Legal Issues in Nursing

What are the sources of law?

statutory law, common law, administrative law

Statutory Law

laws that come out of Congress (state or federal) that command or prohibit what can be done

Common Law

civil cases made by a judge (someone vs someone)

Administrative Law

administrative body writes rules and regulations

Healthcare examples of statutory law

Affordable Care Act

HIPPA

Good Samaritan Law

Healthcare examples of common law

Roe vs Wade

Malpractice Cases

The state vs a nurse/hospital

Healthcare examples of administrative law

hospital policy

Nurse Practice Acts

Tort Law

law that deals with harm to a person or a person's property: negligence and malpractice

Negligence

failure of an individual to perform an act (omission) or to perform an act (commission) that a reasonable, prudent person would or would not perform in a similar set of circumstances

Intentional Tort

intentional harm

Malpractice

negligence by a professional

What elements must be present to prove malpractice?

- duty owed to a pt

- breach

- foreseeable

- causation

- injury or damage

Breach

not giving care that is considered the standard

Foreseeable

we know certain events will cause certain results

What can happen to nurse found guilty of negligence or malpractice?

- license taken away

- fine

- jail

- lose job

- probation

What are preventative measures for nurses to avoid malpractice?

- intervene appropriately with critical and demanding clients

- develop self-awareness

- delegate duties cautiously

- follow agency policies and procedures and standards of care

- write detailed incident reports

- report accidents, safety issues, and unsafe conditions up the chain of command

- stay educated and up-to-date on current practice

- stay healthy

- you control where you work and where you seek employment

What are the types of liability?

- personal

- vicarious

- corporate

- liability insurance (occurrence and claims)

PErsonal Liabity

you are responsible for your own actions

Vicarious Liabilities

employer is responsible for employee's actions

Corporate Liability

entire hospital chain is responsible for hiring qualified staff

Liability Insurance

if something ever comes up, you can use that money to get support

Occurrence Liability Insurance

covers you no matter what, even if you top working , hut it costs more

Claims Liability

only covers you while you are still paying for it/working, but less expensive

Describe the court process

summons --> discovery --> trial or settlement

Discovery

full exchange of info between defense and prosecutor

Licensure

type of credential provided for by state statutes that authorize qualified individuals to perform designed skills and services

What are uniform licensure requirements for nurses?

NCLEX graduates background checks, self-reporting of felonies, chemical dependency, and functional abilities affecting practice

What is the role of the state board of nursing?

- creates the NCLEX

- determent he NCLEX passing standard

- tell the schools what the blueprint of the NCLEX looks like

- investigate complaints against a nurse

- number of continuing education hrs needed to renew

- can you use license in other states

- protect the public

Who comprises of the Illinois State Board of Nursing?

- 4 APNs

- 3 RN educators

- 3 RNs

- 1 LPN

- 1 RN administrator

- 1 member of the public

Who cannot renew their license?

- people who don't pay child support

- people with chemical substance abuse

- other

Multistate Licensure Compact

legal agreement between 2 or more states that if you ar licensed as a nurse in one state, then you cna practice as a nurse in another state

Nurse Practice Act

affects all facets of nursing practice; each state has a board of nursing, which sets and enforces riles and regulations pertaining to the practice of nursing and enforces statutes to ensure protection of the public

What does the nursing practice act define?

levels of nursing practice, sets educational and NCLEX requirements, provides licensing to those who are eligible, establishes SBON, nurses' scope of practice, titles, standards, educational requirements, violations, and penalties

How many hours do you need to renew your license?

20 continuing education hrs every 2 years

What does Illinois require you have an hour of additional education on?

- dementia

- sexual harassment

- implicit bias

What are the patient's care rights?

- privacy

- confidentiality

- informed consent

- to refuse treatment

- freedom from restraints

What are the 3 things that must be included to be considered informed consent?

1. competent

2. have to have all the information given to them

3. must be voluntary

Advanced Directives

when adults made treatment choices before an illness surfaces (so if something happens to them and they cannot make decisions, their choices are documented)

Living Wills

stipulates the care they desire or don't desire for terminal illness

Durable Power of Attorney

designates a proxy to speak for you when you can't

IL POLST Form

Illinois form for advance directives

What is the order for Power of Attorney?

1. spouse

2. parent

3. child

4. sibling

5. aunt/uncle

5. friend

What is a pt has no family, no friends, and no one willing to take the responsibility of power of attorney?

get a proxy appointed by state

Delegation

the process by which responsibility and authority for performing a task is transfrred to another individual who accepts that authority and responsibility

What can you NOT delegate?

- assessment

- mediation administration (LPNs cannot give IV meds)

- education

- evaluation

- blood transfusion

- admission/discharge

Describe the delegation process?

1, define the task

2. decide on the delegate

3. determine the task

4, reach agreement

5. monitor performance and provide feedback

What are the 5 rights of education?

- right task

- right circumstance

- right person

- right direction and communication

- right supervision

What is the "Right Circumstance"? Give an example.

The patient’s condition and setting must make delegation safe.

Correct: CNA performs hygiene care for stable post-op patients.

Incorrect: Delegating vital signs on an unstable post-op patient with dropping BP.

What is the "Right Person"? Give an example.

The task must match the delegate’s training and competency.

Correct: CNA obtains intake/output for a stable patient they are trained to care for.

Incorrect: Assigning a CNA to manage a fresh post-op patient with chest tubes.

What is the "Right Direction & Communication"? Give an example.

Clear, specific instructions must be given about the task, limits, and expectations.

Correct: “Please take vitals on Room 202 every 30 min x2 and report if SBP < 100.”

Incorrect: Saying “Keep an eye on him,” with no specifics.

What is the "Right Supervision"? Give an example.

The RN must monitor, evaluate, give feedback, and stay accountable.

Correct: RN checks CNA-reported vitals and reassesses unstable patients.

Incorrect: Delegating, then never following up on patient condition.

How might a nurse delegate correctly to a CNA when caring for two stable and two unstable post-op patients?

Correct:

- CNA performs ADLs, vitals, ambulation, I/O for the stable pts.

- RN gives clear instructions and follows up.

Incorrect:

- Sending CNA to monitor the unstable pts or assess changes in condition.

Why can unstable post-operative patients generally NOT be delegated to a CNA?

They require RN assessment, clinical judgment, and close monitoring, which CNAs are not licensed to perform

What questions should you ask yourself before you'd delegate something?

- are there rules in place to support that delegation?

- is it in my scope too elevate and their scope to accept?

- did i assess the client first?

- is the task consist with what they can do?

- do their abilities match the need of the client?

- are there policies in place?

- is appropriate supervision available?

Can nurse refuse to float?

legally, a nurse cannot refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove lack of knowledge for the performance of assigned tasks

Is there mandatory OT in Illinois?

mandatory OT is prohibited in IL unless during emergency circumstances (e.g. big snow storm and new nurses cannot get there)