chapter 4-Legal and Ethical Aspects of Nursing
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Chapter 4: Legal and Ethical Aspects of Nursing
Copyright notice references the source material (2012/2022) and the publisher.
Slide 2 – Introduction
Laws = written rules enforced by authority (government, courts).
Ethics = study of right vs. wrong (values, morals, cultural standards).
Ethics change over time as society evolves.
Nurses must know both legal and ethical standards before caring for patients.
Slide 3 – Legal Issues of Nursing Practice #1
Nurses are responsible for following nursing standards of care.
Types of law that affect nursing:
Constitutional law → e.g., right to free speech.
Statutory law → e.g., Nurse Practice Acts.
Administrative law → e.g., State Boards of Nursing.
Criminal law → e.g., malpractice prosecutions.
Civil law → e.g., HIPAA privacy violations.
Slide 4 – Legal Issues of Nursing Practice #2
Major legal/ethical concerns for nurses include:
Nurse Practice Acts (laws governing nurses).
Nursing standards and licensure.
Differences between nursing vs. medical practice laws.
Client rights: informed consent, privacy, protection of rights.
Malpractice & negligence → legal responsibility if harm occurs.
Liability → nurse’s accountability for actions.
Documentation must be accurate and complete.
Balancing ethical issues, law, and healthcare needs.
Slide 5 – Legal Terminology #1
Crime → Wrong against a person, property, or public; intentional wrongdoing.
Felony → Serious crime (e.g., murder, drug trafficking).
Misdemeanor → Less serious than felony but still important; may lead to loss of nursing license.
Slide 6 – Legal Terminology #2
Liability → Legal responsibility for your actions (or failure to act).
Includes both doing something wrong (commission) or not doing what’s required (omission).
Tort → Injury caused by someone’s actions (intentional or unintentional).
Negligence → Harm caused by not following duties, procedures, or precautions.
Slide 7 – Legal Terminology #3
Malpractice → Faulty or improper treatment that results in harm/illness.
Assault → Threat or attempt to cause harm (can be physical or verbal intimidation).
Battery → Actual physical contact without consent (e.g., touching, procedures without permission).
Slide 8 – Legal Terminology #4
Consent for care:
Must be given by client, parent, or guardian (if client is a minor, has intellectual disability, or mentally incompetent).
Inferred consent: assumed in life-threatening situations.
Informed consent:
Patient must be told about: test/treatment, medications, outcomes, risks, and alternatives.
Must be explained, documented, and signed.
Usually obtained by a physician.
All teaching must be documented.
Emergency consent: may be provided by 2 physicians.
Slide 9 – Legal Terminology #5
False imprisonment → Unnecessary restraint or confinement (physical or chemical).
Libel → False or damaging written statement or photo.
Slander → False or harmful spoken statements.
Defamation → Any act that harms a person’s reputation or good name (includes libel + slander).
Slide 10 – Legal Terminology #6
Abandonment of care → Stopping care too soon (leaving a client without proper handoff).
Invasion of privacy & confidentiality:
Right to expect personal property and information to be left alone.
Includes trespassing, illegal searches, or taking information without consent.
Need written consent to share information.
Must protect private info when using computers/technology.
Slide 11 – Question #1
Q: Is it acceptable to give an injection to a client if they refuse and don’t give written consent?
Why?
Giving treatment after refusal = battery (illegal).
Consent must be understood and signed by client or legal guardian.Answer: False
Slide 13 – HIPAA and Client Privacy #1
HIPAA = law that protects client health information.
Security Rule covers PHI/EPHI (Protected Health Info/Electronic PHI):
Health status
Medical records
Payment history
Requirements:
Written privacy policies.
Privacy officer assigned.
“Need to know” rule → share info only with those who need it.
Backup plans for emergencies.
Internal audits to check compliance.
Slide 14 – HIPAA and Client Privacy #2
Consequences of violations:
Disciplinary action.
Heavy financial penalties.
PHI can only be released under certain circumstances.
Title II Act (HIPAA):
Regulates who can access client info.
Sets standards for storage & transmission.
Gives clients the right to:
See their own health info.
Ask for corrections of errors.
Slide 15 – HIPAA and Client Privacy #3
On admission, clients/caregivers sign HIPAA form.
Violations may result in:
Job/student termination.
Civil or criminal penalties.
Patient Safety Act:
Encourages confidential reporting of errors or safety issues.
Protects reporters from extra liability.
Slide 16– Release of Client Information #1
A Signed Release of Information (ROI) is required before personal info can be shared.
Must confirm:
The receiver is authorized.
Client’s wishes (may not want location known).
Always protect confidentiality:
Speak privately.
Protect computer screens.
Log off when leaving a computer.
Never allow info to be overheard
Slide 17 – Release of Client Information #2
Options for protecting client identity:
“No Information” Status → patient not listed as admitted.
Alias → use of a false name.
AKA (Also Known As) → alternative name on record.
John Doe Admissions → identity kept confidential.
Slide 18 – Special Healthcare Concerns
Some situations require special legal/ethical attention:
Duty to provide treatment (nurses must give care).
Abortion and sterilization decisions.
Experimentation in healthcare (must protect client rights).
Release from liability forms.
Death in hospice care (facility or home).
Slide 10 – Question #2
Q: Is it vitally important for the nurse to ask permission from the client each time someone asks about the client’s condition?
Why?
The client’s Signed Release of Information (ROI) lists who is allowed to receive information.
If a person is not listed, the nurse cannot share info.
Nurses don’t need to ask the client every time.Answer: False
Slide 20 – Nurse Practice Act
The Nurse Practice Act = law that defines and regulates nursing in the U.S.
Covers:
Who can legally call themselves a “nurse.”
Rules for both practical nurses (LPN/LVN) and registered nurses (RN).
Each state/territory has its own Nurse Practice Act.
Slide 21 – State Boards of Nursing
State Boards = agencies that enforce the Nurse Practice Act.
Powers:
Can initiate, regulate, and enforce nursing laws.
Interpret rules (within legal limits).
Used to create licensing exams, but now exams are written by the NCSBN (National Council of State Boards of Nursing).
Licensing laws vary by state.
Goal: make requirements uniform so licenses are recognized across states.
A national nursing license has been proposed.
Slide 22 – Major Concepts of Nurse Practice Acts
Define practical nursing and registered nursing.
Protect nursing functions under the law.
Requirements for approved nursing schools.
Steps for licensure (getting and keeping a license).
Rules for continuing education.
Handling of renewals, suspension, revocation, reinstatement.
Allows interstate endorsement (using a license in multiple states if accepted).
Slide 23 – Important Points to Remember
Facilities can limit what a nurse can do.
May require extra training for certain specialties.
Education = lifelong process.
Always practice within your training limits.
Use common sense and good judgment.
If unsure → ask questions.
Report errors immediately.
Report defective equipment right away.
Slide 24 – Cause for Revoking or Suspending a License
Reasons a license may be revoked/suspended:
Drug or alcohol abuse.
Fraud or deception.
Criminal acts.
Previous disciplinary action.
Negligence (gross or ordinary)
Slide 25 – The Licensing Examination: NCLEX
First step after finishing nursing school = pass NCLEX-PN (practical) or NCLEX-RN (registered).
Test is provided by the NCSBN (National Council of State Boards of Nursing) for all U.S. states & territories.
Questions are written by nurses & educators.
The exam is updated regularly.
You don’t need to retake it if you move to another state.
Nurses must complete continuing education units (CEUs) and keep records of them.
Slide 26 – Legal Responsibilities in Nursing #1
Nurses and students are personally liable for harm caused by their own actions.
Healthcare facilities may also be held responsible for harm caused by staff.
Negligent acts can result in malpractice lawsuits.
Slide 27 – Legal Responsibilities in Nursing #2
Precautions to protect yourself legally:
Always follow accepted procedures.
Be competent in your skills.
Ask for help when needed.
Document everything clearly and accurately.
Never give legal advice to clients.
Don’t accept gifts from clients.
Don’t help clients prepare wills or legal papers.
Consider getting malpractice insurance.
Slide 28 – Legal Responsibilities in Nursing #3
Legal concerns during emergencies:
Some states require nurses/doctors to give emergency care outside work.
Nurses should act within their training and experience.
Good Samaritan Act: protects nurses if they give first aid in a reasonable and careful way.
Slide 29 – Question #3
Q: If a client is terminally ill, has no relatives, and asks a nurse for help preparing a will, can the nurse help?
Why?
Nurses should never help prepare legal documents (like wills).
A nurse may only witness the signing of a will if asked, but not create it.Answer: False
Slide 30 – Professional Boundaries
Nurses hold power (access to private info, authority in care).
Must not take advantage of vulnerable clients.
Boundary crossing → questionable behavior (blurring lines).
Boundary violation → serious misconduct (excessive personal disclosures, over-involvement).
Professional sexual misconduct → any sexual, demeaning, or harassing behavior.
Slide 31 – Advance Directives
Legal documents where a person states healthcare choices or names someone to decide if they can’t.
Examples:
Living will → says what care you do/don’t want if terminally ill.
Directive to healthcare providers.
Durable power of attorney for healthcare → names a decision-maker.
Mental health advance declaration.
Slide 32 – Question #4
Q: If a client has a living will in their file, must the nurse honor it if the client can’t make decisions?
Why?
A living will is a legally witnessed document.
Requests no extraordinary measures in case of terminal illness.
Nurses and healthcare providers are bound by the patient’s wishes. Answer: True
Slide 33 – Vulnerable Persons
Groups considered vulnerable include:
Children.
Adults who are hospitalized, isolated, or elderly.
People with mental illness or intellectual disabilities.
The law protects vulnerable people from injury, abuse, or neglect whether in hospitals, nursing homes, schools, or their own homes.
Slide 34 – Definitions of Death #1
Traditional definition → no breathing + no heartbeat.
Technology changed this → new definitions exist.
Two modern definitions:
Legal death → permanent loss of breathing & circulation.
Brain death → irreversible loss of all brain activity (including brain stem).
Slide 35 – Definitions of Death #2
Brain death signs:
Breathing stops once artificial ventilation is removed.
Heartbeat stops without external help.
No response to external stimuli.
No brain reflexes.
Pupils fixed & dilated.
Complete, irreversible loss of brain function (a.k.a. irreversible coma or vegetative state).
May allow for organ donation.
Slide 36 – Definitions of Death #3
Exceptions when brain death may not apply:
Severe hypothermia (very low body temperature).
Drug overdose with central nervous system (CNS) depressants.
These conditions can mimic brain death but are reversible
Slide 37 – Ethical Standards of Healthcare #1
Prejudice & Personal Values
Every nurse has personal beliefs, but must not impose them on clients.
Quality of Life
Complex ethical issue.
Sometimes used to decide who gets treatment or what type of care is provided.
Nurse’s Role in Ethics
Must practice ethically at all times.
Nurses are often the first to notice ethical problems.
Responsible for reporting concerns and helping find solutions.
Slide 38 – Ethical Standards of Healthcare #2
Common ethical issues in treatment:
Organ transplantation decisions.
Who qualifies and how organs are allocated.
Refusal of treatment by patients.
Withholding or terminating treatment.
Euthanasia (mercy killing/assisted death) → highly controversial.
Slide 39 – Ethical Standards of Healthcare #3
Ethics Committee in healthcare facilities may include:
Nurses, doctors, chaplains, social workers, and others.
Main functions:
Education.
Policy-making.
Case review & consultation.
Acts as advocates for clients, ensuring ethical issues are considered and addressed fairly.
Slide 40 – Clients’ Rights and Responsibilities #1
Clients’ Rights
Include the Patient’s Bill of Rights.
Clients’ Responsibilities
Healthcare is a partnership.
Must give accurate medical history.
Ask for clarification or more info if needed.
Recognize how lifestyle choices affect health.
Make sure the facility has a copy of their advance directive
Slide 41 – Clients’ Rights and Responsibilities #2
More client responsibilities:
Tell providers if you think you’ll have problems following treatment.
Respect the facility’s rules and regulations.
Respect the rights of other clients and the community.
Provide needed information to help with care.
Cooperate in the payment process for services.
Slide 42 – Question #5
Q: The various laws and ethical standards are designed to make sure each client gets the best healthcare possible. true or false
Why?
Laws and ethics set practice standards.
Define the limits of care for each team member.
Clarify client responsibilities.
Outline facility duties.
Provide penalties if rules are broken.
Together, these ensure clients receive the highest quality care possible.
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Answer to Question #5
True. Laws and ethics set standards of practice, define limits of care, assign responsibilities to each member of the healthcare team, outline roles of facilities, specify penalties for infractions, and collectively work to provide the best possible healthcare.