Legal Implications of Nursing – Flashcards

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Everything you do has a consequence because you're dealing with people that will have a reaction to that consequence

Need to know the parameters that you're legally held accountable for

Our roles have expanded: more accountable for our actions Independent of the physician not their "hand maiden" - Responsible for the patient your being assigned to - Hospitals will not cover for nurses - they're being sued. - Have a legal responsibility to question and clarify orders - Liability used to falls an employing agency or physician WHAT NURSES ARE MOST OFTEN SUED FOR - Falls - IV Inflitrations - Pressure ulcers • Human response --- assess, diagnose, and implement care. What we are held accountable for #1 trusted profession Work within your realm and scope of practice (what you can and can not do) Maintain competency

Act in the public interest Defining of the practice base Establishing uniform basis for nursing education Development of structures through which nursing services will be delivered Quality Assurance Mechanisms Verification of Credentials Professional status and recognition: today nurses are held accountable for their own actions Accountable for patients you're assigned to whether its through direct or indirect care - Always know policies and procedures of where you work. If your following these and something happens, then the hospital can help you - Every facility is required to have a quality assurance department = deal with mistakes: how/why they happened & try to stop them from happening again

Responsible for the actions done by LPN's and CNA's - When you sign your RN license it means you agree to work under the standard scope of practice care for that license.

Definition of Law: Standard or rule of conduct established and enforced by the government that is intended to protect the rights of the public Protect society- describes patterns of behaviors Enforceable by a controlling authority Public law Private law; civil law Criminal law- type of public law, concerns state and federal criminal statues which define criminal actions Is enforced and can be punished - Public law = enforced by government agencies - Private law= medical mal practices, issues among people (property, ect)

U.S. Constitution or state (Constitutional Law) Statutes (Statutory Law) Administrative Law (Regulatory) Court Decisions: Common law- based on the principle of "let the decision stand" Attorney General Opinions All have equal force and effect and establish precedents for future behavior Every state has a constitution - Bill of Rights & 4th amendment = gives patient right of privacy & being informed of what's going to happen - Most of our laws come from statutes - Federal law trumps state laws - Each state has a statutory laws that determines scope of practice, certifications, licensure, will have a board that regulates all this in each state. - Common Law=

Nurse Practice Acts- most important law affecting nursing practice State role Protects the public by broadly defining the scope of nursing practice Standards; voluntary: developed and implemented by the nursing profession itself; based on guidelines for peer review Legal standards: developed by legislature and implemented by authority granted by the state to determine minimum standards for the education of nurse, set requirements for licensure or registration and to decide when a license can be suspended or revoked As a professional nurse, you have guidelines you're held accountable = determined by nurse practice acts

Credentialing: ways in which professional competence is ensured and maintained Accreditation: states give responsibility for the public welfare State legislative enact laws controlling occupational and professional groups Legal accreditation of a school preparing nursing Licensure Certification Credentialing= have a higher standard to live up to, are competent to take care and no harm Accreditation—specialty areas, ensures competency in a higher level of care.

Anything that breaks the law, committed against a person, property, ect. - Misdemeanor: involves punishment (less then yr in jail, fine, or community service) depends on seriousness of crime and punishment - Felony: more serious, prison of more then a year

Tort Law is a civil wrong inflicted or imposed on another person or their belongings Intentional tort Assault and Battery Defamation Invasion of Privacy False Imprisonment Fraud Civil action vs. criminal action: Civil: subject to civil action usually settled with money biggest obstacle to bringing down healthcare costs in this country (lawsuit process is very expensive and takes a long time) - some states pit a cap on how much a lawsuit can be - even is lawsuit is frivolous, people will settle just to end the case. - Intentional tort= can be shown there was intent (actual or threatened) assalt= threatening bodily harm or do something to a patient with out their consent battery= actually carried out your threat -- willfully or negligently touched the person / their property; doing a procedure with out their consent defamation= slander (speak something bad about someone's character) or liable? written bad remarks about someone & their reputation ex. facebook Invasion of Privacy: space, ect. False: holding someone against their will, can't restrain with out consent (can also fall under battery) anything that makes the patient not be able to leave the area

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Liability: Proof of Malpractice: Duty Breach of duty Causation: *most difficult part of lawsuit to pursue sympathy usually sides with the victim.* Damages: *actual harm/ what was done to the patient* Standards of Care: Areas of Potential Liability for Nurses: Nursing Process

Nurse as Defendant *the one being sued/ going to trial (goal is to keep it out of trail as much as possible) can be multiple defendants* Nurse as Fact Witness *testifies to the facts of the case* Nurse as Expert Witness *paid to review cases to either defend or not defend it -- -needs to know standards each and give their opinion need facts to back it up *

Level of conduct for which a nurse is held accountable Care that a reasonable and prudent nurse would give under the same or similar circumstances Based on expected conduct by a similarly educated and experienced nurse (education, intelligence, judgment, foresight and skill) Flexible and constantly changing Reflect advancements in medicine and nursing that affect patient care Nurses are expected to keep current with the standards that affect individual practice Maintaining currency and competency; continually updating knowledge, skills and responsibilities *foundation of everything you do and what you're held accountable for - keeping current on what's going on in nursing and medicine - must have a specific number of continuing hours to maintain license *

Written: external and internal State and Federal Laws Joint Commission on Accreditation (JC) American Osteopathic Association National Committee for Quality Assurance Professional journals American Nurses Association (ANA) Professional Standards evolve from the scope of nursing practice and provide a framework for development of competency statements (specific specialties/organizations)

Federal Law: Bill of Rights HIPAA *1996: federal law, very strict and serious about this* Emergency Medical Treatment and Active Labor Act (EMTALA) *treated regardless of ability to pay when go to ER; and if being transported must be stable* Patient's Self Determination Act *to refuse treatment being informed, make own healthcare decisions* Americans with Disabilities Act (ADA) *cannot discriminate any patient (illness, age, race)*

State Law: Good Samaritan Laws *protects person doing act if they show they were doing it in good faith (ex. doing CPR for someone in an accident) In some states, nurses and physicians are expected to stop* Nurse Practice Acts Medical Malpractice Statutes Other guidelines for Practice: Institutional Policies ad Procedures ANA Code of Ethics Patient Care Partnership ANA Bill of Rights for RNs ANA Standards of Practice Nurse Practice Acts

High-quality care A clean and safe environment Involvement in care Protection of privacy Help when leaving the hospital Help with billing claims *Patient has responsibility to partner with healthcare providers in their treatment patients except these things when getting tx*

Practice in a manner that fulfills their obligation to society and to those who receive care Practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice Work environment that supports and facilitates ethical practice to the Code of Ethics for Nurses Freely and openly advocate for themselves and their patients, without fear of retribution Fair compensation for there work, consistent with their knowledge, experience, and professional responsibilities *Nurses have rights too ---> practice in safe environment*

*commit or omit foundation for everything we do = standard of care Nursing process*

A work environment that is safe for themselves and for their patients Negotiate the conditions of their employment, either as individuals or collectively, in all practice settings

Failure to assess and make appropriate diagnoses Failure to make ongoing assessments Failure to recognize a cluster of data that indicates a problem Failure to listen to patient concerns or requests Failure to identify safety needs, such as risk of falls and pressure ulcers Failure to plan care: plan of care; nursing interventions Failure to implement plan of care appropriately; failure to follow standards of practice; follow state laws and regulations regarding medications

Failure to respond to a patient's needs or requests in a timely manner Failure to document critical information Failure to communicate with other health team members; about a patient or patient response to care

Drug or alcohol abuse Fraud, deceptive practice *Fraud= lying about credentials, not doing things you said you did* Criminal acts, previous disciplinary actions * Criminals act= can be outside of work too* Gross or ordinary negligence Physical or mental impairments including age *Age = can't function and do you're job = not being safe* *if a complaint is made against you-- evidence compiled, case made Reasons a case can be brought against you*

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

Early legal counsel Character and expert witnesses Through preparation for all proceedings *get a lawyer*

All parties work toward fair settlement Case is presented to malpractice arbitration panel Case is brought to a court trial

*parties cannot come to fair settlement, so it's brought in front of a panel to be resolved if still can't be resolved = brought to court (costly and traumatic) *

Informed Consent *when not medicated! must give risks, benefits, any potential outcomes - person responsible for education and informed consent = physician * Contracts Competent practice Patient education Carrying out physician orders Report/Documentation Whistle-blowing *if you are a witness/ know someone is doing harm to a pt and don't report it = you can be held accountable* Adequate staffing *need to be able to take care of pt safely staffing ratios* Liability insurance Quality Assurance/Risk Management programs

Occurrence Reports/Incident reports Event monitoring Patient bill of rights Good Samaritan Laws *federal law to report to dr & pt that a mistake has been made*

Definition: patient is informed and gives consent for treatment: on admission gives approval for routine care; each specialized procedure requires written informed consent specific for the stated procedure; must be signed by the patient or the patient's surrogate Four element that must be met: Disclosure Comprehension Competence Voluntariness

Advance Health Care Directives Health Care Proxy (Durable Power of Attorney for Health Care) Living Will DNAR Orders *Assisted Suicide- dr. prescribes medication give to patient and they end their own life terminally ill, competent, older, then 18, and must do it themselves (in a few states)* *Euthanasia- ending pt life (not in US -- come countries) giving them the medication yourself* Withholding or Terminating Life-Sustaining Treatment, Food, and/or fluid Certification of Death, Organ Donation and Post-Mortem Care *know DNR status of ur pt before beginning their care - directives = ex. feeding tube*

Definition Types of programs Occurrence/Incident Reports Nurse Education *when a mistake is made always fill out proper paperwork*

* regulates these things. All equipment must be functioning properly every hospital has policies for this* Electrical equipment Isolation techniques Use of radiation Use of chemicals

Act of record patient status and care (history) Medical Record is a legal document Written Electronic Or combination Reporting: purpose to maintain continuity of care Oral Handoff report Bedside report Face to face oral Audio recorded report

Standardized Report Forms PACE (Patient/Problem, Assessment/Actions, Continuing/Changes, Evaluation) SBAR (Situation, Background, Assessment, Recommendation) *SBAR- nurses calling drs ect. - purpose of giving report = continuity* Transfer Report

*things in a good report* Patient progress made during your shift Therapies and treatments administered Teaching done Consultations done or planned with other disciplines Status of identified desired outcomes Any changes in patient status Planned activities, tests, procedures or concerns that require follow-up Progress made on discharge planning

The fundamental principle regarding documentation is that if an observation or action is not documented, it is as if it did not occur Equally important to document negative findings as it is the positive findings Comprehensive and accurate documentation of nursing care is crucial to assuring quality There is a direct correlation between quality of nursing documentation and quality of care *- factual -objective -only used to approved abbreviations -notes by hand must be legible & factual-- use quotes - state things in a way that are medically acceptable -- don't use normal or good - chart at time closest to when it happened! b/c people and conditions change rapidly*

Primary purpose: to record pertinent information regarding the patient Should relate specifically to the patient's diagnoses and problems, both medical and nursing Second purpose: obtaining reimbursement for the health care facility Third purpose: creation of a legal record for the patient Permanent record Legal document: patient/facility and providers *history of that patient - important for reimbursement*

Factual information Timeliness Legibility Approved abbreviations

Careful documentation when calls made to health care providers Explicit Document the assessment of patient or events (SBAR) Documentation and actions if health care provider cannot be reached *cannot give confidential info over the phone -document telephone conversations -- be careful of "no information" patients

Document when important for care and treatment Used direct quotes as much as possible Helps to determine understanding of instructions and to make treatment decisions Any potential claim or lawsuit comments should be documented and reported to direct supervisor