Legal Aspects of Nursing Practice/Risk Management

Law in nursing

The system of binding rules and practices that govern relationships and protect the health, safety, and welfare of citizens.

Public law

Legislation affecting the public at large; includes constitutional, administrative, and criminal law.

Private law

Deals with relationships between individuals or organizations; includes contract and tort law.

Administrative law in nursing

Each state's Nurse Practice Act (NPA) establishes licensure, defines scope and standards of practice, and sets disciplinary procedures.

Nurse Practice Act (NPA)

State law that governs nursing practice; protects the public and defines nurse responsibilities and disciplinary actions.

Board of Nursing (BON)

State agency that enforces the Nurse Practice Act, issues licenses, investigates complaints, and takes disciplinary action.

Licensure

Mandatory credentialing in all states requiring completion of an approved nursing program and passing the NCLEX-RN.

Nurse Licensure Compact (NLC)

Allows nurses to hold one license and practice in multiple compact states; subject to the laws of the state where they practice.

Delegation

The process of empowering another person to perform nursing tasks while the RN remains accountable for outcomes.

Five rights of delegation

Right task, right circumstances, right person, right direction/communication, and right supervision/evaluation.

Disciplinary procedures

State boards have regulatory power (create rules) and adjudicatory power (investigate and decide complaints); nurses are entitled to due process.

Americans with Disabilities Act (ADA)

Prohibits discrimination based on disability and ensures reasonable accommodations for nurses and patients.

Employment law

Governs contracts and workplace rights including fair labor standards, overtime, minimum wage, FMLA, and workers' compensation.

Employment at will

Allows either employer or employee to end employment at any time for any reason, unless illegal or discriminatory.

Labor law

Protects nurses' rights to unionize and collectively bargain for wages, hours, and conditions under the NLRA.

Compliance programs

Organizational systems ensuring adherence to federal and state laws and reporting of violations.

Tort law

Civil wrongs that cause harm; includes negligence, malpractice, assault, battery, false imprisonment, and breach of confidentiality.

Negligence

Failure to act as a reasonably prudent person would under similar circumstances, resulting in harm.

Malpractice

Professional negligence; failure of a nurse to act according to accepted standards, causing injury to a patient.

Four elements of malpractice

Duty, breach of duty, causation, and damages must all be proven by the plaintiff.

Assault

Threatening to touch or harm a patient without consent.

Battery

Intentional touching without consent; examples include giving medication against a patient's will or improper use of restraints.

Informed consent

The process of providing sufficient information before a procedure to allow a voluntary, knowledgeable decision.

Express consent

Consent given verbally or in writing.

Implied consent

Consent inferred from a patient's actions, such as offering an arm for an injection.

Role of the nurse in consent

Verify that consent is obtained before procedures, witness signatures when appropriate, and ensure patient understanding.

Emergency consent exception

Allows treatment without consent in life-threatening situations when the patient cannot consent.

Discharge against medical advice (AMA)

Patient's decision to leave care; nurse must notify physician, document, and have the patient sign AMA form.

False imprisonment

Unlawful confinement without consent or proper justification; includes inappropriate restraint use or threats to detain.

Restraints

Used only to protect the patient or others; require a written order, least restrictive method, and frequent reassessment.

Confidentiality

The legal and ethical duty to protect private patient information.

HIPAA

Health Insurance Portability and Accountability Act; sets national standards for privacy, security, and portability of health information.

Duty to report

Legal obligation to report child or elder abuse, domestic violence, and certain communicable diseases.

Good Samaritan Law

Protects nurses who render emergency care in good faith and within scope of practice from liability.

Errors of omission and commission

Omission = failure to act causes harm; Commission = wrong action causes harm.

Sentinel event

Unexpected occurrence involving death or serious injury that signals need for immediate investigation.

Never event

Serious preventable error such as surgery on the wrong patient; may lead to loss of CMS reimbursement.

Risk management

Programs designed to identify and reduce potential legal risks and improve patient safety.

QSEN competencies

Quality and Safety Education in Nursing standards promoting safe, evidence-based practice.

Preventing legal problems—facilities

Implement quality improvement policies, maintain incident reporting, and monitor sentinel events.

Preventing legal problems—nurses

Maintain clear communication, accurate documentation, clarify unclear orders, and follow scope of practice.

Professional liability insurance

Personal coverage that protects a nurse's assets and income in case of a lawsuit.

Standards of care

Authoritative statements defining competent levels of nursing practice and professional performance.

Positive nurse-patient relationships

Providing compassionate, competent, and respectful care reduces likelihood of legal action.