insufficient; the injury must be serious and permanent.
• A claim based on psychological or emotional distress is seldom successful.

Intentional torts

• Are actions taken by an individual with intent to perform the action.
• Intent separates them from negligence and malpractice.
• These torts include assault, battery, and false imprisonment

Assault

• It is an act that creates an apprehension of offensive, insulting, or physically injurious touching, including threatening a patient who refuses to agree to a nursing action.

Battery

• It is willful touching or apprehension of touching that is unwanted, embarrassing, or unwarranted.
  • Battery includes touching without permission, giving an injection without a patient's consent, or forcing a patient to ambulate against their will.

False Imprisonment

• It is the unjustified detention of a person without legal warrant.

Invasion of Privacy

• Individuals have a right to privacy.
• Information about patients is confidential and may not be disclosed without authorization.
• A patient's right to privacy extends to the use of the patient's name, photographic, or videographic representations.
• Right to privacy includes the patient's personal belongings and personal space.
• Nurses are bound by the privacy rule of HIPAA.
  • HIPAA protections are minimum requirements, and state law or professional codes may include more strict protections.

Strategies to prevent Malpractice

• Continuing issue of medication errors
  • Document and discuss with patients
• Communicate key information and patient concerns
• Orders must be clear
• Training and competence with equipment is essential
• Mentoring, assessment and care-plans

Maintaining Patient Safety

• Failure to observe and take appropriate action
  • Nurse is liable when action or inaction causes an injury via falls
  • Ignore a patients complaints
  • Failure to observe and take appropriate action
• Correct Identification of patients
  • Surgery performed on the wrong patient
• Renders nurse liable for malpractice

Minimizing Medication Errors

• Apply the Seven Rights of Medications
  • Right assessment
  • Right patient
  • Right drug
  • Right does
  • Right time
  • Right route
  • Right Documentation
• Use new technology to reduce errors
• Clarify order
• Know each medication before administration
• Get questions answered
• Nothing can replace nursing judgement

Effective Communication

• Increases chances of malpractice claims
• Clear direction reduce bad outcomes
• Accurate documentation
• Documentation servers as legal record

General Guidelines for Documentation

• Maintain record confidentiality with legal standards
• Recordings should include
  • Date and time
  • No recording is to be done before providing care
  • Use accepted terminology
  • Acronyms and symbols
  • Full terms

Documentation Should Include

• Correct spelling
• Signature
• Facts, objective observations
• Sequence
• Appropriateness
• Pertinent inforamtion for care

Additional factors

• Reflective nursing process
• Progress toward goals
• conciseness
• Complete
• Legal Rationale
• clinical records as court evidence
• Adhere to proffesional standards

Do's of Documentation

• Follow-up
• Prior notes
• Objective
• Accurate
• Chart all teaching
• Quotations
• Patient responses

Don'ts of Documentation

• Chart in advance
• Vague terms
• Change records unless you have permission
• "Patient" instead of name
• Assumptions or words reflecting bias

Professional Liability

• Nurses must carry insurance
• Individual group are options
• Sponsored by your employer
• Programs cover liability

Risk Management

• Report incident immediately
• Document everything
• Don't point fingers/discuss
• Acknowledge patients feelings
• Accountability
• System oversight

Overview of legal issues in nursing practice. It includes statutory and administrative laws. Focus on sources and types of laws that govern nursing.