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Leadership > Legal and Legislative Issues Part II & Professional Advocacy (Ch. 5 & 6) > Flashcards

Legal and Legislative Issues Part II & Professional Advocacy (Ch. 5 & 6) Flashcards

1
Q

what is the Nurse Practice Act?

A

Legal instrument that defines the functions of nursing and sets standards for licensure.

It grants authority to carry out those functions.

Each state has its own NPA, but all must be consistent with provisions or statutes established at the federal level

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2
Q

Nurses are at increased legal liability in the 21st century due to:

A
  1. More authority and independence in decision making.
  2. Increased legal accountability for decision making.
  3. Doing more things that used to be in the realm of medical practice.
  4. Making more money.
  5. More of carry malpractice insurance
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3
Q

what are two types of negligence and what are the differences?

A

Ordinary negligence (the omission to do something that a reasonable person would do)

Professional negligence (also called malpractice)

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4
Q

what is the background for professional negligence?

A

Liability
Role expansion
Professional liability
Advanced practice nurses

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5
Q

what is the definition of professional negligence?

A

The failure of a person with professional training to act in a reasonable and prudent manner (also known as Malpractice).

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6
Q

what are the elements of malpractice?

A

Plaintiff

Defendant

Negligence

Reasonable & Prudent

Malpractice

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7
Q

what are the 5 elements for malpractice liability?

A
  1. Standard of Care
  2. Breach of Duty
  3. Foreseeability of harm
  4. Relationship between breach & harm
  5. Actual injury
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8
Q

what is the standard of care?

A
  • What is expected of a professional, prudent nurse
  • Appropriate care for circumstances
  • Liability: Duty to use due care
    Ex: Giving meds
    ~ Meds should be given accurately, completely & timely
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9
Q

what is the breach of duty?

A

Not giving the appropriate care for under relative circumstances.

Liability: Failure to meet standard of care

Ex: Nurse fails to administer meds accurately, completely & timely

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10
Q

what is under ordinary circumstances?

A

The question of whether a nurse acted with reasonable and prudent care is determined by the testimony of expert nursing witnesses.

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11
Q

what is foreseeability of harm?

A

Must have had the knowledge or information that not meeting the standard could pose harm.

Liability: If the reasonable person could have for seen the injury as a result of the action

Ex: Available drug info. Specifies that the wrong dosage or route may cause injury.

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12
Q

what is breach in care?

A

Direct relationship between failure to meet standard of care & injury can be proven

Liability: Failure to meet the standard of care could injure the patient.

Ex: Wrong dosage causes the patient to have a convulsion

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13
Q

what is injury?

A

The injury is more than temporary. The action caused the injury.

Liability: Actual patient injury

Ex: Convulsion or the occurrence of a serious complication

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14
Q

what is professional negligence?

A

Nurses are being sued more and more for not attempting to notify health care providers of changes in a patient’s condition or to convince the providers of the seriousness of a patient’s condition (ability to foresee harm)

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15
Q

what should be known about being sued for malpractice?

A

“Just following physician orders” is NOT a defense for malpractice.

Nurses have an independent responsibility to take appropriate steps to safeguard patients.

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16
Q

how do you avoid malpractice?

A
  • 3 Areas in the call of action
  • Healthcare in Crossroads (Joint Comm.)
    ~ Prevent Injury
    ~ Improve Communication
    ~ Examine mechanisms for injury compensation
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17
Q

what are actions to reduce malpractice claims?

A
  1. Practice in scope NPA
  2. Adhere to agency P & P
  3. Model practice on EBP
  4. Patients & rights first
  5. Know law, doctrine & basis of Nsg. Practice
  6. Practice in areas of competence
  7. Update skills & certification
    • Liability insurance*
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18
Q

what is extending liability?

A 
Joint Liability
Charitable Immunity
Vicarious Liability
Respondent Superior
Personal Liability
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19
Q

what are incident report and what should you know?

A
  1. Records of unusual or unexpected incidents that occur in the course of a client’s treatment.
  2. Reports are considered confidential and cannot be subpoenaed by clients or used as evidence in their lawsuits in most states.
  3. NEVER leave a copy of the incident report in the chart
  4. NEVER document on the nurses notes that an incident report was completed
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20
Q

what are unintentional torts (malpractice)?

A 
Assault and battery
False imprisonment
Invasion of privacy
Defamation of character
Slander
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21
Q

what is assault?

A

conduct that makes a person fearful and produces a reasonable apprehension of harm.
Ex: If you take dressing off, apply restraints

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22
Q

what is battery?

A

an intentional and wrongful physical contact with a person that entails an injury or offensive touching.
Ex: Use of restraints

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23
Q

what is false imprisonment?

A

The restraint of a person’s liberty of movement by another party who lacks legal authority or justification to do so.

Ex. Involuntary commitments to mental health facilities, keeping a patient in the hospital who wants to sign out AMA, and……

The use of physical restraints has led to claims of false imprisonment. (without proper documentation, neuro checks, supervision)

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24
Q

what are frequent causes of claims against nurses?

A
  1. Inadequate documentation
  2. Inadequate communication with physician or supervisors about changes in patient conditions
  3. Leaving potentially harmful items within patient reach
  4. Unattended patient falls
  5. Inaccurate counting of operative instruments and sponges
  6. Misidentifying patients for medications, surgeries, tests
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25
Q

what is defamation?

A

Communicating to a third party false information that injures a person’s reputation.

26
Q

what is libel?

A

When defamation is written

27
Q

what is slander?

A

When defamation is spoken

28
Q

as a legal responsibility of the manager, what is Quality Nursing Practice?

A
  1. Reporting dangerous understaffing
  2. Validating staff credentials & qualifications
  3. Implementing appropriate disciplinary actions
  4. Assure proper training on equipment
  5. Require adherence to policies & procedures
  6. Reporting inadequate care by physician
29
Q

as a legal responsibility of the manager, what is product liability?

A

Strict liability

Grey area

30
Q

what are the different types of consent?

A

Informed consent

Implied consent

Express consent

31
Q

what is informed consent? who may it be given by?

A 
Person giving consent must fully comprehend:
    ~ Procedure
    ~ Risks
    ~ Outcome
    ~ Complications & S. E’s
    ~ Alternative Treatments 
Done by Physician
Consent may be given by:
Competent adult
Legal guardian
Durable power of attorney
Emancipated or married minor
Mature minor
Parent of minor child
Court order
32
Q

what is implied consent?

A

Emergency situation

Proper documentation

33
Q

what is expressed consent?

A

Witnessing patient signing standard
Assure patient received inform consent
Remedy situation

34
Q

what is the nurse’s role in implied and expressed consent?

A

Teaching & clarification

No new info., contact Dr.

35
Q

what should be known about medical records?

A
  • Record accurate information
  • No alteration of record
  • Patient owns information
  • Facility owns record
  • Client has reasonable access to records
  • Know procedure for procuring records
  • Foster a trusting relationship
36
Q

what is the Patient Self Determination Act (PSDA)?

A

created in 1991

HCO receiving Fed. Money provide it
1. Education to staff & patients re:
    ~ Treatment & end-of-life issues
    ~ Advance Directives
           `  End of life care
           ` Durable power-of-attorney
2. AD’s must be documented in Medical record
37
Q

what is Good Samaritan Immunity?

A

Generally, a nurse is not liable for injury that occurs as a result of emergency treatment, provided that:

	* Actions are not negligent
	* Does not exceed scope of practice

Be careful with giving non-emergent care or advice to family, friends and neighbors because it is not covered

Know your state laws
LPN/RN
Non-nursing protection
Be careful with giving non-emergent care
Volunteer work
Neighbors/ Friends
38
Q

what is the Health Insurance Portability and Accountability Act (HIPAA) of 1996?

A
  • Protects privacy of health information
    • Improves the portability and continuity of health insurance coverage
    Liability:
    Invasion of privacy
    Defamation & slander
    Managers enforce compliance & changes
39
Q

what are legal considerations of managing a diverse workforce?

A

` Respect for other cultures
` Cultural sensitivity
` Self/staff awareness of cultural bias
` Comprehensive cultural diversity program
` Role model cultural sensitivity
` Language diversity
` Civil Rights (Title VII)- discrimination
` Lack of promotion & unfair assignments may occur with minority employees

40
Q

what is the Board of Registered Professional Nursing (BON)?

A 
protects citizens by:
 ` RN licensing
 ` Monitoring of RN educational standards
 ` RN continuing education
 ` Disciplining RNs
41
Q

what should be known about licensure?

A

Nurses who violate specific norms of conduct, license can be suspended, or revoked:
~ Securing a license by fraud
~ Performing specific actions prohibited by the NPA
~ Exhibiting unprofessional or illegal conduct
~ Performing malpractice
~ Abusing alcohol or drugs

If you have been found guilty of a crime, you HAVE to report this to the Board of Nursing within 30 days (state of Florida)

Other states, different rules apply

Suspension and revocation proceedings are administrative laws
Following a complaint, the board of nursing completes an investigation.
Most of the investigations reveal no grounds for discipline
If the investigation, supports the need for discipline, nurses are notified of the charges and are allowed to prepare a defense.

At the hearing, which is very similar to a trial, the nurse is allowed to present evidence.
Based on the evidence, an administrative law judge makes a recommendation to the state board of nursing, which makes the final decision.
The entire process, from complaint to final decision may take up to 2 years

42
Q

when Integrating L & M Functions in Legal & Legislative Issues, what should be known about the leader?

A

Role model highest standards of care
Maintain expertise & certification
Vision, risk taking & energy
Active member in professional organization

43
Q

when Integrating L & M Functions in Legal & Legislative Issues, what should be known about the manager?

A

Promote self & subordinates practice is legal
Know & uphold current laws & doctrines
Fair & non-discriminatory

44
Q

what should be known about integrated L&M?

A

Patients needs & welfare priority

Caring, respect & honesty

45
Q

what is the definition of advocacy?

A

helping others to grow and self-actualize

46
Q

what are the actions of an advocate?

A

To inform others of their rights and assure that they have adequate information to make a decision

47
Q

what nursing values are central to advocacy?

A

Caring

Autonomy

Respect

Empowerment

48
Q

what is the leadership role in regards to advocacy?

A
  1. Create climate for advocacy & risk taking
  2. Differentiate between controlling & assisting choices
  3. Advocate fairness & justice as needed
  4. Strengthen patient & subordinate support systems
  5. Provide information & mediate as needed
  6. Membership in professional organization
  7. Role model proactive involvement in policy
  8. Advocate the Bill of Rights for Patients
49
Q

what is the management role in advocacy?

A
  1. Assures patient & subordinates have information
  2. Maintain a safe & healthy workforce & env.
  3. Provide an environment of empowerment.
  4. Take action when illegal, unethical & inappropriate behavior occurs.
  5. Aware of legislative efforts
  6. Demonstrate skills with media & legislators
  7. Seeks consultation with advocacy conflict
  8. Encourage subordinates to address concerns
50
Q

what is patient advocacy?

A

Standard VII of ANA Scope & Standards of Practice (2010)
~ Take appropriate action in illegal, unethical & inappropriate behavior, that threatens the consumer or situation.
~ Speak up to question health care practice.
~ Advocate for equitable health-care consumer care.
~ Differentiate between controlling & assisting patient choices

51
Q

what are the areas for nurse-patient advocacy?

A
  1. End-of-life decisions
  2. Technological advances
  3. Health-care reimbursement
  4. Access to health care
  5. Provider-patient conflicts
  6. Blatant lying or withholding of information
  7. Insurance challenges
  8. Medical errors
  9. Patient information disclosure
  10. Patient grievance & appeals
  11. Cultural sensitivity & diversity
  12. Respect for patient dignity
  13. Inadequate consents
  14. Incompetent HCP’s
  15. Complex social problems
  16. Aging Population
52
Q

what are the L&M roles in patient advocacy?

A
  1. Create a work environment that recognizes patients needs as paramount.
  2. Managers must advocate for patients in regards to use of technology and distribution of resources.
  3. Leaders must be risk takers when advocating for patients
53
Q

what are the patient rights? how are they protected?

A
  1. Bill of Rights
    ~ Help patients feel more confident in HCS
    ~ Stress importance of the relationship between patient & HCP.
    ~ Stress the role of patients in staying healthy
  2. NLN & AHA:
    ~ Created documents rights of patients
    ~ Not legally binding
    ~ Guide professional expectations in patient advocacy
  3. Affordable Care Act
  4. HIPAA, ARRA, GINA, & Mental H. Acts
54
Q

what is subordinate advocacy?

A 
Standard 16: ANA for Nsg. Adm.
Environment:
	Collaborative DM
	Know staff & listen to needs
	Know challenges & work them out
	Promote shared governance
	Empower staff & promote autonomy
	Provide a workable system
	Assist with ethical situations in  DM
55
Q

what is workplace advocacy?

A
  • Safe work environment
  • Conducive for professional & personal growth
  • Workplace violence
    ~ OSHA
    ~ Physical violence
    ~ Worker exposure
  • Human resources
  • Nursing shortages
  • Subordinate empowerment
56
Q

what is whistleblowing as advocacy?

A
  • Internal-occurs within org. Report up chain
  • External-reporting outside org.(media, elected officials)
  • Looked upon as disloyal—repercussions
  • Society has mixed views
  • LM must advocate for them
  • Nurses have responsibility to report acts
  • Takes courage, limited protection
57
Q

what is professional advocacy?

A
  • Be an advocate for nursing profession
  • Established a culture for professional nsg.
  • Be a part of a system that is socially defined
  • Personal & public duty to serve
  • Commitment to the profession
  • Broaden the sociopolitical
  • Speaking out in legislation
  • Membership on policy making boards
  • Influence society concerns
58
Q

what is advocacy in legislation and PP?

A
  • Attention on nurses & the profession
  • Participation in National Nsg. Organizations
  • Influence health policy & legislation
  • Lobby legislators in person/letter
  • Collective influence to impact HC policy
  • Political action committees
  • ANA reps attend official meetings
  • Group representation
  • Network groups
  • Speaking to groups, friends, neighbors
59
Q

what should be known about nursing and the media?

A
  • Take on the opportunity
  • Training programs
  • Be prepared
  • Manage 3-4 points
  • Stick to these points
  • Provide clear, concise information
  • Don’t be afraid to say that you do not have the information or expertise to answer
60
Q

what should be known about integrating L&M in Advocacy?

A
  • Obligation to advocate for self, patients, subordinates & profession
  • Furthering the goals of the profession
  • Value autonomy & empowerment
  • Leadership: Risk taking & support varied choices, role model & political involve
  • Manager: Create equitable and safe environment to meet needs & goals. Advocate public relations and demonstrate skills for working with the media

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