Unit 4&5 Flashcards
What is standards of care?
Patients are entitled to competent and safe, nursing care. The standards of care are established by:
job description of facility
Facility, policies and procedures
Patients NCP
State nurse, practice act
You are accountable for your own actions
Scope of practice
Every state establishes a scope of practice for each level of nurse, based on an educational preparation
Defines those duties that a nurse is considered, competent to carry out and authorized to perform 
Nurse practice act
It’s a law that governs the nurses actions it’s written to protect the public, and all states have a scope of practice, and all nurses must practice within their scope
This can change from State Annette to State
You must adhere to not only the state standards, but also your organization
What are the functions of the nurse practice act?
To establish a minimum standard of practice
To outline requirements of nursing licensure
Defines functions of a nurse
Explains use of the title, RN and LPN
Provides rules of conduct that may be enforced in the punishment, if rules are not observed
State board of nursing
Members are appointed by governor, and they represent Nursing, Nursing education, and the public
The mission of the board of nursing
To protect the public health, safety and welfare by assuring that Nursing is practiced by at least, minimally, competent individuals within their authorize scope of practice
Functions of the board of nursing
To protect the public safety and welfare
To protect nursing profession, in individual nurses safety
Determine and enforce the contents of the Nurse Practice Act for their state
What does the State board of nursing has the authority to regulate
Nursing practices
Nursing education
Continuing education-CEU
Additional things, the state board of nursing have the authority to do
Issue license for RN and LPN practice
Issue a citation in a warning
Revoked or suspended licensure
Place individuals on probation
Fine for practicing without a license
Fine for falsification of CEUs
In order to become a nurse you must
Meet state criteria and pass the NCLEX examination
What are the two different kinds of NCLEX exams
NCLEX - PN
NVLEX - RN
Reasons a license would be suspended or revoked
Drug and alcohol abuse – most frequent reason
Fraud, deceptive practice
Criminal acts previous disciplinary action
Gross or ordinary negligence
Physical or mental impairment
Precautions for nurses to take against lawsuits
Timely and accurate documentation
Knowing your scope of practice
Reporting incidences right away
Following facility policies
Honesty
Ask for help
Do not accept gifts
What is the liability of a nurse?
Being accountable or answering for your actions
In nursing, this is measured by the nursing standards of practice
Techniques to avoid liability suits
Deliver nursing care, according to the standards of care
Document all nursing care, accurately, and concisely
Follow your facilities, policies and procedures, do not deviate from these
Assess patient’s carefully and always look for risk factors
Concentrate on what you were doing when performing task and skills
Know your limits of your training, expertise and license, and do not practice beyond these limits
Student liability
Student nurses are responsible for their own actions, comparable to knowledge of nurses at the same education level
Student nurse liability
Performing according to the standards of care for their education and experience
Ask for guidance when they are uncertain
Student nurses are held to the same standards of care that would be used to evaluate the actions of an RN
Be familiar with agency policies and procedures
Malpractice – professional, liability, insurance
Nurses may need to carry their own malpractice insurance
They may not be covered under the employers liability insurance
What are CEUs-continuing education units
Online classes
Home studies
College courses
Organize courses through employment or Nursing organization
You must keep your own record of your continued education units -may be audited
In-service or staff development
Different than CEUs
Orientation of the new staff
Updating skills of employees
Educating about a new piece of equipment, policy or procedure
What does a diploma or degree indicate
It is written, academic achievement, a form of credentials, such as ADN, BSN, MSN
What are legal credentials?
It is your licensure to practice as an RN or LPN
How do you obtain other credentials?
By getting certificates in areas of special practice, such as pediatrics
Why is Nursing considered a profession?
Because we have identified and developed in four areas
Theory
Service
Autonomy
Code of ethics
Iowa central uses the BENNER-it is a theory moving from a novice learner to an expert
Theory
Theoretical models to provide a knowledge base and framework for practice
Service
Vital component of healthcare system
Consumer and service space focus
Autonomy
Independent, in decision, making and practice
Code of ethics
Set of principles
Accepted by all members of a profession
Reflects moral judgment
Serves as a guideline to assist professionals when conflicts or disagreement arises
What is the CDC center for disease control?
It’s a federal agency of the United States, public health service, which focuses on epidemiology, prevention, control, and treatment of communicable disease
What is OSHA, occupational safety and health act
Set standards for working conditions
Controlled substance act
Set standards for proper storage, documentation and administration of these substances per doctors orders
What is accreditation agencies?
It’s a voluntary non-governmental agency that grants status to institutions that have met predetermined standards
Examples are: nursing programs – NLNAC
Joint commission in hospitals
If you fail to follow the policies and procedures of the institution and giving care
Exposes You as a nurse to personal liability, without protection from the institution
Nurses must know the policies and procedures of their employers, and follow them
Five rights of delegation
Right task
Right circumstance
Right person
Right communication
Right supervision
Definition of law
System of rules, established and enforced by an institution
What is federal regulation?
Federal laws affecting nursing practice, health insurance, portability, and accountability act, HIPAA
Administrative law
Regulates law that governs the daily activities of various federal and state agencies
Examples are:
Food and drug cosmetic act
National labor relations act
Iowa nurse practice act
Criminal law
Applies to law that protects the public and society as a whole and punishments are designed to the tear people from committing crimes
What are the two categories of criminal law?
Felony and misdemeanor
What is a felony?
Hey serious crime that may carry a penalty of state imprisonment or death
What is a misdemeanor
A crime, punishable by fines, or less than one year in a local imprisonment jail
Violation of criminal law in the nursing profession
Violation of narcotic law, this includes falsifying narcotic records
Practice without a license
With holding life support, this is considered murder
Child, elder abuse
Violation of nurse, practice act, even if no harm came to the patient
What is civil law?
Civil law protects an individuals, personal rights, life, liberty, thinking, speaking privacy, etc.
Examples of civil law
Contract laws
Torts
Protective and reporting laws
What is a contract law?
Governs written, or implied agreement between individuals or an individual in an institution
What are three kinds of contracts?
Formal contract
Expressed contract
Implied contract
What are the three elements of a legal contract?
A promise statement between two legally competent individuals, stating what each must do or not do
A mutual understanding of the terms, and obligations the contract and poses on each individual
Compensation for lawful actions performed
Informed consent
Patient must be mentally and physically competent adult
It’s given voluntarily
Obtained for invasive procedures, for therapeutic or diagnostic purposes
Nurses may witness signature
Physicians need to explain
What is the responsibility of the physician to explain
What the treatment will be
What the risk are
What the alternatives are
Who will perform the treatment
Will the treatment be necessary
What makes informed consent not legal
If the patient is confused, unconscious, mentally, incompetent, a minor, or under the influence of sedatives the informed consent is not legal
What is a tort?
A wrongful act commission or failure to act omission that causes injury to another person or his property
Subject to action in civil court, and can be compensated for damages
Can be unintentional or intentional
What is negligence?
Conduct a practice that falls below the standards, expected by an ordinary, reasonable and prudent nurse
The conduct place is another person at risk of harm
Malpractice
Is professional negligence where the professional fails to use the same care that a responsible prudent nurse would use under the same or similar circumstance
This involves an unreasonable risk of harm to the patient
What are the four things that must be present to prove malpractice?
Duty owed to the patient
Breach of duty
Causation
Injury or damages
Duty owed to the patient
A contract or responsibility to care for the patient that must be followed per facility, policies, procedures, job description, and standards of care
Breach of duty
Failure to do something or should have done something based on standards of care
Causation
Actions performed, or omission of actions must be proved to have legal caused the injury. A cause-and-effect relationship must be clearly established.
Damages or injury
Harm or injury, was caused physically financially or emotionally
Examples of unintentional torts
Failure to assess
Failure to report
Failure to document
Failure to provide safety
Delegating improperly
Failure to follow standards of care
Lack of knowledge
Lack of skills
Lack of acceptance or responsibility
Examples of intentional torts
Willful act that violates another persons, rights or property
Intent to do a wrongful act
Assault
Battery
What is assault?
Any willful attempt or threat to harm another person?
What is battery?
Any intentional touching of another persons, body without consent?
Invasion of privacy
A patient has the right to have his medical condition or other personal information kept confidential at all times
Freedom from unwanted exposure, keeping them covered
HIPAA
Health insurance, portability, and accountability act
Established in 1996
Standards set regarding the electronic exchange of health information
Be careful not to mention name, room, disease, or any other information in the hall, elevator dining room, or anywhere else
What is defamation of character?
When information is communicated to a third-party, and causes damage to the reputation
Libel defamation of character
A persons reputation is damaged by something that is written
Slander defamation of character
A persons reputation is damaged by something that is spoken
What is false imprisonment?
Unlawful restraint on the freedom of a person, or an unlawful detention of of a person
Lawful reasons to apply restraints
To protect from injury of self, or others without order, but must have order to continue use, and assess hourly
Failure to use restraints when required is also negligence
Protective and reporting laws
Good Samaritan law
Patient abandonment
Reporting obligation
Controlled substance, dense act
What is the good Samaritan law?
It’s a law that protects from liability for negligent acts that may occur when giving emergency care
Patient abandonment
Walking out on your patient assignment
Reporting obligation of a mandatory reporter
Adult or child abuse
As healthcare providers, we are mandatory reporters
We do not have to prove anything, only that there is suspicion or concerns
Controlled substance act
Maintain concise records of dispensing wasting in storage of controlled substances
Report unsafe, or impaired health professionals
Reporting information may vary from state to state 
What is an incident or variance report?
Intended to provide in-house improvements in care
Administration records required by federal law so that agencies can see patterns and correct them
Reports are written as soon as possible after occurrence and are accurate
Examples are medication errors falls, and surgical mixups
Reports are objectively written with fax with no finger-pointing and are not in medical records
What is ethics?
Philosophy that examines the difference between right and wrong
Code of ethics
Set of principles that are generally accepted by all members of profession
Ethical principles
Guide, professional, practice, and decision making
Autonomy
Refers to an individuals right to choose in the ability to act on the choice
Example AMA against medical advice
Fidelity
Duty to be faithful
Justice
Refers to the principal of fairness to treat everyone the same
Beneficence
Considering the patient’s best interest to do good for the patient
Non-maleficence
The fundamental agreement to do no harm
Responsibility
The execution of duties associated with the Nursing role
Accountability
The ability to answer for your own actions
Confidentiality
The requirement to keep personal healthcare information, confidential
Veracity
Duty to tell the truth
Advocacy
Look out or speak up for the right of others
What is an advance directive?
It helps drive care and direction, and decides who will make decisions for the patient in a case that he or she is unable
Decides the kind of medical treatment. The patient wants or doesn’t want a written instruction that is recognized under the state law.
DNR comfort measures do not hospitalize organ donation
Examples are power of attorney, DNR LivingWell
Documentation
A legal document and can be used in court
Forms may be different different, but basics are the same
Way to show you have a legitimate knowledge base
A way to show you function within the standards of care 
Five professional values of nursing
Altruism
Human dignity
Integrity
Autonomy
And social justice
Altruism
The selfless concern and actions for the benefit of someone else
An example would be a nurse rushing to help someone in need sometimes ignoring the wrist to themselves and putting the needs of the client first
Human dignity
Implies that each individual regardless of things, such as race, religion sex, gender, etc. has values and she’ll be respected simply because human beings are all equal
Integrity
The quality of being honest, and having strong moral principles
Autonomy
Is the right to self determination autonomy refers to the nurses responsibility to respect the clients right to make their own decisions regarding their healthcare
Social justice
Is the awareness of the basic right to health and well-being being of every individual
Change in health policy, aimed at analysts and critique of social structures, laws and customs that harm groups through exclusion. Every person has the right to quality healthcare.
Ethical dilemmas
Situations where a critical choice must be made, but the solution may not be ethically acceptable
Ethical dilemmas can also occur when the personal values of the nurses are different from those of the client
When faced with ethical dilemmas, it is important for the nurse to abide by the code of ethics, regardless of their personal beliefs and values
Ethical decision making
The process of evaluating and choosing options in an ethical, consistent manner, using ethical principles
One vision of the ethical decision making process uses eight sequential steps
What are the eight sequential steps to ethical decision making
Step one is there an ethical dilemma
Step two clearly identify the ethical dilemma
Step three identify possible solutions
Step for apply ethical principles to the solution
Step five include all relevant individuals and factors
Step six decide on a solution
Step seven review the decision
Step eight put the decision into action
EMTALA
Emergency medical treatment and labor act
PHI
Protected health information
What is a tort?
A tort is carrying out an act or failing to act against what is considered, reasonable or acceptable
Examples of intentional torts
Defamation
Battery
Invasion of privacy
Assault
Examples of unintentional torts
Negligence and malpractice
Examples of implied consent
Implied consent is for things that are invasive
Insertion of a urinary catheter
Initiation of an IV site
Administering a pain med
Examples of informed consent
Colonoscopy to screen for colon cancer
Scheduled cesarean section
Elective, cosmetic surgery
Informed consent is for invasive procedures
What is an advance directive?
A written statement of a persons wishes regarding medical treatment
Whistle blowing
Reporting private information about an organization wrongdoing or illegal activity
Examples of reportable diseases that are considered a significant public health risk
Measles and influenza
Examples of non-reportable conditions of diseases or illnesses that are not considered significant public health risks
Pneumonia
MRSA
Sentinel event
An adverse event that should never occur
ANA
American nursing association 
Just culture
Values, supportive model of shared, accountability, and mindfulness
Standards of practice
Explanatory statements that describe a competent level of care for all nurses using the critical thinking model known as the nursing process
Standard of professional performance
Define competent behavior of all registered nurses were professional care is provided
Define competent behavior of all registered nurses and licensed, practical nurses work hair is provided in an ethical manner with respect for cultural diversity 
The sixth ethical principles of the nursing profession
Autonomy, beneficence, non-maleficence, veracity, fidelity, and justice
The five professional values of nursing
Altruism, human dignity, integrity, autonomy, and social justice
What process the nurse must complete to identify, assess, and develop their own personal value system
Value clarification
What is the first step of the ethical decision making process?
To identify if an ethical dilemma exists
A federal law that protects an individuals, identifying private and personal health information
HIPAA, the health insurance, portability and accountability act
The two types of unintentional torts
Malpractice and negligence
What is the nurses role when obtaining informed consent?
To witness the client signature
What are two types of advance directives
Living will and durable power of attorney for healthcare
What are the five rights of delegation?
Right task right circumstance, right person, right direction, and right communication, right supervision, and evaluation
The ANA documents that addresses the expected values and ethical principles of the nursing profession
The code of ethics for nurses with interpretive statements
The act requiring emergency departments to provide equal care for clients, regardless of their insurance status
The emergency medical treatment and labor act, EMTALA
The physical and mental exhaustion that can cause the nurse to be unable to function safely
Nurse, fatigue
The process of documentation that is in accurate and incomplete and misleading
Falsification of health records
Nurse practice act NPA
A state law that explains the functions and responsibilities of the professional nurse
Current laws and regulations, governing nursing practice in every state and territory of the United States 
Scope of nursing practice
Sets for the service or activities that licensed professionals are deemed competent and permitted to perform
Quality and safety education for nurses QSEN
Set of nursing competencies and proposed targets for the knowledge skills and attitudes that all pre-licensure nursing students should have obtained for entry to practice
What are the QSEN competencies quality and safety education for nurses
Safety
evidence based practice,
patient centered, care,
informatics,
teamwork, and collaboration,
quality improvement
NLN
National league of nursing is a nationally known Nursing organization for nursing faculty, and Nursing educationleaders
What are the National League of Nursing integrated competencies?
Professional identity
Human flourishing
Nursing judgment
Spirit of inquiry
Standards of professional performance
Defined competent behavior of all registered nurses where professional care is provided
Standards of practice
Explanatory statement that describes a competent level of care for all nurses using the critical thinking model known as the nursing process
What is the nursing process?
Assessment
Diagnosis
Planning
Implementation
Evaluation
NCLEX
National council licensure examination
Nationwide, standardized test for the examination and licensing of either registered nurses or practical nurses
How many days does a nurse applicant have to complete the NCLEX exam
90 days
Requirements for initial licensure
Verification of graduation
Completion of a criminal background of the NCLEX exam
Confirmation of successful completion of the NCLEX exam
Requirements for renewal
Completion of continued education hours
Confirmation of practice hours, and or activities
Requirements for both initial and renewal licensure’s
Disclosure or disciplinary action, taken against any professional license
Disclosure of any criminal record history
Disclosure of reporting of any substance misuse within the previous five years
NLC
Nurse, licensure compact
An agreement by state licensing boards that allows a nurse to practice in any state that has adopted the compact under one license
Reciprocity
Ability to transfer current state license to another, providing the nurse has an initial nursing license and is in good standings
Credentials
Formal verification, and recognition of an individuals qualifications incompetence to provide service in their occupation
Order to sign during a signature
Name, education, licensure, certification
