1. Legal Aspects of Nursing NUR101 FALL 2010 LECTURE #21 K. Burger, MSEd, MSN, RN,CNE PPP by: Sharon Niggemeier RN MSN Revised kburger8/06

2. Legal Aspects Legal accountability for all nursing actions rests with the nurse. Nurses and student nurses are legally responsible for their actions

3. Regulated by laws New York State Nurse Practice Act Patient Self-determination Act (PSDA) Health Insurance Portability and Accountability Act ( HIPAA) Americans with Disabilities Act ( ADA) Medicaid Statutes / Resident’s Rights Public Health Laws New York State Nurse Practice Act Regulation of Nursing Practice

4. Regulated by Standards of Care guidelines developed by: -nursing organizations such as ANA -state boards of nursing -health care institutions -procedural textbooks -written nursing policies/procedures Mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

5. Licensure of Nursing Practice Licensure requirements are set by State Board of Nursing -educational requirements -licensing exam (NCLEX) -maintenance and renewal -suspension and revocation -professional misconduct proceedingsprofessional misconduct proceedings Take a look at www.op.nysed.gov/nurse.htmwww.op.nysed.gov/nurse.htm

6. The State Board of Nursing may revoke or suspend a nurses license for willfully violating the nurse practice act: drug/ETOH abuse (most common) fraud ( in obtaining license) conviction of a felony gross or ordinary negligence previous disciplinary actions in other states physical / mental impairments practicing after your license expires

7. Types of Legal Action- Crimes Criminal Action –a wrong against persons and society –criminal court –punishable by imprisonment Felony Misdemeanor

8. Types of Legal Actions- Torts Civil Action- Tort –A wrong against an individuals rights or property –civil court –punishment usually with monetary settlement –tort may also be a crime and tried in both courts Intentional Unintentional

9. Torts Intentional: fraud invasion of privacy defamation of character false imprisonment assault and/or battery Unintentional : negligence Malpractice = negligence as it applies to a profession

10. Elements of Malpractice FOUR elements must be met to prove guilty of malpractice Duty- (relationship) nurses responsibility to provide care in an acceptable manner Breach of Duty- failed to provide care in acceptable manner Injury(damages)- nurses act caused harm Proximate cause- reasonable cause and effect can be shown between the omission or commission and the harm

11. Common Malpractice Allegations Failure to maintain safety Improper technique/treatment Failure to monitor and report Medication errors Failure to follow policy/procedures Poor documentation Improper use of equipment

12. Protecting Yourself Practice safely & competently Always follow standards of care!! Develop a caring relationship with your pt Communicate, communicate, communicate! Document, document, document!

13. Protecting Yourself Remember - the nurse enters into a contractual obligation ( ethical AND legal) when caring for a client. You are responsible for the actions of your ancillary staff ( Respondent superior ) Carry your own liability insuranceliability insurance You have increased responsibility in regards to Good Samaritan Laws.

14. Patient’s Bill of Rights Every patient has rights under PUBLIC HEALTH LAW See handout and/or NYS Department of Health Website NYS Department of Health Website

15. Informed Consent INCLUDES: Explanation of procedure Explanation of risks, anticipated discomfort Explanation of alternatives Client has right to refuse Client must be competent and of legal age It is the physician’s duty to obtain informed consent It is the nurse’s duty to verify that client was informed

16. Ethics & Values NUR101 FALL 2010 LECTURE #21 K Burger MSEd,MSN,RN,CNE

17. Ethics versus Laws Nurse Practice Act governs legal practice You govern ethical practice It is the ETHICS of nursing practice that elevate it as the #1 most trusted profession Source: Gallup Poll, Honesty and Ethical Standards of Professions Survey, 2004.

18. Nursing Code of Ethics Written by professional organizations American Nurses Association (ANA) International Council of Nurses Remember…one of the hallmark characteristics of a “profession” is that it has a Code of Ethics.

19. Values versus Ethics VALUES = personal belief about the worth of a given idea, attitude, custom ETHICS = good character and conduct

20. Values Clarification Your first step in development of ethical behaviors Recognize and understand your values Critically examine your ethical thinking Transformational learning Critical reflection Constructive discourse Emotional intelligence Democratic habits of heart Aids in the development of ethical agency ( the ability to “do the right thing”)

21. Essential Values for Nursing Altruism Autonomy Human dignity Integrity Social Justice Cultural competence All of above correlate to universal principles of biomedical ethics.

22. Universal Ethical Principles Veracity Autonomy Beneficence Nonmaleficence Fidelity Confidentiality Justice

23. Ethical Behavior of the Professional Nurse includes: Accountability Responsibility Advocacy

24. Ethical Stressors in Nursing Quality of life Futile care Euthanasia Abortion Allocation of scarce resources

25. Processing Ethical Dilemmas FIRST… ask yourself “is it really an ethical dilemma” THEN if yes: - gather all relevant data - do a values clarification process - state the problem - consider all possible courses of action - negotiate an outcome - evaluate Also consider use of institutional resources: Ethics Committee