Ethical and legal Issues in nursing Flashcards
Professional Nursing Practice: Nurse Practice Acts
- Most important piece of legislation for nurses.
- Define the categories of nurses.
- Set educational and examination requirements.
- Establishes a state board of nursing, which develops and implements rules and regulations.
- Defines Unprofessional Conduct.
The “practice of nursing by a registered nurse” consists of the following 10 components:
a. Assessing the patient’s physical and mental health, including the patient’s reaction to illnesses and
treatment regimens.
b. Recording and reporting the results of the nursing assessment.
c. Planning, initiating, delivering, and evaluating appropriate nursing acts.
d. Teaching, assigning, delegating to or supervising other personnel in implementing the treatment regimen.
e. Collaborating with other health care providers in determining the appropriate health care for a patient but,
subject to the provisions of G.S. 90-18.2, not prescribing a medical treatment regimen or making a medical
diagnosis, except under supervision of a licensed physician.
f. Implementing the treatment and pharmaceutical regimen prescribed by any person authorized by State law
to prescribe the regimen.
g. Providing teaching and counseling about the patient’s health.
h. Reporting and recording the plan for care, nursing care given, and the patient’s response to that care.
i. Supervising, teaching, and evaluating those who perform or are preparing to perform nursing functions and
administering nursing programs and nursing services.
j. Providing for the maintenance of safe and effective nursing care, whether rendered directly or indirectly.
Nursing Licensure Compact
- RNs may be licensed in one state and practice in another state within the compact.
- The state where the patient or client resides is the state that regulates the nurse’s practice.
what is negligence
- Carelessness
- A deviation from the care that a reasonable person would deliver
what is malpractice
- “Professional Negligence”
- The failure of a person with professional education and skills to act in a reasonable and prudent
manner.
the failure to do something that the reasonable,
prudent person or nurse would have done
omission - nonintentional
acting in a way that causes injury to the patient
commission - nonintentional
Causes of Malpractice Among
Direct Care Nurses Failure to follow standards of care, including:
- Failure to use equipment responsibly
- Failure to document
- Failure to communicate
- Failure to assess and monitor
elements of malpractice
Duty/Standard of Care
Breach of Duty/Standard of Care
Causation
Damages
individual responsibility and
accountability for actions or omissions
personal liability
employer’s accountability for the
negligence of employees
vicarious liability
institution’s responsibility and
accountability for maintaining an environment that ensures quality healthcare delivery for consumers
corporate liability
Causes of Malpractice Among
Nurse Managers
- Assignment, delegation, and supervision
- Duty to orient, educate, and evaluate
- Failure to warn
- Staffing issues
- Accreditation
- Mandatory Overtime
- Floating
- Temporary Staff
- Protective and reporting laws
the transfer of both responsibility and accountability from one person to another
assignment
the transfer of responsibility, but not of accountability, for the performance of an activity
delegation
the active process of directing, guiding, and influencing the outcome of an individual’s
performance of an activity.
supervision
Duty to Orient, Educate,
& Evaluate Nurse managers:
- Are responsible for the daily evaluation of safe and competent nursing care delivery.
- Should promptly respond to all allegations of incompetent
or questionable nursing care. - Should thoroughly investigate such allegations, recommend
options for correcting situation, and follow up on recommendations.
failure to warn
- This involves warning subsequent potential employers of staff incompetence or impairment.
- Provided by using qualified privilege, which is communication made in good faith between
persons or entities with a need to know. - Also need to consider Board of Nursing or overseeing agency
Staffing Issues
Three considerations:
- Maintaining adequate numbers of staff in a time of advancing patient acuity and limited resources
- Floating staff from unit to unit
- Using temporary staff to augment current staffing numbers
Accreditation
Mandate adequate staffing with qualified personnel
Applies to both numbers of staff and staffing mix
Adequate staffing is based on:
* Numbers of patients
* Care acuity scores
* Numbers and classification of nursing staff
Mandatory Overtime
- Prohibited by several states
- Protect employees from disciplinary action or retribution for refusing to work overtime
- Establish monetary penalties for the employer’s failure to adhere to the law
Floating Staff to Alternate Units
- One means to ensure that every area of the facility is adequately staffed
- Consider staff expertise, patient care delivery systems, and patient care requirements before deciding which staff to float
- Cross-train staff during times of adequate staffing
Guidelines For Inadequate Staffing
Nurse managers in times of inadequate staffing should:
* Alert agency administration of concerns
* Reassign staff as appropriate
* Approve overtime for adequate coverage
* Restrict new admissions
Temporary Staff
- Has become more important because of the principle of apparent agency.
- Nurse managers must ensure that the agency or temporary nurse can deliver safe and competent nursing care.
Protective & Reporting Laws
Ensure the safety or rights of specific classes of individuals:
* Child and elder abuse
* Certain categories of diseases or injuries
Includes the mandatory reporting of
incompetent practitioners.
Preventing Malpractice Lawsuits:
Nurse Managers Role
- Ensure that employees meet or exceed standards of care
- Review standards periodically so that standards can be revised
- Review randomly selected patient records for evidence that standards are being met
- Perform scheduled evaluations of staff
Informed Consent
- The authorization by the patient or the patient’s legal representative to do something to the patient
- Based on legal capacity, voluntary action, and comprehension
- Allows the patient to refuse treatment
Determined by age and competency
legal capacity
Means that the patient was not
coerced into allowing the procedure or treatment.
voluntary action
The patient must be given sufficient information in terms that the patient can reasonably be expected to comprehend to make an
informed choice.
comprehension
Information Required for
Informed Consent
- An explanation of the treatment or procedure to be performed and the expected results of the treatment or procedure
- Description of the risks involved
- Benefits that are likely to result because of the treatment or
procedure - Options to this course of action, including absence of treatment
- Name of the person(s) performing the treatment/procedure
- Statement that the patient may withdraw consent at any time
Nurses Role in Informed Consent
- Serve as a witness by signing the document
- Signing means they are attesting only to the voluntary
nature of the patient’s signature - Ensure no concerns with health literacy
- Obligated to inform PCP if the patient asks questions that alert the nurse to the inadequacy of true
comprehension on the patient’s part or the expression of uncertainty
the patient’s right to protection
against unreasonable interference with reputation or right to be left alone
privacy
the right to privacy of the
medical record
confidentiality
Policies & Procedures
- Documents that set standards of care for the institution and direct practice.
- They must be clearly stated, well
delineated, and based on current
practice.
Employment Laws
- Equal Employment Opportunity Laws
- Americans with Disabilities Act of 1990
- Occupational Health and Safety Laws
- Family and Medical Leave Act of 1993
- Employment-at-Will and Wrongful
Discharge
Equal Employment Opportunity Laws
- Prohibit discrimination based on gender, age, race, religion, handicap, pregnancy, and national origin.
- Title VII of the amended Civil Rights Act of 1964 governs these equal employment opportunities.
- Amended Civil Rights Act of 1991 governs sexual harassment in the workplace.
Americans with Disabilities Act of 1990
Provides protection to persons with disabilities
Disability is defined as:
- Physical or mental impairment that substantially limits
one or more of the major life activities of an individual. - The fact that there is a record of such impairment to the
individual is regarded as establishing that the individual
has the impairment.
Occupational Safety and Health Act
Ensures that healthful and safe working conditions
exist in the workplace setting.
Newer aspects that the rules address include:
* Violence and bullying in the workplace
* Safe patient handling
* Ergonomic issues common in the healthcare industry
Family and Medical Leave Act
of 1993
Balances the demands of the workplace with the demands of the
family, allowing employed individuals to take leaves for medical
reasons
Includes care for:
* The birth or adoption of a child
* Care of a spouse, child, or parent with serious health problems
* Healthcare needs of the employed individual
Employment-at-Will and Wrongful Discharge
Historically, employment has been considered a “free
will” relationship, with the following exceptions:
Public Policy:
* Jury Duty
* Whistleblowing
* Workers’ Compensation Claims
Implied Contract
“Good faith and fair dealing”
Professional Nursing Practice: Ethics
- Concern the individual within society and the “why” of actions as opposed to what was done or not done
- Provide no right or wrong answers; rather there are better or less desirable actions
- Often encountered in conjunction with legal concerns
Ethical Principles
- Autonomy
- Beneficence
- Confidentiality
- Fidelity
- Justice
- Nonmaleficence
- Paternalism
- Respect
- Veracity
Code of Ethics
Formal statements that articulate values and beliefs of a
given profession.
Serve the following functions:
* Inform the public of the minimum standards of conduct for members of the profession.
* Outline ethical considerations of the profession.
* Provide guidelines for ethical practice by members of the profession.
* Guide the discipline’s self-regulation.
ANA Code of Ethics: Provisions 1-9
- The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
- The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
- The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
- The nurse has authority, accountability, and responsibility for nursing practice; makes decisions;
and takes action consistent with the obligation to promote health and to provide optimal care. - The nurse owes the same duty to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.
- The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conductive to safe, quality health care.
- The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing
and health policy. - The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
- The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate
principles of social justice into nursing and health policy.
Framework for Ethical Decision-Making
- Uses an orderly, systematic, and objective method
- Involves reflection on factors including intended
outcomes, resources available, professional
organizational directives, and likely and
unintended consequences.
Moral Distress
- Occurs when faced with situations in which two ethical principles compete.
- Experienced in clinical settings when nurses cannot provide what they perceive is the best care or outcome for a given patient.
- Examples include disagreements regarding patient interventions and limited patient care resources.
Moral Disengagement
- Moral distress may result in negative emotions, including anxiety, fear, sadness, and anger.
- If feelings escalate, a sense of moral disengagement may occur, leading to nursing behaviors that put patients at risk.
Provide long- and short-term assistance by:
Providing structure and guidelines for potential problems
Serving as open forums for discussion
Functioning as patient advocates by placing the patient at the core of the committee discussions
Blending Ethical & Legal Issues
- Read and comply with provisions of the State Nurse Practice Act.
- Apply legal principles in all healthcare settings.
- Understand and follow state and federal employment laws.
- Follow the Code of Ethics for Nurses
- If available, use Ethics Committees to deal with ethical dilemmas.
- Remember that no right and wrong answers exist in ethical situations,
merely better or worse solutions. Consider all aspects and consult with
others before proceeding if there are unanswered questions. - If legal and ethical issues contradict one another, legal aspects must
be adhered to first.
- Autonomy
The right of patients to make decisions about their medical care without their health care provider trying to influence the decision
- Beneficence
duty to do good, or to promote the well-being of patients
- Confidentiality
the right of patients to keep their records private and represents physicians’ and medical professionals’ moral and legal obligations
- Fidelity
faithfulness to a person, belief, or cause
- Justice
fair, equitable, and appropriate treatment of persons
- Nonmaleficence
duty to ‘do no harm’ to a patient.
- Paternalism
physician or other healthcare professional makes decisions for a patient without the explicit consent of the patient
- Respect
an integral aspect of ethics and professionalism in medicine
- Veracity
truth telling
