Nursing Practice and the Law 2

8/7/2019 Nursing Practice and the Law 2

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Nursing PracticeNursing Practiceand the Lawand the Law

Nursing PracticeNursing Practiceand the Lawand the Law

Dr BeverleyDr Beverley Brownell, RN, FNP, PhDBrownell, RN, FNP, PhD

ObjectivesObjectivesObjectivesObjectives1. Identify 3 major sources of laws.1. Identify 3 major sources of laws.2. Explain the differences between various2. Explain the differences between various

types of laws.types of laws.3. Differentiate between intentional3. Differentiate between intentional

and an unintentional Tort.and an unintentional Tort.3. Differentiate between negligence and3. Differentiate between negligence and

malpracticemalpractice4. Describe how nurse practice acts guide4. Describe how nurse practice acts guide

nursing practice.nursing practice.5. Discuss advance directives and how they5. Discuss advance directives and how they

pertain to clients rights.pertain to clients rights.

Meaning of the LawMeaning of the Law

For our particular purposes the lawmeans those rules that prescribe andcontrol social conduct in a formal andlegally binding manner (Bernzweig, 1996).They are created in 3 ways:

Statutory laws Common law

Administrative law


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Meaning of the LawMeaning of the LawStatutory Laws

Definition: Laws written and enacted bylegislative bodies, such as state legislatures orCongress i.e.

Patient Se -Determination Act o 1990Americans with Disabilities ActGood Samaritan Act

Also includes laws that govern nursing practicesuch as the state nurse practice acts.


Common law

Develops within the court system asudical decisions are made in various

cases, i.e. one case sets a precedentfor another.


Administrative law

Established through authority given toovernment a encies i e state boards, . .

of nursing. These board have a dutyto meet the intent of laws or statues.


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Sources of LawSources of Law

T he Constitutio n the U.S. constitution

is the foundation of American law. Statutes created by localities, statele islatures and the U.S. Con ress.

Administrative Law the Depart. ofhealth and Human Services, the Dept. ofEducation are the federal agencies thatadminister health-related laws.

Types of Law Criminal LawTypes of Law Criminal LawDeveloped to protect society from actions

that may threaten existence.Felony- serious, includes homicide, grandlarcen and nurse ractice act violation(practicing without a license)

Misdemeanor- includes lesser offenses i.e.traffic violations or shoplifting ofa small amount (misuse ofcontrolled substances)

Juvenile crimes carried out by individuals younger than 18 years

Case StudyCase Study You are working in a hospital where a well-known actor

is admitted with pheumocystic pneumonia which youknow is usually associated with AIDS. You are askedby the physician to give an IV drug to sedate thisclient while the physician does a procedure. The

,and dies. You call your best friend to explain thesituation and you mention the actors name and that hehas AIDS. Your friend says that it is illegal for youto be giving what he call IV conscious sedation and

you are in deep trouble. Where might you be able tosearch to determine whether this is true? What typeof legal trouble might you have?


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Types of Law Civil lawTypes of Law Civil law Usually involve the violation of one

persons rights against anothers rights.Area that particularly affect nurses inparticular is tort law.

ort1. Quasi- Intentional tort defamationof character (slander & libel)2. Intentional tort = Assault & Battery3. Unintentional tort = Negligence &Malpractice

TortsTorts A tort = a civil wrong carried out by one

person against the person or property ofanother (Black, 2004) i.e. nurses have aduty to deliver care in such a mannerthat the consumers of care are notharmed.

These legal duties of care may be

violated intentionall y or unintentionally.

Examples of TortsExamples of Torts

1. Failing to provide privacy during aprocedure

2. Medication error

3. Restraining a patient against his or her will 4. Telling the patient that he or she cannotleave before paying the bill

5. Failing to report significant changes in apatients condition

6. Patient falls *unintentional or intentional


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Intentional TortsIntentional Torts

False Imprisonment ssau an a ery

False imprisonmentFalse imprisonment- confining an individual against his or her

will by either physical (restraining) orverbal (detaining) means i.e.,Using restraints without appropriate consentRestraining mentally handicapped individualswho represent no threatDetaining unwilling clients when they desire toleaveThreatening clients with physical, emotionalaction if they insist on leaving

Assault and batteryAssault and battery Assault is threatening to do harm. Battery is touching another person

without his or her consent. If ou dont sto ushin that call bell, Ill

give you this injection with the biggest needlethat I can find: is an assaultive statement.

Battery would occur if the injection weregiven.

Most medical treatments particularly,surgery, would be battery if it were not for

informed consent from the client.


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UnintentionalTortsUnintentionalTorts

Negligence = the unintentional tort of acting or failingto act as an ordinary, reasonable, prudent person,

resulting in harm to the person to whom the duty ofcare is owed (Black, 2004). Four requirements for negligence are:1. Aduty was owed to client2. Professional duty violate d, non-conformance to

standards of care3. Failure to act by professional caused

the injuries4. Actual harm or injury did occur.

Unintentional TortsUnintentional TortsMalpractice - Represents professionalnegligence .Important principle to remember is referredto as Respondeat superio r , (let the master

for any negligence by their employees whenthe employees were acting within the realm ofemployment and when the alleged negligentacts happened during employment (Aiken,2004)

Malpractice Case Study #1Malpractice Case Study #1 You are a nurse working in a hospital when the

physician tells you that you need to give an injectionof Vistaril (hydroxyzine pamoate). You made surethat the order is documented and the medical comesup from pharmacy which you check against the MAR

.ensure the right pt and give the injection in the upperouter quadrant of the buttocks and you document it.A yr later you are being sued because the client saysthat the injection caused sciatic nerve damage and hiswhole leg is numb.


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QuestionsQuestions 1. Is there a relationship? 2. Did you breach your duty? 3. Did the breach of duty cause the

injury? 4. Did injury or damage directly occur

as a result of the incident?

Case Study#2Case Study#2 You are a nurse working on a surgical unit when you are

asked to float to pediatrics. Having no experiencewith children a physician asks you to give digoxin to aninfant and writes an order for 2mL. To you this seemsa lot and you question the order with the head nurse.

that this is normal. You give the medication byinjection and shortly afterwards the child codes.When you attempt to use an Ambu bag, it is not on thecrash cart. The child eventually recovers; however, 21

years later, you receive notice that a young man issuing you for giving him the wrong dose of digoxinwhen he was an infant.

Case Study#3Case Study#3 A nursing instructor on a clinical unit in a busy

metropolitan hospital instructed her students ot toadminister any medications unless she was present.Andres, a second semester student, was unable to findhis nursing instructor, so he decided to administer

digoxin to his client without supervision. The dosewas 0.125mg. The unit dose came as digoxin 0.5mg/mL. Andres gave the entire amount withoutchecking the dose or the clients blood and potassiumlevels. The client became toxic, and was transferredto ICU. The family sued the hospital and the nursingschol for malpractice. The nursing instructor was suedunder the principle of respondeat superior , eventhough specific instructions had been given to thestudent


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Case Study#4Case Study#4 Robin a new nurse on a medical-surgical floor is caring

for a 55 yr old male who is 2 dys post-op from alobectomy. The physician orders ambulation at least

twice a day. While Robin was attempting to ambulatethe patient in the morning, the patient became light-headed and nauseated, so she instructed him to lie

.in the afternoon. On the 2 nd attempt, Robin assessedthe patient who did not complain of any symptoms hehad previously experienced so Robin and the NursingAssistant (NA) took him for a walk. As they left theroom, the patient again complained of light-headedness so they turned returned him to his bed.The patient slipped, fell and fractured his arm on achair

Other Laws Relevant toNursing

Other Laws Relevant toNursing

Good Samaritan lawsConfidentiality (HIPAA)

Good Samaritan lawsGood Samaritan laws Developed to encourage physicians and

nurses to respond to emergencies. States that;

When administering emergency care, nurses an p ysicians are protecte from civil liability providing they behave as an

ordinary, prudent, reasonable professional inthe same or similar circumstances (Prosser &Keeton, 1984).

However, if a payment is received for thecare, the law does not hold


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ConfidentialityConfidentiality Health Insurance Portability and

Accountability Act (HIPAA) of 1996was passed as an effort to preserveconfidentiality and protect patient privacyregar ng ea n orma on an o mprovethe portability and continuation of health-carecoverage.

Standards ofStandards of

Nursing StandardsNursing Standards

Established as guidelines for theprofession to ensure quality of care

Also used as criteria to determinewhether appropriate care has beendelivered


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Types of StandardsTypes of Standards

Internal standardsOrganizational standards

ccep e s a e an na ona s an ar sNurse Practice ActsPatient Care Partnership Patient Bill ofRights

Informed ConsentInformed Consent

Without informed consent many medicalprocedures could be considered batteryConsent to treatment by the client givesthe health care personnel the right todeliver care without fear of prosecution

Informed ConsentInformed ConsentThe physician obtains the consent

Gives the client the informationStates the risks and advantages

by gaining signatures on the appropriateforms


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Helpful SuggestionsHelpful Suggestions A mentally competent adult has

voluntarily given consent client hasright to refuse care

or she is consenting to The consent includes the risks,

alternative treatments, and outcomes The consent is written

Court

Court

PreventionPrevention

Keep yourself informed about new informationrelated to your area of practice

Insist that the health care institution keeppersonnel informed of all changes in policiesand procedures and in the management of newtechnological advances


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PreventionPrevention

Follow the standards of care or practicefor your institutionDele ate tasks and rocedures toappropriate personnelIdentify clients at risk for problems

PreventionPreventionEstablish and maintain a safe environmentDocument precisely and carefullyWrite detailed, factual and objective incidentreportsFile incident reports with appropriatepersonnel and departmentsRecognize client behaviors that may causeproblems

Common Causes ofNegligence

Common Causes ofNegligence

Client falls Equipment injuriesFailure to monitorFailure to communicateMedication errorsMedical errors


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Avoiding Medication ErrorsAvoiding Medication Errors

1. Right drug2. Right dose3 Ri ht route.4. Right time5. Right client6. Right reason7. Right documentation

Appropriate DocumentationAppropriate DocumentationThe adage not documented, not doneholds true in nursing.According to the law, if something hasnot been documented, the res onsibleparty did not do whatever needed to bedone.

If a nurse did not do something they

can be open to negligence ormalpractice charges.

Appropriate DocumentationAppropriate Documentation

Contemporaneous document at time care wasgiven

Accurate document exactly what was doneTruthful document only what was doneAppropriate document only what could bediscussed comfortably in a public setting.


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Common ActionsLeading to Malpractice

Common ActionsLeading to Malpractice

The 6 FsThe 6 FsFailure to appropriately assess a clientFailure to report changes in clientstatusFailure to document in the client record Failure to obtain informed consentFailure to report a coworkers negligenceFailure to provide adequate education

The 2 Big Bad OnesThe 2 Big Bad Ones

Altering or falsifying a record

io ation o an interna orexternal standard of practice


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If a Problem ArisesIf a Problem ArisesWhen served with a complaint,immediately contact legal counselNever sign any documents withoutlegal counselNotify your malpractice carrier ifcovered; notify your institutionimmediatelyKeep all correspondence: written andverbal

Professional ResponsibilitiesProfessional ResponsibilitiesDNR orders specific orders to health carepersonnel not to initiate CPR measures.Advance directives Patient self-determination act designed to address

-.advance

The living will states an individuals wishesregarding the use of life-prolonging medicaltreatment in the event that he/she is nolonger competent to make their owninformed tx decisions.

Professional ResponsibilitiesProfessional ResponsibilitiesHealth care surrogate - a family member orclose friend who has been chosen to make thewishes of the client known to medical andnursing personnel.


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Documents

Nursing Practice and the Law 2