Chapter 7

Legal Dimensions of Nursing

Practice

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Definition of Law

Standard or rule of conduct established and enforced by

government
Designed to protect the rights of the public

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Four Sources of Law

Constitutions: serve as guides to legislative bodies

Statutory law: enacted by a legislative body
Administrative law: empowered by executive officers
Common law: judiciary system reconciles controversies,
creates body of common law

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Law Terminology

Litigation: process of bringing and trying a lawsuit

Plaintiff: person bringing suit
Defendant: person being accused of a crime
Presumed innocent until proven guilty

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Types of Laws

Public lawgovernment is directly involved

Regulates relationships between individuals and
government
Private lawcivil law
Regulates relationships among people
Criminal lawconcerns state and federal criminal
statutes
Defines criminal actions (e.g., murder, theft)

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Professional and Legal Regulation of

Nursing Practice
Nurse practice acts
Enacted by every state to define the scope of nursing
practice
The most significant law governing nursing practice
Standards
Voluntary standards to guide practice
Credentialing
Accreditation of education
Licensure of nurses
Certification in specialty practice areas
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Reasons for Suspending or Revoking a

License
Drug or alcohol abuse
Fraud
Deceptive practice
Criminal acts
Previous disciplinary actions
Gross or ordinary negligence
Physical or mental impairments, including age

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Due Cause for Revoking a License

Notice of investigation
Fair and impartial hearing
Proper decision based on substantial evidence

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Nurses Best Defense of License

Investigation
Early legal counseling
Character and expert witnesses
Thorough preparation for all proceedings

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Criminal Law
Crime: wrong against a person or the persons property
as well as the public
Misdemeanor: punishable by fines or less than 1 year
imprisonment
Felony: punishable by imprisonment for more than 1
year
Tort: a wrong committed by a person against another
person or that persons property; tried in civil court
Intentional
Unintentional

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Intentional and Unintentional Torts

Intentional
Assault and battery- physical contact with another
Defamation of character- slander or libel
Invasion of privacy- confidentiality or physical
False imprisonment- restraints, enforcement of care
Fraud- dishonesty of self or to a client
Unintentional
Negligence- failure to perform to standards
Malpractice- negligence by a professional

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Four Components of Liability

Duty
what a professional would do
Breach of duty
failure to meet standard of care
Causation
failure to meet the standard caused injury
Damages
the harm or injury sustained by the patient

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HIPAA-Ensured Patient Rights

To see and copy their health record

To update their health record
To request correction of any mistakes
To get a list of the disclosures a health care institution
has made independent of disclosures made for the
purposes of treatment, payment, and health care
operations
To request a restriction on certain uses or disclosures
To choose how to receive health information

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Categories of Malpractice Claims

Failure to follow standards of care

Failure to use equipment in responsible manner
Failure to assess and monitor
Failure to communicate
Failure to document
Failure to act as a patient advocate

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Three Outcomes of Malpractice Litigation

All parties work toward fair settlement.

Case is presented to malpractice arbitration panel.
Case is brought to trial court.

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Roles of Nurses in Legal Proceedings

Nurse as defendant
Nurse as fact witness
Nurse as expert witness

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Recommendations for Nurse Defendant

Do not discuss the case with those involved in it.
Do not alter patient records.
Cooperate fully with your attorney.
Be courteous on witness stand.
Do not volunteer any information.

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Legal Safeguards for Nurses

Competent practice
Informed consent or refusal
Contracts
Collective bargaining
Patient education
Executing physician orders
Documentation

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Legal Safeguards for Nurses (cont.)

Adequate staffing
Whistle-blowing
Professional liability insurance
Risk management programs
Incident, variance, or occurrence reports
Sentinel events and Never events
Patients rights
Good Samaritan Laws

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Safeguards to Competent Practice

Respecting legal boundaries of practice
Following institutional procedures and policies
Owning personal strengths and weaknesses
Evaluating proposed assignments
Keeping current in nursing knowledge and skills
Respecting patient rights and developing rapport with
patients
Keeping careful documentation
Working within agency for management policies

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Elements of Informed Consent

Disclosure
Comprehension
Competence
Voluntariness

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Types of Risk Management Programs

Safety program
Products safety program
Quality assurance programs

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Information Contained in Incident Reports

Complete name of person and names of witnesses
Factual account of incident
Date, time, and place of incident
Pertinent characteristics of person involved
Any equipment or resources being used
Any other important variables
Documentation by physician of medical examination of
person involved

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Laws Affecting Nursing Practice

Occupational Safety and Health
National Practitioner Data Bank
Reporting obligations
Controlled substances
Discrimination and sexual harassment
Health Insurance Portability and Accountability Act (HIPAA)
Restraints
People with disabilities
Legal issues related to death and dying (wills, advance
directives)

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OSHA Legal Regulations

Use of electrical equipment

Use of isolation techniques
Use of radiation
Use of chemicals

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