Exam #2

Question 1

HIPAA

Answer 1

1996 Health Insurance Portability & Accountability Act (HIPAA)
Requires all health providers, including Doctors, Hospitals, health plans, pharmacies, public health, Insurance Companies, billing agents, information sales, Service Providers, to ensure the privacy and confidentiality of patients.
HIPAA regulations require several major patient protections:
§ Patients are able to see and obtain copies of their medical records, generally within 30 days of their request, and to request corrections if they detect errors. Providers may charge patients for the cost of copying and mail the records.
§ Providers must give patients written notice describing the provider’s information practices and explaining patients’ rights. Patients must be asked to agree to these practices by signing or initialing the notice.
§ Limitations are placed on the length of time records can be retrieved, what information can be shared, where it can be shared, and who can be present when it is shared.
§ Patient Protections
· Pts are able to see/obtain their medical records within 30 days and require changes if there are errors
· Providers must give pts written notice describing the provider’s information practices and explain pt rights. Pt must agree to these practices by signing the notice
Limitations are placed on the length of time records can be retrieved, what information can be shared, where it can be shared, and who can be present when it is shared

Question 2

American Legal System

3 Seperate but equal Branches:

Answer 2

1) Executive Branch Charged to implement the law (the president is
the highest power)
2) Legislative branch- Charged to create the law ( US Congress)
3) Judicial branch Charged to interpret the law (Supreme Court)

Question 3

3 types of law:

Answer 3

Common
Statutory
Administrative

Question 4

Common Law

Answer 4

Decisional, meaning the judges’ ruling becomes the law.

Question 5

Statutory Law

Statues

Answer 5

Are those established through a formal legislative processes.

Question 6

Administrative Law

Answer 6

results when the legislative branch of the government delegates authority to government agencies to create laws that meet the intent of a statute. Both federal and state administrative laws have the force and effect of statutory law. When a person violates the regulation and rules established by administrative law.
Example: when a nurse practices without a valid license or beyond the scope of nursing practice.
This will be reviewed by the State Board of Nursing.

Question 7

Civil Law

Answer 7

recognizes and enforces the rights of the individuals in a dispute over legal rights or duties of the individual in relation to one another.
Example: the party judged responsible for the harm may be required to pay compensation to the injured party.

Question 8

Criminal Law

Answer 8

involves public concerns regarding an individuals unlawful behavior that threatens society.
Example: Murder, Robbery, Kidnapping, or domestic violence.

Question 9

Purpose of licensing

Answer 9

To protect the public health, safety, and welfare

Question 10

State Boards of Nursing & Legislative (SBN)

Answer 10

regulatory bodies by which nursing practice acts are administered and enforced. They regulate nursing to protect the public from harm by unprepared or incompetent practitioners.
• Administrative Law
• Legislature establishes and amends laws regarding nursing practice.
• The legislature delegates authority to enforce the law to an executive agency
– board of nursing.
• The board of nursing enforces the laws and publicizes rules and regulations
that expand the law.
• The executive branch (both federal and state) administered and implements
the law (the governor is the highest state office—they generally delegate the
responsibility for administering the nursing practice act to the SBN)
• SBN- agency charged with executing laws—usually consists of RNs, LPNs.
CANNOT enlarge the law, but can clarify general provisions of the nursing
practice act
• SBN functions:
• Executive- with the authority to administer the nursing practice act.
o Legislative- authority to adopt rules (rules are different from Laws)necessary
to implement the act.
o Judicial- authority to deny, suspend, or revoke a license or to otherwise
discipline a licensee or to deny the application for licensure.
The state boards of nursing have the power to sanction a nurse for performing professional functions that are dangerous to the patient or the general public.
• Probation
• Suspension
• Revocation
Most common reason for disciplining nurses: Practicing while under the influence of alcohol or drugs (diverted from the workplace).
• Rehabilitation of Nurses Who Are Impaired by Mental Health Issues or Substance Abuse.

Question 11

Nursing practice acts

Answer 11

in each state accomplish at least 4 objectives
• Defines the practice of professional nursing
• Sets the minimum educational qualifications and other requirements for licensure
• Determines the legal titles and abbreviations nurses may use
• Provides for disciplinary actions of licensees for certain causes.
• Once the law regarding nursing practice is established or amended by the legislature, the legislative branch delegates authority to enforce the law to an executive agency, usually the State Board of Nursing (SBN). SBNs are responsible for enforcing the nursing practice acts in the various states.
• defines and controls nursing
• In many states, NPA is a statutory law affecting nursing practice within the bounds of the state.
• The NPA is important to professional nurses.
• ANA and NCSBN have developed and suggested language for the content of state NPA.

Question 12

What is the State Nurse Practice Act and why is it important:

Answer 12

One of the most significant definitions of nursing is contained in the nursing practice act of the state in which a nurse practices. Regardless of how restrictive or permissive it may be, the definition contained in a nursing practice act constitutes the legal definition of nursing in a particular state. Professional nurses must maintain familiarity with the latest version of the act

Question 13

Define: Nursing

Answer 13

“the protection, promotion and optimization of health and ability, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations” (ANA, 2015b)

Question 14

6 Contemporary Nursing Practices:

Answer 14

• Provision of a caring relationship that facilitates health and healing
• Attention to the range of human experiences and responses to health and
illness within the physical and social environments
• Integration of objective data with knowledge gained from an appreciation of
the patient or group’s subjective experience
• Application of scientific knowledge to the processes of diagnosis and
treatment through the use of judgment and critical thinking
• Advancement of professional nursing knowledge through scholarly inquiry
• Influence on social and public policy to promote social justice.

Question 15

Code of Ethics for Nurses (ANA, 2015a):

Answer 15

“Nursing encompasses the prevention of illness, the alleviation of suffering, and the protection, promotion, and restoration of health in the care of individuals, families, groups, and communities”

Question 16

Henderson’s Definition of

Nursing

Answer 16

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. (Henderson, 1960, p. 3)

Question 17

National Council of State Boards of Nursing: (NCSBN)

American Nurses Association (ANA) ANA’s Model practice Act

Answer 17

serves as a guide to state nurses associations seeking revisions in their nursing practice acts. 1996 ANA Model Practice Act – encourages consideration of the many issues inherent in a nursing practice act and the political realities of the state legislature and regulatory processes.
ANA recommends that they include:
1.) clear differentiation between advanced and general nursing practice
2.) authority of boards of nursing to regulate advanced nursing practice
3.) including authority for prescriptive writing and to oversee unlicensed assistive personnel
4.) clarification of nurses responsibilities for delegation to and supervision of other personnel.
5.) Support for mandatory licensure.

Question 18

National Council of State Boards of Nursing: (NCSBN)

Answer 18

is a not-for-profit organization whose members include the boards of nursing in the 50 states, the District of Columbia and four U.S. territories. provides education, service, and research through collaborative leadership to promote evidence-based regulatory excellence for patient safety and public protection.

Question 19

Executive Authority of State Boards of Nursing:

Answer 19

The state boards of nursing authority is limited.
• They can adopt rules that clarify general provisions of NPA.
• They do not have the authority to enlarge the law.
Functions of state boards of nursing:
• Executive – authority to administer the nursing practice act
• Legislative – authority to adopt rules necessary to implement the act
• Judicial – authority to deny, suspend, or revoke a license or to discipline a
licensee or to deny an application for licensure

Question 20

Mandatory law

Answer 20

requires anyone who practices the profession to be licensed.

Question 21

Permissive laws

Answer 21

protects and limits the use of the title granted in the law, but does not prohibit persons from practicing the profession or occupation if they do not use the title.

Question 22

Licensing Powers

Answer 22

All states have a mandatory licensure law for the practice of nursing to safeguard the public. Thus, only licensed nurses – RN or LVN/LPN – can practice nursing.
• The state boards of nursing have the authority to set and enforce minimum criteria for nursing education criteria.
• An applicant for licensure must graduate from a state-approved nursing education program.
o Schools of nursing must have state-approval to operate.
o State-approvals are less stringent than national accreditation standards.
Some states are undertaking rule changes to require nursing programs to have national accreditation to achieve state approval.

• The practice act stipulates that an applicant for licensure must graduate from a state-approved nursing education program as a prerequisite to being admitted to the licensure exam.
• Schools always have to have state approval, but can voluntarily seek national accreditation
• The state boards of nursing has the power to sanction a nurse for performing professional functions that are dangerous to the patient or general public.
• Probation
• Suspension
• Revocation
Most common reason for disciplining nurses: Practicing while under the influence of alcohol or drugs (diverted from workplace).
• Rehabilitation of Nurses Who Are Impaired by Mental Health Issues or Substance Abuse.
• ANA (1990) and Nursing Disciplinary Diversion Act
• NCSBN (2015) Substance Abuse Disorder in Nursing
• A comprehensive resource to assist with evaluation, treatment, and management of nurses with substance problem
• Nurses misuse drugs and alcohol at approximately the same rate 10–15% as the general population.
• Goal of state boards of nursing: Return the nurse with drugs and alcohol misuse to safe practice

Question 23

Substance Abuse by Nurses

Answer 23

Most common is reason for disciplining nurses is alcohol and drugs-Practicing while under the influence of alcohol or drugs. Rehabilititation of Nurses who are impaired by mental health issues or substance abuse.
ANA(1990) and Nursing Disciplinary diversion Act
NCSBN (2015) Substance Abuse Disorder in Nursing.
• A comprehensive resource to assist with evaluation, treatment, and
management of nurses with substance problem
• Nurses misuse drugs and alcohol at approximately the same rate 10–15% as
the general population.
• Goal of state boards of nursing: Return the nurse with drugs and alcohol
misuse to safe practice

Question 24

Licensure examination

Answer 24

NCLEX-RN- National Council Licensure EXamination for Registered Nurses.
• The licensure exam is updated regularly and tests critical thinking and nursing competence in all phases of the nursing process.
• Computerized adaptive testing
• Minimum: 75. Maximum: 265
• Duration: 6 hours

Question 25

Licensure by Endorsement

Answer 25

All states recognize the NCLEX-RN passing the test allows for:
• Endorsement – the RN may practice in different states without having to take another licensing exam
• Requirements:
• Proof of licensure in another state
• Licensure fee

Question 26

Nurse Licensure Compact

Answer 26

• The compact allows nurses to have one license yet practice in another compact state without additional licensure in the state of employment. 24 states with 6 pending, and 1 enacted.
• NCSBN (2000) developed the nurse licensure compact.
• 2015: NLC has been adopted by 24 states
o 6 states (Illinois, Massachusetts, Minnesota, new Jersey, New York, and Oklahoma) with pending legislation
o 1 state (Montana) has enacted but implementation is pending.
• Each state that wishes to participate in the compact must pass legislation
enabling the board of nursing to enter into the interstate NLC.
• Nurses licensed in a compact state can practice in their own state and in any
other compact state without applying for licensure by endorsement.
• A nurse, who is licensed in a compact state and changes permanent
residence, may practice under the license from former state of residence for
up to 90 days.
2005: NCSBN began administering licensure exams internationally to recruit nurses from outside the United States

Question 27

Legal Risks in Professional Nursing Practice

Answer 27

Malpractice

Professional Negligence

Question 28

Malpractice

Answer 28

occures when a professional fails to act as a reasonably prudent professional would have acted under the same circumstances

Question 29

Professional Negligences

Answer 29

(malpractice) may occur by:
Commission
Omission

Question 30

Comission

Answer 30

Doing something that should not have been done

Question 31

Omission

Answer 31

Failing to do things that should have been done.

Question 32

Nursing Standard of Care

Answer 32

is “What a reasonable prudent nurse, under similar circumstances, would have done.”

Question 33

Standard of Care

Answer 33

basic minimum level of prudent care based on the ethical principle of non-maleficence (“do no harm”)

Question 34

Prevailing

Answer 34

is ascertained through expert witness testimony, documents (including national standards of practice), Patient record, and other pertinent evidence (direct testimony of the patient, nurse and others).

Question 35

2 requirements for Malpractice Action:

Answer 35

The defendant (nurse):
• Has the specialized knowledge and skills
• Causes the plaintiff’s (patient’s)
-injury through the practice of that specialized knowledge and skills

Question 36

Four Elements of a Cause of Action for Negligence

Answer 36

The professional (nurse) has assumed the duty of care (responsibility for the patient’s care).
• The professional (nurse) breached the duty of care by failing to meet the standard of care.
• The failure of the professional (nurse) to meet the standard of care was the proximate cause of the injury.
• The injury is proved.

Question 37

“Captain Of the Ship”

Answer 37

doctrine implies that the physician is ultimately in charge of all patient care and thus should be responsible financially.

Question 38

Respondeat superior

Answer 38

(from Latin, meaning “let the master answer”) attributes the acts of employees to their employer.

Question 39

Croke (2003)

Answer 39

Paper that analyzed cases– review of 350 trial, appellate, and supreme court cases summaries . The cases where held between 1995 -2001.
Criteria:
• A nurse was engaged in the practice of nursing as defined by his or her
state’s nurse practice act.
• A nurse was a defendant in a civil lawsuit as the result of an unintentional
action (no criminal cases were considered).
60% occurred in acute care hospitals
• Six major categories of negligence resulted in malpractice lawsuits against
nurses
• 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

Question 40

Delegation

Answer 40

Professional nurses may delegate independent nursing activities (as well as medical functions that have been delegated to them) to other nursing personnel.
• State nurse practice acts do not give LPNs or LVNs the authority to delegate.
• Professional RNs retain accountability for acts delegated to another person.
• The RN is responsible for determining that the delegated person (delegatee) is competent to perform the delegated act.
• The delegatee is responsible for carrying out the delegated act safely.
• The professional nurse remains legally liable, however, for the nursing acts delegated to others unless the delegatee is also a licensed professional whose scope includes the assigned act.
• Example:
▪ An RN can assign an unlicensed CNA who has been properly trained to take vital signs of all the patients under the RN’s care. The nursing assistant cannot, however, reassign this responsibility to another person.
▪ The RN remains accountable for the data that the CNA collects, because it is not the CNA’s responsibility, nor is it within his or her training, to interpret those data.
▪ However, if the RN asks another RN to take the vital signs of a patient, and the second RN agrees, the second RN then becomes responsible for carrying this out, interpreting the data, and acting on them accordingly.

• Giving someone authority to act for another-
• RNs have power, LPNs do not
• RN retain accountability for acts delegated to another person

Question 41

5 Rights to Ensure Safe Delecgation

Answer 41

1) Right task
2) Right Circumstances
3) Right Person
4) Right Direction-communication
5) Right supervision/evaluation

Question 42

Delegation and ethical implications

Answer 42

ANA’s Code of Ethics for Nurses, Provision 4.4 Delegation of Nurse Activities (2015) states,
• “The nurse must make reasonable efforts to assess individual competence when assigning selected components of nursing care to other healthcare workers. This assessment involves evaluating the knowledge, skills, and experience of the individual to whom the care is assigned, the complexity of the assigned tasks, and the health status of the patient
• Nurses may not delegate responsibilities such as assessment and evaluation; they may delegate tasks. ….
• Employer policies or directives do not relieve the nurse of responsibility for making judgments about the delegation and assignment of nursing care tasks” (p. 2).
• The Code of Ethics is clear that workplace policies or directives do not supersede the ethical standards described in the Code.

Question 43

Informed Consent

Answer 43

• All patients/family must be given opportunity to grant informed consent before treatment (unless life threatening emergency)
• 3 major conditions
• Consent given voluntarily
• Consent must be given by individual with the capacity and competence to understand
• Patient must be given enough information so that the locus of the decisions lies without the patient and not the providers; in other words, the provider cannot influence the patient unduly by giving incomplete information or obscuring data that the patient should have to make a truly informed decision.
• Role of nurse is to collaborate with the primary provider- the nurse may witness the signing, but is not responsible for explaining proposed treatment. Nurse is NOT responsible for evaluating risks/benefits/alternative treatment. Nurse is responsible for determining that all elements are valid for consent, providing feedback and communicating with primary provider for further information
• Completeness refers to the quality of the information provided.
• Competency takes into account the capability of a particular patient to understand the information given and make a choice.
• Voluntariness refers to the freedom the patient has to accept or reject alternatives.
• Autonomy
• Minors, under the effects of drugs and alcohol, mental deficits, and competency to consent
• Unless primary providers, nurses collaborate with the primary provider.
• A nurse may witness a patient’s signing but is not responsible for explaining the proposed treatment.
• The nurse is not responsible for evaluating whether the physician has truly explained the significant risks, benefits, and alternative treatments.
• The nurse is responsible for determining that the elements for valid consent are in place, providing feedback if the patient wishes to change consent, and communicating the patient’s need for further information to the primary provider.

Question 44

Confidentiality

Answer 44

The challenge to Protect Privacy
legal and ethical concern. Protection of private information gathered about a patient during provision of care.
The Code of Ethics for Nurses Provision 3.1 states that:
• “…the nurse has a duty to maintain confidentiality of all patient information, both personal and clinical in the work setting and off duty in all venues, including social media and any other means of communication ¼ Nurses are responsible for providing accurate, relevant data to members of the health care team and others who have a need to know” (ANA, 2015).
• The Code acknowledges exceptions to the obligation of confidentiality.
• Discussing the care of patients with others involved in their direct care, quality assurance activities, legally mandated disclosure to public health authorities, and information required by third-party payers (ANA, 2015).
• Disclosing information without the patient’s consent when the safety of innocent parties is in question (Tarasoff v. Board of Regents of the University of California, 551 P2 334, 1976).
• The principle of confidentiality is protected by state and federal statutes, but there are exceptions and limitations.
• Some professions have statutorily protected privileged communication, such as attorneys and priests, nurses are usually not included in such statutes.
• Nurses may be ordered by a court to share information without the patient’s consent.
• Based on common, state, or municipal law, nurses have the duty to report or disclose certain information such as suspected abuse or neglect of a child (or elder, in some states), gunshot wounds, certain communicable diseases, and threats toward third parties.
These laws vary by state and may be the responsibility of institutions providing health care services and not of an individual practitioner

Question 45

Assault

Answer 45

a threat or an attempt to make bodily contact with another personal without the persons consent
Assault is a threat or an attempt to make bodily contact with another person without the person’s consent.

Question 46

Battery

Answer 46

assault carried out; impermissible, unprivileged toughing of one personal by another.
Battery is the assault carried out; the impermissible, unprivileged touching of one person by another.

Question 47

Prescriptive authority

Answer 47

legal acknowledgement of prescription writing as appropriate act of nursing practice. Supported by the ANA and American Academy of Nurse Practitioners
Generalist nurses must know from whom they can accept medication prescriptions.
Advanced practice nurses must stay within their legal scope of practice.
• Prescriptive authority
• The legal acknowledgement of prescription writing as an appropriate act of nursing practice
• General nurses must know from whom they can accept medication prescriptions, and advanced practice nurses must stay within their legal scope of practice
•

Question 48

Supervision of Unlicensed Assistive Personnel (UAP)

Answer 48

Supervision of Unlicensed Assistive Personnel (UAP)
• Nursing assistants- NNAAP
• RNs must know the limitations of particular assistance personnel under their supervision
• Supervision of UAP
• UAP and risk for patient injury
• NCSBN and National Nurse Aide Assessment Program
• NCSBN: Medication Aide Certification Examination (MACE)