7Fundamentals of Nursing: The Art & Science of Person Centered Care, 10th Edition; Taylor, Lynn, Bartlett. Chapter 7 Legal Dimensions of Nursing Practice

A nursing professor pulls a student aside to discuss documenting a patient’s blood pressure of 202/122 but not reporting this to the primary nurse. When discovered, the patient was transferred to the intensive care unit for treatment and monitoring. How does the faculty best explain to the student that their inaction reflects negligence?

a. “You did not re-assess your patient.”

b. “There was poor interprofessional communication with the health care team.”

c. You failed to act as a reasonably prudent nurse would under similar circumstances.”

d. “This action is consistent with a felony criminal action.”

c. You failed to act as a reasonably prudent nurse would under similar circumstances.”

Negligence is defined as performing an action that the reasonably prudent nurse would not perform or failing to act as a reasonably prudent nurse would in similar circumstances. Negligence may be an act of omission or commission. Criminal law concerning state and federal criminal statutes includes murder, manslaughter, criminal negligence, theft, and illegal possession of drugs. Public law regulates relationships between people and the government. Private or civil law includes laws relating to contracts, ownership of property, and the practice of nursing, medicine, pharmacy, and dentistry.

Nursing students approaching graduation and licensure are required to read the state nurse practice act. Which topics in the law will they identity as guides to professional practice? Select all that apply.

a. Actions resulting in discipline

b. Clinical procedures

c. Medication administration

d. Scope of practice

e. Delegation policies

f. Medicare reimbursement

a. Actions resulting in discipline

d. Scope of practice

Each state has a nurse practice act that protects the public by broadly defining the legal scope of nursing practice. Practicing beyond those limits makes nurses vulnerable to charges of violating the state nurse practice act. Nurse practice acts also list the violations that can result in disciplinary actions against nurses. Clinical procedures are covered by the health care institutions themselves. Medication administration and delegation are topics covered by the board of nursing. Laws governing Medicare reimbursement are enacted through federal legislation.

A nurse on a surgical unit is concerned about a colleague’s possible substance use disorder. Which signs and symptoms could support the nurse’s suspicion? Select all that apply.

a. Exhibiting diminished alertness and somnolence while working

b. Attending multiple continuing education conferences

c. Offering to medicate coworkers’ patients for pain

d. Making incorrect narcotics counts and creating wastage

e. Leaving the unit frequently

a. Exhibiting diminished alertness and somnolence while working

c. Offering to medicate coworkers’ patients for pain

d. Making incorrect narcotics counts and creating wastage

e. Leaving the unit frequently

Signs of substance use in nurses may include diminished alertness or somnolence, leaving the unit frequently, incorrect narcotic counts, wastage, offers to medicate colleagues’ patients, or changes in job performance, among others. Attending professional conferences is an example of a nurse who is fully engaged with their work.

A new graduate nurse tells the preceptor they want to obtain recognition in wound care, a specialty area of nursing. What credential will this nurse need to seek?

a. Accreditation

b. Licensure

c. Certification

d. Board approval

c. Certification is the process by which a person who has met certain criteria established by a nongovernmental association is granted recognition in a specified practice area. Nursing is one of the groups operating under state laws that promote the general welfare by determining minimum standards of education through accreditation of schools of nursing. Licensure is a legal document that permits a person to offer to the public skills and knowledge in a particular jurisdiction, where such practice would otherwise be unlawful without a license. State board of approval ensures that nurses have received the proper training to practice nursing.

The nurse reports to their manager that informed consent was not obtained from a patient for whom HIV testing was already performed. The nurse suggests which intentional tort may have been committed?

a. Assault

b. Battery

c. Invasion of privacy

d. False imprisonment

b. Assault is a threat or an attempt to make bodily contact with another person without that person’s consent. Battery is an assault that is carried out. Every person is granted freedom from bodily contact by another person unless consent is granted. The Fourth Amendment gives citizens the right of privacy and the right to be left alone; a nurse who disregards these rights is guilty of invasion of privacy. Unjustified retention or prevention of the movement of another person without proper consent can constitute false imprisonment.

A patient died during routine outpatient surgery, and the nurse was accused of having failed to monitor and interpret vital signs. Which fact must be established to prove them guilty of malpractice or negligence?

a. The surgeon testifies the nurse’s action was pure negligence, saying that the patient could have been saved.

b. This patient should not have died since they were healthy, physically active, and involved in the community.

c. The nurse intended to harm the patient and was willfully negligent, as evidenced by the tragic outcome.

d. The nurse had a duty to monitor the patient, and due to the nurse’s failure to perform this duty, the patient died.

d. The nurse had a duty to monitor the patient, and due to the nurse’s failure to perform this duty, the patient died.

Liability involves four elements that must be established to prove that malpractice or negligence has occurred: duty, breach of duty, causation, and damages. Duty refers to an obligation to use due care (what a reasonably prudent nurse would do) and is defined by the standard of care appropriate for the nurse–patient relationship. Breach of duty is the failure to meet the standard of care. Causation, the most difficult element of liability to prove, shows that the failure to meet the standard of care (breach) caused the injury. Damages are the actual harm or injury resulting to the patient.

An attorney representing a patient’s family who is suing for wrongful death calls the nurse to obtain a better understanding of the nurse’s actions. How will the nurse respond?

a. “I can’t talk with you; you will have to contact my attorney.”

“b. I will answer your questions, so you’ll understand how the situation occurred.

c. “I hope I won’t be blamed for the death because it was so busy that day.”

d. “First tell me why you are doing this to me. This could ruin my career!”

a. “I can’t talk with you; you will have to contact my attorney.”

The nurse should not discuss the case with anyone at the facility (except the risk manager), with the plaintiff, with the plaintiff’s lawyer, with anyone testifying for the plaintiff, or with reporters. This is one of the cardinal rules for nurse defendants.

A nurse follows a prescription written by the health care provider to administer a medication to which the patient is allergic. How does the nurse interpret their liability for administering this medication?

a. The nurse is not responsible because they were following the provider’s orders.

b. The nurse is responsible because they administered the medication.

c. The health care provider is responsible because they ordered the drug.

d. The nurse, health care provider, and pharmacist bear responsibility for their actions.

d. The nurse, health care provider, and pharmacist bear responsibility for their actions.

Nurses are legally responsible for carrying out the orders of the health care provider in charge of a patient unless an order would lead a reasonable person to anticipate injury if it was carried out. If the nurse should have anticipated injury and did not, both the prescribing health care provider and the administering nurse are responsible for the harms to which they contributed.

A nurse answers a call light and finds the patient on the floor. After the health care provider examines the patient and finds no injury, the nurse returns the patient to bed and fills out an incident report. What statements are true about incident reports? Select all that apply.

a. They can be used as disciplinary action against staff members.

b. They can be used as a means of identifying risks.

c. They can be used for quality control.

d. They must be completed by the facility manager.

e. They make facts available in litigation cases.

f. They should be documented in the patient record.

b. They can be used as a means of identifying risks.

c. They can be used for quality control.

e. They make facts available in litigation cases.

Incident reports are used for quality improvement and should not be used for disciplinary action against staff members. They are a means of identifying risks and are filled out by the nurse responsible for the injured party. An incident report makes facts available in case litigation occurs; in some states, incident reports may be used in court as evidence. A health care provider completes the incident form with documentation of the medical examination of the patient, employee, or visitor with an actual or potential injury. Documentation in the patient record should not include the fact that an incident report was filed.

A nursing student is preparing to administer medications and asks the clinical instructor about legal liability in clinical practice. What is the most appropriate response?

a. “Students are not responsible for their acts of negligence resulting in patient injury.”

b. “Student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse.”

c. “Hospitals are exempt from liability for student negligence if the student nurse is properly supervised by an instructor.”

d. “Most nursing programs carry group professional liability making student personal professional liability insurance unnecessary.”

b. “Student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse.”

Student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse. Student nurses are responsible for their own acts of negligence if these result in patient injury. A hospital may also be held liable for the negligence of a student nurse enrolled in a hospital-controlled program because the student is considered an employee of the hospital. Nursing instructors may share responsibility for damages in the event of patient injury if an assignment called for clinical skills beyond a student’s competency or the instructor failed to provide reasonable and prudent clinical supervision. Most nursing programs require students to carry personal professional liability insurance.

The nurse manager reviews the medical record of a patient who has accused a nurse of negligence after requiring a “needless” admission to the intensive care unit postoperatively. Which entry in the electronic health record requires follow-up by the manager?

Exhibit: Electronic health record (EHR)

Nursing Notes: Postoperative follow-up

12:20 pm: patient still reporting incisional pain of 10/10, provider contacted, increased morphine from 1 mg to 2 mg every hour

2: 15 pm: dime-sized, dark red–brown blood stain on dressing; area circled

2:30 pm: patient reports incisional pain, 7/10, 2 mg morphine administered

2:45 pm: vital signs T 99.2°, P 120, RR 20, BP 84/48; will continue to monitor

a. Inappropriately recorded vital signs

b. Pain treated without appropriate assessment

c. Failure to follow up on tachycardia and hypotension

d. Lack of interpretation of vital signs and follow-up

d. Lack of interpretation of vital signs and follow-up

Nurses are responsible for gathering assessment data including vital signs and interpreting them considering the patient’s condition and trends. The nurse did not document interventions from the health care provider for typical symptoms of shock, including tachycardia and hypotension.

A patient admitted through the emergency department for a severe infection is receiving intravenous (IV) antibiotics. The patient, who has been oriented, demands the nurse remove the IV because the patient is leaving now. What action will the nurse take?

a. Apply soft wrist restraints

b. Perform a neurologic assessment

c. Explain that after signing an “against medical order form,” the patient may leave

d. Call the patient’s family to encourage the patient to stay

c. Explain that after signing an “against medical order form,” the patient may leave

A person cannot be legally forced to remain in a health facility, such as a hospital, if that person is of sound mind. The patient signs an “against medical orders” form when insisting on being discharged, to indicate not holding the facility responsible for harm from leaving. Applying soft wrist restraints when the patient has expressed wanting to leave constitutes battery, which includes willful, angry, and violent or negligent touching of another person’s body or clothes or anything attached to or held by that other person. The patient has been oriented, so another assessment is not indicated. The patient, not the family, has autonomy.