Legal Aspects and Leadership Role of the RN

Civil law

concerned with the protection of the client’s private rights

criminal law

deals with the rights of individuals and society as defined by legislative laws

nursing negligence

failure to exercise the proper degree of care required by the circumstances that a reasonable, prudent person would exercise under the same or similar circumstances to avoid harming others (careless act)

nursing malpractice

failure to use the degree of care that a reasonable, prudent nurse would use under the same or similar circumstance (professional negligence)

• the nurse owed a duty to the client

• the nurse did not carry out that duty or breached that duty

• the client was injured

• the nurse’s failure to carry out that duty caused the client’s injury

malpractice is found when what occurs

standards of care

nurses are required to follow these which originate in NPAs, state/federal law, accreditation recommendations, and professional organizations when performing procedures, exercising professional judgement, and implementing HCP’s orders

• the nurse believes it is in errors

• it violates hospital policy

• it is harmful to the patient

nurses must follow the HCP’s orders unless what

• Contact the charge nurse, nurse manager, or nurse supervisor to intervene

• make a formal report explaining the refusal

• file an incident report in any situation that will potentially cause harm to a client

if a HCP confirms an order and a nurse beleives it is inappropriate the nurse should do what

• assess the client’s knowledge of advance directives

• provide the client information about advanced directive

• must review advanced directive on admission and put in patient chart

• integrate advanced directive into care

what is important about advanced directives

advanced directives

can limit life-prolonging measures when there is little or no chance of recovery

living will

a written document that directs treatment in accordance with a client’s wishes in the event of a terminal illness or condition that is activated when a client is no longer able to communicate their wishes independently

durable power of attorney for health care

a client appoints a representative (healthcare proxy) to make health care decisions based on the client’s wishes

• frequent unexplained crying by the older individuals

• an older’s persons unexplained fear/suspicion of a particular person(s) in the home

the National Center on Elder Abuse identifies what as the two most important indicators of abuse

• the injury does not match the story

• obvious physical injury or neglect

  • malnutrition

  • bruising on trunk or extremities

what is a red flag for abuse

vulnerable populations (elderly, pediatric, vulnerable adult)

what type of abuse are nurses mandated to report

liable for civil/criminal legal action

what occurs if HCPs do not report suspected abuse/neglect

restraints

used only to ensure the physical safety of the client or other client when less restrictive interventions fail

• must have a written order from an HCP, which must be reassessed

• must follow agency policy and procedure to restrain the client

• documentation of restraint use and follow-up assessments must detail the attempt to use less restrictive interventions

• a nurse is liable for improper or unlawful restraint

• any UAP/PN working under the RN must use restrains properly

  • they can put on restrains but the RN must assess the patient

what are the rules for a patient with restraints

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

established standards for the verbal, written, and electronic exchange of private health information

• to consent to use and disclosure of health info

• to inspect and copy their medical records

• to amend mistaken/incomplete info

what rights does HIPAA establish for clients

• competent and of legal age

• voluntary

• risk, benefits, and alternatives are explained

• opportunity for questions

• the HCP obtains informed consent

• the RN witnesses signature (cannot delegate to UAP)

• answers about procedure related to the procedure by the HCP

• have the right to change their minds/withdraw consent

what are the components of informed consent

Good Samaritan Laws

limits liability if a nurse offers assistance at the scene of an emergency, as long as the care is within the nurse’s level of expertise and care is delivered in a reasonable and prudent manner

authoritarian

aggressive leadership style; “do it my way”

laissez faire

passive leadership style; “whatever, as long as you like me”

democratic

assertive leadership style; “let’s consider the options available”

delegation

the process by which responsibility and authority, but not accountability, are transferred to another individuals

the nursing process or any activity requiring nurse judgement

what may not be delegated to a UAP

• right task

• right circumstance

• right person

• right direction/communication

• right supervision

what are the 5 rights of delegation

• direction/guidance

• evaluation/monitoring

• follow-up

what does the right supervision (a part of the 5 rights of delegation include)

• determine client needs and when to delegate

• ensure proficiency and availability of delegatee

• evaluate outcomes of and maintain accountability for delegated responsibility

what are the RN’s responsibilities of delegation

• accept activities based on own competence level

• maintain competence for delegated responsibility

• maintain accountability for delegated activity

what are the delagatee’s responsibilities of delegation

team building, facilitating collaboration, consulting, delegating, supervising, and leading/managing

what are the focuses of communication

lateral violence

acts that occur among collegues

bullying

acts perpetrated by one in a higher level of authority that occur over time

• delayed med admin caused by failure to notify the nurse responsible for administering the med of a change

• delayed notification of a change in prescriptions by the HCP

• nurse omits pertinent info regarding client’s care or prescriptions

how can lateral violence and bullying impact client safety

• communicate clearly

• treat others with respect

• avoid gossip

• rely on facts

• collaborate

• offer assistance when needed

• speak directly to the individual with whom one has as issue

what are the best practices of communication

handoff communication

a transfer of communication along with authority and responsibility during transitions in care; important info is shared at pertinent points of care to ensure continuity of care and client safety and improve communication and delegation

SBAR

an interdisciplinary communication strategy that promotes effective communication about clients between caregivers

Situation: state the issue or problem

what does the S in SBAR stand for

Background: provide the client’s history

what does the B in SBAR stand for

Assessment: give the most recent vital signs and current findings

what does the A in SBAR stand for

Recommendations: state what should be done

what does the R in SBAR stand for

• primary language spoken

• pain management expectations

• support systems

• feelings toward self-care (like the gender of the caregiver, do they give family members control of decision making)

• diet preferences

• beliefs regarding death and dying

what should a cultural assessment include

primary IVs and IVP

what is not within the scope of LPNs