Chapter 11Legally Responsible Nursing Practice
OBJECTIVES 1. Discuss the purpose of Good Samaritan laws. 2. List the two sources of laws and give examples of each. 3. Discuss the relationship between the nurse practice acts and the state boards of nursing. 4. Explain the association among responsibility, accountability, and legal liability. 5. Define the term respondeat superior. 6. Define the term breach of contract. 7. Define the term tort and give two examples of torts. 8. Illustrate the difference between a tort and a crime. 9. Differentiate negligence and gross negligence. 10. Discuss how nurses can assist in preventing malpractice claims. 11. Explain the purpose of malpractice insurance. 12. Give examples of crimes that may involve nurses.
Legally Responsible Nursing Practice A nurse’s duty is to do good and to avoid harm in accordance with the law Laws are rules of conduct derived from: Cultural values Moral practices Ethical beliefs
Good Samaritan Statutes Protect people from prosecution who voluntarily aid others in an emergency Intend to encourage giving emergency care outside the hospital or health care facility Some states require people to help strangers in distress To act or not act is an ethical decision
Sources of Laws Public (federal, state, and local government) Private Constitutional law Administrative law Criminal law Private Contract law Laws of torts
Regulation of Nursing Practice Administrative Law—The Nurse Practice Act Defines legal functions, powers, and duties of the state board of nursing Enforces the Nurse Practice Act Holds disciplinary hearings Identifies membership of the board and how to become a board member Defines terms Includes laws governing licensure and legal titles
Responsibility and Liability Responsibility is being accountable for your actions Explain the action and accept any consequences Liability is the legal obligation to make good for the loss of, or damage to, something for which he or she is responsible. Nurses are personally and legally responsible for their nursing actions. Best protection against charges: Carry out duties at or above the standard expected
Legal Relationships Between Employer and Employee Employer has right to hire employees, direct, and control performance of work Employee accepts wages, provides service to employer Respondeat superior Both the nurse and the employer can be held liable for nurse’s acts Employer’s guidelines (policies and procedures) state what action is expected in a specific situation
Standards of Care Guidelines to identify appropriate levels of professional care Rules and regulations defining care expected of professional and practical/vocational nurses Accrediting agencies and organizations develop standards of care Employer policy and procedure manuals
Legal Issues for Nurses Contracts An agreement between two or more parties Written or verbal promises with exchange of something of value Breach of contract Failure to fulfill any or all parts of a contractual obligation
Legal Issues for Nurses Torts An injury or wrong committed by one person, group, or organization against another person, group, or organization Strict Liability Describes actions that cause injury to others Intentional Injuries caused by willful, forceful and aggressive behavior
Legal Issues For Nurses False imprisonment Violation of confidentiality Defamation of character Violating informed consent Assault and battery Fraud
Legal Issues for Nurses Negligence Failure of a reasonable person to do something or not do something that a reasonable person in the same circumstances would or would not do General term describing neglect by a physician or nurse to apply education and skills which other physicians or nurses apply in similar circumstances
Legal Issues for Nurses Gross Negligence Human life endangered or lost Often tried under Criminal law
Legal Issues for Nurses Malpractice Claims Patients’ perceptions Impersonality of American health care system Health care is big and profitable business Liability insurance justifies making claims Frequent news stories of enormous judgments encourages lawsuits
Legal Issues for Nurses Traits of “suit prone” patients High levels of criticism Fault-finding Hostility Uncooperativeness Sensitivity to being offended Successful prior lawsuits
Legal Issues for Nurses Prevention of or discouraging lawsuits Strict personal and institutional adherence to high standards of care Attention to accurate documentation Being aware of areas where nurses are often found negligent
Legal Issues for Nurses Documentation Patient’s medical record is a legal document Entries must be factual, to the point, accurate, legible, related to patient’s needs or plan of treatment, objective, consistent Use agency-approved abbreviations and chart- correction procedures Computer charting confidentiality
Legal Issues for Nurses Delegation of Nursing Duties Licensed nurse is accountable for the appropriateness of delegated nursing tasks The best way for a nurse to avoid being sued for negligence is to constantly look for and correct situations in which a patient may suffer an injury.
Legal Issues for Nurses Malpractice Insurance Institutional employers carry malpractice liability insurance to protect employees and themselves Personal malpractice liability insurance policy is a wise investment Settlements may exceed employer’s policy limits Employer’s insurance company may sue you Claims-based rather than occurrence-based policies
Legal Issues for Nurses Wills Legal statement of a person’s wishes regarding disposition of property after death Attorney is most appropriate to help write a will Follow institutional guidelines regarding witnessing a will
Legal Issues for Nurses Gifts Don’t accept gifts or money It is legal but not ethical to accept or solicit gifts
Criminal Law and Nursing A crime is an offense committed against the public welfare or safety The state prosecutes criminal acts Minor offenses Misdemeanors Felonies Practicing without a nursing license is a felony
Criminal Law and Nursing Grossly negligent acts are considered crimes Criminal background, elder abuse, and child abuse checks done prior to being hired Drug and alcohol screening prior to hire
Criminal Law and Nursing Other crimes in which nurses may become directly or indirectly involved: Right-to-die situations Violations of federal and state narcotic and controlled substance laws Fraud Robbery Death due to lack of or incorrect nursing care Murder
Question Is the following statement true or false? Respondeat superior means that your employer cannot be held liable for your acts as a nurse.
Answer False Rationale: Respondeat superior means that both the nurse and the employer can be held liable for a nurse’s acts.
Question Putting a person into his room, locking the wheelchair wheels and closing the door to keep him from annoying others is known as: A. Fraud B. False imprisonment C. Battery D. Violating informed consent
Answer B. False imprisonment Rationale: Confining a person to a room, locking the wheelchair locks to prevent the person from moving about is false imprisonment.
Question Is the following statement true or false? It is illegal for a nurse or any other health care provider to accept or solicit gifts from patients or families.
Answer False Rationale: It is legal but not ethical to accept or solicit gifts from patients or families.
Question Which of the following is true about documentation? A. It is not a legal document B. Never use abbreviations when charting C. When making an error, just cross it out so it is illegible D. Entries must be objective and consistent
Answer D. Entries must be objective and consistent Rationale: The patient’s medical record is a legal document. Use agency-approved abbreviations and chart correction Procedures.
Question Is the following statement true or false? Laws are rules of conduct that derive from ethical beliefs, moral practices, and cultural values.
Answer True Rationale: Laws are rules of conduct that derive from ethical beliefs, moral practices, and cultural values.