Legal and Ethical Foundations for Nursing Practice

Why nurses need to know the law

nurses are accountable for their own actions and decisions

Statutory Law

laws passed by legislative bodies, outline general scope of practice, licensure requirements, disciplinary authority, mandatory reporting laws, controlled substance laws, and HIPAA

Administrative Law

rules and regulations created by executive branch agencies, such as a state Board of Nursing, that specify how statutory laws are carried out, including licensing, regulating nursing practice, investigating complaints, and disciplinary actions

Civil Law

law governing disputes between individuals or organizations, such as nurse malpractice

Criminal Law

law governing offenses against society, such as diversion of controlled substances, patient abuse, fraud, and falsification of records

Scope of Practice (8)

what a nurse is legally permitted and professionally prepared to do,
determined by the Nurse Practice Act,
board of nursing regulations,
education and training,
licensure,
competence,
institutional policies (blood administration), professional standards

Just because a nurse has seen someone perform a procedure doesn’t mean…

nurse is competent or legally authorized to perform it

A newly licensed nurse is asked to perform a procedure that was discussed in school, but …

nurse has never independently performed it

Nurse Practice Act

example of statutory law that defines scope of practice

Board of Nursing regulations

example of administrative aw-regulation to enforce the Nurse Practice Act statute

Key point about watching a procedure

Having seen someone perform a procedure does not mean a nurse is competent or legally authorized to perform it

Negligence

failure to act as a reasonably prudent person would act

Malpractice

negligence committed by a professional who is performing professional responsibilities

Duty (malpractice element)

nurse has a professional responsibility to the patient

Breach of duty (malpractice element)

nurse failed to meet the expected standard of care

Causation (malpractice element)

nurses actions or failure to act contributed to the patients injury

Damages (malpractice element)

patient experienced an actual injury or loss

Five key elements to prove malpractice

duty to provide care, breach of duty, foreseeability of harm, causation, and harm must have occurred

Duty to provide care

there has to be a profession relations between the nurse and the patient according tot a certain standard

Standard of care

reasonable and prudent nurse would do in the same situation

Common medication and IV error risks (4)

failure to follow medication administration standards, failure to assess the patient,
failure to monitor medication effects,
failure to question unsafe orders

Failure to assess and monitor risks (3)

not recognizing changes in patient condition, inadequate reassessment,
failure to respond to abnormal findings

Questioning an unsafe order

nurses remain accountable for their own actions, must clarify potentially unsafe orders before administering a medication even if the provider insists

Failure to assess example lesson

nurse must assess a patient promptly when informed of a change in condition

(failure to assess and respond to a change in condition may constitute a breach in the standard of care)

Failure to communicate risks (3)

not reporting deterioration,
poor handoffs,
failure to escalate concerns

Equipment error risk

failing to use equipment properly

Patient falls and safety event risks (3)

failure to assess risk,
failure to implement precautions,
failure to follow institutional policy

Documentation problem risks (4)

failure to document,
inaccurate or incomplete documentation,
alteration of records,
documentation of care not performed

Assault (intentional tort)

creating fear of unwanted physical contact, such as threatening to hold a patient down to give a medication

Battery (intentional tort)

intentional physical contact without consent,
such as performing a procedure after a competent patient refuses

False Imprisonment

Patient is confined or restrained against their will

Defamation (quasi-intentional torts)

communication that harms another persons reputation

What are the two types of defamation

libel: written, slander: spoken

Invasion of Privacy

improper disclosure or exposure of private patient information
(what are types of ways that confidentiality could be violated, who can you share information with?)

Confidentiality in public spaces

discussing a patients diagnosis in a public area like an elevator is not acceptable even without naming the patient, because patients may be identified from contextual information

Social media and patient confidentiality

even without a name, photo, or hospital identified, posting identifying clinical details about a specific patient encounter can still violate patient confidentiality

Key legal risk-reduction strategies (liability) (5)

follow the standard of care, communicate effectively, document thoroughly, know and follow facility policies, consider liability insurance

Good Samaritan Law (4)

protects a person who voluntarily helps in an emergency without pay or reward,
acts in good faith,
asks a conscious victims permission before helping, provides reasonable care matching their level of training

Informed Consent definition

legal and ethical process in which a patient voluntarily agrees to a medical treatment or procedure after fully understanding its risks, benefits, and alternatives

Providers role in informed consent (3)

explains the diagnosis,
proposed procedure, risks, benefits, and alternatives, answers specific clinical questions about the procedure

RNs role in informed consent (4)

witnesses the patient signing the consent form, verifies the signature is authentic and voluntary, confirms the patient is competent and not under mind-altering sedation,
advocates for the patient if they express confusion or have questions

Law vs Ethics

law asks what am I required to do
ethics asks what ought I to do

When you are a nurse you practice ethics…

daily

Key nursing ethics topics (8)

respecting patient preferences,
maintaining confidentiality,
speaking up about unsafe care,
treating patients without discrimination,
maintaining professional boundaries,
addressing personal bias,
protecting vulnerable patients,
caring for oneself sufficiently to provide safe care

Gallup Honest and Ethics Poll findings

nurses have ranked number one every year since 1999 except 2001 when firefighters ranked first

_____ of US adults rates nurses as having “very high” or ”high” honesty and ethical standards. (Gallup Honest and Ethics Poll)

75%

Nurses consistently outperform who

peers

Core Ethical Principles (6)

autonomy, beneficence, nonmaleficence, justice, fidelity, veracity

Autonomy (ethical principle)

respecting the patients right to make informed decisions

Beneficence (ethical principle)

acting to promote the patients well-being

Nonmaleficence (ethical principle)

avoiding or minimizing harm

Justice (ethical principle)

treating individuals fairly and addressing inequities

Fidelity (ethical principle)

keeping commitments and maintaining professional responsibilities

Veracity (ethical principle)

communicating truthfully

Case: blood transfusion refusal: A competent adults refusal of a blood transfusion due to faith creates a conflict between

autonomy and beneficence

Case: taking away fast food: A nurse unilaterally taking away food a competent diabetic patient wants violates

autonomy by overriding the patients own informed choice in the name of beneficence

Case: family pressuring a competent patient: when a competent patient does not want surgery but family insists, the nurse should first

support and advocate for the patients autonomous decision and notify the provider, consistent with ANA Provision 3

Case: fatigued nurse asked to work another shift

nurse has a moral duty to self and professional wholeness under ANA Provision 5, an unsafe level of fatigue can compromise patient safety, so the nurse is not ethically obligated to accept an unsafe shift

ANA Code of Ethics Provision 1

compassion and respect for human dignity

ANA Code of Ethics Provision 2

primary commitment to the recipient of nursing care, whether an individual, family, group, community, or population

ANA Code of Ethics Provision 3

establishes a trusting relationship and advocates for patient rights, health, and safety

ANA Code of Ethics Provision 4

nurse has authority over their nursing practice, is accountable and responsible for their own actions

ANA Code of Ethics Provision 5

moral duty to self and professional wholeness, including duties to self like dignity and worth

ANA Code of Ethics Provision 6

maintaining and improving the ethical work environment

ANA Code of Ethics Provision 7

advancement of the nursing profession through knowledge development

ANA Code of Ethics Provision 8

collaborative relationships with nurses, other healthcare and nonhealthcare disciplines, and the public

ANA Code of Ethics Provision 9

enact practices, policies, and legislation to promote social justice and eliminate health inequities

ANA Code of Ethics Provision 10

global nursing and health solidarity through organizations and associations

Why student ethical behavior matters: academic dishonesty in nursing education has been associated with dishonest behavior in clinical education, is a threat to

professional integrity and patient safety, must align with internalizing the Code of Ethics, and can affect licensure since a review of moral character is required

Predictor of Clinical honesty: Academic dishonesty in nursing education has been associated with

dishonest behavior in clinical education, considered a threat to professional integrity and patient safety

Alignment with Code of Ethics:

internalize the values and morals of our profession

Licensure and legal standing

applying for a license requires a review of moral character

Academic suspensions for ____, ____, _____ can be reported to the BON.

cheating, plagiarism, clinical dishonesty

The NJ BON can deny a graduate the right to sit for the NCLEX-RN exam for what?

legal and ethical violations and a pattern of “moral turpitude”