Legal and Ethical Aspects of Nursing
Learning Objectives for Legal and Ethical Nursing
Theory-Based Objectives: - Explain legal requirements for nursing practice and their relation to the student nurse role. - Identify consequences associated with violating the Nurse Practice Act. - Examine professional accountability, professional discipline, and the role of continuing education for licensed nurses. - Compare and contrast the terms negligence and malpractice. - Discuss strategies to protect oneself from lawsuits or associated damages. - Differentiate a code of ethics from laws/regulations. - Compare codes of ethics between the National Association of Licensed Practical/Licensed Vocational Nurses (NALPN), National Association for Practical Nurse Education and Service, Inc. (NAPNES), and the American Nurses Association (ANA).
Clinical Practice Objectives: - Reflect on the impact of laws regarding discrimination, workplace safety, child abuse, and sexual harassment on nursing practice. - Discuss National Patient Safety Goals and identify where they are located. - Interpret patient rights across various settings: hospitals, nursing homes, community settings, and psychiatric facilities. - Describe the four elements required for informed consent. - Explain advance directives and the advantages of having them in writing. - Consider the relationship between the Health Insurance Portability and Accountability Act (HIPAA) and social media usage.
Sources and Types of Law
Definitions and Origins: - Laws are defined as rules of conduct established by the government. - Three primary sources of law: - The Constitution and Bill of Rights. - Laws made by elected officials (Legislative). - Regulations made by agencies created by elected officials.
Categories of Law: - Constitutional Law: Provides basic rights and creates legislative bodies. - Judicial Law: Results from challenges to laws or court decisions where a judge affirms or reverses the decision. - Administrative Law: Originates from agencies created by the legislature. - Civil Law: Guarantees individual rights. A violation of civil law is known as a tort. - Criminal Law: Deals with wrongs against society. Convictions may result in imprisonment and/or fines.
Nursing Regulation and Licensure
Nurse Practice Acts (NPA): - Define the legal scope of nursing practice. - Regulated by each individual state's board of nursing. - Include specific definitions of nursing for Registered Nurses (RNs), Licensed Practical Nurses (LPNs), Licensed Vocational Nurses (LVNs), and potentially advanced-practice nurses.
Licensure and the NCLEX: - Eligibility for licensure is determined by the state's board of nursing. - The National Council of the State Boards of Nursing (NCSBN) develops the National Council Licensure Examination (NCLEX). - A passing score on the NCLEX-PN is accepted in all states as a requirement for licensure. - Current Issues: Reciprocity, nurse licensure compacts, and the recognition of one state's license by another state.
Student Nurse Status: - Student nurses are held to the exact same standards as licensed nurses. - They are legally responsible for their own actions or inactions. - Responsibility to consult with instructors when unsure of a situation or when a patient's condition changes rapidly. - Students must be familiar with their state's Nurse Practice Act.
Professional Responsibility and Advocacy
Professional Accountability: - The nurse’s responsibility to meet the health care needs of patients in a safe and caring manner. - Students must apply classroom theory to clinical settings. - Entails a commitment to staying current and knowledgeable in the field.
Delegation: - Defined as the assignment of duties to another person. - LPNs may supervise nursing assistants, technicians, or other LPNs. - The delegating nurse maintains the duty to supervise and evaluate the care provided by both licensed and unlicensed personnel.
Standards of Care: - Provide a framework for judging the quality and effectiveness of patient care. - Used in legal cases to determine if a nurse acted correctly.
Professional Discipline: - State boards of nursing are the authorities responsible for discipline. - Common charges: Substance abuse, incompetence, and negligence. - Misconduct Reporting: It is considered negligence to fail to report another professional's misconduct.
Continuing Education (CE): - Many states require evidence of CE after initial licensure. - Necessary to keep abreast of changes in practice, pharmacology, and technology to ensure safe practice.
Federal Laws and Guidelines Affecting Nursing
Occupational Safety and Health Administration (OSHA): - Regulates handling of infectious/toxic materials, radiation safeguards, and electrical equipment. - Mandates orientation and education on blood-borne pathogens, exposure, fire safety, bomb threats, lifting, and evacuation. - Requires facilities to maintain records of hazardous substances and Material Safety Data Sheets (MSDS).
Child Abuse Prevention and Treatment Act (CAPTA): - Defines child abuse and neglect as "any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm." - Licensed health care personnel are mandated reporters for child abuse.
Discrimination and Harassment: - Discrimination: Making decisions based on race, religion, sex, or group membership rather than individual qualities. It is illegal for employers to ask about race or protected health status on applications. - Sexual Harassment: Unwelcome sexual advances or conduct. Illegal when linked to employment/promotion or when interfering with job performance.
Good Samaritan Laws: - Protect healthcare professionals from liability when providing aid in an emergency. - Liability is limited unless there is proof of gross negligence or intentional misconduct.
National Patient Safety Goals: - Evidence-based solutions for patient safety problem areas. - Sentinel Event: An unexpected event resulting in death or serious injury (or risk thereof). The most frequent cause is a lack of communication among caregivers.
Patient Rights and Privacy
The Patient Care Partnership (2003): - Formerly known as Patient's Rights. - An ethical (not legal) document preserving dignity, privacy, freedom of movement, and information needs. - Note: State legislators may write specific laws that guarantee these rights legally.
Health Insurance Portability and Accountability Act (HIPAA): - Regulates patient privacy and electronic medical records. - Non-compliance leads to civil penalties. - Intentional violations can lead to sizable fines and jail time.
The Medical Record: - A legal document of all assessments, tests, and care. - Property of the hospital, agency, or physician (not the patient). - Confidential: Only those directly involved in care have legal access.
Legal Documents and Consents
Consent and Informed Consent: - A legal document recording permission for treatment, surgery, or information sharing. - Informed Consent: Indicates the patient participated in decision-making. The signer must know what the consent allows and be able to make a knowledgeable decision.
Releases: - Legal forms to excuse a party from liability (e.g., Leave Against Medical Advice or Leave AMA). - Also used to authorize the transfer of confidential info to other agencies, schools, or insurers.
Witnessing Legal Documents: - Most agencies have policies against nurses witnessing wills. - Nurses witnessing documents may be called to testify regarding the patient's mental state or relationships.
Advance Directives: - Allow planning for medical wishes if the patient becomes unable to communicate. - Durable Power of Attorney: Gives legal power to a health care agent chosen by the patient to make medical decisions on their behalf.
Tort Law: Violations and Liability
Negligence vs. Malpractice: - Negligence: Failing to act as a reasonably prudent person would, or doing what a prudent person would not do. - Malpractice: Negligence committed by a professional person; failing to meet professional standards of care.
Intentional Torts and Privacy Violations: - Assault: The threat to harm or the threat to touch another without permission. - Battery: Actual physical contact that is refused or carried out against a person's will. - Defamation: Making untrue remarks that damage a person's reputation. - Slander: Oral remarks. - Libel: Written remarks. - Invasion of Privacy: Violation of the confidential nature of the professional relationship; unauthorized persons learning patient info. - False Imprisonment: Restricting movement or preventing a person from leaving. Involuntary admission is only permitted for a short time to prevent self-harm or harm to others.
Protective Devices: - Inappropriate use of mechanical or chemical restraints can lead to false imprisonment charges. - A physician’s order is required for any protective device.
Risk Management and Ethics
Decreasing Legal Risk: - Nursing Competence: Possessing necessary skills, knowledge, and experience. - Documentation: Key in proving appropriate actions and protecting from liability. - Incident/Occurrence Reports: Used for out-of-the-ordinary events. They document facts and witnesses. They are not filed in the patient's chart, and no reference to the report should be made in the medical record. - Liability/Malpractice Insurance: Protects assets, pays for legal defense, and covers awards up to policy limits. Covers attorney costs for state board reviews.
Ethics and Ethical Committees: - Ethics: Voluntary rules of conduct agreed upon by a group as morally right. - Codes of Ethics: Emphasize respect for human dignity regardless of race, religion, or culture; commitment to competence; and confidentiality. - Ethics Committees: Multi-departmental groups that develop policies and address ethical dilemmas. - Common Ethical Dilemmas: Life-prolonging vs. refusing treatment, terminating life support, assisted suicide, and euthanasia.
Questions & Discussion
Question 1: Universal guidelines are developed for all nursing interventions, which define appropriate measures that should be observed during the performance of those interventions. These are known as: - Answer: Standard of care.
Question 2: Since a nurse’s first duty is to the patient’s health, safety, and well-being, it is necessary to report: - Answer: Unethical behavior.
Question 3: Malpractice is negligence by a professional person. In order to prove malpractice, four elements must be present. Which of the following is not an element of malpractice? - Options: Defamation, Duty, Breach of duty, Causation. - Answer: Defamation (The four elements are Duty, Breach of duty, Causation, and Damages).
Question 4: When Mrs. Tingle, age 82, is admitted, the nurse notices bruises all over her body and suspects elder abuse. She may report her suspicions to everyone except the: - Options: Supervisor, Police, Family, Appropriate agency. - Answer: Family.