week 1 laws impacting nursing

Question 1

Functions of Law in Nursing

Answer 1

Provides a framework depicting which nursing actions are
legal
Differentiates the nurse’s responsibilities from those of
other health professionals
Establishes boundaries of independent nursing actions
Makes nurses accountable under the law

Question 2

Constitutional Law

Answer 2

public Statutory law
Federal and State
criminal laws

Question 3

Administrative law

Answer 3

public Statutory law
federal-Osha
state board of nursing
local city depart

Question 4

criminal law

Answer 4

public Statutory law
federal drug transport
state-murder
local - parking violation

Question 5

contract law

Answer 5

private law (common law)
written and verbal contracts

Question 6

law of torts

Answer 6

private law (common law)
Legal wrongs not included
under contracts
 Negligence
 False imprisonment
 Confidentiality
 Defamation of character
 Consent
 Assault and battery
 Fraud

Question 7

statutory law

examples of

Answer 7

Also known as Public Law
 Developed by the legislative branch of the state
 Nurse Practice Acts
 Or in Michigan – the Public Health Code
 Other examples
 Speed limits
 Helmet law

Question 8

common law

examples of

Answer 8

Now known as Case Law
“Judge made law” that originates in the courts
Judge makes the decision that sets the precedent for future
similar cases
Examples
Informed consent
Right to refuse treatment

Question 9

nursing practice what is it under

Answer 9

Governed by Administrative Law
The Board of Nursing “administers” the law that was
created and approved by the state legislature, and signed by
the Governor of the State.
State BON’s have the legal authority to interpret, implement
and enforce the laws governing nursing.
Includes nursing practice
Education
Licensure

Question 10

in Michigan we don’t have what

Answer 10

nurse practice act

Question 11

criminal law examples

Answer 11

Misdemeanor
 Felony
 Requires proof beyond a
reasonable doubt
 When criminal case is
complete, a civil case is
possible, regardless of outcome
 Punishment is incarceration or
death

Question 12

civil law examples

Answer 12

Intentional Tort
 Intended to cause harm
 Unintentional Tort
 Did not intend harm
 Proof established by
preponderance (majority) of
evidence
 Punishment is always
compensation (money)

Question 13

civil law affecting nursing

intentional tort

Answer 13

Intentional Torts (private/civil)
 Defamation
 Libel – written or pictures
 Slander - verbal
 Invasion of privacy
 Assault and battery
 False imprisonment
 Abandonment

Question 14

negligence

Answer 14

Negligence—failing to do something a
reasonably prudent person with the same
background and experience would do (or not do)
• Conduct which falls below the established standards

Question 15

malpractice

Answer 15

Malpractice—negligence by a professional

person according to the standards of care

Question 16

Proving Negligence
4 elements needed
tested on

Answer 16

1. Duty – the nurse had a responsibility to provide care
2. Breach of duty – the nurse did not adhere to the standard
   of care
3. Damages – there was some harm done by the nurse. The
   patient has to prove this damage.
4. Proximate cause – The nurses action actually caused the
   damage.

Question 17

Common Sources of

Malpractice

Answer 17

Medication errors
Treatment errors
Lack of observation and timely reporting
Defective equipment
Infections caused by or worsened by the nurse
Poor communication of important information
Failure to intervene to protect the patient
“Failure to rescue

Question 18

Types of Laws Affecting
Nurses
Criminal

Answer 18

Homicide, manslaughter
Theft
 Arson
 Active euthanasia
 Illegal possession of drugs
 Sexual assault

Question 19

Occupational Safety

and Health Act

Answer 19

Passed in 1970 to improve the work environment
in areas that affect workers’ health or safety
• Includes the handling of infectious or toxic
materials, radiation safeguards, and electrical
equipment safety
• Requires mandatory orientation and education in
many topics such as blood-borne pathogens,
exposure, fire, bomb threats, lifting procedures,
and evacuation procedures

Question 20

Child Abuse Prevention and Treatment Act

Answer 20

Federal Law passed in 1973 (redefined in 1996)
• Defines what constitutes child abuse and neglect as “any
recent act, or failure to act, that results in imminent risk of
serious harm, death, serious physical harm or emotional
harm, sexual abuse or exploitation of a child by a parent or
caretaker who is responsible for the child’s welfare
• Requires licensed health-care providers to report child
abus

Question 21

Selected Legal Aspects of Nursing
Practice
Abuse and Neglect

Answer 21

Mandated reporters
 Child and Elder Abuse (CPS and APS)
 Social work referral
 Call Police if evidence of crime
 Stabbing, shooting, rape…..

Question 22

Discrimination

Answer 22

Discrimination: making a decision or treating a person
based on a class or group to which he or she belongs,
such as race, religion, or sex
• Law passed in 1964 prohibits employers from
discriminating against employees based on race, color,
religion, sex, or national origin
• Law was amended to protect people with disabilities and
the aged, people with HIV or AIDS, or recovering drug or
alcohol addicts

Question 23

Good Samaritan Laws

Answer 23

Those laws that protect a health care professional from
liability if he or she stops to provide aid in an emergency
outside the clinical setting
• Most states do not have laws requiring nurses to provide
care in an emergency outside of the clinical setting.
• Emergency response workers are not covered under
these laws

Question 24

Patients’ Rights

Answer 24

Developed in 1972 and revised in 1992
• Developed by the American Hospital Association
• A list of rights that patients could expect
• Also includes a list of responsibilities the patient has

Question 25

The Medical Record

Answer 25

A legal document, the property of the hospital • Patient does have the right to access • All parts considered confidential • Should not be copied and taken from the institution; all entries must be made in ink • Health Insurance Portability and Accountability Act

Question 26

Consents

Answer 26

Permission given by the patient or his or her representative • Patients have the right to consent to and also to refuse treatment • They must be competent in order to make the decision

Question 27

legal competency

Answer 27

18 or older Pregnant or married women Self-supporting minor

Question 28

Clinical competence is a patient who can:

Answer 28

Clinical competence is a patient who can: Identify the problem Understand the options and consequences Make a decision Provide sound reasons for the option chosen

Question 29

informed consent

Answer 29

the risks and benefits of a procedure are explained to the patient in terms the patient can understand. Informed consent is obtained by the person providing the service. Usually for a procedure Written permission PN is not responsible for getting this signature

Question 30

informed consent entails

Answer 30

``` Responsibility is on who is going to perform the procedure Nurses are responsible for three things: Consent was voluntary Signature is authentic Client appears to be competent Call doctor to come up and see patient again if necessary Nurses should educate your patients before you perform any procedures with implied consent DOCUMENT ```

Question 31

General consent (Implied consent)

Answer 31

Obtained at admission OK for PN to get this consent Implied because they came in voluntarily to seek care They may revoke portions of this consent Example – they can refuse a shot, or a test, etc.

Question 32

Patient Self-Determination Act | Advance Directives

Answer 32

Sometimes called a living will • A consent to allow treatment to a certain level before the need arises, in case the patient becomes unresponsive or incompetent • Usually spell out whether a patient would want to live or die in certain situations • Regulated differently by each state

Question 33

Advance Directives

Answer 33

Durable power of attorney • Give legal power to a person to make health care decisions for patients if they become unable to make them for themselves • Need to be accessible (preferably as part of the medical record) 5 Wishes Valid in Michigan Michigan requires your patient advocate to sign that they have accepted this responsibility.

Question 34

how many states recognice a living will

Answer 34

47 and Michigan is not one of them

Question 35

what does the 5 wishes entail

Answer 35

``` who you want to make decisions treatment that you want how comfortable you want to be how you want people to treat you do you want your loved ones to know ```

Question 36

Do-Not-Resuscitate (DNR) Orders

Answer 36

Written by physicians when patients have indicated that they do not want to be resuscitated • May be in conflict with the families’ wishes Performing CPR on a patient with a DNR order is considered battery Not performing CPR on a patient who does not have a DNR order is considered practicing without a license. DNR does not mean “Do Not Provide Care” DNR orders can be written with limitations

Question 37

Decreasing Legal Risk

Answer 37

Maintaining nursing competence Defined as possessing the suitable skills, knowledge, and experience necessary to provide adequate nursing care • Identification of dissatisfied patients • Occurrence reporting Generally not part of the patient’s chart • Liability insurance

Question 38

Reasons to Carry Malpractice Insurance

Answer 38

Jury’s award exceeds the limits of the agency’s coverage. Agency pays the award (settles out of court) and then counter sues you. Employers insurance may only cover you while you are employed. Agency settles out of court but the patient then sues you personally. Do you really know if the agency is paying their insurance? The agency pays for the case, but then the agency’s insurer sues you personally for the money spent. You choose your own lawyer when you have your own insurance. That way you don’t have to be represented by the agency’s lawyer.

Question 39

The Profile of Patient’s Prone to Sue | Accountability

Answer 39

Wishing to see staff disciplined and | called to account

Question 40

The Profile of Patient’s Prone to Sue | explanantion

Answer 40

Explanation: A combination of wanting an explanation and feeling ignored or neglected after the incident

Question 41

The Profile of Patient’s Prone to Sue | standards of care

Answer 41

Standards of Care: Wishing to ensure that a similar | incident does not happen again

Question 42

The Profile of Patient’s Prone to Sue | compensation

Answer 42

Compensation: Wanting compensation and an admission of negligence. There seems to be a profile of patients who tend to sue health care providers. Overly dependent Hostile Uncooperative Noncompliant Blame others Insecure

Question 43

Traits of Nurses Who Trigger Lawsuits

Answer 43

Have difficulty developing close relationships Tend to shift blame to others Insensitive to patient complaints Fail to take patient complaints seriously Aloof More concerned with technology and machines than the patient Delegates to others to avoid patient contact

Question 44

Professional Accountability

Answer 44

Professional accountability is a nurse’s responsibility to meet the health care needs of the patient in a safe, caring way. • Accountability means asking for assistance when unsure and performing tasks in a safe prescribed manner. • Accountability means documenting care delivered and the patient’s response to that care.

Question 45

STANDARDS OF CARE

Answer 45

Purpose is to protect the public Sources for the Standards of Care Job descriptions, credentials, education, agency P&P Nurse Practice Acts ANA, AMA, MNA, specialties such as; Critical Care Nurses, Telephone Triage, Orthopedic Nurses……Orthopedic Surgeons……. JCAHO, Medicare, CDC, NIH

Question 46

student nurse risk

Answer 46

Run the same risk for liability as do professional nurses Must follow the same standards as the nurses Liability may extend to the instructor or preceptor Students have a responsibility not to attempt assignments for which they are not qualified, and to not perform tasks that they were not assigned

Question 47

the impaired nurse

Answer 47

67% or higher for reported disciplinary actions You will be working with someone at some point who is chemically dependent Report any suspicions to HPR or supervisor

Question 48

common sources of nursing liability

Answer 48

``` Medication errors Falls Failure to report changes Violation of P&P Doctor’s Failure to Respond Defective Equipment Improper Patient Teaching Infection caused or worsened by nursing care ```

Question 49

FALLS

Answer 49

``` Injuries caused by falls are the most common cause of negligence lawsuits against hospitals and nurses Those who are at risk include the elderly, sedated, blind, dizzy, confused or immediately postoperative ```

Question 50

failure to observe

Answer 50

``` As a nurse one of your greatest responsibilities is to assess and monitor your patient You have a duty to properly assess for symptoms or changes that are indicative of deterioration ```

Question 51

Violation of P&P

Answer 51

If you violate an established policy, the court will most likely say that you breached your duty You are responsible for knowing the policy and following the procedure

Question 52

Failure to Notify Doctor

Answer 52

Along with assessment it is your duty to report any pertinent information to the doctor

Question 53

if the doctor fails to respond could you be held responsible

Answer 53

yes

Question 54

Defective Equipment

Answer 54

``` Law states that nurses are responsible to inspect equipment and remove it from patient areas if defective ```

Question 55

Improper Patient Teaching

Answer 55

Teach your patients according to policy Instruct them when to seek medical care and when to call 911 Document that the patient understands all instructions Have a teaching record and use it Nurses fail to take credit for all the teaching that we do