essentials of nursing leadership & management, 4th edition

Essentials of Nursing Leadership & Management, 4th EditionEssentials of Nursing Leadership & Management, 4th Edition

CHAPTER 3

NURSING PRACTICE AND THE LAW


GENERAL PRINCIPLES


Meaning of Law

Statutory law Common law Administrative law


Sources of Law

The Constitution Statutes Administrative


Types of Law

Criminal law Civil law


Criminal Law Criminal acts are considered offenses

against the state Three categories of criminal law

Felony Misdemeanor Juvenile


Civil Law Usually involve the violation of one

person’s rights against another’s rights Tort Quasi-intentional tort Negligence Malpractice


Other Laws Relevant to Nursing

Good Samaritan laws Confidentiality Slander and libel False imprisonment Assault and battery


STANDARDS OF PRACTICE


Nursing Standards

Established as guidelines for the profession to ensure quality of care

Also used as criteria to determine whether appropriate care has been delivered


Types of Standards

Internal standards Organizational standards Accepted state and national standards Nurse Practice Acts Patient Care Partnership


Internal Standards

Developed by institutions Institutional policies Maintained in policy and procedure

manuals


Boards of Nursing

Develop the Nurse Practice Acts along with state legislatures

The courts have upheld the authority of the boards of nursing to regulate standards

With the expanded role of nursing, it is important to clarify the distinction between nursing and medicine


Uses of Standards in Nursing Negligence or Malpractice

Standards are used as a guide State, local, or national standards Institutional policies that alter or adhere to the

nursing standards of care Expert opinions on appropriate standards of care Available literature substantiating current

standards


INFORMED CONSENT


Informed Consent

Without informed consent many medical procedures could be considered battery

Consent to treatment by the client gives the health-care personnel the right to deliver care without fear of prosecution


Informed Consent

The physician obtains the consent Gives the client the information States the risks and advantages

The nurse may be involved in the process by gaining signatures on the appropriate forms


Helpful Hints A mentally competent adult has voluntarily

given consent The client understands exactly what he or

she is consenting to The consent includes the risks, alternative

treatments, and outcomes The consent is written


STAYING OUT OF COURT


Prevention

Keep yourself informed about new information related to your area of practice

Insist that the health-care institution keep personnel informed of all changes in policies and procedures and in the management of new technological advances


Prevention

Always follow the standards of care or practice for your institution

Delegate tasks and procedures to appropriate personnel

Identify clients at risk for problems such as falls or the development of decubiti


Prevention Establish and maintain a safe environment Document precisely and carefully Write detailed incident reports File incident reports with appropriate

personnel and departments Recognize client behaviors that may cause

problems


COMMON CAUSES OF NEGLIGENCE


Common Causes of Negligence

Client falls Equipment injuries Failure to monitor Failure to communicate Medication errors Medical errors


AVOIDING MEDICATION ERRORS


Medication Errors Right drug Right dose Right route Right time Right client Right documentation


APPROPRIATE DOCUMENTATION


Tips for Credible Documentation

Contemporaneous Accurate Truthful Appropriate


COMMON ACTIONS LEADING TO MALPRACTICE SUITS


The 6 Fs Failure to appropriately assess a client Failure to report changes in client status Failure to document in the client record Failure to obtain informed consent Failure to report a coworker’s negligence Failure to provide adequate education


The 2 Big Bad Ones

Altering or falsifying a record Violation of an internal or external standard

of practice


If a Problem Arises

When served with a complaint, immediately contact legal counsel

Never sign any documents without legal counsel

Notify your malpractice carrier if covered; notify your institution immediately

Keep all correspondence: written and verbal


END-OF-LIFE DECISIONS


End-of-Life Decisions

DNR orders Advance directives The “living will” Durable power of attorney Health-care surrogate


Mandatory Overtime

Increased demand due to nursing shortages

Physical and mental fatigue Increased physical and emotional stress Decreased concentration


Licensure

In the United States, granted through the state government via state boards of nursing (NCLEX-RN)


Qualifications for Licensure

Graduation from an approved nursing program

English proficiency Disclosure of criminal conviction


NCLEX-RN Examination

Computerized Adaptive Testing (CAT) Minimum and maximum number of

questions Regulated length of time to complete the

examination


NCLEX-RN Examination

Based on client needs and the nursing process

Multiple choice and alternative item formats Fill in the blank Drag and drop


Preparing for the NCLEX-RN

Review courses Review books Videos DVDs


Moving?

Endorsement Multistate licensure


Disciplinary Action State boards of nursing Major Issues:

Falsifying documents Felony Drugs or alcohol Functioning outside the scope of practice Abuse


Conclusion Nurses need to be aware of the Nurse

Practice Act in their states Nurses need to familiarize themselves with

their institutions’ standards of care Nurses need to understand the most

common causes of negligence Nurses need to document accurately and

appropriately

essentials of nursing leadership & management, 4th edition

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