Nursing Legal Implications Chapter 23

Legal Limits of Nursing

• Sources of law: constitutional law, statutory law, administrative law, common law, and case law.
• Scope and standards of nursing: define nursing and reflect the values of the nursing profession, and standards of nursing care reflect the knowledge and skill ordinarily possessed and used by nurses.

Federal Statutes Affecting Nursing Practice

• Patient Protection and Affordable Care Act (PPACA): consumer rights and protections, affordable health care coverage, increased access to care, and quality of care that meets the needs of patients.
• Emergency Medical Treatment and Active Labor Act: prohibits the transfer of patients from private to public hospitals without appropriate screening and stabilization.
• Health Insurance Portability and Accountability Act (HIPAA): provides rights to patients and protects employees.
• Health Information Technology Act: ensures protected health information (PHI) is protected.
• Americans with Disabilities Act (ADA): protects the rights of people with physical or mental disabilities.
• Mental Health Parity and Addiction Equity Act: requires health insurance companies to provide coverage for mental health and substance use disorder (SUD) treatment.
• Patient Self-Determination Act: requires health care institutions to provide written information to patients concerning their rights to make decisions about their care, including the right to refuse treatment and to formulate an advance directive.
• Uniform Anatomical Gift Act: provides the foundation for the national organ donation system.
• The Omnibus Budget Reconciliation Act (1986): altered the way in which health care is provided to older adults.

State Statutes Affecting Nursing Practice

• Nurse practice acts: state laws intended to protect citizens, make nurses accountable, and assure that care is consistent with best practice within the scope and standards of nursing.
• Licensure: nurse licensure compact.
• Health care acts and informed consent: patients receive an explanation of the procedure, names and qualifications of people performing and assisting in the procedure, description of serious harm that may occur, and the right to refuse the procedure or treatment without discontinuing other supportive care.
• Good Samaritan laws: limit liability and offer legal immunity if a nurse helps at the scene of an accident.
• Public health laws: laws affect individuals, populations, and communities, and are intended to improve the health of people.
• Termination of pregnancy: laws vary by state, and nurses should know the law in their state related to termination of pregnancy before working in this area of practice.
• Physician-assisted suicide: laws vary by state, and nurses should know their state's laws and ensure that their practice falls within the laws' requirements.
• The Uniform Determination of Death Act: determines actual death.

Nursing Workforce Guidelines

• Staffing and nurse-to-patient ratios: ensure adequate staffing and patient care.
• Nursing assignments: ensure appropriate delegation of tasks.
• Patient abandonment: nurses should not abandon patients without proper transfer of care.
• Nurse delegation: ensure that tasks are delegated to competent personnel.
• Nursing students: ensure students are properly supervised and assigned tasks.

Legal Implications and Reducing Your Legal Risks

• Torts: civil wrongful acts or omissions of care made against a person or property.
• Quasi-intentional torts: acts in which a person may not intend to cause harm to another but does.
• Unintentional torts: arise when a person is harmed and the person inflicting the harm knew, or should have known, that these actions were less than the accepted scope and standard of practice.
• Negligence: conduct that falls below the generally accepted standard of care of a reasonably prudent person.
• Malpractice: a type of negligence, the person being held liable for malpractice must be a professional.
• Standard of proof: what a reasonably prudent nurse would do under similar circumstances in the geographical area in which the alleged breach occurred.
• Malpractice insurance: contract between an insurance company and a nurse or employer that is intended to cover costs incurred when a patient sues the employer and/or the nurse.
• Nurse experts: testify about the standards of nursing care as applied to the facts of a case.
• Reducing legal risks: remain involved in the nursing profession, implement actions in your own practice, develop and use clinical judgment, remain aware of current issues in healthcare, and become involved in professional organizations and committees that define the standards of care for nursing practice.