1000- Professional Standards and Legal Issues in Nursing Practice

Professional Standards and Legal Issues

Objectives

  • After this class, the student will:
    • Describe the professional and legal regulation of the nursing practice.
    • Identify legal concepts of negligence and malpractice.
    • Determine appropriate legal safeguards in nursing practice.

Professional & Legal Regulation

  • Accreditation
    • Educational programs are evaluated to ensure they meet certain standards.
    • Each state’s constitutions, legislative bodies, and laws determine the minimum standards of education.
    • Nursing programs must be accredited by the state to be legally recognized.
    • Normandale Community College holds voluntary accreditation from the AACN (American Association of Colleges of Nursing); accreditation was conducted on September 24.

State Board of Nursing, Nurse Practice Act and Licensure

  • Purpose of Licensing
    • To protect public health, safety, and welfare.
  • Ways to Get Licensed
    • Under the Nurse Practice Act, which defines and controls the nurse’s scope of practice.
    • Rules may differ by state.
  • State Boards of Nursing
    • Serve as regulatory bodies.
    • The legislature delegates authority to enforce laws to an executive agency, specifically the Board of Nursing.
    • The Board of Nursing enforces the laws and publicizes rules and regulations that expand upon those laws.

Nurse Practice Act (NPA)

  • Every state has unique laws regulating nursing.
  • Defined by the NPA, which the Board of Nursing (BON) regulates.
    • The BON sets standards, issues licenses, disciplines unsafe nurses, and has other duties.
  • Resources for information:
    • Minnesota Nursing Board
    • Minnesota Board of Nursing website.

Scope of Practice

  • Education and Training
    • Consider: Has the individual received adequate education or training to perform the activity in question?
  • Governing Body
    • Does the relevant governmental body (state, district, or federal) permit the activity?
  • Institution
    • Does the institution allow the individual or profession to perform the activity?

State of Minnesota Statute

  • Nurse Practice Act
    • MNBON - Minnesota Board of Nursing
    • Develops practice standards
    • Writes rules and policies
    • Disciplines unsafe nurses
    • Accredit nursing programs
    • Enforces the Nurse Practice Act
    • NCSBN - National Council of State Boards of Nursing
    • Responsible for licensure and NCLEX RN.
    • Professional Organizations
    • Such as the American Nurses Association which provides a Code of Ethics for Nurses and advocacy for nurses.

State Legislation

  • Governs:
    • Scope of practice for RNs, LPNs, and advanced practice nurses.
    • Educational requirements for nursing.
    • Composition and disciplinary authority of the Board of Nursing.
Nurse Practice Act Components
  • Differentiates from the Medical Practice Act and includes other statutes.
  • Responsibilities of the Board of Nursing include:
    • Delegation of tasks
    • Overseeing medication administration
    • Addressing unprofessional conduct
    • Rules and regulations implementation
    • Issuing position statements
    • Making declaratory rulings specific to settings or institutions.

Joint Commission

  • An independent non-profit organization that accredits and certifies healthcare organizations.
  • Purpose:
    • To continuously improve healthcare for the public in collaboration with stakeholders by evaluating healthcare organizations, inspiring excellence in providing safe and effective care of high quality and value.
    • Accreditation occurs every three years.

Nursing License

  • A legal document necessary to practice nursing, issued after passing the NCLEX (National Council Licensure Examination).
  • For inquiries regarding NCLEX, consult the National Council of State Boards (NCSBN) website.

Informed Consent

  • A legal expression of the ethical principle of autonomy.
    • Can be implicit or explicit.
    • Must be obtained by the person performing the procedure.
    • If obtained by another practitioner, the nurse's role is to witness and monitor.
    • Emergency consent is assumed when the individual is unable to provide it.
    • The nurse's responsibility includes ensuring patient comprehension of the procedure, ensuring the correct signatory is signing.

Capacity to Consent

  • Decision-making capacity is assessed (not competency) based on:
    • Appreciation of the right to make a choice.
    • Understanding the risks and benefits of the procedure.
    • Understanding the risks and benefits of opting out of the procedure.
    • Communication of the decision, which may require professional interpretation if non-verbal.
    • Avoidance of using medical jargon in explanation.

Quality and Safety Framework

  • Principles:
    • Self-Determination
    • Institutional Policies and Procedures
    • Nurse Practice Act and Rules and Regulations
    • Nursing Professional Scope of Practice
    • Standards of Practice
    • Code of Ethics
    • Specialty Certification

Standards of Care

  • Established standards within the profession and specialty practice area used to evaluate nurses during malpractice suits.
  • External Standards:
    • Set by organizations such as the American Nurses Association (ANA), Accreditation Commission for Education in Nursing (ACEN), state NPA, nursing specialty practice groups, and federal agency regulations.
  • Internal Standards:
    • Specific to institutional policies and procedures.
  • Regulatory Goals:
    • Protect nurses, patients, and institutions, prioritizing public safety.

Legal Concepts in Nursing Care

  • Negligence:
    • Definition: Performing an act that a reasonably prudent person under similar circumstances would not do, or failing to perform an act a reasonably prudent person would do.
    • A violation of the standard of care is not required.
  • Malpractice:
    • Definition: A specific form of negligence as it applies to professionals like nurses.
    • Involves knowingly failing to adhere to the standard of care, resulting in patient harm.
    • Focus on injury caused by action or inaction.
Examples of Negligence and Malpractice
  • Negligence Example:
    • A patient receiving incomplete self-care instructions upon discharge sustains an injury.
  • Malpractice Examples:
    • Attempting to lift a heavy patient without proper lifting equipment, resulting in a fall.
    • Ignoring infection control protocols, which leads to the spread of infection to other patients.

Preventing Negligence and Malpractice

  • Adhere to the standard of care, which includes accurate documentation.
  • Question authority when concerns arise.
  • Follow up on unsafe situations or practices.
  • Align with The Joint Commission and their 2030 Patient Safety Goals.
  • Ensure practice occurs in a safe environment.
  • Communicate effectively with patients, families, and other healthcare professionals.
  • Maintain professional liability insurance.
  • Foster positive interpersonal relationships.

Potential Causes of License Suspension

  • Professional negligence.
  • Practicing nursing without a valid license.
  • Fraud in obtaining a license.
  • Felony convictions not reported.
  • Not reporting substandard care.
  • Providing care while under the influence of drugs or alcohol.
  • Administering narcotics without an order.
  • Misrepresenting qualifications or credentials.

Malpractice Insurance

  • Query: Does possessing malpractice insurance make a nurse more or less likely to be sued?

Legal Safeguards

  • How can a nurse protect themselves?
    • By following best practices and adhering to standards of care, including following internal facilities’ procedures and policies.
    • Invoke the prudent or reasonable person rule during practice.
Legal Safeguard Examples
  • Only administer medications that one has prepared.
  • Ensure accurate, timely, and thorough documentation.
  • Prioritize infection control at all times as it is a matter of degree.
  • Monitor patient conditions and promptly respond to any changes.
  • Receive appropriate training pertinent to nursing responsibilities.

Scenario Analysis

  1. If a nurse faces a situation with a new medication prescription where the prescribed dosage exceeds recommendations and the nurse cannot reach the healthcare provider, the nurse should:

    • A. Contact the nursing supervisor
    • B. Administer the prescribed dosage
    • C. Hold the medication until the healthcare provider is contacted
    • D. Administer the recommended dosage until the healthcare provider can be reached

  2. As an advocate for the client, the nurse must ensure that 'safe, effective care' is provided in accordance with:

    • A. Nurse Practice Act
    • B. American Nursing Association
    • C. National Council for Licensure Exams
    • D. State Board of Licensure

Dosage Calculations

  • A child weighs 11.2 kg and has an order for Acyclovir 120 mg IV every 8 hours. The safe dosage range for Acyclovir is 25-50 mg/kg/day. - Calculation to determine the safe dosage range in mg for this child in 24 hours needed.
  • Augmentin oral suspension is prescribed at 280 mg P.O. three times a day with specifics on proper reconstitution direction.
  • Another scenario: A dose of 2g of medication is ordered IV BID, with a supply of 4g/0.4mL; calculation required to determine the administration volume.