1. Legal considerations for nursing practice

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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!

12. 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

13. 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

14. 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

15. 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!

16. 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.

17. 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.

18. 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.

19. 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

20. 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.

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

22. 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!

23. 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!

24. 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!

25. 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!