Unit 3 Regulation

2 Regulation of Nursing Practice l Protection of Public l Licensure l Certification

3 Licensure l Permission to practice l Establishes minimum competence l Enforced by Board of Nursing l Board established through Practice Act l Elected Board in North Carolina

4 Certification l Competence established above minimum criteria

5 Functions of Board of Nursing l Govern own operation l Approved/deny Schools of Nursing l Examine/license applicants l Review licenses l Regulate specialty practice l Discipline

6 Authority of Board of Nursing l Legislative - rules and regulations l Quasijudicial - hearings l Administrative - license control

7 Types of Licensure l Mandatory Licensure: regulates practice l Permissive Licensure: protects title only l Institutional Licensure: government regulates institution who in turn regulates staff practice

8 Nurse Practice Acts l 1903: North Carolina had first permissive Nurse Practice Act l 1938: New York had first mandatory Nurse Practice Act

9 Elements of Nurse Practice Acts l Definition of Nursing l Requirements for licensure l Exemptions - Grandfather clause l Licensing across jurisdictions: reciprocity, endorsement, examination, waiver

10 Disciplinary Hearings l Filing of complaint l Review of complaint l Disciplinary action l Appeal to court for reversion

11 Expanded Practice Scope l Nurse Practice Act l NP Rules and Regulations l Medical Practice Act l Joint Statements l Standing Orders

12 Updating Practice Acts l Legislative action: amendments l Rules and Regulations l Sunset Laws

13 Advanced Roles l Nurse Anesthesia, 1878 l Nurse Midwifery, late 1800’s l Nurse Practitioners, 1965

14 Issues for NPs l Prescriptive Authority l Admitting privileges l Reimbursement l Direct Access to provider

15 Common Areas of Liability l Medication Errors l Falls/Restraints l Failure to assess l Failure to communicate l Technology l Suicide prevention l Discharges - Patient Advocate

16 False Imprisonment l Unjustifiable detention of person without legal warrant to confine person l Must be knowledge of imprisonment by patient for it to occur l Incompetent, mentally ill, or persons posing a threat to society may be detained against will

17 Conversion of Property l Interference with right to possession of patient’s property l Need to have adequate justification of action

18 Intentional Infliction of Emotional Distress l Professional conduct goes beyond that tolerated by society l Conduct calculated to cause mental distress l Conduct causes mental distress

19 Invasion of Privacy l Unreasonable unwarranted interference with individual's solitude l Patient has right against 1) Appropriation of plaintiff’s name or picture for defendant’s sole advantage; 2) Intrusion by defendant upon patient’s seclusion or affairs; 3) Publication by the defendant of facts that place the patient in a false light; 4) Public disclosure of private facts about the patient by hospital staff or medical personnel

20 Defamation l Comprised of slander (oral) and libel (written) l Wrongful injury to another’s reputation l Five elements l Defamatory language that adversely affects reputation l Defamatory language concerning living person

21 Defamation Continued l Publication to a third party or several persons l Damage to person’s reputation l Fault on part of defendant in writing or telling another the defamatory language

22 Defenses against intentional torts l Consent or implied by law through: prevention of loss of life or limb; person incapable; no reasonable reason to believe consent would not be given; reasonable person in similar circumstances would give consent l Truth in defamation cases

23 Defenses Against Torts Continued l Privilege - to protect public and private interests. Example - recommendation from former to prospective employer; appropriate channels used; truthful; objective terms l Disclosure Statutes: reporting of information for health reasons l Intentional torts mitigated by retraction, if provoked

24 Defenses to Nonintentional Torts l Release: only compensated for negative action l Contributory negligence: patient contributes to negative action l Assumption of risk: Plaintiff understood and is partially responsible l Immunity Statutes: Example - Good Samaritan Law

25 Statute of Limitation l In most states, 2 to 4 years, or with a child, until age of maturity l In North Carolina, 3 years for most cases

26 Informed Consent l Expressed or implied; written or oral, complete or partial l Major exceptions: Emergency, therapeutic privilege, patient waiver, prior patient knowledge or common knowledge l Other exceptions: preservation of life, protection of minors, prevention of self destruction, maintenance of ethical integrity, protection of public’s health