Marquis Leadership 8e Ch 5: Legal and Legislative Issues

B) The Nurse Practice Act

Feedback:

The 51 Nurse Practice Acts representing the 50 states and the District of Columbia are

examples of statutes. These Nurse Practice Acts define and limit the practice of nursing,

stating what constitutes authorized practice as well as what exceeds the scope of

authority. Although Nurse Practice Acts may vary among states, all must be consistent

with provisions or statutes established at the federal level. The other options lack the

comprehensiveness and focus of a state's Nurse Practice Act.

What defines the legal boundaries of nursing at the state level?

A) The state's Attorney General

B) The Nurse Practice Act

C) The ANA standards of practice

D) The ANA Code for Nurses

A) The expert testimony of nursing witnesses

Feedback:

The testimony of other nurses in the same specialty as the defendant may be used to

prove breach of duty. The other options are not considered qualified to testify to this

matter.

How is the question of whether a nurse acted with reasonable care generally proven?

A) The expert testimony of nursing witnesses

B) The defendant's explanation of what the nurse did

C) The trial judge, after checking the outcome of prior similar court cases

D) The testimony of expert medical witnesses

C) The nurse can be held legally liable for any harm if the procedure is carried out

without question

Feedback:

All nurses have personal liability, which means that every person is liable for his or her

own conduct. None of the remaining options describes that liability or its outcomes

accurately.

A doctor orders a medical procedure that the staff nurse has reason to believe will harm

the patient. Which statement accurately states the legal consequences of carrying out, or

refusing to carry out, the procedure?

A) The staff nurse cannot be held legally liable for any harm to the patient if the

procedure is carried out with due care

B) The nurse may lose his or her license by refusing to carry out the procedure

C) The nurse can be held legally liable for any harm if the procedure is carried out

without question

D) The nurse can be held accountable for practicing medicine without a license

A) Observed the client sign the consent form

Feedback:

Informed consent is obtained by a physician; therefore, a nurse is not legally responsible

for informed consent but is confirming that the client signed the consent form. The other

options are the responsibilities of the professional performing the procedure.

The nurse witnesses a patient sign an operative permit form. Legally, what does the

nurse's signature imply?

A) Observed the client sign the consent form

B) Is certain the client understands the proposed procedure

C) Believe the client is capable of understanding the proposed procedure

D) Assumes the client has had an adequate evaluation to agree to the procedure

D) Revision of the Nurse Practice Act

Feedback:

RN scope of practice is always determined by the Nurse Practice Act and any expansion

of roles must occur through legislated changes in that statute. None of the remaining

options are sufficient to expand nursing roles legally.

How is the legal expansion of nursing roles accomplished?

A) The expansion of job descriptions in an agency

B) Written contracts between the nurse and the client

C) A written agreement between the nurse and the physician

D) Revision of the Nurse Practice Act

Document

Feedback:

It is the responsibility as manager to immediately document the error according to

hospital policy. Since policies concerning such situations vary, it is vital to know and

follow established policies. It is not generally appropriate to make such a note on the

client's chart.

What is the responsibility of a charge nurse who discovers that a medication error was

made on the previous shift?

A) Share that information with the charge nurse on the previous shift

B) Document the incident as per hospital policy

C) Write a memo to the nurse who made the error requesting incident report be

written

D) Write a note in the client's chart that an incident report will be completed

B) Laws are fluid and subject to change

Feedback:

When using doctrines as a guide for nursing practice, the nurse must remember that all

laws are fluid and subject to change. Laws are not static. It is the responsibility of each

manager to keep abreast of legislation and laws affecting both nursing practice and

management practice. While the other options are correct, they do not describe the most

encompassing reason that nurse-managers need to keep aware of current legislature

affecting nursing practice.

What is the best reason that nurse-managers have an ongoing responsibility to be aware

of legislation affecting nursing practice?

A) This will prevent them from getting sued

B) Laws are fluid and subject to change

C) It will protect the agency from a lawsuit

D) It will ensure that correct procedure is carried out

A

C) Average nursing judgment and skills

Feedback:

Reasonable and prudent generally means the average judgment, foresight, intelligence,

and skill that would be expected of a person with similar training and experience. The

other options describe qualifications not required of a reasonable and prudent nurse.

Which characteristics are required of a reasonable and prudent nurse?

A) Years of clinically focused nursing experience

B) Specialized nursing skills

C) Average nursing judgment and skills

D) Earned advanced nursing degree

A) Statutes

Feedback:

Statutes are the only laws made by official enactment by the legislative body.

A state Nurse Practice Act is an example of which source of law?

A) Statutes

B) Constitution

C) Administrative

D) Judicial

C) Administrative

Feedback:

A verdict of suspension or loss of licensure represents administrative law. This type of

law is not based on any of the other options.

A verdict of suspension or loss of licensure represents what type of law?

A) Criminal

B) Civil

C) Administrative

D) Judicial

A) Breach of duty

B) Presence of injury

C) Ability to foresee harm

D) Causal relationship

Feedback:

A lawsuit pertaining to professional negligence must include duty, breach of duty,

injury, a causal relationship between breach of duty and injury, and the ability to foresee

harm. Intent to cause injury is not a requirement.

A lawsuit pertaining to professional negligence must include duty, breach of duty,

injury, and a causal relationship between breach of duty and injury. What else must be

included? Which element is necessary to prove professional negligence? Select all that

apply.

A) Breach of duty

B) Presence of injury

C) Ability to foresee harm

D) Causal relationship

D) A causal relationship

Feedback:

A direct causal relationship between failure to meet the standard of care (breach) and

injury can be proved when a patient is harmed because proper care is not given. None of

the remaining options are relevant to this criterion.

What component of professional negligence is represented when a patient experiences a

seizure resulting from a medication error?

A) Duty to use due care

B) Failure to meet standard of care

C) Foreseeability of harm

D) A causal relationship

C) Foreseeability of harm

Feedback:

The nurse must have reasonable access to information about whether the possibility of

harm exists not fulfilling this responsibility may result in a foreseeable harm to the

client. None of the remaining options are relevant to this criterion.

What component of professional negligence is represented when a nurse fails to look up

an unfamiliar medication before administering it?

A) Duty to use due care

B) Failure to meet standard of care

C) Foreseeability of harm

D) A direct relationship between failure to meet the standard of care (breach) and

injury can be proved

C) Information regarding the risks involved in the proposed procedure

Feedback:

Informed consent can be given only after the patient has received a complete

explanation of the surgery, procedure, or treatment and indicates that he or she

understands the risks and benefits related to it. Timeline and nursing responsibilities are

not components that are included. Outcomes are identified as expected or desired; no

guarantees are given.

What element must be included in the process of securing informed consent?

A) A timeline of when the treatment is expected to occur

B) Written information on what the post procedure outcomes will be

C) Information regarding the risks involved in the proposed procedure

D) An explanation of the nature of all associated treatment provided by the nurse

A) Suspected incidents of elder abuse

B) Examples of substandard medical care

C) Client-reported incidents of child abuse

D) Confirmed case of a communicable disease

Feedback:

In addition, the manager, like all professional nurses, is responsible for reporting

improper or substandard medical care, child and elder abuse, and communicable

diseases, as specified by the Centers for Disease Control and Prevention. Disagreements

are not mandated reportable situations.

Which situations is a nurse-manager illegally responsible for reporting? Select all that

apply.

A) Suspected incidents of elder abuse

B) Examples of substandard medical care

C) Client-reported incidents of child abuse

D) Confirmed case of a communicable disease

Ans: A) Involving health-care consumers as active members of the health-care team

Feedback:

One way to promote open communication between patients and practitioners is

involving health-care consumers as active members of the health-care team. Pursing

patient safety initiatives prevent medical injury by promoting the creation of cultures of

patient safety in health-care organizations; establishing a federal leadership locus for

advocacy of patient safety and health-care quality; and building an evidence-based

information and technology system that impacts patient safety and pursue proposals to

offset implementation costs.

What is one way to promote open communication between patients and practitioners?

A) Involving health-care consumers as active members of the health-care team

B) Promoting the creation of cultures of patient safety in health-care organizations

C) Establishing a federal leadership locus for advocacy of patient safety and healthcare

quality

D) Building an evidence-based information and technology system that impacts

patient safety and pursue proposals to offset implementation costs

A) A state nursing license

Feedback:

In general, a license is a legal document that permits a person to offer special skills and

knowledge to the public in a particular jurisdiction when such practice would otherwise

be unlawful. A state nursing license allows for the practice of nursing in a specific state.

Some professionals have advocated shifting the burden of licensure, and thus

accountability, from individual practitioners to an institution or agency. Proponents for

this move believe that institutional licensure would provide more effective use of

personnel and greater flexibility. The ANA is not capable of permitting a person to

practice nursing.

What document permits a registered nurse to offer special skills and knowledge to the

public in a particular jurisdiction when such practice would otherwise be unlawful?

A) A state nursing license

B) Institutional licensure

C) ANA certificate

D) ANA practice standards

A) Higher than those required by law

D) Are established prior to those required by law

,

Feedback:

Professional organizations generally espouse standards of care that are higher than those

required by law. These voluntary controls often are forerunners of legal controls. The

standards are written by health-care professionals while laws are written by legislatures.

Professional organizations generally espouse standards of care that have what

relationship to those required by law? Select all that apply.

A) Higher than those required by law

B) The same as those required by law

C) Are established after those required by law

D) Are established prior to those required by law

A) Professional negligence

Feedback:

While professional negligence is considered to be an unintentional tort, assault, battery,

false imprisonment, invasion of privacy, defamation, and slander are intentional torts.

What is an example of an unintentional tort?

A) Professional negligence

B) Assault

C) Battery

D) False imprisonment

C) Five

Feedback:

Five components must be present for a professional to be held liable for malpractice:

duty to use care, failure to meet standard of care, foreseeability of harm, direct

relationship between failure to meet the standard of care and injury can be proved, and

injury.

Malpractice or professional negligence is the failure of a person with professional

training to act in a reasonable and prudent manner. How many components must be

present for an individual to be found guilty of malpractice?

A) Three

B) Four

C) Five

D) Six

) Incarceration is a likely consequence of being found guilty of a criminal offense

B) Intentionally giving an overdose of a potent narcotic is a criminal offense

C) A guilty verdict requires evidence beyond a reasonable doubt

Feedback:

In criminal cases, the individual faces charges generally filed by the state or federal

attorney general for crimes committed against an individual or society. In criminal

cases, the individual is always presumed to be innocent unless the state can prove his or

her guilt beyond a reasonable doubt. Incarceration and even death are possible

consequences for being found guilty in criminal matters. Nurses found guilty of

intentionally administering fatal doses of drugs to patients would be charged in a

criminal court. Most malpractice cases are tried in civil court.

Which statement is true regarding criminal law cases? Select all that apply.

A) Incarceration is a likely consequence of being found guilty of a criminal offense

B) Intentionally giving an overdose of a potent narcotic is a criminal offense

C) A guilty verdict requires evidence beyond a reasonable doubt

D) Most malpractice cases are tried in criminal court

B) Always function with the state's nursing practice act

Feedback:

Nurses can reduce the risk of malpractice claims by practicing within the scope of the

Nurse Practice Act. Nurses should purchase their own liability insurance and understand

the limits of their policies. Although this will not prevent a malpractice suit, it should

help to protect a nurse from financial ruin should there be a malpractice claim. While

the other options present reasonable advice, they will not necessarily help in the

avoidance of a malpractice claim.

Which behavior will best minimize a nurse's risk for a malpractice claim?

A) Always carry a personal liability insurance policy

B) Always function with the state's nursing practice act

C) Ask for assistance when engaged in complicated procedures

D) Devote time to establishing an effective nurseñpatient relationship

C) In order for protection to apply, the nursing care cannot be considered negligent

D) A nurse who provided out-of-scope care is not protected by the Good Samaritan

law

Feedback:

Nurses are not required to stop and provide emergency services as a matter of law,

although most health-care workers feel ethically compelled to stop if they believe they

can help. Good Samaritan laws suggest that health-care providers are typically protected

from potential liability if they volunteer their nursing skills away from the workplace

(generally limited to emergencies), provided that actions taken are not grossly negligent

and if the health-care worker does not exceed his or her training or scope of practice in

performing the emergency services. However, not being paid for your services alone

will not provide Good Samaritan law protection. Good Samaritan laws apply only if the

health-care worker does not exceed his or her training or scope of practice in performing

the emergency services. Protection under Good Samaritan laws varies tremendously

from state to state. In some states, the law grants immunity to RNs but does not protect

LVNs or LPNs. Other states offer protection to anyone who offers assistance, even if

they do not have a health-care background. Nurses should be familiar with the Good

Samaritan laws in their state.

Which statement is true regarding the implications of a Good Samaritan law for a

registered nurse? Select all that apply.

A) A nurse has a legal responsibility to provide emergency services

B) Such laws are universally worded so as to minimize state-to-state differences

C) In order for protection to apply, the nursing care cannot be considered negligent

D) A nurse who provided out-of-scope care is not protected by the Good Samaritan

law

) Remains current on all institutional policies and procedures

B) Delegates with consideration to appropriate scopes of practice

C) Requires physical proof of appropriate professional licensure each year

Feedback:

Sound management functions regarding legal issues include understanding and adhering

to institutional policies and procedures delegating to subordinates wisely, looking at the

manager's scope of practice and that of the individuals he or she supervises, and

monitoring subordinates to ensure they have a valid, current, and appropriate license to

practice nursing. In-services should be held frequently especially when related to issues

that affect care delivery. The reliance on peers for advice in such matters is not prudent;

the institution's legal advisor is much better prepared for this task.

Which action demonstrates appropriate management regarding legal issues? Select all

that apply.

A) Remains current on all institutional policies and procedures

B) Delegates with consideration to appropriate scopes of practice

C) Requires physical proof of appropriate professional licensure each year

D) Provides yearly in-services on the operation of newly acquired equipment

B) It supports the sharing of blame among all involved sources of health-care

services

Feedback:

Nurses must remember that the purpose of respondeat superior is not to shift the burden

of blame from the employee to the organization but rather to share the blame, increasing

the possibility of larger financial compensation to the injured party. While the other

options may be true statements, the correct option describes the more nurse-related

implication of the concept.

Which statement best describes the impact that the concept of respondeat superior has

on the issue of nursing liability?

A) It allows for joint liability among physicians, nurses, and health-care

organizations

B) It supports the sharing of blame among all involved sources of health-care

services

C) It encourages legal intervention when health care is thought to be substandard

D) It implies that the institution is responsible for the acts of its employees