Chapter 4: Nursing Practice and State Laws

Safe, Effective Care Environment

• Each state has enacted statutes that define the parameters of nursing practice and give the authority to regulate the practice of nursing to its state board of nursing.
• Boards of nursing have the authority to issue and revoke a nursing license, set standards for nursing programs, and further delineate the scope of practice for RNs, practical nurses (PNs), and advanced practice nurses.

Licensure

• Nurses must have a current license in every state in which they practice.
• The nurse licensure compact allows licensed nurses who reside in a compact state to practice in other compact states under a multistate license.

Sources of Law

• Federal laws affecting nursing practice include:
  • Health Insurance Portability and Accountability Act (HIPAA)
  • Americans with Disabilities Act (ADA)
  • Mental Health Parity Act (MHPA)
  • Patient Self-Determination Act (PSDA)
• Tort laws include:
  • Unintentional torts (e.g., negligence)
  • Quasi-intentional torts (e.g., breach of confidentiality)
  • Intentional torts (e.g., assault, battery, false imprisonment)

Professional Negligence

• Professional negligence is the failure of a person with professional training to act in a reasonable and prudent manner.
• Examples of negligence include:
  • Failure to follow professional and facility-established standards of care
  • Failure to use equipment in a responsible and knowledgeable manner
  • Failure to communicate effectively and thoroughly with clients
  • Failure to document care provided
  • Failure to notify the provider of a change in the client's condition

Clients' Rights

• Nurses are accountable for protecting the rights of clients, including:
  • Informed consent
  • Refusal of treatment
  • Advance directives
  • Confidentiality
  • Information security
• Clients have the right to understand the aspects of care to be active in the decision-making process.
• Clients have the right to accept, refuse, or request modification of the plan of care.

Informed Consent

• Informed consent is a legal process by which a client or their legally appointed designee gives written permission for a procedure or treatment.
• The client must be informed of:
  • The reason they need the treatment or procedure
  • The benefits of the treatment or procedure
  • The risks involved if they choose to receive the treatment or procedure
  • Other options to treat the problem, including not treating the problem
• The nurse's role in the informed consent process is to witness the client's signature on the informed consent form and ensure that the provider has obtained the informed consent responsibly.

Refusal of Treatment

• Clients have the right to refuse treatment, including the right to leave a health care facility without a discharge prescription from the provider.
• If the client refuses a treatment or procedure, the nurse must document the incident and discuss the risks involved with refusing the treatment or procedure with the client.

Advance Directives

• Advance directives are used to communicate a client's wishes regarding end-of-life care should they become unable to do so.

• Types of advance directives include:

  • Living will
  • Durable power of attorney for health care

• The Patient Self-Determination Act (PSDA) requires asking all clients on admission to a health care facility whether they have advance directives.### Healthcare Facilities' Policies and Procedures

• Establish the standard of practice for employees in that facility

• Provide detailed information on how to respond to or provide care in specific situations and while performing client care procedures

• Implicate nurses in malpractice lawsuits if they do not follow these standards

Nursing Role in Advance Directives

• Provide written information about advance directives
• Document the client's advance directives status
• Ensure that the advance directives reflect the client's current decisions
• Inform all members of the healthcare team of the client's advance directives

Mandatory Reporting

• Healthcare providers have a legal obligation to report their findings in accordance with state law in certain situations
• Nurses must report any suspicion of abuse (child or elder abuse, adult violence) following facility policy
• Nurses must report communicable disease diagnoses to the local or state health department
• Reporting allows officials to ensure appropriate medical treatment, monitor for common-source outbreaks, plan and evaluate control and prevention plans, and identify outbreaks and epidemics

Impaired Coworkers

• Impaired healthcare providers pose a significant risk to client safety
• Nurses who suspect a coworker of any behavior that jeopardizes client care or could indicate a substance use disorder have a duty to report the coworker to the appropriate manager
• Facilities' policies provide access to assistance programs that facilitate entry into a treatment program

Nursing Interventions to Avoid Liability for Negligence

• Refuse to practice beyond the legal scope of practice or outside of their areas of competence
• Use the formal chain of command to verbalize concerns related to assignment
• Document all client information and communications accurately and fully
• Inform all members of the healthcare team of the client's advance directives
• Verify that the client has given informed consent before performing any procedure or treatment

Good Samaritan Law

• Protects healthcare workers from liability when intervening at the scene of an emergency
• Exists in all states

Licensure

• Nurses must have a current license in every state they practice
• Some states have adopted the Nurse Licensure Compact, allowing licensed nurses to practice in other compact states
• Nurses must practice in accordance with the statutes and rules of the state in which they provide care

Sources of Law

• Federal laws affecting nursing practice:
  • Health Insurance Portability and Accountability Act (HIPAA)
  • Americans with Disabilities Act (ADA)
  • Mental Health Parity Act (MHPA)
  • Patient Self-Determination Act (PSDA)
• Criminal and civil laws:
  • Criminal law: relates to the relationship between an individual and the government
  • Civil law: protects individual rights

Tort Law

• Unintentional torts: negligence (e.g., failing to implement safety measures for a client at risk for falls)
• Quasi-intentional torts: breach of confidentiality (e.g., releasing a client's medical diagnosis to a member of the press)
• Intentional torts:
  • Assault (e.g., threatening to place an NG tube in a client)
  • Battery (e.g., physically contacting a client without consent)
  • False Imprisonment (e.g., restraining a competent client to prevent their leaving)

Reporting Responsibilities

• Abuse: nurses must report any suspicion of abuse (child or elder abuse, adult violence) following facility policy
• Communicable diseases: nurses must report diagnoses to the local or state health department to:
  • Ensure appropriate medical treatment
  • Monitor for common-source outbreaks
  • Plan and evaluate control and prevention plans
  • Identify outbreaks and epidemics