Nursing as a Regulated Practice: Legal Issues

at what level are the boundaries and the practice of nursing and many others established and regulated

state

state boards of nursing (SBN)

• State boards of nursing (SBNs) are the regulatory bodies by which nursing practice acts are administered and enforced.

• SBN publicizes rule and regulations that expand the law; giving full meaning to the nursing practice act in each state.

• State nurses associations are usually instrumental in lobbying their state legislators for appropriate updating of nursing practice acts.

- ensures order

- protects individuals

- resolves disputes

- promotes the general welfare

U.S. Constitution

- resolves disputes

- amends the common law

- interprets statutory law

judicial branch

implements laws through government agencies

executive branch

- makes statutory law

- delegates authority to governmental agencies to create rules and regulations to meet the intent of statutes (administrative law)

legislative branch

usually instrumental in lobbying their state legislators for the appropriate updating of nursing practice acts

state nurses associations

what does the nurse practice act in each state accomplish

- defines the standards and scope of professional nursing

- describes the authority, power, and composition of the board of nursing

- defines educational program standards

- sets the minimum educational qualifications and other requirements for licensure

- determines and protects the legal titles and abbreviations nurses may use

- provides for disciplinary action of licensees for certain causes

what urges the inclusion of

- a clear differentiation between advances and generalist nursing practice

- authority for boards of nursing to regulate advanced nursing practice, including authority for prescription writing

- authority for boards of nursing to oversee unlicensed assistive personnel (UAP)

- clarification of the nurse's responsibility for delegation to and supervision of their personnel

- support for mandatory licensure for nurses while retaining sufficient flexibility to accommodate the changing nature of nursing practice

NCSBN model nursing practice act (2012)

in many states, the _______ is a statutory law affecting nursing practice within the bounds of the state

NPA

encourages consideration of the many issues inherent in a nursing practice act and the political realities of the state legislature and regulatory processes

1996 ANA model practice act

what are the three functions of the SBNs similar to those of federal and state governments

- authority to administer the nursing practice act (executive)

- authority to adopt rules necessary to implement that act (note that rules are different from laws, which are made by the state's legislative body)

- authority to deny, suspend, or revoke a license or to otherwise discipline a license or to deny an application for licensure (judicial)

a mandatory law requires what for any person who practices the profession or occupation

license

in most states, SBNs have the authority to set and enforce what for nursing education programs

minimum criteria

along with its ability to grant licenses, the SBN also has the power to ________ a nurse for performing professional functions in a manner that is dangerous to patients or the general public

sanction

what are the ranges of sanctions from SBNs

probation, suspension, revocation

what is the most common reason nurses are disciplined by SBNs

practicing while under the influence of alcohol or other substances, often narcotics

what is the goal of SBNs

to return nurses who have been identified as having a problem with drugs and/or alcohol use safely back into practice

tests critical and thinking nursing competence in all phases of the nursing process

nclex

what type of test is the nclex

computer adaptive testing (CAT)

minimum and maximum number of questions for nclex

75, 256

time to complete the nclex including breaks

6 hrs

what happens if you are unsuccessful for the first time on the nclex

must pay fees, must wait 45 days

what reflects the quality of education programs being provided

nclex passing rates

means that RNs may practice in different states without having to take another licensing examination

endorsement

a mutual recognition model for licensure

national licensure compact (NLC) and the enhanced NLC (eNLC)

why was the endorsement/nurse licensure compact developed

to improve the mobility of nurses while still protecting the public health, safety, and welfare

explain the mobility of nurses granted by the endorsement/nurse licensure compact

travel nursing, in crossing state lines from one's home to one's workplace, in telehealth practices, and simply moving to another state for personal or career purposes (as long as the state you are traveling to is part of the compact- you don't have to retake the nclex just get a new license)

informed consent and confidentiality are particularly important in terms of _ risks

delegation

the primary legal concern of health care professionals

malpractice

the negligence applied to the acts of a professional

malpractice

nurses are ______ for their own practice and can be named in a malpractice suit, just as any practitioner can be named

accountable

what is the most important question in a malpractice case

was the prevailing standard of care met?

what do standards of care reflect

the minimum level of prudent care based on the ethical principle of non-maleficence (do not harm)

who are nurse expert witnesses hired by

both the plaintiff and the defendant

what is included in the expert witness testimony

documents, including national standards of nursing practice, the patient record, and the other pertinent evidence, such as direct testimony of the patient, the nurse, and others

what place significant limitations on the content of nurses' social media activites and comments

the ethical principle of confidentiality and HIPPA regulations

by violating HIPPA what type of laws has the nurse broken

federal law (and possibly state laws)

the legal acknowledgement of prescription writing as an appropriate act of nursing practice

prescriptive authority

specific legal issues illustrating the changing nature practice are related to role changes, supervision of UAP, payment mechanisms, and issues associated with the implementation of the ________

patient self-determination act (PSDA)

advanced practice nurses and their advocates scored a major legislative victory with the passage of what to obtain direct reimbursement

1997 balanced budget act

three major conditions of informed consent

o Disclosure: release of information to patient

o Capacity: patient’s understanding of that information

o Voluntariness: voluntary consent to treatment

implied consent

inferred from a patient's actions or circumstances.

federal legislation was enacted requiring who to pay certain nurses directly for services provided to medicaid patient

state medicaid agencies

- what was passed in 2010 and enacted with a number of initiatives implemented incrementally

- the law reformed health care and health insurance industries in the US, with the legal goal of increasing quality, availability, and affordability of health insurance

affordable care act (ACA)

- _______: nurses are in a position to help patients and families understand this law and how it can assist them to have the end-of-life care they prefer

- it encourages patients to consider which life-prolonging treatment options they desire and to document their preferences in the event they become incapable of participating in the decision-making process

patient self-determination act (PSDA)

how do nurses protect themselves from legal problems

practice in a safe setting, communication with other health professionals, patients, and families (the importance of the patient record as the basis for safe practice remains), meet the standard of care, carry and understand professional liability insurance, promote positive interpersonal relationships

what are four documents you should own

a copy of the nursing practice act of the state in which you practice, nursing's social policy statment: the essence of the profession, nursing: scope and standards of practice, ANA's code of ethics for nurses with interpretive statement

individuals who advise lawyers on medical plans for lawsuits

legal nurse consultant

- always maintain patient privacy and confidentiality

- do not post patient photos or videos of patients or identify patients by name

- do not refer to patients in a disparaging manner, even if patients are not identified

- use caution when connecting with patients or former patients via social media

- do not post inappropriate photos, or negative comments about colleagues or employers

- never discuss drug and alcohol use, or make racially derogatory or threatening remarks

- be aware of your employer's social media policies

- share educational information that may benefit others, such as safety notices and medical news

- select conservative privacy and security settings for your accounts

- use social media to enhance the role of nursing in the community, among friends and the public

NSO social media dos and donts

do state boards of nursing make laws or rules

rules

who was the president when HIPPA was passed

clinton