Chapter 3 Ethical and Legal Issues in Nursing PDF

Chapter 3 Ethical and Legal Issues in Nursing  Learning Outcomes ‚ Apply the principles included in state nurse practice acts, including scope of practice and unprofessional conduct. ‚ Apply various legal principles when acting in leading and managing roles in nursing p...

Chapter 3 Ethical and Legal Issues in Nursing  Learning Outcomes ‚ Apply the principles included in state nurse practice acts, including scope of practice and unprofessional conduct. ‚ Apply various legal principles when acting in leading and managing roles in nursing practice settings. ‚ Evaluate informed-consent issues, including patients’ rights in research and health literacy, from a nurse manager’s perspective. ‚ Analyze how employment laws benefit professional nursing practice. ‚ Analyze ethical principles and codes and institutional policies that influence nursing practice. ‚ Apply best practices to assist staff in addressing legal and ethical situations, particularly when the law and ethics overlap. 2  Professional Nursing Practice: Nurse Practice Acts ‚ Most important piece of legislation for nurses. ‚ Define the categories of nurses. ‚ Set educational and examination requirements. ‚ Establishes a state board of nursing, which develops and implements rules and regulations. 3  Licensure and Nursing Practice Acts ‚ Nurse Licensure Compact (NLC)  RNs may be licensed in one state and practice in another state within the compact.  The state where the patient or client resides is the state that regulates the nurse’s practice. 4  Negligence and Malpractice ‚ Negligence equates with carelessness. ‚ Malpractice or “professional negligence” concerns professional actions. ‚ Both concern actions taken as well as actions omitted. ‚ Both are nonintentional. 5  Elements of Malpractice ‚ Duty/Standard of Care ‚ Breach of Duty/Standard of Care ‚ Causation ‚ Damages 6  Duty Owed the Patient ‚ Established through a valid employment contract with the healthcare facility ‚ Based on standards of care or the minimum requirement for acceptable practice 7  Breach of Duty Owed the Patient ‚ Synonymous with failing to uphold the standard of care owed the patient ‚ Generally shown at court through the testimony of expert witnesses 8  Causation ‚ What the nurse did or failed to do must directly cause the patient’s subsequent harm 9  Damages ‚ The patient must be able to prove injury so that damages may be assessed. ‚ Purpose of damages is to compensate the injured party for the harm that was done. ‚ Thus immediate and future medical costs can be assessed. 10  Liability ‚ Personal liability: individual responsibility and accountability for actions or omissions ‚ Vicarious liability: employer’s accountability for the negligence of employees ‚ Corporate liability: institution responsibility and accountability for maintaining an environment that ensures quality healthcare delivery for consumers 11  Preventing Malpractice Lawsuits ‚ Nurse managers should:  Ensure that employees meet or exceed standards of care  Review standards periodically so that standards can be revised  Review randomly selected patient records for evidence that standards are being met  Perform scheduled evaluations of staff 12 Causes of Medical Malpractice for Nurse Managers  Assignment, delegation, and supervision  Duty to orient, educate, and evaluate  Failure to warn  Staffing issues  Accreditation  Mandatory Overtime  Floating  Temporary Staff  Protective and reporting laws 13  Assignment, Delegation, and Supervision ‚ Supervision is the active process of directing, guiding, and influencing the outcome of an individual’s performance of an activity. ‚ Delegation is the transfer of responsibility, but not of accountability, for the performance of an activity. ‚ Assignment is the transfer of the responsibility and the accountability for the performance of an activity. 14  Duty to Orient, Educate, and Evaluate ‚ Nurse mangers are responsible for the daily evaluation of safe and competent nursing care delivery. ‚ Key is reasonableness and should be determined on a case-by-case basis. 15  Failure to Warn ‚ This involves warning subsequent potential employers of staff incompetencies or impairment. ‚ Provided by using qualified privilege, which is communication made in good faith between persons or entities with a need to know. 16  Staffing Issues ‚ Three areas to consider:  Maintaining adequate numbers of staff  Floating staff from unit to unit  Using temporary staff to augment current staff numbers 17  Accreditation ‚ TJC and the Community Health Accreditation Program (CHAP) ‚ Mandate adequate staffing with qualified personnel ‚ Applies to both numbers of staff and staffing mix ‚ Adequate staffing is based on:  Numbers of patients  Care acuity scores  Numbers and classification of nursing staff 18  Mandatory Overtime ‚ Prohibited by several states ‚ Protect employees from disciplinary action or retribution for refusing to work overtime ‚ Establish monetary penalties for the employer’s failure to adhere to the law 19  Floating Staff to Alternate Units ‚ One means to ensure that every area of the facility is adequately staffed ‚ Consider staff expertise, patient care delivery systems, and patient care requirements before deciding which staff to float ‚ Cross-train staff during times of adequate staffing 20  Guidelines ‚ Nurse managers in times of inadequate staffing should:  Alert agency administration of concerns  Reassign staff as appropriate  Approve overtime for adequate coverage  Restrict new admissions 21  Temporary Staff ‚ Has become more important because of the principle of apparent agency. ‚ Patients can infer that the agency staff are working directly for the institution. Thus it is imperative that the agency or temporary nurse can deliver safe and competent nursing care. 22  Protective and Reporting Laws ‚ Ensure the safety or rights of specific classes of individuals. ‚ Examples include the mandatory reporting for suspected child and elder abuse and reporting of certain categories of diseases or injuries. ‚ Includes the mandatory reporting of incompetent practitioners. 23  Informed Consent ‚ Authorization by the patient or the patient’s legal representative to do something to the patient ‚ Based on legal capacity, voluntary action, and comprehension 24 Selected Informed Consent Issues ‚ Research issues are impacted by the federally enacted HIPAA laws. ‚ Research issues vary in regard to de-identified information and protected health information. ‚ Issues also arise in relationship to a patient’s health literacy. 25  Privacy and Confidentiality ‚ Privacy: the patient’s right to protection against unreasonable interference with reputation or right to be left alone ‚ Confidentiality: right to privacy of the medical record 26  Policies and Procedures ‚ Documents set standards of care for the institution and direct practice. ‚ They must be clearly stated, well delineated, and based on current practice. 27  Employment Laws ‚ Nurse managers need to be familiar with several of these federal laws, including  Equal Employment Opportunity Laws  Americans with Disabilities Act of 1990  Occupational Health and Safety Laws  Family and Medical Leave Act of 1993  Whistleblower laws 28  Equal Employment Opportunity Laws ‚ Prohibit discrimination based on gender, age, race, religion, handicap, pregnancy, and national origin. ‚ Title VII of the amended Civil Rights Act of 1964 governs these equal employment opportunities. ‚ Amended Civil Rights Act of 1991 governs sexual harassment in the workplace. 29  Americans with Disabilities Act of 1990 ‚ Provides protection to persons with disabilities ‚ Disability is defined as:  Physical or mental impairment that substantially limits one or more of the major life activities of an individual.  The fact that there is a record of such impairment to the individual is regarded as establishing that the individual has the impairment. 30 Occupational Safety and Health Act ‚ Ensures that healthful and safe working conditions exist in the workplace setting. ‚ Newer aspects that the rules address include:  Violence and bullying in the workplace  Safe patient handling  Ergonomic issues common in the healthcare industry 31  Family and Medical Leave Act of 1993 ‚ Balances the demands of the workplace with the demands of the family, allowing employed individuals to take leaves for medical reasons ‚ Includes care for:  The birth or adoption of a child  Care of a spouse, child, or parent with serious health problems  Healthcare needs of the employed individual himself or herself 32  Employment-at-Will and Wrongful Discharge ‚ Public Policy  Jury  Whistleblower Laws  Workers’ compensation claim ‚ Implied Contract ‚ “Good faith and fair dealing” 33  Professional Nursing Practice: Ethics ‚ Concern the individual within society and the “why” of actions as opposed to what was done or not done ‚ Provide no right or wrong answers; rather there are better or less desirable actions ‚ Often encountered in conjunction with legal concerns ‚ Example: Theresa Schiavo case 34  Ethical Principles ‚ Autonomy: personal freedom ‚ Beneficence: duty to do good ‚ Confidentiality ‚ Fidelity: keeping one’s promises ‚ Justice: fairness ‚ Non-maleficence: do no harm ‚ Paternalism: assisting with decision making ‚ Respect: dignity of the person ‚ Veracity: truth-telling 35  Professional Codes of Ethics ‚ Formal statements that articulate values and beliefs of a given profession. ‚ Serve the following functions:  Inform the public of the minimum standards of conduct for members of the profession.  Outline ethical considerations of the profession.  Provide guidelines for ethical practice by members of the profession.  Guide the discipline’s self-regulation. 36  Ethical Decision-Making Framework ‚ Use of orderly, systematic, and objective method ‚ Ethical model to assist in complex decision making 37  Moral Distress ‚ Occurs when faced with situations in which two ethical principles compete. ‚ Experienced in clinical settings when nurses cannot provide what they perceive is the best care or outcome for a given patient. ‚ Examples include disagreements regarding patient interventions and limited patient care resources. 38  Ethics Committees ‚ Provide long- and short-term assistance by:  Providing structure and guidelines for potential problems  Serving as open forums for discussion  Functioning as patient advocates by placing the patient at the core of the committee discussions 39  Blending Legal and Ethical Issues ‚ In conclusion,  Read and comply with provisions of the state nurse practice act.  Apply legal concepts in all healthcare settings.  Understand and abide by state and federal employment laws.  Implement the provisions of the Code of Ethics.  If legal and ethical issues are contradictory, legal aspects take precedence. 40