REGULATORY BODIES AND LEGAL ASPECTS IN NURSING

JENITA JOYCE JOHNI YEAR MSc (N)APOLLO COLLEGE OF NURSING

INTRODUCTION Regulatory agencies are usually a part

of the executive branch of the government, or they have statutory authority to perform their functions with oversight from the legislative branch. Their actions are generally open to legal review. Regulatory authorities are commonly set up to enforce standards and safety

REGULATORY BODIES A regulatory body

is a public authority or government agency responsible for exercising autonomous authority over some area of human activity in a regulatory or supervisory capacity.

INTERNATIONAL AGENCIES INTERNATIONAL COUNCIL OF NURSES

(ICN) AMERICAN NURSES ASSOCIATION (ANA) CANADIAN NURSES ASSOCIATION (CNA) AUSTRALIAN NURSES AND MIDWIVES

ASSOCIATION BRITISH NURSES ASSOCIATION

INDIAN REGULATORY AGENCIES INDIAN NURSING COUNCIL TRAINED NURSING ASSOCIATION OF

INDIA (TNAI) STATE NURSING COUNCIL STATE MEDICAL HEALTH UNIVERSITIES

INTERNATIONAL COUNCIL OF NURSES Founded in 1899,

headquartered in Geneva, Switzerland

World’s first largest international organization for health

Represents 16 million international nurses

130 national nurses organization

The Three goals are: To bring nursing together worldwide To advance nurses and nursing worldwide To influence health policy.Core Values: Visionary Leadership Inclusiveness Flexibility Partnership Achievement

OBJECTIVES

QUALITY NURSING CARE FOR

ALL

SOUND HEALTH

POLICIES

COMPETENT & SATISFIED

WORKFORCEADVANCEMENT

OF NURSING KNOWLEDGE

BOARD OF DIRECTORS ICN governed by 16 member board of

directors Board meets every year

JUDITH SHAMIAN

• President

DAVID C BENTON

• CEO

PUBLICATIONS International Nursing Review Health and Well being of Women Incentive for health professionals

AMERICAN NURSES ASSOCIATION Founded in 1896,

based in Silver Spring, Maryland, USA

Represents RNs of USA Professional

organization to advance and protect nursing profession

Functions:• Policy development• Organizations partnership• Publications and Newsletters > The American Nurse > American Nurse Today

INDIAN NURSING COUNCIL (INC)AIM – To establish a uniform standard of training for nurses midwives and health visitors INC is a regulatory body for

nurses and nursing education in India

It is an autonomous body under the Government of India, Ministry of Health and Family Affairs

ORGANIZATIONAL STRUCTUREPRESIDENT

VICE PRESIDENT

SECRETARY

JOINT SECRETARY

DEPUTY SECRETARY

ASSIATANT SECRETARY

OFFICE STAFF

COMMITTEESEXECUTIVE

NURSING EDUCATION

EQUIVALENCE

FINANCE VIGILANCE

ANTI RAGGING

DEPARTMENTAL

PROMOTION

PURPOSESUNIFORM

STANDARDS OF EDUCATION

NURSES REGISTRATIO

N

REGISTRATION OF FOREIGN

NURSES

INDIAN NURSING REGISTER

FUNCTIONS INC FUNCTIONS

PRESCRIBE SYLLABI

IMPLEMENT SYLLABI

INSPECTION OF EXAM CENTRES

INSPECTION OF SCHOOLS AND COLLEGES OF NURSING

MAINTAIN INDIAN NURSES REGISTER

WITHDRAWL OF RECOGNITION

TRAINED NURSES ASSOCIATION OF INDIA (TNAI) Formed in 1908 at

Delhi, India It is a National body

of practitioners of nursing at various levels

It is a professional association of nurses

Affiliated to Commonwealth Nurses Federation

AIMS upgrading

UPGRADING, DEVELOPMENT AND STANDARDIZATION OF

NURSING EDUCATION

IMPROVEMENT OF LIVING AND WORKING CONDITIONS

OF NURSES IN INDIA

REGISTRATION FOR QUALIFIED NURSES

ACTIVITIES

CONFERENCES CNE

PUBLICATIONS

NURSING REGULATION

S

SCHOLARSHIP

FUNCTIONS OF THE TNAI Nurses Charter Standardization of Nursing Education Service Condition for Nurses Continuing Education Programme Socio – Economic Welfare programmes Scholarships Nurse’s welfare Funds Relationship with the Government International Affiliations Projects

BOARD OF DIRECTORS President – Mr. A.B Kulkarni Vice President – Sr. (Prof) Gilbert Secretary General – Mrs. Sheila Seda

PUBLICATIONS

CHN MANUAL

NURSING JOURNAL OF INDIA

HANDBOOK OF TNAI

MEMBERSHIP Membership is

obtained by submission of a copy of own state registration certificate

Membership can also be transferred by SNA to TNAI within 6 months after course completion

STATE NURSING COUNCIL Maintains register of names of

professional nurses of their state These names are also maintained in

the Indian Nurses Register by INC

FUNCTIONS

RECOGNITION OF SCHOOLS

AND COLLEGES

CONDUCT EXAMINATI

ONS

PRESCRIBE RULES

MAINTAIN REGISTERS

TAMIL NADU NURSES AND MIDWIVES COUNCIL

Registering body for nurses, midwives, ANM, MPHW, health visitors as per INC standards

Extends registration to union territories – Pondicherry, Andaman & Nicobar Islands

BOARD OF DIRECTORS

Dr. A. Chandranathan

• President

Prof. Dr. Ani Grace

• Registrar

THE TAMIL NADU DR MGR MEDICAL UNIVERSITY

Known as The Tamil Nadu Medical University in 1980

1988 – The Tamil Nadu Dr MGR Medical University

Deals with Medicine, Dentistry, Indian Medicine/Homeopathy and Allied Health Sciences

OBJECTIVESORGANIZE ADVANCED STUDIES

INSTITUDE DEGREES, DIPLOMAS & OTHER ACADEMIC DISTINCTIONS

SCHOLARSHIPS, MEDALS, PRIZES

DEVELOP RESEARCH FACILITIES

ORGANIZE STUDY PROGRAMS

BOARD OF DIRECTORS

Dr. K. Rosaiah

• Chancellor

Dr. D. Shantharam

• Vice Chancellor

LEGAL ASPECTS IN NURSING

INTRODUCTION

It is important for nurses to know the basic legal concepts because nurses are accountable for their professional judgments and actions

NURSING LAW Defined as that body of status, executive orders, regulations, rule and legal precedents which have their objective the promotion and protection of individual and community by nursing service

FUNCTIONS

FRAMEWORK FOR NURSING ACTIONDIFFERENTIATES NURSES RESPONSIBILITYBOUNDARIES INDEPENDENT NURSING ACTIONSMAINTAIN STANDARD PRACTICE

SOURCES OF LAW

CONSTITUTIONAL LAW

COMMON LAW

ADMINISTRATIVE LAW

TYPES OF LAW

PUBLIC LAWPRIVATE LAWCRIMINAL LAW

VOLENTI – NON – FIT - INJURIA French, it means

Voluntarily – suffered – injury

It is a law that no man can sue for a tort to which he had consented either expressly or impliedly

PATIENT’S RIGHTS

LEGAL SAFEGUARDS IN NURSING PRACTICE Licensure Good Samaritan Law Good rapport Standards of care Standing orders Informed consent Correct identity Documentation Reporting

LEGAL RESPONSIBILITIES OF A NURSE Appointing and assigning Quality control Equipment Observation and reporting Record keeping and recording Death and dying

MEDICO LEGAL ASPECTS OF DEATH Be with patient during

death Reassure patient’s

relatives Do not whisper Only doctors declare death Death records Respect body and conduct

all last offices Take signature of party

before releasing the body

INDIAN PENAL CODE AND MEDICAL PRACTICE The patient or guardian

can only claim damages from doctor and hospitals

Both parties bear their own legal expenses

Patient or guardian can get the doctor and hospital authority fined or jailed by proving negligence in court of law

TORT Tort is a civil wrong for which remedy is

common law action To constitute a tort all the following

conditions must be satisfied Omission Wrongful Act Legal Damage Legal Remedy

CLASSIFICATION OF TORT

INTENTIONAL TORT• Willful act that violate

another’s rights – AssaultUNINTENTIONAL TORT• Includes negligence or

malpractice

Types of Law

Private/CivilContract

Law TortIntentio

nalAssault/Battery

False Imprisonment

Invasion of

PrivacyDefamat

ionLibe

lSland

er

Willful ActionIntended

consequences

Causation

Unintentional

Negligence/Malpractice

Failure to meet

standard of care

Duty,Breach of

duty,Forseeability,Causation,Injury/harm,damag

e

Public

Criminal Law

Felony

Misdemeanor

Felony – A serious crime Tort – Civil wrong for which remedy is a

common law action Assault – Any willful attempt or threat

or harm another with ability to actually harm the person

Battery – Intentional touching of another’s body or anything without consent

Legal – Connected with the law

Plantiff – Person who has lodged the complaint

Malpractice – Professional misconduct Malice – Desire to harm someone Slander – Act or crime of making a false

statement damaging to a person’s reputation Negligence – Carelessness which caused

negative results Fidelity – Quality of being faithful/loyal Defendant – A person accused of crime Breach of duty – There must be a standard of

care but the nurse did not observe

Foreseeability- A link must exist between the nurses’ act and the injury suffered

Causation – It must be proved that the harm occurred as a direct result of the nurses’ failure to follow the standard of care the nurse should have

Harm/Injury – The client must demonstrate some type of harm or injury physical, financial or emotional) as a result of the breach of duty owed the client

Damages – If malpractice causes injury the nurse is liable foe damage

Manslaughter – second degree murder Misdemeanor – Offence of a less

serious nature and usually punishable by fine

LEGAL ASPECTS Informed consent Delegation Violence, abuse and neglect Controlled substances The impaired nurse Sexual harassment Abortions Death and related issues

INFORMED CONSENTIt is an agreement by a client to accept a course of treatment or a procedure after being provided complete information including the benefits and risks of treatment.

TYPES

EXPRESS

IMPLIFIED

DELEGATIONTransfer of responsibility for the performance of an activity from one person to another while retaining accountability for the same

VIOLENCE, ABUSE AND NEGLECT When an identified instance of injury

appears to be present as the result of abuse, neglect or exploitation the nurse must report it to the authorities

CONTROLLED SUBSTANCESThe laws regulate the distribution of controlled substances such as narcotics, depressants, stimulants and hallucinogens

THE IMPAIRED NURSERefers to a nurse whose ability to perform the functions of a nurse is diminished by chemical dependency on drugs, alcohol or mental illness

SEXUAL HARASSMENTUnwelcome sexual advances, request for favors and other verbal or physical conductNurses must develop skills of assertiveness to deter harassment in the work place

ABORTIONS The nurses have the right to refuse

participation in abortions Nurse can assist abortions under MTP

act

DEATH AND RELATED ISSUES Autopsy Certification of death Do Not Resuscitate orders Euthanasia Inquest Organ donation

LEGAL ISSUES IN SPECIALTY PRACTICE AREAS

MEDICAL SURGICAL NURSING CHILD HEALTH NURSING MATERNAL AND NEW BORN NURSING PSYCHIATRY NURSING

MEDICAL SURGICAL NURSING Disoriented adults may require some

form of restraints to prevent accidental self injury

Side rails are available on most hospital beds

Disoriented older patients may require belt restraints to prevent them falling off the bed

If patient falls off the bed they may sue the nurse and hospital

COMMON ACT OF NEGLIGENCE IN MEDICAL SURGICAL NURSING

Overlooked sponges, needles and instruments Burns Falls Injury due to use of defective apparatus or

supplies Loss or damage Assault and battery Failure to report accidents Maintenance of records and reports

COMMON ACT OF NEGLIGENCE IN CHILD HEALTH NURSING

Pediatric nurses are responsible for preventing children in their care from accidently harming themselves

Cribs with restraints are designed to keep infants and toddlers from climbing out of bed

Poisonous substances and sharps should be kept out of reach of children

Suspected child abuse or neglect must be reported

COMMON ACT OF NEGLIGENCE IN OBG NURSING

Causes of lawsuit for malpractice in this area can be divided into 2 – Mother and Child

Lawsuits brought against physicians and nurses differ

LIKELY AGAINST DOCTORS… Failure to diagnose a high risk

pregnancy Delay in performing a Caesarean

section Improper vaginal delivery or failure to

perform a C section Improper use of forceps Delay in arriving to hospital Non attendance at the delivery

LIKELY AGAINST NURSES… Problems of medication Failure in adequate client monitoring Failure to adequately assess the client Failure to report changes in the client Abortions Nursing care of new born

COMMON ACT OF NEGLIGENCE IN PSYCHIATRY NURSING

CRITERIA Dangerous to others Dangerous to self Need for treatment

Immediate restraint of the insane Voluntary admission Admission through magistrate Admission through police power Reception after judicial inquisition Discharge Discharge on parole Abscond of the patient

CONCLUSION

JOURNAL INFORMATIONMenendez Juliet Battard, “Informed Consent”, JONA healthcare, Laws, Ethics and Regulation, Volume 15, Number 4, Oct – Dec 2013

THANK YOU