Ethics, Law, and Leadership in Nursing (Vocabulary flashcards)

Ethics, Legalities, and Leadership in Nursing

• Ethics and law are foundational in nursing care; ethics governs daily conduct and right vs. wrong, while legal considerations come into play when harm occurs or mandated processes are required.
• Ethics is about the way someone conducts themselves and discerning right from wrong in practice.
  • Simple terms: right vs. wrong, good vs. evil.
  • Nurses encounter ethics daily, from patient care decisions to reporting concerns about colleagues.

Ethics in daily nursing practice

• Scenarios to consider:
  • A patient refuses medication: what are your options? You cannot coerce; explore alternatives, document the discussion, and follow policy.
  • A close colleague self-administers a drug or steals from a patient: you must report through proper channels (nurse manager, ethics committee, HR) or through designated processes; anonymity may be available.
  • You discover a peer is under the influence: protect patients and yourself, report, and follow rehabilitation and probation procedures that facilities may require.
  • Balancing patient advocacy and family wishes, especially when family asks you not to disclose diagnoses (e.g., stage IV cancer): discuss with ethics committee, charge nurse, or physician; do not reveal patient information against patient wishes if the patient is competent.
• Anonymity and reporting: reporting is often anonymous or confidential; your name should not be involved in certain reports according to policy.
• Why report tough issues? Failing to report can lead to patient harm and can backfire on you if the substitute problems surface later (e.g., narcotics counts off, or someone can attempt to shift blame).
• Ethical complexity in practice: when families try to override the patient’s knowledge about their own status, ethics and law guide the physician and team to balance rights, family involvement, and patient autonomy.
• Real-world example: rehabilitation approaches for nurses with substance abuse when patient safety is at risk; facilities may require rehab and probationary periods.
• In ethics discussions, you can involve the ethics committee or nurse manager to navigate tricky disclosures and ensure patient advocacy while complying with laws.

Values and pharmacology in ethics

• Values: beliefs about the work and what matters; they guide behavior in clinical decisions.
• Pharmacology and patient understanding:
  • Patients may not know drug names or why they are taking them; explain what the medication does and why it’s prescribed.
  • Highlight major side effects and key concerns; not every possible side effect needs listing, but the main ones should be covered.
  • If a new medication is started, stay with the patient for the first 15 minutes because acute hypersensitivity reactions often occur in that window; reactions can occur later as well.
• The American Nurses Association (ANA) Code of Ethics:
  • A set of principles reflecting the profession’s goals, values, and obligations.
  • Provides clear statements about ethical obligations for every nurse and nursing student.
  • Encourages collaboration with others in medicine for ethical issues; hospitals may have ethics committees; you can join.
  • In emergencies (e.g., Jehovah’s Witnesses refusing blood products), ethics and legal processes may drive the decision; life-saving measures may be prioritized, with alternatives discussed.
• Ethical principles overview (autonomy, nonmaleficence, beneficence, justice, fidelity, veracity, confidentiality) and their practical implications in patient care.
• Autonomy: patients have the right to make informed decisions about their health; involve patients in decisions and include family or caregiver where appropriate when patient capacity is impaired.
• Beneficence: actively promoting the well-being of patients (do good) and avoiding harm.
• Nonmaleficence: commitment to do no harm; de-escalation in mental health or combative situations to prevent harm to patient or staff.
• Veracity: commitment to telling the truth; if you don’t know an answer, say so and find out; do not lie to patients.
• Fidelity: keeping promises and being reliable; avoid giving false estimates of return time to patient room; communicate honestly about what you can do.
• Justice: fairness and equality in distribution of health resources, treatment, and decision-making.
• Confidentiality: protect patient information; HIPAA governs protection; do not disclose patient data in public areas or on social media.

The ANA Code of Ethics and professional practice

• The Code provides ethical obligations for nurses and nursing students; it’s a guide for professional behavior day-to-day.
• Ethics committee involvement: when complex cases arise, consult the ethics committee; they help interpret values, laws, and patient rights.
• In emergencies, life-saving interventions may take precedence temporarily, but documentation and subsequent legal review ensue.
• Ethics and patient advocacy: nurses advocate for patients while balancing family input and physician recommendations; you may need to explain why certain information cannot be shared with family if the patient is capable of deciding.
• Ethics and religion: conflicts between patient/family wishes and medical recommendations may require legal and ethical consultation; decisions can become legally reviewed.
• The importance of documentation in ethical decisions: documenting your reasoning, patient preferences, and steps taken helps protect the patient and yourself.

Advanced directives and end-of-life planning

• Advanced directives include:
  • Living wills, medical power of attorney, prehospital Do Not Resuscitate (DNR) orders, and the patient’s autonomous wishes.
  • These directives guide care when the patient becomes incompetent or unresponsive.
  • Do not resuscitate (DNR) orders: indicate that resuscitation should not be attempted; DNR does not mean no treatment—palliative and comfort measures may still be provided.
• Living wills vary; sometimes patients specify preferences about antibiotics, tube feeds, blood products, and other interventions.
• Death with dignity laws: vary by state; some allow patients with terminal illnesses to control timing of death; these laws are legal rather than hospice-focused and involve complex ethics and law.
• Practical implications: always read and respect a patient’s advanced directive; if there is conflict with family wishes, involve the physician and ethics committee; nurses must document the directives and ensure care aligns with the patient’s stated wishes.

Informed consent and patient education

• Informed consent must be valid and obtained by the physician; nurses act as witnesses and provide information but do not obtain consent themselves.
• Components of informed consent by the physician:
  • Description of procedure and risks/benefits.
  • Discussion of alternatives.
  • Assessment of patient understanding and voluntary agreement.
• Nurses’ role:
  • Serve as witnesses to consent.
  • Clarify information if the patient has questions, but defer to the physician for final explanations.
  • If a patient asks questions after the consent is signed, the physician should be called back to provide complete explanations.
• Competence and age: patient must be competent and at least 18 years old to give informed consent; if not, a guardian or power of attorney may provide consent.

Ethical dilemmas and practical decision-making

• Ethical dilemmas arise when trying to do the right thing but conflicting obligations exist (e.g., disclosure vs. family wishes, patient autonomy vs. surrogate decision-maker).
• When unsure, consult colleagues, supervisors, and ethics committees to explore options and potential solutions.
• Advanced planning and communication help mitigate ethical dilemmas (e.g., advance directives, patient education, and early ethics involvement).

Professional responsibilities and legal considerations

• State Nurse Practice Act defines rights, responsibilities, and scope of practice; these vary by state (e.g., Pennsylvania vs. New Jersey).
• Scope of practice: know what you can and cannot do; you may be certified to perform specific procedures (e.g., PICC line insertion) but this may vary by state and facility.
• Each nurse is responsible for their own negligent actions; do not hide mistakes—transparency and accountability are essential.
• Documentation and accountability:
  • Historically, medications were tracked on MARs (medication administration records); modern systems are computerized, but accuracy remains critical.
  • If a mistake is made, acknowledge it, report, and correct it; repeated lies or concealment can lead to severe consequences.
  • Documentation should reflect all safety measures (bed position, rails up, call bell in reach, patient needs, etc.).
• Safety fundamentals to prevent harm:
  • Bed in the lowest position when leaving the patient, rails up, call bell within reach, appropriate side rails (usually two, unless ordered otherwise).
  • For bed baths or procedures, ensure safety measures are in place and document accordingly.
• Legal concepts:
  • Tort law: negligence or malpractice leading to injury; there are four elements to prove liability: Duty, Breach, Causation, Injury.
  • Duty: obligation to report and provide care; mandated reporters must report suspected abuse (child abuse CEUs required for licensure).
  • Causation and injury: link between the breach of duty and injury; if no injury or breach, liability may not be established.
  • Intentional torts: assault and battery (threat or contact without consent; actual harmful contact).
  • Defamation: slander (spoken) and libel (written).
  • Invasion of privacy and HIPAA: protect patient privacy; improper disclosure can result in fines and liability.
• Professional identity and accountability:
  • Professional identity is formed by aligning actions with nursing values and the standards of practice.
  • The state board of nursing determines minimal qualifications; practice confidently and safely within scope.
  • If you see another nurse performing outside of scope or unsafe practice, address it through proper channels, not publicly or unprofessionally.

Confidentiality and HIPAA

• Confidentiality is central to patient trust and care; do not discuss patient information in public spaces (elevator, cafeteria) or share details with people not authorized to know.
• HIPAA provides privacy protections; patients can request access to their records, request corrections, and decide who can receive their health information.

Leadership in nursing practice

• Leadership is an interactive process that provides guidance, direction, and influence; three dynamic elements: the leader, the follower, and the situation.
• What makes a good leader?
  • Clear and effective communication
  • Competence and confidence in skills
  • Responsibility and accountability
  • Empowerment of staff and delegation without abdicating oversight
  • Growth orientation: ongoing education, CEUs, and research; involve staff in problem-solving and committee work
• Leadership styles:
  • Autocratic: leader makes all decisions; useful in crises but often less effective in healthcare teams.
  • Democratic: shared decision-making; acknowledges staff achievements; inclusive of all shifts.
  • Laissez-faire: followers have freedom; limited planning; may not suit high-stakes clinical settings.
  • Transactional: focus on daily operations and rewards/punishments; maintains status quo; emphasizes compliance.
  • Transformational: inspires change, challenges assumptions, motivates professional growth; supports education and career development.
  • Situational: flexible, adapts style to the situation; combines elements of other styles as needed.
• Leadership and nurse retention: good leadership improves nurse satisfaction and retention; staffing shortages contribute to burnout; supportive leadership and fair workloads help retain staff.
• Burnout in nursing:
  • Common causes: heavy workload, long shifts, inadequate breaks, high emotional/physical demands, frequent codes, staffing shortages.
  • Consequences: reduced morale, higher turnover, safety concerns.
  • Coping: pace yourself, set boundaries, advocate for staffing and resources, utilize support systems.
• Delegation and accountability in leadership:
  • Delegation requires assigning tasks to competent staff and ensuring they are completed and documented.
  • Leaders must supervise delegated tasks and verify baselines (e.g., vital signs before/after tasks) to ensure quality care.
• Conflict management in leadership:
  • Process to resolve conflicts and minimize negative effects; address issues early (e.g., chronic lateness) to prevent escalation; involve managers or HR if needed.

Practical nursing safety and ethics in leadership contexts

• Professional behaviors:
  • Align actions with standards of practice; accept responsibility for mistakes and seek education to prevent recurrence.
  • Do not conceal errors; transparency supports patient safety and professional trust.
• Central responsibilities:
  • Manage patient safety equipment (bed rails, side rails, call bells) and ensure proper setup before leaving the room.
  • Maintain patient privacy and minimize exposure of charts and information; always log out of computer systems when stepping away.
• Conflict and change management:
  • Proactively address recurring issues (lateness, missed tasks) via leadership channels.
  • Build committees to brainstorm and implement solutions with evidence-based practices.

Quick recap of key terms and concepts

• Autonomy: patient involvement in decisions about care.
• Beneficence: doing good for the patient.
• Nonmaleficence: do no harm.
• Justice: fair distribution of resources and care.
• Fidelity: keeping promises and being trustworthy.
• Veracity: truth-telling and honesty with patients.
• Confidentiality/HIPAA: protect patient information.
• Informed consent: patient/guardian consent with physician explanation; nurses witness only.
• Advanced directives: living will, power of attorney, DNR orders.
• Tort and negligence: wrongful acts causing harm; four liability elements: Duty, Breach, Causation, Injury.
• Assault and battery: threats or harmful touching without consent.
• Slander/Libel: defamation (spoken/written).
• Scope of practice: state-specific Nurse Practice Act; competencies and certifications vary by state.
• Ethical dilemmas: conflicts between values, laws, and patient rights; address via ethics committee and supervisors.
• Leadership styles: autocratic, democratic, laissez-faire, transactional, transformational, situational.
• Burnout and staffing: impact on patient care; imperative to pace overtime and advocate for staffing.
• Documentation: critical for accountability and legal protection; ensure accuracy and timely entries.

Connections to earlier and real-world relevance

• The ethics principles guide daily decisions in patient interactions, medication administration, and patient advocacy.
• Informed consent, DNR, and advance directives directly impact end-of-life care and patient autonomy.
• The Nurse Practice Act and scope of practice shape what tasks you can perform and where cross-state practice is permitted; awareness prevents illegal practice and improves patient safety.
• Leadership concepts translate into daily team dynamics, delegation, conflict management, and staff retention—crucial for high-quality care and patient outcomes.
• Ethical dilemmas often require collaboration with ethics committees, physicians, and administrators to balance patient rights, family input, and clinical feasibility.

Examples and hypothetical scenarios to study

• Scenario: A patient with stage IV cancer asks you not to tell their family about prognosis. You consult the patient’s autonomy and, if the patient is competent, maintain confidentiality and involve the physician and possibly an ethics committee for guidance.
• Scenario: A co-worker is suspected of diverting narcotics. You report through appropriate channels, document your actions, and ensure patient safety and narcotic counts are correct; anonymity is sometimes possible, but documentation and process are critical.
• Scenario: An HIV-positive nurse accidentally injures a patient with a needle; you report the incident per policy, review fidelity and nonmaleficence, and participate in the investigation while maintaining patient safety and confidentiality.
• Scenario: An emergency situation with a Jehovah’s Witness child needing blood; you provide other compatible products if possible and escalate to the ethics committee and legal avenues if necessary, while ensuring life-saving care.
• Scenario: A patient on a new medication experiences anaphylaxis within the first 15 minutes; you stay with the patient for the critical window, monitor closely, and follow protocol for adverse reactions.

Key takeaways for exam readiness

• Know and be able to define the core ethics principles (autonomy, beneficence, nonmaleficence, justice, fidelity, veracity) and how they apply to nursing practice.
• Be able to describe the ANA Code of Ethics and its relevance to patient advocacy, collaboration, and professional conduct.
• Understand informed consent roles: physician drives consent; nurse as witness; patient must be competent; 18+; alternatives must be discussed.
• Understand advanced directives and DNR, and how they guide care at end-of-life; know that DNR does not equal no treatment.
• Be fluent in legal concepts: torts (intentional vs. unintentional), key terms (assault, battery, defamation), and four elements of liability (Duty, Breach, Causation, Injury).
• Appreciate the importance of confidentiality and HIPAA; responsible handling of patient information and proper documentation practices.
• Recognize the state-specific nature of the Nurse Practice Act and scope-of-practice constraints; know what tasks require certification.
• Value leadership concepts: three elements (leader, follower, situation); leadership styles; delegation; conflict management; and burnout mitigation.
• Emphasize professional behaviors: accountability, honesty (veracity), and accountability for mistakes; do not misrepresent facts or skip reporting.
• Appraise the impact of staffing and burnout on patient safety; advocate for reasonable workloads, breaks, and teamwork.