VOLUME TWO | SECOND EDITION
Nursing and the Law
NSG 421
October 2023
Definition
• Understanding the legal implications of nursing
practice demands critical reasoning skills to
protect the patient’s rights and the nurse from
liability.
The Concept of Legal Issues
• Rights, responsibilities, scope of nursing practice
• As defined by state nurse practice acts
• Malpractice
• Conduct deviating from standard of practice dictated by the profession
Legal Limits of Nursing
• Sources of legal guidelines come from:
• Statutory law (Nurse Practice Act)
• Criminal law (felonies or misdemeanors): controlled substance
misuse
• Civil law: Malpractice
• Regulatory law (administrative law): State Board of
Nursing
• Common law (judicial decisions): based on legal cases;
patient’s rights
Standards of Care
• Legal requirements for nursing practice that
describe minimum acceptable nursing care.
• American Nurses Association and State Nurse
Practice Acts set these standards
Civil and Common Law Issues in Nursing
Practice
• Torts: a civil wrong
• Intentional
• Assault
• Battery
• False imprisonment
• Invasion of Privacy
Civil and Common Law Issues in Nursing
Practice (cont’d)
• Quasi-intentional
• Invasion of privacy
• Malice
• Slander
• Libel
• Unintentional
• Negligence: Conduct that deviates from what a responsible
person would do in a particular circumstance
• Malpractice
Common Negligent Acts
• Failure to assess and/or monitor, including
making a nursing diagnosis
• Failure to monitor in a timely fashion
• Failure to use proper equipment to monitor
the patient
• Failure to document the monitoring
Failure to notify the healthcare provider of
problems
Failure to follow orders
Failure to follow the six rights of medication
administration
Common Negligent Acts
(cont’d)
• Failure to convey discharge instructions
• Failure to ensure patient safety, especially for patients who
have a history of falling, are heavily sedated, have
disequilibrium problems, are frail, are mentally impaired,
get up at the night, and are uncooperative
• Failure to follow policies and procedures
• Failure to properly delegate and supervise
Proof of Negligence
• The nurse owed a duty to the patient.
• The nurse did not carry out the duty or breached
it.
• The patient was injured.
• The patient’s injury was caused by the nurse’s
failure to carry out that duty.
Informed Consent
• Client's legal and ethical rights to be informed of, give permission for
procedure, treatment
• Client must not be coerced
• Client understanding essential
• Client's cultural, spiritual preferences
• Follow employing agency's specific protocols
Informed Consent, continued
• Competency for consent
• Adult assumed to be competent if over 18, not declared legally
incompetent, rendered temporarily incompetent
• Consent in an emergency
• Assumes participation of client in situations where consent
impossible, impractical to obtain
• Child participation in healthcare decisions
• Parent, guardian unless mature minor
Statutory Guidelines for Legal
Consent for Medical Treatment
Adults
Any competent individual 18 years of age or older for
himself or herself
Minors
A. For his or her child and any child in his or her legal custody
B. For himself or herself in the following situations:
1. Lawfully married or a parent (emancipated)
2. Pregnancy (excluding abortions)
3. Venereal disease
4. Drug or substance abuse
Controlled Substances Act
• Federal law
• Drugs classified
• Schedules numbered from I to V
• Schedules I, II highest potential for abuse
Good Samaritan Laws
• Encourage healthcare providers to help victims in an emergency
• Protect healthcare workers from potential liability
• Nurse responsible for following through with emergency care
Nurse Practice Acts
Overview
• Nurse Practice Act (NPA)
• Defines
• Scope of practice
• Standards for education programs
• Licensure requirements
• Grounds for disciplinary actions
• Enforced by state boards of nursing (BONs) a.k.a Nursing and Midwifery
Council of Nigeria
Licensure
• Allows nurses legal privilege to practice nursing as defined by each
state's NPA
• The NMCN oversees the administration of a licensure examination.
Licensure
• National Council of State Boards of Nursing (NCSBN)
• NCLEX-RN®
• NCLEX-PN®
• In Nigeria, the NMCN oversees all professional examinations (basic, and post-
basic)
• Nurses are required to meet responsibilities to clients, the healthcare
system
Nurse Licensure Compact
• Mutual recognition model
• Single license that confers the privilege to practice in other states
• Nurse held accountable for following laws, rules of the state
• Like driver's license
Credentialing
• Certification
• Federal organizations
Joint Commission
Centers for Medicare and Medicaid Services
Nursing Students
• Guidelines for clinical performance
• Ensure client safety
• Know facility's policies, procedures before undertaking any clinical
assignment
• Ensure knowledge about client's condition, interventions, medications,
treatments
• Never perform care if unprepared
• Seek help before beginning procedure if unsure
Standards of Practice
• Established by ANA
• Address nursing care, professional performance
• Available for specialties
• Pediatric nursing
• Nurse anesthesia practice
• Critical care nursing
• Psychiatric nursing
Advance Directives
Overview
• Healthcare advance directive
• Legal document
• Expresses an individual's desires regarding medical treatment
• Patient Self-Determination Act
• Types of advance directives
• Living will
• Durable power of attorney for health care
Elements of Advance Directives
• Gives agent or surrogate decision maker authority to:
• Consent to or refuse medical treatment or diagnostic procedure
• Hire or discharge medical providers
• Authorize admission to medical and long-term care facilities
Have access to all medical records
Take any measures to carry out wishes
Role of the Nurse
• Reassure clients and families that they have option to change their
decision when competent
• Assess whether clients, families have accurate understanding of life-
sustaining measures
• Be supportive of clients' decisions
Health Insurance Portability and
Accountability Act (HIPAA)
Overview
• HIPAA
• Purposes
• Minimizes exclusion of preexisting conditions
• Designates special rights for those who lose other health coverage
• Eliminates medical underwriting in group plans
• Includes Privacy Rule
Protected Health Information
• Protected by Privacy Rule:
Information that identifies individual
Access to medical records
Required notice of privacy practices and opportunity for
confidential communications
Limits on use of medical information
Prohibition of use of personal information for marketing
Just Culture
Just Culture
• A just culture:
• Supports employee involvement in decision making
• Supports learning
• Examines system failure when error, adverse event
• Encourages members to learn from each other's mistakes, near-misses
