Accountability and Legal Aspects of Nursing - Study Notes

The Profession of Nursing

  • Regulator, Professional, Educational, Union roles converge to advance the profession, protect the public, improve health, strengthen working conditions, and support nurses.
  • Key functions include: advance education and represent nurses, provide support, and work to improve health outcomes for society.
  • Source note: Based on Almost, J. (2021) Regulated nursing in Canada: The landscape in 2021 (Figure 2). Canadian Nurses Association. Reprinted with permission.

Legal Limits of Nursing

  • Nurses have fiduciary relationships with patients.
  • Sources of law include:
    • Constitution of Canada
    • Civil law (Quebec)
    • Common law (rest of Canada)

Function of Law in Nursing

  • Outlines responsibilities of nurses and other professions.
  • Aims to ensure safe, consistent, competent care that serves society while preserving individual rights (to protect the public).
  • Also serves to protect nurses from liability.
  • Reason for knowledge of the law: to promote safe practice, accountability, and risk management.

Legal Framework for Nursing Practice in Quebec

  • Quebec framework governed primarily by the Nurses Act (Loi sur les infirmières et infirmiers - 1973) 19731973.
  • The act defines: scope of practice for nurses, the professional order of nurses, and the framework for activities and responsibilities.
  • The Ordre des infirmières et infirmiers du Québec (OIIQ) is the regulatory body that licenses and regulates nursing in Quebec.

Bill 90

  • An Act to amend the Professional Code and other legislative provisions as regards the health sector.
  • Came into effect in 20032003.
  • Covers 1111 professions: Nurses, Pharmacists, Physicians, Dietitians, Speech Therapists, Radiology Technologists, Physiotherapists, Occupational Therapists, Nursing Assistants (LPN), Medical Assistants, Audiologists.

Bill 90 – Additional Resources

  • PDFs and perspectives related to Bill 90 and nursing in Quebec are referenced (e.g., fascicule, English editorial, and professional-activities documents).

OIIQ: Quebec Regulatory Body

  • The OIIQ maintains regulation of nursing.
  • Nurses have exclusivity of practice (self-regulation/self-government).
  • All entry-level nursing education programs must be approved by the regulatory body.
  • Licensure and registration are the mechanisms to protect the public; registration occurs once a year.

Legal Liability Issues in Nursing Practice

  • Tort: a civil wrong committed against a person or property; can be intentional or unintentional.

Intentional Torts

  • Willful acts that violate a person’s rights; common examples include:
    • Assault: physical or verbal threat
    • Battery: intentional physical contact without consent
    • Invasion of privacy: unwanted intrusion into private affairs, release of confidential information, breaches involving computers and confidentiality, social media
    • False imprisonment: restraining a person against their will and without lawful justification

Battery

  • Battery is intentional, harmful, or offensive contact without consent.
  • A battery does not need to result in actual harm to be actionable.
  • Distinctions:
    • If consent is not obtained for treatment, it is a violation.
    • If treatment goes beyond or differs from that for which consent was obtained, it may constitute battery.
    • If a patient consented but reports inadequate information, this can indicate negligence rather than battery.

Invasion of Privacy

  • Protects a patient’s right to be free from unwanted intrusion into private affairs.
  • Not necessary that battery causes harm for invasion of privacy to be actionable.
  • Releasing patient information to an unauthorized person is a breach.
  • Nurses should not assume family members’ knowledge of health history or diagnoses; disclose information only as appropriate and authorized.

Invasion of Privacy (continued)

  • Reference to confidentiality and privacy concerns in nursing practice.
  • Policy and professional guidance exist regarding confidentiality of patient records.

False Imprisonment

  • Intentional confinement of a person within fixed boundaries without the person’s consent.
  • Plaintiff need not prove damages to succeed; must show intentional restraint with no reasonable avenue of escape.
  • May involve inappropriate or unsatisfactory use of restraints (physical or chemical).

Unintentional Tort: Negligence

  • Negligence is conduct that falls below the standard expected of a reasonably prudent nurse.
  • Common examples include: failing to obtain informed consent, falls due to improper moving techniques, medication errors causing injury, IV infiltration leading to phlebitis, etc. (Potter & Perry, 7th edition, Box 10.1).
  • See: Potter, P. A., Perry, A. G., et al. for standard references.

Negligence – 4 Elements

  • Duty: A nurse-patient relationship that requires care.
  • Breach: Failure to meet the standard of care.
  • Harm: The patient sustains injury, damage, or harm.
  • Causation: The harm is a direct result of the nurse’s failure to meet the standard.

Standards of Care

  • Legal guidelines for nursing practice.
  • Establish expectations to provide safe and appropriate patient care.
  • Sources include:
    • Nursing practice acts
    • Provincial/territorial laws regulating health care agencies
    • Professional and specialty nursing organizations
    • Written policies and procedures

How to Prevent Negligence

  • Follow standards of care for your jurisdiction and institution.
  • Provide competent care.
  • Be proactive with ongoing education.
  • Document accurately, completely, and thoroughly every nursing assessment, intervention, and evaluation.
  • Principle: "If it is not documented, it was not done."

Legal Requirements: Consent

  • Legal responsibility for obtaining consent for surgical or medical procedures lies with the physician.
  • Obtaining consent for nursing procedures is the responsibility of the nurse.

Informed Consent

  • Express: Oral or written consent.
  • Implied: In emergencies; during surgery when additional procedures are needed that are consistent with the already consented procedure; in therapy contexts.

Elements of Informed Consent

  • Three components:
    • Disclosure: Adequate information about the treatment/procedure to make an informed decision.
    • Voluntariness: Decision made without coercion.
    • Capacity: Legal and mental ability to make the decision.

Confidentiality – Legal Requirements

  • Avoid posting or sharing information.
  • Take permission before disclosing information.
  • Maintain privacy.
  • Keep personal profiles private.

Nursing Students and Legal Liability

  • Students must know their capabilities and competencies; should not perform actions unless competent.
  • Students are liable for harm caused by their actions, as are instructors, the hosting hospital, and the college/university.
  • Students must separate their nurse role from other unregulated care roles.

Good Samaritan Law

  • Quebec's Civil Code (Article 14711471) protects individuals who provide aid from liability for harm caused while helping, unless harm results from intentional fault or gross negligence.

Abandonment & Assignment

  • Short staffing can create legal problems due to insufficient nurses to provide care.
  • Abandonment refers to leaving a patient without adequate care.
  • Prescriber’s orders: Must be followed unless the nurse believes an order is in error, violates agency policy, or could harm patients.

Carrying Out a Prescriber’s Order

  • Question any order a patient questions.
  • Question orders if the patient’s condition has changed.
  • Question and record any verbal orders to avoid miscommunications.
  • Question any order that is illegible, unclear, or incomplete.

Medication Errors

  • Occur more often than expected; must be addressed immediately.
  • Must be reported, recorded, and the patient must be informed.
  • An incidence report must be completed.

Risk Management

  • A system to ensure appropriate nursing care by identifying hazards and preventing harm.
  • Tools include incident/adverse occurrence reports.
  • Steps: Identify risks, analyze risks, act to reduce risks, evaluate steps taken.

Quiz (Key Concepts)

  • In Canada, nurses maintain registration with: the provincial association or college of nursing (correct).
  • When do nurses have an ethical and legal responsibility to maintain confidentiality? When they are in a therapeutic relationship with a patient (and related contexts like collaboration, etc. may apply). The explicit correct context listed is: when asked information by the person who holds a proxy directive.

Student Resources

  • Coffee break resource: https://www.dawsoncollege.qc.ca/first-year

Thank you

References

  • Potter, P. A., Perry, A. G., Barbara J. A., Wendy D., Stockert, P., & Hall, A. (2019). Canadian Fundamentals of Nursing (7th Canadian ed.). Toronto, ON: Pearson.
  • Canada Health Act: Retrieved from: https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/hcs-sss/alt_formats/pdf/pubs/cha-ics/2015-cha-lcs-ar-ra-eng.pdf