Legal Issues in Nursing

Fall Term, 2012

Nursing 297 - Professional Nursing Concepts and Challenges

Welcome

Index Cards Name, area of interest, location of preceptor, definition of nursing If I could change nursing, Id Introductions Classroom norms mine and ours Review of Syllabus

P Taylors Classroom Norms

Assume goodwill Be on time and be prepared Cell phones/computers for classroom use only Be respectful and open to different perspectives Please leave room if needed to take call or text Participate and fully engage Food and drink OK but eat quietly No side conversations disrepectful to peers Feel free to let me know if needing breaks

Overview continued.

Syllabus Overview N297 Contact information posted also in CAMS

Prof. Taylor Office 205 Phone # 5134353050 Office hours See Cams mostly Wed and Thurs

At the completion of the course the students will:

Discuss similarities and differences in scope of practice among nursing educational programs and levels of nursing practice in the U.S. today. Explore the complex role that professional organizations and associations play in the nursing profession and society. Use critical thinking to analyze the similarities and differences between the concepts of management, leadership, and delegation.

At the completion of the course the students will:

Describe a model for ethical decision-making that could be applied to ethical dilemmas resulting from conflicts between clients and health care policy development Explore global societal issues and the nursing professions response to meet these future challenges and trends in nursing. Formulate self-development goals for employment and life long learning. Examine socio-cultural issues that impact nursing practice.

Review of Evaluation Methods

Class Participation examples Due at beginning of class on assigned weeks Written assignment/attendance for full credit Special Project Portfolio review week 5, due week 9 Quiz, Midterm, Final. Some essay type questions ATI out of class homework due Friday at noon of the week its due (three assignments) Proctored Final During Class Time week 10 Concepts/Vocab list will be distributed

Legal Issues in Nursing

Nursing as a Regulated Practice

Nurse Practice Act is the statute that defines nursing practice (so it could be a uniform of practice) Found in all 50 states (different in all states b/c it can be tailored to the needs of that population), Washington, D.C, and several U.S. territories State legislation comes up with it, a lot of legally to it Accomplishes four objectives Defines practice of professional nursing Sets educational and other requirements for licensure Determines legal titles and abbreviations Provides for disciplinary action Also defines authority of the State Board of Nursing

Nurse Practice Act

Nurse Practice Act

Usually is the most important law affecting nursing practice within state bounds Responsible for enforcing the Nurse Practice Act Publish rules and regulations that expand law Revised to keep up with new health care developments

State Boards of Nursing

Authority of State Boards of Nursing

Have power to clarify provisions of nurse practice act

But cannot enlarge the law (we can give narcotics but not prescribe them, they cannot enlarge the law and ok it) Executive: Administers nurse practice act Legislative: Adopts necessary rules to implement act (like when they made up the role of STNAs able to give meds) Judicial: Authority to discipline a licensee or deny licensure

Three functions mirror federal and state governments

Types of Licensing Law

Mandatory law Requires licensure (you have to pass your NCLEX) Permissive law Protects use of the title but does not prohibit practice if persons do not use the title (back along time ago people were using the RN title but didnt have the additional training). You have a minimum amounts of requirements to be called a RN now, you have to prove it All states now have mandatory licensure for the practice of nursing at the RN and LPN levels

Enforcing Educational Requirements and Discipline

State Boards of Nursing (SBNs)

Set and enforce minimum criteria for nursing education programs

Schools of nursing must have state approval to operate, you must have state approval to sit for boards NLN is a great accreditation but not required To protect the public from dangerous practice Most frequent reason for discipline is for practicing while impaired

Have the power to discipline a licensee

Licensure Examinations

NCLEX-RN: National Council Licensure Examination for Registered Nurses

Tests critical thinking and nursing competence Established in 1978 to develop the examination Each state participates in licensing process through the NCSBN Every state takes the same NCLEX, its national!!! You can practice in other states you just have a different Scope of Practice

National Council of State Boards of Nursing

Licensure to Accommodate Nurses Mobility

Licensure by Endorsement (RNs practicing in other states) you never have to take NCLEX again, its endorsed in all 50 states

RNs may practice in different states without repeating the licensing examination Must apply in each state for endorsement States may have residency requirements A nurse may hold several licenses at once, but in cases of multi-state practice such as case management, one state is the home state.

If you practice in 3 states how many license will you have? 3 you will get a license in all three states but only take NCLEX once. All states have their own rules as far as keeping up with continued hours so you need to find out the laws in the state your practicing in.

Licensure to Accommodate Nurses Mobility

Nurse Licensure Compact

Allows RN to have one license yet practice in other compact member states Does not require application for licensure by endorsement 24 states are in compact: all the people that participate in this compact can practice in all 24 states it will cover you Ohio does not participate https://www.ncsbn.org/nlc.htm 6 states have pending legislation (Ohio is NOT one of them)
OHIO IS NOT PART OF THE COMPACT!!!!!

Legal Risks in Nursing Practice

Negligence is central issue. Defined as: Failure to act as a reasonably prudent person would act in the same circumstances Anyone can be found negligent (i.e.: a parent) Malpractice Defined as: negligence by professional personnel Does not have to be intentional Occurs through commission or omission Central question in malpractice charge is: Was the prevailing standard of care met? Standard of care reflects basic minimum level of prudent care.

Requirements of a Malpractice Action

Two requirements:

Nurse (defendant) practices with specialized knowledge and skills Through this practice caused patients (plaintiffs) injury.

All four elements of a cause of action for negligence must be proved:

Nurse has assumed the duty of care (obliged to give care). Nurse breached the duty by failing standard of care. This failure was the proximate (directly related to) the cause of the injury. There is a connection between the failure of care and the injury. There was an actual injury or damage. ALL FOUR OF THESE HAVE TO BE MET FOR YOU TO BE CHARGED WITH NEGLIGENCE!!!!

Six Major Causes of Negligence

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

Assault and Battery as Basis for Legal Action

Assault: Defined as threat or attempt to make bodily contact with another without that persons consent

Precedes battery
Impermissible, unprivileged touching

Battery: Defined as assault carried out

Actual harm may or may not occur as a result

Consent

Written consent not required by law. Written consent is most likely required by facility policy. Consent, written and/or verbal are required to honor patients rights and protect against charges of battery. Minors 14 years and over must consent along with Parent/guardian. No consent is covered under Good Samaritan Act in cases of medical emergency (as long as provider acts in accordance of a reasonable and prudent person. NURSES DO NOT GET INFORMED CONSENT!!!! THEY CAN GET IT BUT NOT GIVE IT

Informed Consent

Three major considerations (elements)

Voluntarily Capacity/competence to understand Enough information given

Role of the nurse

Witness patients signature Determine three elements are present to patients satisfaction Provide feedback to provider if patient requires further information or is unable to sign Make sure the consent form is signed and on the patients chart prior to the procedure

Role of the nurse DOES NOT include explaining a surgical procedure; only the provider can give explanation.

HIPAA as a Privacy Standard

The Health Insurance Portability and Accountability Act (HIPAA) (1996)

First federal privacy standard governing protection of patients medical records Comprehensive legislation providing major patient protections

Reinforces protection of electronically transmitted information Requires all health care providers to ensure patients privacy and confidentiality

Changing Nature of Nursing Practice Creates New Legal Issues

Role changes for nurses require expansion of the legal authority for nursing practice

Increases in the scope of nursing practice Prescriptive authority Supervision of unlicensed assistive personnel (UAP)

Payment mechanisms for nurses Patient Self-Determination Act (1991)

Supports ethical principle of autonomy Uses Advance Directives

Preventing Legal Problems in Nursing Practice

Practice in a safe setting Communicate with other health professionals, patients, and families Meet the standard of care Carry and understand professional liability insurance Promote positive interpersonal relationships

Delegation Carries Great Legal and Safety Implications

Delegation

Defined as giving someone authority to act for another

Nurses primary legal and ethical consideration is safe, effective care for patients Professional nurses retain accountability for acts delegated to another person There are five rights to ensure safe delegation of tasks to unlicensed assistive personnel Most debated area of delegation involves medication administration by unlicensed assistive personnel

Preventing Legal Problems in Nursing Practice: Delegation

Right Task Right Circumstance Right Person Right Direction/Communication Right supervision/Evaluation

Five Rights to Successful Delegation

The National Council of state Boards of Nursing (NCSBN, 1995) developed guidelines when changes in delivery of patient care first included the use of unlicensed assistive personal (UAP) https://www.ncsbn.org/Joint_statement.pdf

Delegation to UAP (basics)

UAP (or AP) can: Feed, unless there is paralysis Take vital signs, unless known to be unstable Do ROM Hygiene Measure urine output from catheter bag, collect urine specimen from bag Transport/ambulate, unless new ambulation Do I&O

Delegation to LPN/LVN (basics)

LPN (or LVN) can: Give meds, including injections Collect data Dressing changes Catheter insertions Suctioning REINFORCE previous teaching, NO NEW TEACHING and NO Discharge instruction Can assist Physician LPN cannot insert IV (this requires special certification beyond basic licensure) or initiate any step in nursing process.

Delegation to RN

ADPIE Receive/give report Patient teaching Invasive tasks Sterile tasks Coordination and management of care Must understand abilities of RN under your charge before delegating

Do Not Delegate When:

Activities fall outside the scope of practice for the individual Activities that require specialized nursing knowledge and judgment Those activities which fall under the RN job description (unless delegating to another competent RN) Activities can not be supported and/or supervised due to time constraints

Scope and Standards

Is the RN legally responsible for the mistake of the aide? The LPN? The RN she delegated to? Is it OK to delegate discharge teaching to a float RN as long as the nurse says she can do it? Can the UAP collect urine for C&S?

Sample Question: Delegation

Which would be appropriate to assign to an LPN? (select all that apply):
a.
b.

c.
d. e. f.

Client who needs preoperative teaching for use of PCA pump Client with a leg cast needing neuro/circulation checks and prn Hydrocodone Client who had a toe amputation and has diabetic neuropathic pain Client with terminal cancer and severe pain who is refusing pain medication Client complaining of abdominal pain after being kicked and punched Client with arthritis who needs scheduled pain meds and heat applications

OBN Website: http://www.nursing.ohio.gov See laws and rules, standards of practice, delegation, Momentum Magazine What other key information on the OBN website?

Example: Scopes of Practice: Registered Nurse and Licensed Practical Nurse (six pages)

NCSBN video on Social Media

http://www.youtube.com/watch?v=i9FBEiZRnmo&f eature=youtu.be
Social media use is ubiquitous, but inappropriate posts by nurses have resulted in licensure and legal repercussions. NCSBN has developed guidelines for nurses and nursing students for using social media responsibly. Key points of these guidelines are summarized, along with dramatization of potential scenarios of inappropriate social media use. (5 minutes)