Week 6 lecture Flashcards
Legal rights and responsibilities: overview
Nurses may not knowingly administer or perform tasks that will harm a client
Nurse’s may refuse to carry out orders that would harm a client
Staff nurse is not licensed to make an order independently
Nurse Manager legally responsible for actions that fall within scope of practice of staff member that performed them
Scope of practice within a facility may be more narrow than the scope described in nurse practice act but should never be broader
Nurses have legal obligation to practice within your nurse practice act’s limits
Protect yourself by knowing your facility’s policies and nurse practice act
Common law
Law that results from previous legal decisions. Based on legal precedent
Statutatory law
law passed by a legislative body such as a state’s legislatute or US congress
Constitutional law
law that is included in the Constitution of the USA and its amendments
Administrative law
rules and regulations legally enacted to support some statutory law i.e., state nursing boards
Criminal law
public law, covers acts that are illegal and against the law. i.e. felony/misdemeanor
Civil law
public law, covers torts & contract laws
Torts
civil laws that address legal rights of clients and responsibilities of the nurse in nurse patient relationship. i.e. malpractice, negligence
Unintentional torts
malpractice & negligence
intentional tort
false imprisonment, assault, battery, breaches of confidentiality, slander
liability
Liability-vulnerability and legal responsibility. i.e. nurse is liable if fail to carry out provider’s order
Respondeat Superior
employers are legally responsible for acts of its employees
Negligence
unintentional tort, nurse fails to follow policies or standards of care in some manner that another reasonable nurse would do in the same situation
Malpractice
unintentional tort, specific type of negligence, violation of professional duty or a failure to meet a standard of care, or failure to use the skills and knowledge of other professionals in similar circumstances
Assault
intentional tort, threatening to touch a person without their consent
Battery
intentional tort, touching a person without their consent
false imprisonment
restraining, detaining/restricting a person’s freedom of movement. Restraint’s without an order would be an example
Defamation
making false statements about a person in writing or orally that leads to destruction of a persons reputation
Slander
oral defamation of character using false statements
Libel
written defamation of character using false statements
ID legal issues affecting staff and clients: licensure
must be currently licensed to practice within their state. failure or falsification is fraud and falls under intentional torts
The safeguarding of clients personal possessions and valuables
we are responsible for watching patients personal possessions and valuables. we must not borrow them either
facility has policy on how and where to store belongings - usually with name on bag and what is in bag
dif between malpractice and negligence
difference between these two is that if we can not clearly ID the elements as malpractice, then we ID it as negligence
ID legal issues affecting staff and clients: mandatory reporting
legally mandated to report abuse, neglect, GSW, dog bites, and some communicable diseases, unsafe/illegal practices done by another HCP
ID legal issues affecting staff and clients: documentation
all forms of documentation considered legal documents
ID legal issues affecting staff and clients: acceptance of an assignment
can only accept assignments that are appropriate in terms of nurse practice act and our scope of practice. if you do not feel competent to perform, go up chain of command
ID legal issues affecting staff and clients: provision of staff and client education relating to legal issues
nurse managers assess staff members educational deficits and need then implement ways to correct it and then re-evaluate
ID legal issues affecting staff and clients: compliance with and adherence to other laws
nurses are expect to adhere to other national, state and local laws and regulations
Reviewing the facility policy, federal mandates, and state mandates for interpreter services
American with Disabilities Act of 1990 and Rehabilitation Act of 1973
Civil rights act 1964
Title VI Prohibition Against Discrimination
Any organization or agencies receiving federal funding must provide interpreter services to those that need it
Reporting client conditions as required by law: legally required to report:
abuse/neglect GSW Dog bites Communicable diseases Illegal practices done by other HCP (unsafe or inappropriate)
Disciplinary action
State Board
Nurse can face discipline if she endangers client’s health, safety or welfare
Board may formal reprimand, probation, suspend or refuse to renew license, or revoke license
More action may include Probationary person, imposing a fine, restricting scope of practice
Convicted of crime
Punished for habitual use of or addiction to drugs or alcohol
Unprofessional Conduct
Falsifying or improperly altering client’s records
Negligently administering medications/treatments
Performing tasks beyond state practice act
Failing to take appropriate action to safe guard client
Abandoning client
Abusing a client verbally or physically
Performance improvement and risk management
Goal is to enhance and improve outcomes of care, insure client safety, increase efficiency of patient care, reduce costs, reduce risks and liability.
Client education
RN’s have responsibility to educate all clients they provide care to
RNs must work together to decide on best methods
If discharge teaching is a concern for a discharged teachers then the nurse manager should be contacted to pursure the concern, not the staff
No complaint should be ignored. Evaluating client education must happen in numerous settings
Budgeting: who’s role?
nurse-manager provies unit budget for next chapter
What are the 3 budgets that a nurse manager must develop?
- Capital = review annual, outlines equipment needs >$500
- Operating = day to day of specified area, utilities, small equipment, continuing education and staff education
- Personnel = cost of staffing the unit, must include salaries, potential raises, benefits
What does the nurse manager comply the new budget with?
complies budget using historical data, client population, staffing needs, equipment needs, accrediting agency requirements
What are variances projected based off?
Variance is projected based off of personnel costs, to minimize the variance they are advised to reduce outside agency personnel
Overhead cost can be 60% or more for outside agency staff
Revenue over expenses in a nonprofit organization is what?
tax-exempt, usually reinvested into organization to improve services
What do for profit organizations do with extra revenue?
divide among stockholders or reinvest into organization
Performance evaluation: overview
Growth of staff = self-reflective approach, evaluation and goal setting
Primary managerial role
Doesn’t have to be fully agreed upon by staff
Effective evaluation provides recognition of strengths, identifies area of improvement, clarifies expectations
Done in private
All components documented in writing
Input from staff in preparing evals may be useful but the task cannot be delegated
Peer evaluation may be done if in a systematic way with clear criteria, not an informal “vouching”
Staff development is typically responsibility of employing institution
Benchmarking
This refers to the process of comparing client care practices in one organization to those in the best health care organization
If a nurse-manager has contacts at what’s considered “best facilities” then they are most appropriate to obtain necessary information
Nurse-manager should evaluate policies to determine if some shall be implemented at their facility and make recommendations for change with the staff
May have staff form a task force
Benchmarking saves time, effort, and allows information to be obtained from excellent resources.
Quality management
Continuous quality improvement, continually assess and evaluate effectiveness of client care
Quality improvement
- Involves performance improvement, performance evaluations with recommending ways to improve and promote professional growth
What is an example of quality management?
benchmarking
What needs to be done with incidents?
Incidents should be investigated, a plan shall be developed to minimize/eliminate risk of the incident reoccurring
Performance improvement committee
identify problems and recommends changes within the facilities policy. Procedure, or documentation in an effort to improve client care
Joint Commission
a private agency with established guidelines for hospitals and other health care facilities
Unit counsil
a group of individuals who represent nursing unit.
They voice concerns of other staff members
Role of Nurse-Manager
Is responsible for performance of staff
Job description should define manager’s authority over specified group of employees & describe responsibilities
Needs to continuously search for methods to improve quality of client care
Has to think strategically, plan for changes before they occur as change is constant in health care
Performance evaluations
Must not ignore staff’s actions that deviate from accepted policy
Never correct staff member in front of others- embarrasses nurse and isn’t professional
Roles of the nurse
Systematically enhances quality and effectiveness of nursing practice
Demonstrate quality by documenting the application of nursing in an accountable and ethical manner
Use results of quality-of-care activities to make changes in practice
Use creativity and innovation to improve care delivery
Participate in quality improvement activities
Help identify areas for quality monitoring
Collect and analyze quality data
Assists in developing polices, procedures and guidelines
Participate on teams or committees
Maintain personal record of competency and continued learning activities
Engage in self-evaluation
Take action to achieve goals identified in performance evaluation
Referrals
Contacts initiated by nurse or other team member to meet the needs of the client.
Recognizing the Need for Referrals and Obtaining Necessary Orders
Nurses assess clients to determine need for referrals for actual or potential problems. Other healthcare team members can also do this.
When a need is discovered then internal or external resources sought.
When a referral is made the medical data & information needed in order to provide the requested/needed care is shared with the person/department/community resource that is accepting the referral
ID community resources for the client
Crisis intervention Anger management programs Social services --> Uninsured, Meals on Wheels Respite Self-help groups Housing Transportation Elder day care/in home care for elderly Parenting resources
Abuse overview
Support services for abusers and victims
Temporary housing – shelter
–> Victim may be able to stay with friend or family member
Social workers may be able to offer suggestions on housing
Police department called to collect evidence if the client wants to press chargers against abuser
If child then law requires nurse to file a report with government family-service agency
Nurse needs to evaluate abuser’s ability to handle stress
Nurse may be able to refer abuser to local or state agency that can offer help
Abuser poses a continued threat to others and needs help to understand behavior and how to change it
If abuser of a child a local Parents Anonymous group may be helpful
–> Self-help group made up of former abusers, attempts to help abusing parents by teaching them how to handle their anger
Telephone hotlines
Crisis intervention services give abusers someone to talk to when stressed and in crisis. May help prevent abuse
Typically staffed by volunteers. Offers a way to connect those wanting help with trained counselors
Self-Help Groups
Provides help in a crisis, members may be able to prevent an abusive incident
Being familiar with local and state resources allows the nurse to respond quickly and authoritatively when an abuser or victim needs your help.
