Week 2 - documentation and legal issues

Question 1

What are the 5 foundations of legal and ethical responsibilities of the nurse?

Answer 1

1. follow laws and guiding docs
2. meet entry level compentencies and standards of practice
3. gain competence in specific areas
4. Maintain fitness to practice
5. continuous learning

Question 2

What are the three formal things nurses must follow in their practice?

Answer 2

1. law
2. regulation
3. code of ethics

Question 3

What is CRNM guided by?

Answer 3

the RHPA- regulated health professions act

Question 4

What document do nurses follow for ethics?

Answer 4

CNA code of ethics for registered nurses

Question 5

What is the RHPA?

Answer 5

-umbrella law
- statute law
- governs the practice of 21 diff health professions
- defines reserved acts
- only HCPs can perform acts under RHPA
- defines how a profession registers its members
- defines how professions are designated and governed
- title protection
- sets requirements for standards of practice, code of ethics, practice directions, PD, conduct and managing complaints
- how to become a regulated profession

Question 6

What are reserved acts?

Answer 6

1. need special training and show compentency
2. not exclusive to any one health profession. encourages IPC

Question 7

When did RNs come under RHPA?

Answer 7

May 31 2018

Question 8

What CRNM regulations govern nursing practice and expand on the RHPA?

Answer 8

1. practice of registered nursing regulation
2. College of registered nurses of Manitoba general regulation

Question 9

what is the practice of registered nursing regulation under CRNM?

Answer 9

• scope of practice- which reserved acts can be done by RN

Question 10

What is the college of registered nurses of manitoba general regulation under CRNM?

Answer 10

• how to become an RN, title protection, reserved acts, standards of practice

Question 11

What are CRNM practice directions?

Answer 11

-written statements about RN practice
- more detailed than regulations
- minimum nurses should practice
- manage public’s expectations
- legal reference to describe reasonable and prudent nursing practice
- compliance with practice directions is required

Question 12

Which is more detailed, regulations or CRNM practice directions?

Answer 12

CRNM practice directions

Question 13

What are the 10 CRNM practice expectations for RNs?

Answer 13

1. professional practice
2. competent practice
3. ethical practice
4. professional communication
5. cultural safety, cultural humility and anti-racism
6. Client centered practice
7. collaborative practice
8. Follow up to diagnosis and tests results
9. practice environment
10. client records

Question 13

what 3 things does the CRNM do ?

Answer 13

1. protect the public
2. set standards for RN education and practice
3. take action when standards are not met

Question 14

what are the 5 components of the CCP (continuing compentency program)?

Answer 14

1. self assessent
2. learning goals and plan
3. documentation of learning activities to meet goals
4. jurisprudence learning module online
5. report actual practice hours

Question 15

when complaints are made and inquiries, what two things do they make their determinations on?

Answer 15

1. standards of practice
2. code of ethics

Question 15

what is professional misconduct?

Answer 15

act or omission that falls short of what would be considered proper in the same circumstances

Question 16

what are 4 foundations of professional misconduct?

Answer 16

1. abuse of a client or staff
2. falsification of record
3. abandonment
4. breaking the law

Question 17

What is the main role of CRNM?

Answer 17

protect the public

Question 18

What is the role of the college/educational insitutution such as UofM?

Answer 18

advance nursing education

Question 19

What is the role of a union (MNU)?

Answer 19

to support the nurse and strengthen working conditions

Question 20

WHat is the role of an association like ARNM?

Answer 20

advance profession and improve health of the public

Question 21

What is the role of liability protection (CNPS) ?

Answer 21

provide protection for nurses in legal situations

Question 22

What is civil tort of negligence?

Answer 22

• Civil wrong occurs
• the harmed party seeks compensation
  -when standards of practice are not met
• negligence lawsuit or civil suit (care not reasonable or prudent)

Question 23

what is negligence ?

Answer 23

conduct that is below the standard that is expected as a nurse

Question 24

What 5 elements MUST be PROVEN before someone can be found guilty of neglegence?

Answer 24

1. duty of care 2. breach of duty 3. Forseeable harm caused by breach (presence of injury/damage) 4. causation 5. patient did not contribute to negligence and or/accept risk voluntarily

Question 25

What does duty of care mean?

Answer 25

"duty to exercise a reasonable degree of skill, knowledge and care in the treatment of a patient" - patient was assigned to the nurse - nurse was suppose to follow EIP protocols - act in a manner that meets or exceeds prudent caregiver standards - you must see and examine your patient - record keeping - give proper report/handoff - supervise colleagues with less experience

Question 25

how do we know there was Breach of duty?

Answer 25

there was neglegence based on evidence from: - documentation - organizational policies - staffing levels and workload - experts

Question 26

What does it mean when there's a breach of duty to care when injury or harm is invovled?

Answer 26

- financial, property damage, injury, death or disability - degree of harm determines the size of award $

Question 27

What does Causation mean?

Answer 27

injury or harm is direct result of nurse's action or inaction - must be a clear link

Question 28

Can negligence reach a level that warrants criminal charges?

Answer 28

yes Manianatha case: 1. criminal code - neglegence 2. civil tort - family sued 3. CPSS - 6 month suspension and upgrade skills

Question 29

What are the 3 diff outcomes an RN who does not uphold their legal and ethical duties could be subject to?

Answer 29

1. Violation of statute law (criminal negligence) 2. Violation of civil/tort law 3. CRNM investigation and discipline

Question 30

What is the Manitoba Fatality Inquiries Act?

Answer 30

-cheif medical examiner in MB oversees investigation of all unexpected and violent deaths

Question 31

What is an inquest?

Answer 31

a court hearing before a judge examines facts around cause and manner of someone's death - goal is not to blame but understand why - prevention - judge makes recommendations to change policy - inquest reports are public

Question 32

What are reportable deaths?

Answer 32

CME - chief medical examiner must be notified of deaths that are unexpected/sudden or a child - don't move the body if medical examiner is involved

Question 33

what is the purpose of nursing documentation?

Answer 33

1. communicate with care team 2. continuity of care 3. proves care = standards 4. compliance with professional standards of care 5. QA-chart audits + accreditation 6. facilitates research

Question 34

what are some errors in documentation?

Answer 34

1. care & treatment is omitted from the record 2. incorrect/inaccurate/vague info in the chart 3. HCP don't read the chart - info is there but they don't do anything