1. Sources of Law Relevant to Health Service Management  Constitutions little relevant to management  Statutes many statues that affect malpractice  Administrative Agencies National Labor Relations Board Health and Safety Board  Court Decisions Tort law (most malpractice law)

2. Legal Basis for NURSING Practice  51 Nurse Practice Acts (states and DC) State Boards of Nursing responsible  Organization guidelines cannot exceed the requirements of the state Nurse Practice Acts  Managers need specific interpretations

3. Professional Negligence  Vicarious liability (employers liable for nurses’ acts) Respondent superior Joint liability Personal liability MALPRACTICE: failure of a person with professional training to act in a reasonable and prudent manner.

4. Elements of Liability  A Standard of Care must have been established  There must be a Breach of Duty  Foreseeable Harm: Nurse must have known that failure to meet the standard of care could result in harm  Failure to meet standard of care must have the potential to cause injury.  Injury occurred

5. Regulations and Legal Issues  OSHA - legislation addresses requirements of the employer.  State Health Facilities Licensing Boards - regulate staffing requirements.  Patient Rights  Informed Consent  Medical Records  Extended Liability

6. Manager’s Areas of Liability and Responsibility  Workman’s Compensation Laws  Inadequate staffing  Delegation or assignment of work  Quality assurance on units such as duty to report dangerous understaffing, checking the credentials and qualifications of staff, and carrying out appropriate discipline.  Reporting improper or substandard medical care  Select areas such as reporting public health information or child abuse

7. RISK MANAGEMENT “EXTENSION OF QUALITY IMPROVEMENT IN A SERVICE PROFESSION…EMBEDDED WITHIN THE MANAGERIAL PROCESS OF CONTROL, TO PREVENT UNDESIRABLE EVENTS FROM HAPPENING AND MINIMIZE THE IMPACT OF UNPREVENTABLE RISKS.”

8. Risk Management  Organization-wide program  Identify risks  Control occurrences  Prevent damage  Control legal liability  Coupled with the QA/QI/TQM movements  Main purpose to control financial loss due to malpractice claims

9. Common Areas of Risk Management  Needle stick injuries  Falls in elderly or disoriented clients