Ethic and Legal Flashcards
California Board of Registered Nursing
✅ The California Board of Registered Nursing (BRN) is responsible for regulating registered nurses (RNs) and certified advanced practice nurses in the state of California.
✅ The board ensures that nurses meet professional standards and are competent to practice safely.
✅ Nurses can visit the official website at www.rn.ca.gov for up-to-date regulations, licensing, and disciplinary actions.
Nurse Practice Acts (NPA)
✅ Each state has its own Nurse Practice Act that legally defines the scope of nursing practice within that state.
The NPA is broad enough to be applied to the dynamic nature of nursing practice and allows for interpretation.
It outlines what nurses can and cannot do in the course of patient care.
✅ Example: In many states, nurses are permitted to administer medications but cannot perform surgery or diagnose conditions—those tasks fall under other healthcare providers’ responsibilities.
✅ The NPA includes educational requirements, licensing criteria, and disciplinary actions for failure to comply with regulations.
Disciplinary action can include revocation of the license, suspension, or fines for unprofessional behavior or malpractice.
✅ DO NOT practice beyond your scope: Nurses must understand their limitations and not perform tasks outside their legal boundaries. Example: A nurse who attempts to administer a new, experimental drug without proper training or approval could face legal consequences.
✅ Excludes unlicensed persons from practicing nursing, meaning only licensed nurses are authorized to perform specific nursing duties.
Areas of Direct and Indirect Patient Care
✅ Nurses are responsible for providing both direct and indirect patient care within their scope.
Direct Care: Involves hands-on patient care, such as administering medications, performing physical assessments, and monitoring vital signs.
Indirect Care: Involves behind-the-scenes work, such as documenting patient data, coordinating care, and communicating with other healthcare providers.
✅ Example: A nurse might administer an IV drip (direct care), while also updating the patient’s medical record (indirect care).
✅ Examples of tasks included in nursing practice:
Medication administration: Administering prescribed medications, following proper protocols.
Immunizations: Nurses administer vaccines and maintain immunization records.
Skin tests: Performing routine tests for allergies or tuberculosis screening.
Recognizing changes in patient status: Identifying changes in a patient’s health condition that require urgent intervention (e.g., recognizing signs of sepsis or heart attack).
✅ Carrying out physician orders: Nurses are expected to critically examine physician orders to ensure they are correct and safe.
Example: A nurse should double-check a medication order for the right dose and patient before administration.
Verbal and telephone orders: Nurses must be clear, precise, and confirm orders to prevent errors.
Nurse Advocacy (Title 16, Section 1443.5)
✅ Nurses act as patient advocates, ensuring that the patient’s rights, preferences, and wishes are respected throughout their care.
✅ Advocacy involves:
Initiating action to improve healthcare when necessary, especially when decisions conflict with the patient’s best interest.
Giving patients the opportunity to make informed decisions about their care.
✅ Example: If a doctor recommends a treatment plan the patient feels uncomfortable with, the nurse might discuss alternative options and ensure the patient’s voice is heard.
The nurse should support the patient in asking questions and understanding their treatment options.
✅ Title 16, Section 1443.5 emphasizes that the nurse initiates actions to protect patients, which could involve reporting unsafe practices or challenging policies that negatively impact patient care.
Informed Consent
📌 1️⃣ Protects Both the Patient & Health Care Provider
✅ Informed consent is a legal and ethical requirement that ensures the patient understands the treatment and gives voluntary permission for procedures.
✅ It protects the healthcare provider from liability by ensuring the patient agrees to treatment knowledgeably.
📌 2️⃣ Essential Elements of Informed Consent
✅ 1. Disclosure – The patient must be informed of the description, purpose, risks, benefits, and alternatives of the procedure.
✅ 2. Comprehension – The patient must understand the information provided.
✅ 3. Competence – The patient must be competent to make the decision.
✅ 4. Voluntariness – The patient must give consent voluntarily, free from coercion or pressure.
✅ 5. Right to Refuse – The patient has the right to refuse any treatment at any time.
✅ 6. Right to Revoke – The patient can withdraw consent at any point before or during the procedure.
📌 3️⃣ Elements of Disclosure
✅ The healthcare provider must disclose the following information to the patient:
Description of Procedure – What will be done during the procedure.
Purpose of Procedure – Why the procedure is necessary.
Risks and Benefits – Potential risks and expected benefits.
Alternatives to Procedure – Other options available, including not having the procedure.
Consequences of Not Having the Procedure – Risks of refusing the procedure.
📌 4️⃣ Nurse’s Legal Responsibilities in Informed Consent
✅ Nurses do not obtain informed consent—this is the responsibility of the person performing the procedure (e.g., physician).
✅ Nurses have the responsibility to:
Witness/confirm the patient’s signature on the consent form.
Ensure consent is documented in the patient’s chart prior to the procedure.
Answer patient’s questions related to the procedure, but do not provide detailed disclosure about the procedure.
Clarify understanding and ensure voluntariness—confirm the patient feels no pressure.
Patient’s Bill of Rights (Renamed The Patient Care Partnership)
📌 1️⃣ Key Expectations in Patient Care
✅ High-quality hospital care: Patients are entitled to receive care that meets high standards and is competent.
✅ A clean and safe environment: Ensuring the hospital environment is clean, safe, and conducive to patient healing.
✅ Involvement in your care: Patients have the right to be informed and involved in decision-making about their treatment and care.
✅ Protection of privacy: Ensuring confidentiality and respect for personal information.
✅ Help preparing you and your family for when you leave the hospital: Discharge planning and transition of care support.
✅ Help with your bill and filing insurance claims: Patients have the right to assistance with billing and insurance issues to ensure they are not financially burdened unfairly.
📌 2️⃣ Right to Privacy & Confidentiality
✅ The Patient’s Bill of Rights (1972) and the Patient Care Partnership (2003) ensure patient privacy and confidentiality.
✅ Strategies to Protect Confidentiality:
Institutional protocols/forms: Hospitals have specific policies and confidentiality agreements to protect patient information.
Personal strategies: Nurses should adopt a toolbox of personal strategies for maintaining confidentiality, including locking patient files, using secure communication, and adhering to HIPAA guidelines.
📌 3️⃣ Nurse’s Responsibility
✅ Nurses play a vital role in ensuring patients’ rights are respected, including protecting privacy and ensuring informed consent.
✅ Examples of nurse responsibilities:
Ensuring patient confidentiality by safeguarding medical records and only sharing information with those directly involved in care.
Advocating for patients’ rights, ensuring they understand their rights to care and involvement in decision-making.
Assisting with discharge planning to ensure patients have a smooth transition from hospital to home.
✅ Nurses also help patients navigate billing and insurance issues when needed, ensuring they have access to resources and support.
What is Liability?
✅ Liability is a legal obligation or responsibility nurses have to act within the scope of their practice and meet professional standards.
✅ Example: A nurse must ensure they follow hospital policies, use proper techniques, and maintain patient safety.
Malpractice/Negligence
✅ Malpractice and negligence occur when a nurse fails to meet the accepted standard of care, resulting in patient harm.
✅ The following elements must be proven to establish liability for malpractice:
Duty – The nurse had a legal duty to care for the patient.
Breach of Duty – The nurse failed to meet the standard of care (e.g., incorrect medication administration).
Causation – The breach of duty directly caused harm to the patient (e.g., medication error led to patient complications).
Damages – The patient must show that harm or injury occurred due to the nurse’s actions (e.g., physical injury, emotional distress, or financial loss).
Student Nurse Responsibilities
✅ You are responsible for your own actions: As a student nurse, you must act within your scope of practice and follow the same standards as an RN.
✅ You are held to the standard of a Registered Nurse (RN): While you work under supervision, your actions are still subject to liability if harm occurs.
✅ Do not attempt anything for which you are unsure of the procedure: Always ask for guidance if you are unsure about any aspect of patient care.
✅ Example: If you are unsure how to properly perform a procedure, do not attempt it without first verifying the correct technique with your instructor or an RN.
✅ Read the relevant sections in Chapter 7 (Pg. 141) to familiarize yourself with the legal and ethical responsibilities as a student nurse.
What is Accountability?
✅ Accountability refers to personal and professional responsibility. It means being answerable for your actions, decisions, and the care you provide.
What Are You Accountable For?
✅ Adequate Training/Knowledge: Nurses must have the skills and knowledge to perform tasks safely and effectively.
Example: A nurse is accountable for ensuring they are trained on new equipment before using it.
✅ Accurate and Timely Documentation: Nurses must ensure that patient records are accurate, complete, and updated on time.
Example: Failing to document medication administration can result in errors and missed opportunities to monitor patient response.
✅ Integrity: Acting with honesty and adherence to ethical principles in all professional interactions.
Example: Reporting a medication error honestly, rather than attempting to cover it up.
✅ Truthfulness: Being transparent and honest in your communication with patients, families, and colleagues.
Example: If a patient asks about their prognosis, being truthful, while being compassionate.
✅ Responsibility for Your Actions and Words: Nurses must take ownership of their decisions, whether it’s administering treatment, giving advice, or speaking with patients.
Example: If a nurse provides advice on a treatment plan, they must be knowledgeable and accurate in their response.
Competent Practice in Nursing
📌 1️⃣ Competent Practice Protects from Malpractice/Legal Problems
✅ Competent practice ensures that nurses provide safe, effective, and legally sound care to patients, minimizing the risk of malpractice.
✅ It is the nurse’s responsibility to meet professional standards and practice in a competent manner to avoid legal and ethical issues.
📌 2️⃣ Standard of Care
✅ The standard of care is a set of guidelines and expectations for nursing practice, ensuring that patients receive appropriate and safe care.
✅ Nurses must adhere to these standards to provide high-quality care and avoid negligence or malpractice.
Example: Administering medications according to safe practice guidelines.
📌 3️⃣ Nurse Practice Act
✅ The Nurse Practice Act defines the scope of practice for nurses, ensuring they operate within their legal boundaries.
✅ Nurses must understand their state’s Nurse Practice Act to ensure their practice is legally compliant.
📌 4️⃣ Follow Policies and Procedures
✅ Facility policies and procedures are in place to standardize care and ensure safety.
✅ Nurses must follow institutional policies and hospital protocols to prevent errors and ensure the best outcomes for patients.
Example: Following the medication administration protocol to prevent medication errors.
📌 5️⃣ Keep Current
✅ Continual education is necessary to ensure nurses remain up-to-date on current practices, technology, and regulations.
✅ Attending workshops, certifications, and continuing education help maintain competence.
Example: Completing training on new electronic health record systems or updated clinical guidelines.
📌 6️⃣ Assess Timely and Accurately
✅ Frequent and accurate assessments are essential in identifying changes in patient condition.
✅ Nurses must assess patients in a timely manner and provide interventions based on clinical findings.
Example: Monitoring vital signs regularly to detect early signs of complications.
📌 7️⃣ Document Accurately
✅ Accurate documentation is crucial for patient safety and legal protection.
✅ Nurses must ensure that all care provided is recorded promptly, correctly, and in accordance with hospital policies.
Example: Documenting all assessments, medications, and any changes in patient status to maintain a clear and legal record of care.
Values
✅ Values are beliefs about the worth of something such as a person, an idea, or an action.
✅ They often guide behavior and influence decisions and actions.
Example: A nurse who values honesty will be truthful with patients and colleagues about treatment options.
Value Systems
✅ A value system is an organization of values into a personal or organizational code of conduct.
✅ Example: A nurse may prioritize compassion, professionalism, and patient safety in their personal value system.
Value Development
✅ Value development occurs over a lifetime through value transmission (e.g., from family, culture, education).
✅ Example: A nurse may develop a strong sense of social responsibility as they learn about the importance of equitable healthcare throughout their career.
Altruism
✅ Concern for the well-being of others.
✅ Example: A nurse advocates for a patient’s needs, wants the best outcome for them, and mentors other nurses to improve care.
Autonomy
✅ The right to make one’s own decisions.
✅ Nurses provide information to patients to support informed decision-making and respect patients’ decisions in the care process.
Human Dignity
✅ Respect for the inherent worth of all patients.
✅ Nurses provide culturally competent and sensitive care, ensuring that patients’ privacy and confidentiality are protected.
Example: A nurse listens to and respects the patient’s cultural background when planning care.
Integrity
✅ Acting honestly and ethically in all situations.
✅ Nurses provide honest, accurate information and document care honestly.
✅ They are accountable for their own practice and decisions.
Social Justice
✅ Ensuring equal treatment for all.
✅ Nurses support fairness, promote universal access to care, and engage in policy and legislation to positively influence healthcare decisions.
Values Clarification
✅ Values clarification is a process of coming to understand our own values and value systems.
✅ It helps nurses understand their own beliefs, making it easier to respect and care for patients with differing values.
How Do We Clarify Our Values?
✅ Clarification Exercise: Nurses engage in self-reflection, discuss ethical dilemmas, and consider the impact of their values on their practice.
Example: A nurse may reflect on their values during a patient conflict regarding treatment choices, gaining clarity on how to support the patient’s preferences.
Potential Sources of Conflict in Nursing
📌 1️⃣ Nurses and Patients
✅ Conflicts can arise when patient preferences or values conflict with nursing practice or institutional policies.
Example: A patient who refuses treatment due to religious beliefs, while the nurse may feel compelled to encourage life-saving treatment.
📌 2️⃣ Nurses and Coworkers
✅ Conflicts can occur between nurses and other healthcare staff due to differences in communication, workload distribution, or professional disagreements.
Example: A nurse may disagree with a coworker’s approach to patient care, leading to tension and possible teamwork breakdown.
📌 3️⃣ Religion
✅ Religious beliefs may create conflicts between nurses and patients or coworkers, especially when treatment choices clash with religious convictions.
Example: A nurse may be tasked with caring for a patient who refuses blood transfusions based on religious beliefs, which can lead to emotional and ethical dilemmas.
📌 4️⃣ Culture
✅ Cultural differences between the nurse and the patient or coworkers can lead to misunderstandings or conflicts regarding care preferences or communication styles.
Example: A nurse may not understand a patient’s cultural practice, such as dietary restrictions or traditional healing methods, leading to miscommunication.
📌 5️⃣ Personal Values
✅ Nurses may experience internal conflict when their personal values do not align with patient needs or institutional practices.
Example: A nurse may have strong personal beliefs about end-of-life care that conflict with a patient’s decision to pursue aggressive treatment.
📌 6️⃣ Moral Compass
✅ Conflicts may occur when a nurse’s moral beliefs about right and wrong differ from the expectations or policies of the institution or other healthcare professionals.
Example: A nurse may feel morally conflicted about assisting with a procedure that goes against their personal ethics, such as a patient-initiated euthanasia request.
📌 7️⃣ Nurses and Physicians
✅ Conflicts can arise between nurses and physicians due to disagreements over treatment plans, communication breakdowns, or different approaches to care.
Example: A nurse may disagree with a physician’s prescription, questioning its appropriateness for the patient’s condition.
📌 8️⃣ Nurses and Institutions
✅ Institutional policies and hospital regulations may cause conflict if they conflict with the nurse’s professional judgment or the patient’s wishes.
Example: A nurse may feel pressured to follow hospital protocol even when it contradicts the patient’s personal wishes or clinical needs.
Ethics in Nursing
📌 1️⃣ Definition of Ethics
✅ Ethics is a systematic inquiry into the principles of right and wrong conduct, examining issues like virtue, vice, and what is considered good or evil as they relate to individual and professional behavior.
Example: Ethical principles guide a nurse’s decisions regarding patient care, ensuring actions align with what is morally right.
📌 2️⃣ Professional Code of Ethics
✅ The professional code of ethics serves as a guideline for nurses in making ethical decisions in their practice.
Example: The American Nurses Association (ANA) Code of Ethics outlines principles such as autonomy, beneficence, justice, and fidelity, helping nurses navigate ethical dilemmas in patient care.
It emphasizes the nurse’s role as an advocate, ensuring patients’ rights and confidentiality are upheld.
📌 3️⃣ Ethics Committees
✅ Ethics committees are multidisciplinary groups formed in healthcare institutions to assist in resolving complex ethical issues.
They review ethical dilemmas, discuss difficult cases, and offer guidance on treatment decisions, particularly in end-of-life care, organ donation, or conflicts between family and medical staff.
Example: An ethics committee might be involved in a case where a patient’s right to refuse life-saving treatment conflicts with the family’s desire for intervention.
