Legal Responsibilities PDF

CHAPTER 4 UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT STATE LAWS SECTION: MANAGEMENT OF CARE Each state has enacted statutes that define the Legal...

CHAPTER 4 UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT STATE LAWS SECTION: MANAGEMENT OF CARE Each state has enacted statutes that define the Legal parameters of nursing practice and give the authority CHAPTER 4 to regulate the practice of nursing to its state board Responsibilities of nursing. In turn, the boards of nursing have the authority to adopt rules and regulations that further regulate nursing practice. Although the practice of nursing is Understanding the laws governing nursing similar among states, it is critical that nurses know the laws and rules governing nursing in the state in which practice helps nurses protect clients’ rights and they practice. reduce the risk of nursing liability. Boards of nursing have the authority to issue and revoke a nursing license. Nurses are accountable for practicing nursing Boards also set standards for nursing programs and further delineate the scope of practice for RNs, practical within the confines of the law to shield nurses (PNs), and advanced practice nurses. themselves from liability; advocate for clients’ All states have some type of Good Samaritan law that protects health care workers from liability when they rights; provide care that is within the nurse’s intervene at the scene of an emergency. scope of practice; discern the responsibilities of nursing in relationship to the responsibilities LICENSURE of other members of the health care team; and In general, nurses must have a current license in every state in which they practice. The states (about half of provide safe, proficient care consistent with them) that have adopted the nurse licensure compact are standards of care. exceptions. This model allows licensed nurses who reside in a compact state to practice in other compact states under a multistate license. Within the compact, nurses SOURCES OF LAW must practice in accordance with the statues and rules of the state in which they provide care. FEDERAL REGULATIONS Federal laws affecting nursing practice Health Insurance Portability and 4.1 Types of torts Accountability Act (HIPAA) Americans with Disabilities Act (ADA) Mental Health Parity Act (MHPA) Unintentional torts Patient Self‑Determination NEGLIGENCE: A nurse fails to implement safety measures for a client at risk for falls. Act (PSDA) MALPRACTICE (PROFESSIONAL NEGLIGENCE): A nurse administers a large dose of medication due to a calculation error. The client has a cardiac arrest and dies. CRIMINAL AND CIVIL LAWS Quasi‑intentional torts BREACH OF CONFIDENTIALITY: A nurse releases a client’s Criminal law is a subsection of public medical diagnosis to a member of the press. law and relates to the relationship DEFAMATION OF CHARACTER: A nurse tells a coworker that between an individual and the they believe the client has been unfaithful to their partner. government. A nurse who falsifies a record to cover up a serious Intentional torts mistake can be guilty of breaking a ASSAULT BATTERY FALSE IMPRISONMENT criminal law. The conduct of one Intentional and wrongful A person is confined or Civil laws protect individual rights. person makes another physical contact with a restrained against their will person fearful and person that involves an A nurse uses restraints One type of civil law that relates apprehensive injury or offensive contact on a competent client to the provision of nursing care is A nurse threatens to place A nurse restrains a to prevent their leaving tort law. (4.1) an NG tube in a client client and administers the health care facility. who is refusing to eat. an injection against their wishes. FUNDAMENTALS FOR NURSING CHAPTER 4 Legal Responsibilities 15  PROFESSIONAL NEGLIGENCE CLIENTS’ RIGHTS Professional negligence is the failure of a person who Nurses are accountable for protecting the rights of has professional training to act in a reasonable and clients. Examples include informed consent, refusal prudent manner. The terms “reasonable” and “prudent” of treatment, advance directives, confidentiality, and generally describe a person who has the average judgment, information security. intelligence, foresight, and skill that a person with similar Clients’ rights are legal privileges or powers clients have training and experience would have. when they receive health care services. Negligence issues that prompt most malpractice suits Clients using the services of a health care institution include failure to: retain their rights as individuals and citizens. ◯ Follow professional and facility‑established The American Hospital Association identifies standards of care. clients’ rights in health care settings. See The ◯ Use equipment in a responsible and Patient Care Partnership on the American Hospital knowledgeable manner. Association website. ◯ Communicate effectively and thoroughly with clients. Nursing facilities that participate in Medicare programs ◯ Document care the nurse provided. also follow Resident Rights statutes that govern ◯ Notify the provider of a change in the their operation. client’s condition. Complete a prescribed procedure. NURSING ROLE IN CLIENTS’ RIGHTS ◯ Nursing students face liability if they harm clients as a result of their direct actions or inaction. They should Nurses must ensure that clients understand their rights, not perform tasks for which they are not prepared, and must protect their clients’ rights. and they should have supervision as they learn new Regardless of the client’s age, nursing needs, or health procedures. If a student harms a client, then the student, care setting, the basic tenets are the same. The client instructor, educational institution, and facility share has the right to: liability for the wrong action or inaction. (4.2) ◯ Understand the aspects of care to be active in the Nurses can avoid liability for negligence by: decision‑making process. ◯ Following standards of care. ◯ Accept, refuse, or request modification of the ◯ Giving competent care. plan of care. ◯ Communicating with other health team members ◯ Receive care from competent individuals who treat and clients. the client with respect. ◯ Developing a caring rapport with clients. ◯ Fully documenting assessments, interventions, and evaluations. ◯ Being familiar with and following a facility’s policies and procedures. 4.2 The five elements necessary to prove negligence ELEMENT OF LIABILITY EXPLANATION EXAMPLE: CLIENT WHO IS A FALL RISK 1. Duty to provide care as Care a nurse should give or what a The nurse should complete a fall risk assessment defined by a standard reasonably prudent nurse would do for all clients during admission. 2. Breach of duty by failure Failure to give the standard of care The nurse does not perform a fall risk to meet standard assessment during admission. 3. Foreseeability of harm Knowledge that failing to give the proper The nurse should know that failure to take fall risk standard of care could harm the client precautions could endanger a client at risk for falls. 4. Breach of duty has Failure to meet the standard Without a fall risk assessment, the nurse potential to cause had potential to cause harm – does not know the client’s risk for falls and harm (combines relationship must be provable does not take the proper precautions. elements 2 and 3) 5. Harm occurs Actual harm to the client occurs The client falls out of bed and fractures their hip. 16 CHAPTER 4 Legal Responsibilities CONTENT MASTERY SERIES  Online Video: Informed Consent INFORMED CONSENT A competent adult must sign the form for informed consent. The person who signs the form must be capable Informed consent is a legal process by which a client of understanding the information from the health care or the client’s legally appointed designee has given professional who will perform the service (a surgical written permission for a procedure or treatment. procedure) and the person must be able to communicate Consent is informed when a provider explains and the with the health care professional. When the person client understands: giving the informed consent is unable to communicate ◯ The reason the client needs the treatment due to a language barrier or a hearing impairment, a or procedure. trained medical interpreter must intervene. Many health ◯ How the treatment or procedure will benefit the client. care facilities contract with professional interpreters ◯ The risks involved if the client chooses to receive the who have additional skills in medical terminology to treatment or procedure. assist with providing information. ◯ Other options to treat the problem, including not Individuals who can grant consent for another person treating the problem. include the following. The nurse’s role in the informed consent process is to ◯ Parent of a minor witness the client’s signature on the informed consent ◯ Legal guardian form and to ensure that the provider has obtained the ◯ Court‑specified representative informed consent responsibly. ◯ An individual who has durable power of attorney INFORMED CONSENT GUIDELINES authority for health care Clients must consent to all care they receive in a health Emancipated minors (minors who are independent care facility. from their parents [a married minor]) can consent For most aspects of nursing care, implied consent for themselves. is adequate. Clients provide implied consent when Include a mature adolescent in the informed consent they adhere to the instructions the nurse provides. process by allowing them to sign an assent as a part of For example, the nurse is preparing to perform a the informed consent document. (4.3) tuberculosis skin test, and the client holds out their arm The nurse must verify that consent is informed and for the nurse. witness the client signing the consent form. For an invasive procedure or surgery, the client must provide written consent. State laws prescribe who is able to give informed consent. Laws vary regarding age limitations and emergencies. Nurses are responsible for knowing the laws in the state(s) in which they practice. 4.3 Responsibilities for informed consent Provider Client Nurse Obtains informed consent. To do so, Gives informed consent. To give Witnesses informed consent. the provider must give the client informed consent, the client must This means the nurse must The purpose of the procedure. Give it voluntarily (no coercion involved). Ensure that the provider gave the A complete description of the procedure. Be competent and of legal age or be client the necessary information. A description of the professionals an emancipated minor. When the client Ensure that the client understood who will perform and participate is unable to provide consent, another the information and is competent in the procedure. authorized person must give consent. to give informed consent. A description of the potential harm, Receive enough information to Have the client sign the informed pain, or discomfort that might occur. make a decision based on an consent document. understanding of what to expect. Notify the provider if the client has more Options for other treatments. questions or appears not to understand The option to refuse treatment and any of the information. The provider is the consequences of doing so. then responsible for giving clarification. Document questions the client has, notification of the provider, reinforcement of teaching, and use of an interpreter. FUNDAMENTALS FOR NURSING CHAPTER 4 Legal Responsibilities 17  REFUSAL OF TREATMENT ADVANCE DIRECTIVES The PSDA stipulates that staff must inform clients they The purpose of advance directives is to communicate a admit to a health care facility of their right to accept or client’s wishes regarding end‑of‑life care should the client refuse care. Competent adults have the right to refuse become unable to do so. treatment, including the right to leave a facility without The PSDA requires asking all clients on admission a discharge prescription from the provider. to a health care facility whether they have If the client refuses a treatment or procedure, the client advance directives. signs a document indicating that they understand the Staff should give clients who do not have advance risk involved with refusing the treatment or procedure directives written information that outlines their rights and that they have chosen to refuse it. related to health care decisions and how to formulate When a client decides to leave the facility against advance directives. medical advice (without a discharge prescription), the A health care representative should be available to help nurse notifies the provider and discusses with the with this process. client the risks to expect when leaving the facility prior to discharge. Types of advance directives The nurse asks the client to sign an Against Medical Living will Advice form and documents the incident. A living will is a legal document that expresses the client’s wishes regarding medical treatment in the STANDARDS OF CARE (PRACTICE) event the client becomes incapacitated and is facing end‑of‑life issues. Nurses base practice on established standards of care or Most state laws include provisions that protect health legal guidelines for care, including the following. care providers who follow a living will from liability. ◯ The nurse practice act of each state. ◯ Published standards of nursing practice from Durable power of attorney for health care professional organizations and specialty groups, A durable power of attorney for health care is a document including the American Nurses Association (ANA), the in which clients designate a health care proxy to make American Association of Critical Care Nurses (AACN), health care decisions for them if they are unable to do so. and the American Association of Occupational Health The proxy can be any competent adult the client chooses. Nurses (AAOHN). ◯ Health care facilities’ policies and procedures, which Provider’s orders Unless a provider writes a “do not resuscitate” (DNR) or establish the standard of practice for employees of “allow natural death” (AND) prescription in the client’s that facility. They provide detailed information about medical record, the nurse initiates cardiopulmonary how the nurse should respond to or provide care resuscitation (CPR) when the client has no pulse or in specific situations and while performing client respirations. The provider consults the client and the care procedures. family prior to administering a DNR or AND. Standards of care define and direct the level of care nurses should give, and they implicate nurses who did NURSING ROLE IN ADVANCE DIRECTIVES not follow these standards in malpractice lawsuits. Nursing responsibilities include the following. Nurses should refuse to practice beyond the legal scope Provide written information about advance directives. of practice or outside of their areas of competence Document the client’s advance directives status. regardless of reason (staffing shortage, lack of Ensure that the advance directives reflect the client’s appropriate personnel). current decisions. Nurses should use the formal chain of command to Inform all members of the health care team of the verbalize concerns related to assignment in light of client’s advance directives. current legal scope of practice, job description, and area of competence. MANDATORY REPORTING Health care providers have a legal obligation to report IMPAIRED COWORKERS their findings in accordance with state law in the Impaired health care providers pose a significant risk to following situations. client safety. A nurse who suspects a coworker of any behavior that ABUSE Nurses must report any suspicion of abuse (child or elder jeopardizes client care or could indicate a substance abuse, adult violence) following facility policy. use disorder has a duty to report the coworker to the appropriate manager. Many facilities’ policies provide access to assistance programs that facilitate entry into a treatment program. Each state has laws and regulations that govern the disposition of nurses who have substance use disorders. Criminal charges could apply. 18 CHAPTER 4 Legal Responsibilities CONTENT MASTERY SERIES  COMMUNICABLE DISEASES Nurses must report communicable disease diagnoses to the local or state health department. For a complete list of reportable diseases and a description of the reporting system, go to the Centers for Disease Control and Prevention’s website, www.cdc.gov. Each state mandates which diseases to report in that state. Reporting allows officials to: Active Learning Scenario ◯ Ensure appropriate medical treatment of diseases (tuberculosis). A nurse is teaching a group of newly licensed nurses ◯ Monitor for common‑source outbreaks (foodborne, about avoiding liability for negligence. Use the ATI Active hepatitis A). Learning Template: Basic Concept to complete this item. ◯ Plan and evaluate control and prevention plans UNDERLYING PRINCIPLES: List the five (immunizations). ◯ Identify outbreaks and epidemics. elements necessary to prove negligence. ◯ Determine public health priorities based on trends. NURSING INTERVENTIONS: List at least four ways nurses can avoid liability for negligence. Application Exercises 1. A nurse observes an assistive personnel (AP) 4. A nurse is caring for a client who is about to undergo reprimanding a client for not using the urinal an elective surgical procedure. The nurse should properly. The AP tells the client that diapers will take which of the following actions regarding be used next time the urinal is used improperly. informed consent? (Select all that apply.) Which of the following torts is the AP committing? A. Make sure the surgeon obtained A. Assault the client’s consent. B. Battery B. Witness the client’s signature on the consent form. C. False imprisonment C. Explain the risks and benefits of the procedure. D. Invasion of privacy D. Describe the consequences of choosing not to have the surgery. E. Tell the client about alternatives 2. A nurse is caring for a competent adult client who to having the surgery. tells the nurse, “I am leaving the hospital this morning whether the doctor discharges me or not.” The nurse believes that this is not in the client’s best 5. A nurse has noticed several occasions in the past interest, and prepares to administer a PRN sedative week when another nurse on the unit seemed medication the client has not requested along with drowsy and unable to focus on the issue at hand. the scheduled morning medication. Which of the Today, the nurse was found asleep in a chair in following types of tort is the nurse about to commit? the break room not during a break time. Which A. Assault of the following actions should the nurse take? B. False imprisonment A. Alert the American Nurses Association. C. Negligence B. Fill out an incident report. D. Breach of confidentiality C. Report the observations to the nurse manager on the unit. D. Leave the nurse alone to sleep. 3. A nurse in a surgeon’s office is providing preoperative teaching for a client who is scheduled for surgery the following week. The client tells the nurse that “I plan to prepare my advance directives before I come to the hospital.” Which of the following statements made by the client should indicate to the nurse an understanding of advance directives? A. “I’d rather have my brother make decisions for me, but I know it has to be my wife.” B. “I know they won’t go ahead with the surgery unless I prepare these forms.” C. “I plan to write that I don’t want them to keep me on a breathing machine.” D. “I will get my regular doctor to approve my plan before I hand it in at the hospital.” FUNDAMENTALS FOR NURSING CHAPTER 4 Legal Responsibilities 19  Application Exercises Key Active Learning Scenario Key 1. A. CORRECT: By threatening the client, the AP is Using the ATI Active Learning Template: Basic Concept committing assault. The AP’s threats could make the UNDERLYING PRINCIPLES client become fearful and apprehensive. B. Battery is actual physical contact without the Duty to provide care as defined by a standard client’s consent. Because the AP has only verbally Breach of duty by failure to meet standard threatened the client, battery has not occurred. Foreseeability of harm C. Unless the AP restrains the client, there is Breach of duty has potential to cause harm no false imprisonment involved. Harm occurs D. Invasion of privacy involves disclosing information about a client to an unauthorized individual. NURSING INTERVENTIONS Following standards of care NCLEX Connection: Management of Care, ® Giving competent care Legal Rights and Responsibilities Communicating with other health team members Developing a caring rapport with clients 2. A. Assault is an action that threatens harmful Fully documenting assessments, interventions, and evaluations contact without the client’s consent. The nurse NCLEX® Connection: Management of Care, Legal Rights and has made no threats in this situation. Responsibilities B. CORRECT: Administering a medication as a chemical restraint to keep the client from leaving the facility against medical advice is false imprisonment, because the client neither requested nor consented to receiving the sedative. C. Negligence is a breach of duty that results in harm to the client. It is unlikely that the medication the nurse administered without his consent actually harmed the client. D. The nurse has not disclosed any protected health information, so there is no breach of confidentiality involved in this situation. NCLEX® Connection: Management of Care, Legal Rights and Responsibilities 3. A. The client can designate any competent adult to be his health care proxy. It does not have to be his spouse. B. The hospital staff must ask the client whether he has prepared advance directives and provide written information about them if he has not. The nurse should document whether the client has signed the advance directives. The hospital staff cannot refuse care based on the lack of advance directives. C. CORRECT: The client has the right to decide and specify which medical procedures he wants when a life‑threatening situation arises. D. The client does not need his provider’s approval to submit his advance directives. However, he should give his primary care provider a copy of the document for his records. NCLEX® Connection: Management of Care, Advance Directives/Self-Determination/Life Planning 4. A. CORRECT: It is the nurse’s responsibility to verify that the surgeon obtained the client’s consent and that the client understands the information the surgeon gave them. B. CORRECT: It is the nurse’s responsibility to witness the client’s signing of the consent form, and to verify that they are consenting voluntarily and appear to be competent to do so. The nurse also should verify that the client understands the information the surgeon has provided. C. It is the surgeon’s responsibility to explain the risks and benefits of the procedure. D. It is the surgeon’s responsibility to describe the consequences of choosing not to have the surgery. E. It is the surgeon’s responsibility to tell the client about any available alternatives to having the surgery. NCLEX® Connection: Management of Care, Informed Consent 5. A. Do not alert the American Nurses Association. The state’s board of nursing regulates disciplinary action and can revoke a nurse’s license for substance use. B. Do not fill out an incident report. Incident reports are filed to document an accident or unusual occurrence. C. CORRECT: Any nurse who notices behavior that could jeopardize client care or could indicate a substance use disorder has a duty to report the situation immediately to the nurse manager. D. Do not leave the nurse alone to sleep. Although the nurse is not responsible for solving the problem, she does have a duty to take action because she has observed the problem. NCLEX® Connection: Management of Care, Legal Rights and Responsibilities 20 CHAPTER 4 Legal Responsibilities CONTENT MASTERY SERIES