Nursing and Legal Issues

What are the sources of law in nursing?

• Statutory

  • Federal or state legislators

• Administrative Law (regulations)

  • This type of law involves rules, regulations, and decisions made by administrative agencies, like the Board of Nursing, which implement and enforce statutory laws, such as setting standards for nursing practice and disciplinary actions. 

• Case/Common law

  • Judge made a ruling at some point that had to be enacted

  • roe v wade

What is the purpose of criminal law?

To protect society from harmful acts of others.

• want to make sure people dont harm other people

• keep society safe

• if you break the NPA, you could be convicted under criminal law

• can only be deemed innocent or guilty is only under criminal law

What are the two main classifications of criminal offenses?

Misdemeanor and felony.

How are violations of criminal law typically punished?

Violations are punished through fines, imprisonment, or other penalties.

• this is when you could go to jail

What violations are addressed under the Nurse Practice Act (NPA)?

Violations related to unprofessional conduct or failure to meet the standards defined in the NPA.

• could lead to conviction under criminal law

What does civil law involve?

It involves relationships between individuals or between individuals and the government.

How are violations of civil law typically punished?

Violations are usually punished with monetary compensation or other remedies to resolve disputes.

• no jail

• more about liability- because of your actions, are you liable for the actions of yourself

What are torts?

Civil wrongs committed by one person against another person or a person's property.

• CIVIL LAW

What types of harm can torts involve?

• Physical harm

  • water on floor and slipped and fell

• Psychological harm

• Harm to livelihood

  • someones action or lack of action causes you to not work

• Harm to reputation

  • libel

  • someone said something or did something on social media that harmed you

What are the two main types of torts?

• Intentional

  • they set up to cause harm

• Unintentional

  • because of your actions, something bad happened but you did not wake up this morning wanting to harm someone

What is the most common type of unintentional tort?

Negligence, such as in slip and fall accidents.

• unintentional tort is most common in workplace

What is malpractice?

Malpractice is professional negligence, where a professional fails to act as a prudent professional according to the standards of care.

• unintentional tort that is most common in healthcare professional

What are the four essential elements of malpractice?

• Harm: Injury is proved.

  • have to prove that something actually happened and pt was harmed

  • ex: gave the wrong medication. if pt wasn’t actually hurt from that error, then there is no harm

• Duty: Responsibility for the patient.

  • who had responsibility for the patient when the accident actually happened

• Breach of duty: Failure to act as a reasonably prudent person and not meeting the standard of care.

  • if you are supposed to turn your pt every two hours but didn’t then there is a breach of duty

• Causation: Failure to meet the standard of care caused harm.

  • you gave the wrong medication, the pt died three weeks later and now they want to sue. but can you prove that the wrong medication led to pt dying.

What are the standards of practice used to determine if a nurse fulfilled their duty?

• Statutes

• Facility policies

• ANA Standards of Clinical Practice

• Accrediting body

• Current literature

• Manufacturer’s instructions

  • malfunctioning

  • lack of training to use that item

• Expert testimony

These are the things that are determined to evaluate whether the nurse fulfilled their duties or not

What are some reasons why malpractice may occur?

• Stressful situations

• Careless actions/inactions

• Fatigue

• Distractions

• Communication barriers

• System issues

OCCURS BC WE ARE HUMAN

What are the five rights of delegation?

• Right Task

• Right Circumstances

  • dont delegate vital signs to someone else for a pt whos vitals are crazy and declining rapidly

• Right Person

• Right Directions/Communication

  • tell people what to look for

• Right Supervision/Evaluation

Delegation happens a lot in healthcare and is appropriate in most situations

• responsibility of delegator to know the skill level

What are some social factors contributing to malpractice claims?

• Large, impersonal systems

• Public awareness of large judgments

• Victim mentality

What are some factors related to suit-prone patients contributing to malpractice claims?

• Hostile attitudes

• Unable to accept personal responsibility

What are some factors related to suit-prone nurses contributing to malpractice claims?

• Insensitive behavior

• Complaining about lack of time, etc.

How can nurses help prevent malpractice claims?

• Develop caring relationships with patients and families

• Maintain clinical competence

• Follow policies and procedures

• Practice good communication

DO YOUR JOB RIGHT

What are some ways to prevent malpractice claims?

• Accept only appropriate assignments

• Know your legal responsibilities

• Inform patients of errors and omissions

What is defensive documentation in nursing?

Defensive documentation involves recording all patient care, treatments, interventions, and responses to protect against potential legal issues.

Does documentation prevent malpractice?

No, documentation doesn’t prevent malpractice, but it can help in defending against claims.

• doesn’t prevent you from being sued but rather prevents from being held liable

What are common types of errors in nursing?

Medication errors.

What should nurses do when an error occurs?

Nurses must self-report errors and disclose them to the patient.

What is an example of fraud as an intentional tort in nursing?

• Nurse imposter (e.g., fraudulent nursing diplomas).

• Promising a miracle cure.

What is a recent case involving nurse fraud?

A massive takedown of a fraudulent nursing diploma scheme was announced, involving individuals selling fake nursing diplomas

What is assault in nursing?

The threat of bodily harm to another person.

What is an example of assault in nursing?

A threat of injection or physical harm to a patient.

What is battery in nursing?

Actual bodily harm to another person without permission.

What is an example of battery in nursing?

Unlawful touching, such as performing surgical procedures without consent.

What is false imprisonment in nursing?

The unlawful detaining of a patient or using restraints without proper justification.

What are examples of false imprisonment in nursing?

• Using restraints without proper justification.

• Detaining patients against their will.

What is defamation of character in nursing?

Defamation of character involves damaging someone's reputation through false statements.

What are examples of defamation of character in nursing?

• Libel: Written statements, such as in patient charts.

• Slander: Spoken statements, like calling a patient "uncooperative, unintelligent, or drug-seeking."

  • CANNOT write subjective- no opinion

What is liability in nursing?

Liability is an obligation that can be enforced by law.

What is personal liability in nursing?

You are legally responsible for your own actions.

What is student liability in nursing?

Students are held to the same standard as registered nurses (RNs).

What is employer liability in nursing?

Employer liability extends responsibility to the employer for the actions of their employees.

What is supervisory liability in nursing?

Supervisory liability involves being responsible for delegation decisions and the actions of those you supervise.

Why is liability insurance important for nurses?

Liability insurance provides legal counsel and covers payment for a judgment.

Who should have liability insurance?

Nurses should have their own liability insurance.

What is a common legal issue in nursing regarding patient care?

The duty to report or seek medical care for a patient, acting as a patient advocate.

What role does a nurse play in advocating for a patient?

A nurse must report or seek medical care when necessary to protect the patient’s well-being.

What is the role of a nurse in protecting patient privacy?

Nurses must maintain confidentiality and the right to privacy, following HIPAA guidelines.

What are the requirements for sharing patient information?

Information can only be shared on a "need to know" basis and must have patient or guardian authorization.

What is prohibited regarding patient privacy?

Taking or sharing photographs without patient consent violates privacy rights.

What is a common cause of nursing liability related to adherence to professional guidelines?

Failure to follow standards of care

What is a common cause of nursing liability related to medical devices?

Failure to use equipment in a responsible manner

What is a common cause of nursing liability related to sharing important information?

Failure to communicate

What is a common cause of nursing liability related to maintaining accurate records?

Failure to document

What is a common cause of nursing liability related to patient observation?

Failure to assess and monitor

What is a common cause of nursing liability related to advocating for the patient’s best interest?

Failure to act as a patient advocate

What was the Winkler County Nurses Whistleblower Case about?

Two RNs reported a doctor with poor practice to the medical board after the hospital failed to intervene.

What issue did the two nurses in the Winkler County case attempt to address?

A doctor with poor medical practices.

How did the two nurses in the Winkler County case initially try to resolve the issue?

They attempted to get the hospital to intervene.

What action did the two nurses take when the hospital did not address their concerns?

They reported the doctor to the medical board.

What charges were filed against the two RNs in the Winkler County case?

Misuse of official information.

do we need to know case results?

?

What are the four elements of informed consent?

Voluntary, complete and accurate information, understanding, competence

What element of informed consent ensures the patient is making a decision free from coercion?

Voluntary

What element of informed consent requires providing all necessary details about the procedure or treatment?

Complete and accurate information

What element of informed consent ensures the patient comprehends the information provided?

Understanding

What element of informed consent confirms the patient has the mental capacity to make an informed decision?

Competence

Who is responsible for providing information to the patient for informed consent?

The healthcare provider (HCP) completing the procedure

What is the nurse’s role in the informed consent process?

The nurse may witness the patient's signature

Can a patient withdraw informed consent after signing?

Yes, consent may be withdrawn at any time

What is the Patient Self-Determination Act?

A federal law that requires patients to be given information to make informed choices about end-of-life care.

Is the Patient Self-Determination Act a state or federal law?

Federal law

What does the Patient Self-Determination Act ensure for patients?

That they receive information to make informed choices about end-of-life care.

What are advance directives?

Legal documents that outline a patient's healthcare decisions, especially for end-of-life care.

• it is not legally binding

What is a living will?

A document that provides direction for end-of-life issues.

What end-of-life decisions can a living will address?

Resuscitation, tube feedings, IV fluids, and ventilator use.

What is a durable power of attorney for health care?

A legal document that designates a substitute decision-maker to ensure the patient’s care preferences are followed.

• subsititute decision maker

What is the role of a substitute decision-maker in a durable power of attorney for health care?

To facilitate the provision of care wanted by the patient.

What does a DNR (Do Not Resuscitate) order mean?

It directs healthcare providers not to perform CPR if the patient's breathing or heart stops.

What does CCO (Comfort Care Only) mean?

It ensures the patient receives palliative care focused on comfort rather than curative treatments.

What does AND (Allow Natural Death) mean?

It allows a patient to pass naturally without aggressive medical interventions.

What type of consent applies in emergency situations when a patient is unable to provide consent?

Implied consent

What do Good Samaritan statutes do for healthcare providers?

They relieve healthcare providers of some liability when reasonable care is used in an emergency.

What legal requirements must nurses follow even when acting under Good Samaritan statutes?

They must continue to operate under the Nursing Practice Act (NPA) and within their scope of practice.

What does GINA stand for?

Genetic Information Nondiscrimination Act

What is the purpose of GINA?

To prevent discrimination based on genetic information.

Is GINA a state or federal law?

Federal law

What areas are protected under GINA?

They cannot deny health insurance and employment because of your genetic makeup

• if you have BRACA gene for breast cancer but have not decided to have a mastectomy, you cannot be denied a job because the employer is worried you will get breast cancer and might die. But life insurance…yes

What types of insurance are NOT covered under GINA?

Life, disability, and liability insurance

• you may not get the things above if you have certain genetic makeup

Can states have more detailed laws regarding genetic discrimination?

Yes, states may have more detailed laws.

Process for open ended question on the quiz

• harm: pressure ulcer that has gotten worse

• duty: all of the hospitals nurses were responsible and have the duty

  • is it the nurses?

  • is it the infectious disease doctor

• breach of duty: failure to turn her in the bed or document it properly

• causation: if you cannot prove causation, she had a 1000 morbidities and dying outside of care.

  • they did not do the right thing for the patient but it is really hard to prove the causation was the nurses not turning her.