Legal and Ethical Aspects of Nursing
Fundamental Sources of Law in the United States
Laws represent the established rules of conduct mandated by the government. Within the United States, there are three primary sources of law that govern society and professional practice. The first is The Constitution and the Bill of Rights, which serve as the foundation for providing basic human and civil rights to all citizens. The second source consists of laws made by elected officials at the federal, state, and local levels of government. The third source is known as Administrative Law, which includes regulations developed by agencies that were created by elected officials to oversee specific areas of public interest.
The Three Branches of Government
The United States government is organized into three distinct branches, each with a specific role regarding the management of laws. The Legislative branch, comprised of Congress (the Senate and the House of Representatives), is responsible for making laws. The Executive branch, headed by the President, is responsible for enforcing those laws. The Judicial branch, which includes the Supreme Court, is tasked with interpreting the laws. To remember this structure, one can use the memory tip: Make, Enforce, Interpret, abbreviated as M-E-I.
Categorization of Law: Civil vs. Criminal
Law is generally divided into two categories: Civil Law and Criminal Law. Civil Law focuses on private wrongs and is designed to guarantee individual rights. A violation of civil law is referred to as a tort, and legal proceedings in this category usually result in the awarding of money damages to the injured party. In contrast, Criminal Law deals with public wrongs, or acts committed against society as a whole. A violation of criminal law is termed a crime, and such violations may result in imprisonment, fines, or both.
The Nurse Practice Act and Scope of Practice
The Nurse Practice Act is a specific state law that regulates the licensure of nurses. This act is essential because it defines the scope of nursing practice, which dictates what a nurse is legally allowed to do within their professional capacity. This regulation is overseen by each individual state's Board of Nursing. The act provides definitions of nursing roles for Registered Nurses () and Licensed Practical Nurses/Licensed Vocational Nurses (), and it may also include definitions for Advanced Practice Registered Nurses (). As an exam tip, students should remember that the "scope of practice" indicates the specific activities a nurse is legally authorized to perform.
Principles of Delegation in Nursing
Delegation is defined as the assignment of nursing duties to another individual. It is critical to note that while many tasks can be delegated, nursing assessments and patient teaching cannot be delegated to others. The nurse who delegates a task remains responsible for supervising and evaluating the care provided. An may be responsible for supervising nursing assistants, technicians, or other Unlicensed Assistive Personnel (). Successful delegation must follow the "5 Rights of Delegation": 1) Right Task (Is the task appropriate?), 2) Right Circumstance (Is it safe to delegate at this time?), 3) Right Person (Does the individual have the necessary knowledge and ability?), 4) Right Supervision (Will the delegating nurse evaluate and follow up?), and 5) Right Direction/Communication (Have clear and concise instructions been provided?).
Legal Responsibilities of Student Nurses
Student nurses are held to the exact same standards of care as a licensed nurse. They are legally responsible for their own actions as well as their inactions. Student nurses have a professional responsibility to consult with their clinical instructor whenever they are unsure of a situation or if a patient's condition begins to change rapidly. Additionally, student nurses are required to be familiar with the Nurse Practice Act of the state in which they are practicing.
Standards of Care and Accountability
The is personally accountable for their own actions and must ensure that every patient receives qualified care. Standards of care provide the framework for judging the quality and effectiveness of the care delivered to patients. In legal proceedings, these standards are used to determine if a nurse acted correctly in a given situation. Nurses must keep their professional knowledge updated and remain familiar with the specific standards for procedures within their facility.
Professional Discipline and Board of Nursing Authority
State Boards of Nursing hold the responsibility for maintaining discipline within the nursing profession. The most common charges brought against nurses include substance abuse, negligence, and incompetence. Disciplinary actions taken by the board can include suspension of the license, probation, revocation of the license, or censure. It is considered an act of negligence for a nurse to fail to report the misconduct of another professional.
Negligence and Malpractice
Negligence is defined as the failure to use the level of care that a reasonably prudent person would exercise in a similar situation. Negligence can happen to anyone, does not always involve professional training, and may or may not result in an injury. Malpractice is a specific type of professional negligence committed by a healthcare professional who fails to meet the standard of care. Key points for malpractice are that it involves a breach of the standard of care by a professional and must result in an actual injury to the patient.
The Four Elements of Professional Malpractice
For a malpractice claim to be successful, four specific elements must be present: 1) Duty (The nurse had a legal duty to the patient, meaning a nurse-patient relationship existed), 2) Breach of Duty (The nurse failed to meet the accepted standard of care), 3) Causation (The breach of duty was the direct cause of the injury), and 4) Injury (The patient actually suffered an injury).
Torts and Specific Legal Terms in Civil Law
A tort is a civil wrong or injury that violates a person's legal rights, for which a court may award money damages. Examples of torts include negligence, assault, battery, false imprisonment, defamation, and invasion of privacy. Specialized terms include: Assault (a threat or attempt to cause injury, such as saying "I'm going to give you a shot!"), Battery (actual, unwanted touching, such as giving an injection without consent), and False Imprisonment (unlawful restraint or holding a person against their will). Defamation involves harm to a person's reputation and is split into two types: Slander (spoken/oral statements) and Libel (written/printed/electronic statements). Invasion of Privacy involves the unlawful intrusion into or use of personal information.
The American Nurses Association (ANA) Code of Ethics
The ANA Code of Ethics provides key provisions for nursing practice. It states that nurses must practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person. The nurse's primary commitment is to the patient, whether that is an individual, family, group, community, or population. Nurses are expected to promote, advocate for, and protect the rights, health, and safety of the patient. The nurse holds the authority, accountability, and responsibility for their practice and must make decisions consistent with the obligation to provide optimal care. Furthermore, nurses owe the same duties to themselves as they do to others, including maintaining integrity, safety, competence, and professional growth. Finally, nurses must act individually and collectively to maintain and improve the ethical environment of their work setting.
Ethical Principles and Guidelines for Moral Decision-Making
Several ethical principles guide nursing practice and moral decision-making. Beneficence involves the duty to "do good" and act in the best interest of the patient to promote well-being. Nonmaleficence is the obligation to "do no harm" and avoid causing injury to patients. Autonomy refers to respecting the patient's right to make their own choices regarding their body and care. Justice represents the principle of fairness, requiring that all patients be treated equally and resources be distributed equitably. Veracity is the requirement to be honest and truthful with patients. Fidelity involves being loyal, keeping promises, and remaining faithful to both patients and the nursing profession.
Statutes and Guidelines Affecting Nursing Practice
Various laws and guidelines impact how nursing is practiced. These include the Occupational Safety and Health Administration (), which ensures safe working conditions; the Child Abuse Prevention and Treatment Act; and regulations regarding Discrimination and Sexual Harassment. Good Samaritan Laws protect individuals who provide emergency care. Other important factors include Patients' Rights, National Patient Safety Goals, the Health Insurance Portability and Accountability Act () which protects patient information, and the legal requirements for Consents and Releases.
Sexual Harassment in the Workplace
Sexual harassment is illegal and a violation of a nurse’s professional responsibility. Examples include sexual jokes or comments, inappropriate touching, suggestive or lewd gestures, the display of sexually explicit pictures or objects, repeated unwelcome requests for dates, and verbal abuse of a sexual nature.
Legal Protocols for Patient Consent
Informed Consent occurs when a patient receives comprehensive information regarding a procedure, including its risks, benefits, and alternatives, and then voluntarily agrees to proceed. Implied Consent is reserved for emergency situations where a patient is unable to give consent but requires life-saving care. It is important to remember that consent can be withdrawn at any time; the patient has the legal right to refuse treatment or withdraw their consent whenever they choose.
Advance Directives and End-of-Life Documentation
Advance directives are legal documents that outline a patient's wishes for medical care. A Living Will is a written statement of a person's wishes for treatment if they become unable to speak for themselves. A Durable Power of Attorney is a document where a person chooses someone else to make healthcare decisions on their behalf when they are incapacitated. A (Do Not Resuscitate) order specifies that no should be performed if the patient's heart stops.
Protection Under Good Samaritan Laws
Good Samaritan Laws provide protection for individuals who provide emergency care in good faith outside of their work environment. These laws vary by state and typically do not protect an individual if there is evidence of gross negligence or willful misconduct.
Standards for Documentation and Incident Reporting
Documentation in the medical record must be accurate, complete, timely, legible, and objective. It is essential to chart facts rather than opinions, following the nursing adage: "If it is not documented, it did not happen." Incident Reports are used to document errors, accidents, injuries, or unusual events. These reports should contain facts only (no opinions) and are notably NOT part of the patient's permanent medical record. The key takeaways for nursing practice are to know the law, follow the standards, document everything, act ethically, and always prioritize patient safety.