1. NURS116
Ch 23 Legal Implication

2. legal issues Nurses need to protect patient’s rights
Nurses need to protect selves from liability
Society expects safe healthcare
Society has very high standards for nurses
New technology and innovations present challenges
Use critical thinking to protect your practice
legal issues

3. Nurse Practice Acts describe and define legal boundries of nursing practice in each state
Americans with Disabilities Act
Regulatory Laws reflect decisions made by State Boards of Nursing
Common Law
Civil Laws
Criminal Laws
Sources of Law

4. LAWS Americans with Disabilities Act
Emergency MedTreatment Active Labor Act
Mental Health Parity
Patient SelfDetermination Act (advance directives, living wills)
Uniform Anatomical Gift Act
HIPAA
Federal Nursing Home Reform Act
LAWS

5. Laws about Nursing Practice
Licensure
Good Samaritan Laws
Public Health Laws
Uniform Determination of Death
Autopsy
Physician-Assisted Suicide
Laws about Nursing Practice

6. consent Complete explanation Names and qualifications of staff
Description of procedure and potential harm
Description of alternatives
Right to refuse any part
Right to refuse even after consenting and starting
Adults (>18)
Parent or guardian
Adult sibling or grandparent in emergency
Emancipated minors
Minor parents
Pregnant minors
STD tx
Drug or subs tx
Court order
consent

7. Nurse’s role in consent
Witness that pt voluntarily gave consent
Witness that pt’s signature is authentic
Witness that pt appears competent
Must ask if pts understand procedure
Notify HCP if consent is not complete
Refusal should be written and witnessed
STUDENT NURSES DO NOT WITNESS
Nurse’s role in consent

8. For patients who are unconscious or otherwise unable to give consent
Always try to reach surrogate, POA
May perform procedure without consent if impossible to obtain, assuming that pt would wish beneficial treatment
Patients with mental illness may refuse treatment
ASSUMED CONSENT

9. Torts Assault Battery False Imprisonment Invasion of privacy
Defamation of character
Negligence
Malpractice
Torts

10. Standards of Care Minimum acceptable nursing care
Reflect knowledge and skill ordinarily possessed by nurses and used by nurses
Outline the scope, function, and role of nurse
“what a reasonably prudent nurse would do under same or similar circumstances”
Standards of Care

11. Worried about a lawsuit?
The nurse owed a duty to the patient
The nurse did not carry out the duty or breached it
The patient was injured (physically, financially, emotionally,) or died
The injury to patient was caused by nurse’s failure to carry out duty
Worried about a lawsuit?

12. Malpractice Insurance?
Insurance will pay for the judgment if you lose a court case
They pay even if you made an error, as long as you were practicing within your scope
Facilities buy insurance to cover nurses
It only covers nurses’ actions during the course of employment
Malpractice Insurance?

13. Maintain familiarity with standards of care and policies and procedures of the facility
Read current nursing literature in your area of practice
Darling v. Charleston Community Hosp (1965)
(go up chain of command)
Nurse Liability

14. Student Nurses You are liable if your action harms a patient
The instructor, hospital, facility, and school share the liability
You should never perform for which you are unprepared
You are expected to perform as a professional nurse does
Do not act in “dual role” if you currently work as an aide or tech
Student Nurses

15. Facilities must staff with enough nurses to provide competent care
Overtime (>12.5 hours/day or >40 hours/week) greatly increases chance of practice error
Staffing ratio laws are in debate
You must accept an “unreasonable” assignment, but make an objection in writing
Insubordination/ abandonment
Staffing/floating

16. You need to inform the supervisor of lack of experience with type of patients in area you float to.
You need to request an orientation to unit
Supervisors take responsibility for inappropriate assignments, but you need to recognize inappropriate assignments
“float “ nurses should be assigned stable patients with expected outcomes.
Staffing/floating

17. Orders HCPs are responsible for directing medical treatment.
Nurses “follow” orders unless they believe they will cause the patient harm or are in error
Follow chain of command for inappropriate orders
Keep HCP informed of all changes, and document HCPs response
Orders

18. Managing Risk Incident reports Complete documentation
Don’t depend on electronic monitoring. Nothing substitutes for your own eyes, ears, hands
Time outs
Site marking, sponge count
Managing Risk