LEGAL CONSIDERATIONS

Question

Answer

What are the three components of credentialing in nursing?

"Accreditation; licensure; and certification."

What is credentialing in nursing?

"The way in which professional competence is ensured and maintained — requires meeting certain standards including continuing education requirements in specific areas."

What is accreditation in nursing?

"The process by which an educational program is evaluated and recognized as meeting certain standards — for example; Grayson College going through ACEN to ensure standards align with Texas nursing practice expectations."

What is licensure in nursing?

"The process by which a state determines that a candidate meets certain minimum requirements to practice in the profession — in Texas; it is renewed approximately every two years on the nurse's birth month."

What is certification in nursing?

"A process by which a person who has met certain criteria established by a non-governmental association is granted recognition in a specified practice area — examples include certified ER nurse or Family Nurse Practitioner (FNP-C)."

What is the Nurse Practice Act?

"The most important law affecting nursing practice — it describes and defines the legal boundaries of nursing practice in each state; including requirements for educational programs; educational requirements to become an RN; and the minimum standards of care."

Does the Nurse Practice Act vary by state?

"Yes — scope of practice may differ by state. For example; states with fewer nurses and providers may give nurses more autonomy and a broader scope than states like Texas."

What is a compact nursing license?

"A license that allows nurses to practice in other compact states that have similar requirements without obtaining a separate license — for example; a Texas license can compact to Oklahoma."

What is a new Texas Board of Nursing requirement related to technology?

Texas now requires nurses to be AI literate as part of their credentialing — nursing programs must incorporate AI literacy into their curriculum.

What is the minimum standard of care in nursing?

Passing the NCLEX demonstrates the minimum safe level of nursing practice — it is novice level; meaning the nurse is just safe enough to practice without causing harm.

For what reasons can the State Board of Nursing revoke or suspend a nurse's license?

"Drug or alcohol abuse; fraud; deceptive practices; criminal acts; gross negligence; and physical or mental impairments."

What must a nurse do if they have a substance abuse problem to avoid losing their license?

Self-report the problem to their manager — if reported voluntarily; the nurse may be placed under supervised practice and enrolled in a protective program (not automatically suspended). If caught without self-reporting; the license will be suspended.

Who develops the standards of care that impact nursing practice?

"State Boards of Nursing; professional organizations (such as the American Nurses Association and specialty nursing organizations); the Joint Commission; and CMS — all require healthcare agencies to have internal standards of care through policies and procedures."

What does the Joint Commission do in relation to nursing standards?

It inspects healthcare facilities to ensure patient safety and compliance with standards — facilities must meet these standards for accreditation and safe patient care.

What are the five nursing process stages that represent areas of potential liability?

"Assessment; diagnosis; planning; implementation; and evaluation."

How is assessment a source of nursing liability?

"Failure to perform a complete assessment; failure to recognize findings; and failure to report abnormal findings all create liability — documenting an assessment that was not actually performed is particularly dangerous."

How is diagnosis a source of nursing liability?

Failure to identify priority concerns critical to care — missing clinical cues or failing to recognize a deteriorating patient creates liability.

How is planning a source of nursing liability?

Failure to keep nursing care plans updated — for example; continuing to plan ambulation for a patient who just had a stroke creates risk of falls and injury.

How is implementation a source of nursing liability?

Failure to document interventions and deviating from the standard of care — if it is not documented; it did not happen.

How is evaluation a source of nursing liability?

No documentation of follow-up — nurses can no longer write will continue to monitor. Documentation must state what was assessed; the patient's response; and the effectiveness of interventions.

What is the correct way to document a pain reassessment?

"State the current pain scale; compare it to the previous pain scale; and document whether the intervention was effective — for example: Patient reports pain 4/10. Previous pain scale 10/10. Pain medication was effective."

What is criminal law in the context of nursing?

A violation punishable by the state — it involves the intent to cause a wrong against a person or property and can result in jail time.

What is the difference between a misdemeanor and a felony?

A misdemeanor is punishable by fines or less than one year in prison. A felony is punishable by imprisonment for more than one year.

Can a nurse be charged criminally for a mistake?

Yes — if a nurse's action causes harm or death and involves criminal intent or criminal negligence; they can face criminal charges including manslaughter.

What is a tort?

A wrong committed by a person against another person or that person's property — it is settled in civil court; typically with monetary damages rather than jail time.

What is the difference between criminal law and tort law in outcome?

Criminal law is enforceable by the state and can result in jail time. Torts are settled in civil court and typically result in monetary damages — which is where professional liability insurance becomes essential.

What are examples of intentional torts?

"Assault and battery; defamation of character; invasion of privacy; false imprisonment; and fraud."

What are examples of unintentional torts?

Negligence and malpractice.

What is false imprisonment as an intentional tort in nursing?

Placing all four bed rails up or applying restraints without a physician order — these fall under civil law as intentional torts.

What is fraud in nursing?

Pulling a medication from one patient's account and giving it to another person — charging one patient's insurance for another person's care. This is fraud and can cost a nurse their license.

What is negligence?

Conduct that falls below the standard of care of a reasonably prudent person — for example; a nurse walking past something on the floor that causes a patient to fall.

What is malpractice?

"The failure to use the degree of care that a reasonable nurse would use under the same or similar circumstances — it is negligence occurring while performing as a professional."

What are the four elements that must be proven to establish malpractice?

"Duty (the nurse had an obligation to perform a specific act); breach of duty (the nurse failed to meet that standard); causation (the failure caused injury); and damages (actual harm or injury resulted)."

What is duty in a malpractice case?

The legal obligation to perform a specific action — what a reasonably prudent nurse would do in that situation.

What is breach of duty in a malpractice case?

"Failure to meet the standard of care — for example; failing to act; failing to report; failing to document; or failing to execute an order correctly."

What is causation in a malpractice case?

The failure to meet the standard of care directly caused the patient's injury — for example; failing to use a safety measure that resulted in a fall.

What is damages in a malpractice case?

The actual harm; injury; pain and suffering; or loss experienced by the patient as a result of the breach — damages must be present for malpractice to be proven.

Can a nurse face both negligence and malpractice charges for the same act?

Yes — an act can be both negligent and constitute malpractice depending on the circumstances and the professional standard applied.

What are the eight legal safeguards for nurses listed in this lecture?

"Competent practice; informed consent or refusal; contracts; patient education; executing physician orders; delegating nursing care; documentation; and appropriate use of social media."

What additional legal safeguards for nurses are listed in this lecture?

"Adequate staffing; whistleblowing; professional liability insurance; risk management programs; incident/variance/occurrence reports and sentinel/never events; patients' rights; Good Samaritan Laws; and student liability awareness."

What is competent practice as a legal safeguard?

Continuing education; practicing only within areas of competence; and asking for help or a refresher when rusty in a skill — if you don't know how to do something; don't do it alone.

What is the most common reason nurses are sued?

Failure to communicate and failure to report — which ties directly to assessment and documentation failures.

Why is patient education a legal safeguard for nurses?

When patients understand what to expect — including side effects — they are less likely to become litigious when those expected things occur. Educating patients protects both them and the nurse.

What is the nurse's responsibility when executing physician orders?

Follow physician orders but also question orders that do not seem correct — nurses cannot blindly follow an order that violates patient safety. If overruled; document all attempts to advocate for the patient.

What are the limits of nursing delegation?

A nurse cannot delegate tasks that fall outside the scope of the person being delegated to — for example; a CNA cannot start an IV; an LVN cannot independently perform a full assessment or push IV medications in most settings.

What is whistleblowing?

Reporting unsafe; illegal; or unethical practices by an organization or individual — it is legally protected but can feel threatening because it requires standing up against institutional pressure.

What is professional liability insurance and why is it important for nurses?

Insurance that protects the nurse financially in the event of a lawsuit — it covers legal fees and damages so that personal and family assets are not at risk.

What are risk management programs in healthcare?

Programs that analyze trends in patient safety incidents — such as increased fall rates or infection rates — and implement quality improvement initiatives to reduce those risks.

What are incident variance or occurrence reports?

Formal reports filed when a patient safety event occurs — they are used to track patterns and identify systemic problems. Sentinel events and never events are the most serious categories.

What are Good Samaritan Laws?

Laws that protect healthcare providers from being sued when they voluntarily stop to provide emergency care outside of their workplace — if you stop to help someone in an emergency in good faith; you are legally protected.

What is appropriate use of social media as a legal safeguard?

Nurses must never post pictures; patient information; or anything that could identify a patient on social media — HIPAA violations through social media are one of the most common causes of nursing legal action.

Are nursing students liable if their actions cause harm to patients?

Yes — nursing students are liable if their actions cause harm; just as a licensed nurse would be.

What standard of care are nursing students held to?

The same standard of care that would be used to evaluate the actions of a registered nurse — nursing students are expected to perform as professional nurses when providing safe client care.

What does reasonable and prudent mean for a nursing student?

A nursing student must practice within their scope and knowledge — if they do not know how to do something; a reasonable and prudent person would not attempt it without supervision or guidance.

Should nursing students get personal professional liability insurance?

Yes — even though nursing programs may carry some group coverage; students should obtain their own personal liability insurance because it provides individual protection.

What are the most frequent allegations against nurses?

"Failure to ensure patient safety; improper treatment or performance of treatment; failure to monitor and report; medication errors and reactions; failure to follow facility procedure; documentation errors; improper equipment use; adverse incidents; and care of patients with HIV or infectious diseases."

What does failure to ensure patient safety include?

"Leaving the bed in a high position; having fall hazards on the floor; improperly positioned oxygen tubing; and any environmental condition that increases patient risk."

What constitutes a medication error as a source of liability?

"Failing to perform the three medication checks; pulling medications without verification; or giving a medication that was not ordered — all can result in litigation and loss of license."

What are the four elements of informed consent?

"Disclosure; comprehension; competence; and voluntariness."

What is disclosure in informed consent?

Informing the patient of the procedure; the risks and benefits; and that no outcome can be guaranteed — including worst-case scenarios such as death or permanent disability.

What is comprehension in informed consent?

The patient or surrogate can repeat the information provided to them in their own words — they must understand what they are consenting to.

What is competence in informed consent?

The patient or surrogate has the mental capacity to understand the information needed to make the decision — a comatose patient or someone with severe cognitive impairment may not be competent to consent.

What is voluntariness in informed consent?

The patient or surrogate is making the decision freely — they have not been manipulated or coerced into signing the consent.

When is a signed consent required?

"For all routine treatments; hazardous procedures such as surgery; some treatment programs; and participation in research."

What must informed consent be based on?

Full disclosure of risks; benefits; alternatives; and the consequences of refusal — partial disclosure is not sufficient.

Whose responsibility is it to obtain informed consent?

The person performing the procedure — typically the physician or surgeon. It is NOT the nurse's responsibility to obtain consent.

What is the nurse's role in informed consent?

To verify that a signed informed consent is present before the procedure begins — if it is not signed; the nurse notifies the surgeon or physician. The nurse may also witness the patient signing the form but does NOT educate the patient about the procedure or obtain consent.

Can a nursing student sign as a witness to informed consent?

No — nursing students may not sign as a witness for informed consent.

What must a nurse do if a patient is illiterate and needs to give informed consent?

Read the consent form aloud to the patient or use a video explanation of the procedure.

What must a nurse do if a patient does not speak English and needs to give informed consent?

Obtain a certified translator or interpreter service — the patient must understand the consent in their own language.

Who gives informed consent for a minor?

A parent or legal guardian — unless the minor is legally emancipated.

Who gives informed consent for an unconscious patient?

"The durable power of attorney for healthcare; the legal next of kin; or the designated healthcare proxy."

Is there a new Texas law regarding AI and informed consent?

Yes — Texas law requires healthcare facilities to disclose to patients when artificial intelligence was used in any part of their treatment or diagnostic process.

What is an advance directive?

A written document in which an individual provides direction regarding desired treatment or action related to healthcare in advance of a situation where they can no longer make decisions.

What are the two basic types of advance directives?

A living will and a durable power of attorney for healthcare (DPAHC).

When does an advance directive become effective?

Only when the client is unable at that time to make decisions — if the patient is conscious and competent; their direct verbal wishes take priority.

What must a patient's medical record include regarding advance directives?

Documentation of whether the client has signed an advance directive — this must be present in the chart.

What is a living will?

A written document that directs treatment in accordance with the patient's wishes — it may stipulate specific instructions such as no CPR; no mechanical ventilation; no feeding tubes or IV fluids; or no emergency medications.

What can be individually specified in a living will?

"Patients can choose specific combinations — for example; allowing emergency medications but refusing CPR; or refusing the ventilator but allowing comfort care. Each preference can be individually documented."

What is a Durable Power of Attorney for Healthcare (DPAHC)?

A legal document that designates a trusted person or persons to make healthcare decisions when the patient is no longer able to make those decisions — they may make decisions such as no CPR; no ventilator; or no feeding tubes on the patient's behalf.

What does DNR mean?

Do Not Resuscitate — a written physician order in the patient's medical record indicating that no resuscitation efforts will be made.

Is a DNR tattoo or a DNR wristband legally enforceable?

No — a DNR must be a written physician order in the patient's medical record. A tattoo or wristband alone is not a legally binding DNR.

What must a patient have to sign a valid DNR?

Sufficient information to make an informed decision and the decision-making capacity to understand the full implications of a DNR — or a durable power of attorney for healthcare who can make that decision on their behalf.

Do DNR orders automatically transfer between facilities?

Not always — it depends on the receiving facility's policy. Always know your facility's policies regarding DNR orders from other institutions.

What is the ANA's position on a nurse's right to refuse to care for a patient undergoing an abortion?

The ANA upholds the nurse's right to refuse to provide care for a patient undergoing an abortion if the nurse ethically opposes the procedure.

What does a nurse's right to ethically refuse care NOT include?

The right to impose their personal opinions or beliefs on the patient — nurses may decline to perform the procedure but may not lecture; judge; or coerce the patient.

What is the nurse's role when they have an ethical objection to a patient's care?

State the ethical objection professionally and request that another nurse take over — for example: This procedure conflicts with my ethical standards; please find someone else to provide this care.

Is ethical refusal limited to abortion?

No — a nurse may also ethically request a different patient assignment if the nature of a case causes significant moral injury; such as caring for a perpetrator of a crime related to personal trauma.

What legal issue surrounds informed consent and patients with cognitive impairments?

Patients with intellectual disabilities or dementia may not be able to give a truly informed consent — nurses must identify this and ensure a legal guardian or power of attorney is in place to make healthcare decisions.

Practice Question: A state attorney charges a nurse with manslaughter for administering a lethal medication. What type of law is this?

Criminal law — because it involves state and federal criminal statutes defining criminal actions such as murder; manslaughter; criminal negligence; theft; and illegal possession of drugs.

Practice Question: Which statement about nursing student liability is true?

Students are held to the same standard of care that would be used to evaluate the actions of a registered nurse. Students are liable for their actions; hospitals are not exempt from liability even if a student is supervised; and group professional liability coverage is not a substitute for individual insurance.

What is the legal principle regarding undocumented nursing care?

If it was not documented; it did not happen — this is the legal standard in nursing practice.

What can incorrect documentation do to a nurse's credibility in a legal proceeding?

Incorrect or inaccurate documentation can nullify an entire report and make the nurse appear incompetent — incorrect patient information undermines the validity of all other documentation.

What must documentation include to demonstrate appropriate follow-up?

"Specific reassessment statements — including the time of reassessment; what was found; and whether interventions were effective. Vague statements like will continue to monitor are not sufficient."

How can AI be used in nursing documentation and what is the nurse's responsibility?

AI can assist with generating SOAP notes and organizing documentation — but the nurse must review; vet; and correct any errors before the documentation is finalized in the patient's chart.

What protects a nurse from being forced to perform tasks outside their scope of practice?

The Nurse Practice Act — a nurse can refuse a task that falls outside their scope by citing this act; regardless of who asks them to perform it.

What is the nurse's responsibility when a physician gives an order the nurse believes is incorrect or inappropriate?

The nurse must question the order; advocate for the patient; document all attempts to advocate and escalate; and document the physician's response — the nurse cannot blindly follow an order that appears unsafe.

What is the danger of delegating a task to someone not qualified to perform it?

Both the delegating nurse and the institution can be held liable if the unqualified person causes patient harm — always know what each role is authorized to perform.

How does the nurse-patient relationship serve as a legal safeguard?

Developing a trusting relationship with patients makes them less likely to sue — patients who feel cared for; listened to; and respected are less likely to pursue litigation even when things go wrong.