Legal considerations for nursing practice

Legal limits for nursing Nurse practice acts: describe and define the legal boundaries of nursing practice within each state Vary from state to state, especially for advanced practice nurses (family nurse practitioners, clinical nurse specialists) Standards of care: legal guidelines for nursing practice Defined by nurse practice acts, ANA, and state boards of nursing

Standards of care In a malpractice lawsuit, nursing conduct/care is compared to the nursing standards of care for that state Court looks to see if the nurse acted as any reasonably prudent nurse would act under the same or similar circumstances Breach of nursing standards: if care did not meet set standards of care, must be proven in negligence or malpractice lawsuits

Negligence & Malpractice Nursing care that falls below defined standards of care Malpractice: professional negligence Nursing malpractice: when nursing care falls below defined standards of care

Malpractice The following must be established in order for nurses to be found guilty of malpractice: The nurse was responsible for caring for the patient The nurse did not carry out that care The patient was injured as a result The patient’s injury was due to the nurse’s failure to provide adequate care

Negligence Nurses may be held liable for negligence if their care does not meet the standards of nursing care for that state Avoiding negligence: Carefully follow standards of care and providing competent care Communicate with other healthcare professionals Develop caring relationships with patients and families Carefully document assessments, care, and patient outcomes

Avoiding negligence Stay aware of current nursing literature in areas of clinical practice or specialty Know and follow clinical policies and guidelines for facilities Be aware of common causes of patient injury and work to prevent such Communicate with patients and their families so that they are aware of nursing care provided Communicate patient changes to physicians promptly and document carefully

Consent A signed consent form is required for procedures and care State laws designate who is legally able to give consent for care Caution must be taken with patients who are: Hard of hearing Unable to speak English Under 18 years of age Sedated Mentally ill

Informed consent Patient’s agreement to procedure or care after being informed of risks, benefits, alternatives, and consequences Health care providers must present information so that patient can understand it, in order to make an informed choice If no informed consent, patient may charge negligence or battery

Nurses & informed consent In most cases, is not the nurses’ responsibility to obtain consent Nurses are often asked to witness patient signature on consent form Means that patient voluntarily gave consent, signature is authentic, and patient appears competent to give consent

Student nurses Are liable if they cause harm to patients Do not do skills that you have not been taught! Make sure that you are carefully supervised when you perform procedures with patients Medication administration IV starts, catheterization, suctioning, etc Prior to giving medications: Make sure that you check patient ID band FIRST! Look up each medication so that you know what you are giving! Check for patient allergies FIRST!

Short staffing Legal problems may occur if there is insufficient staff to provide patient care Staffing problems should be brought to the attention of the nursing supervisor Written protests may be made to facility administration Nurses must not walk out or refuse assignment due to short staffing May be considered insubordination and result in disciplinary action Will make patient care staffing problem even worse

Physician’s orders Sometimes physicians may give orders over the phone, especially late at night. Only RNs can take orders over the phone They cannot be taken by LPNs, nursing assistants, unit secretaries, or other staff members. They may not be left in voice mail Best bet- don’t let doctors give you verbal orders (unless it is an emergency!) Hand the chart to the doctor and ask him to write the order instead

Physician’s orders Nurses are obligated to follow physicians’ orders for patient care If a nurse believes that an order is wrong or may harm a patient, the nurse must notify the physician to clarify the order If the physician insists, the nurse should notify the nursing supervisor to address the problem A nurse should not follow a doctor’s order that may result in harm to the patient- may be legally responsible for any harm suffered by the patient

Myths about student nurses MYTH: Nursing students don’t have to worry about making mistakes with patients because they are working under the RN’s license. REALITY: If a client is harmed as a direct result of a nursing student’s actions or lack of action, the liability for the incorrect action is generally shared by the student, instructor, hospital or health care facility, and the university or educational institution. Student nurses may be named in malpractice lawsuits!

Myths about student nurses MYTH: Nursing students are only glorified nursing assistants. REALITY: While in clinical, student nurses are expected to perform as professional nurses (as an RN would in providing safe client care). Nursing students are not working in the same capacity as nursing assistants and therefore are expected to provide a higher level of care than nursing assistants.

Myths about student nurses MYTH: Nursing students don’t have to hear report about their patients because all the decisions about care are made by the RN REALITY: Staff nurses may serve as preceptors, but that does not excuse the student from performing at the level of a RN. That includes planning care, implementing interventions, and evaluating outcomes.

Myths about student nurses MYTH: Nursing students will never be asked to perform skills that they don’t know how to do. REALITY: Nurse preceptors are not always aware of which skills have been learned by the nursing students. Students may be asked to perform skills that they have not been taught yet.

When in clinical: If you are asked to perform a skill which you have not been taught yet or which you do not feel comfortable doing, let your instructor and the RN know! They may: Perform the procedure and allow you to observe Review the procedure with you and allow you to assist

When in clinical: Do not perform a skill that you have not been taught or you do not feel comfortable doing Use your clinical instructor as a resource- if you are unsure of something, ASK! LOOK BEFORE YOU LEAP! Do not make rash decisions in clinical- take you time and make decisions carefully.

Here are some other suggestions for when you are in clinical…

When in clinical: MAKE SURE THAT YOU HAVE THE RIGHT PATIENT!!! Check the ID band BEFORE you do anything with a patient! Look up every medication before you give it! You need to know the drugs you are giving, in order to make sure that is appropriate for the patient and watch for side effects Your clinical instructor WILL expect this!

When in clinical: The facility may require your instructor to sign your medication sheets. Make sure this is done before you leave clinical for the day Sign your name with your first initial, last name, and credentials (OUSN) Document only in black ink!

When in clinical: Be on time, ready to go! Nurses are busy getting report and don’t have time to deal with nursing students who show up late. Treat the nursing staff (RNs and nursing assistants) with respect and thank them for their assistance. Nursing assistants are a huge help to nursing students- they know where stuff is! Stay on their good side!

When in clinical: Work with your classmates! Nursing school and clinicals are hard enough without having to go it totally alone If your patient is sleeping, see if one of your classmates needs a hand with something If you get to do something really cool or your patient has an unusual wound or heart murmur, share it with your classmates so that they can learn about it too!