LPN 8 Hour Didactic IV Education Legal Aspects of IV Therapy By Pamela Truscott, MSN, Nurse Educator, RN Legal Implications in Nursing Practice Legal Limits of Nursing Knowledge of legal limits allows you: to be a patient advocate to protect patients from harm Sources of Law Constitutional Law Statutory Law civil law and criminal law (example: informed Consent, Nurse Practice Act of each state, Uniform Credentialing Act) Regulatory Law Board of Nursing rules and regulations Common Law Courts decide such as informed consent or patient right to refuse, negligence, and malpractice Standards of Care legal requirements for nursing practice describing minimum acceptable nursing care
STATUTORY ISSUES IN NURSING PRACTICE Patient Protection and Affordable Care Act Americans with Disabilities Act Emergency Medical Treatment and Active Labor Act Mental Health Parity Act as Enacted Under PPACA Advance Directives Living Wills Health Care Proxies or Durable Power of Attorney for Health Care Uniform Anatomical Gift Act HIPAA Health Information Technology Act Restraints Patient Protection and Affordable Care Act (PPACA) Characterized by four themes Created new Patient s Bill of Rights Reduce overall care costs to the consumer Increased access to care Improve Medicare coverage
Americans with Disabilities Act Civil rights statute protecting rights of people with physical or mental disabilities Prohibits discrimination Ensures equal opportunities Emergency Medical Treatment and Active Labor Act (EMTALA) Act provides a patient who enters the emergency department or hospital an appropriate screening within the capacity of the hospital If emergency condition exists staff must evaluate and may not discharge/transfer until condition stabilizes Exception is if patient requests transfer/discharge in writing
Mental Health Parity Act as Enacted Under PPACA Required insurance companies to offer same level of coverage for mental health care Insurers may not discriminate or deny coverage Involuntary admission to mental health unit Require clear documentation on patient behaviors Suicidal patients Require documentation on suicide precautions Advance Directives Includes living wills, health care proxies, durable powers of attorney for health care Based on values of informed consent, patient autonomy, and control For living will or durable powers of attorney for health care to be enforced a patient must be legally declared incapable or lack capacity for making decisions about health care treatment
Living Wills Written documents that direct treatment according to patient wishes in the event of terminal illness or condition Able to declare the treatment that the patient wants when they become terminally ill or persistent vegetative state Health Care Proxies or Durable Power of Attorney for Health Care Legal document that designates a person/people of one s choosing to make health care decisions when a patient is no longer able to make decisions for self This agent makes health care treatment decisions based on patient wishes Also allows patient the right to refuse medical treatment
Uniform Anatomical Gift Act Individual at least 18 years of age has the right to make an organ donation Donors need to make the gift in writing with signature Donated organs cannot be purchased Medicare may cover kidney transplant Sometime private insurance will pay for other transplants Patients are put on waiting list for an organ in their geographic area Health Insurance Portability and Accountability Act Abbreviated to HIPAA Provides rights to patients and protects employees Protects individual employees from losing their health insurance when changing jobs Provides for accountability of privacy in health care settings Limits who has access to patient record Confidentiality protects private patient information
Health Information Technology Act Health Information Technology for Economic and Clinical Health Act (HITECH) Personal Health Information (PHI) Sanctions brought for violations of either HIPAA or HITECH Act Restraints Physical restraint is anything that immobilizes or reduces the ability of a patient to move freely This includes chemical restraints All patients have the right to be free from seclusion, physical or chemical restraints Exception is to ensure safety in emergency situations Liability for improper or unlawful restraint falls on the nurse and the health care agency
STATE STATUTORY ISSUES IN NURSING PRACTICE Licensure Good Samaritan Laws Public Health Laws The Uniform Determination of Death Act Autopsy Death with Dignity Licensure State Board of Nursing licenses all RNs and LPNs Licensure permits nurses to offer skills to the public Provides legal guidelines to protect the public State Board of Nursing suspends/revokes license for violations of Nurse Practice Act
Good Samaritan Laws Encourage health care professionals to assist in emergencies Laws limit liability and offer legal immunity at the scene of accident Must perform only what is in your scope of practice Public Health Laws State legislatures enact statutes under health codes CDC and OSHA provide guidelines on a national level Public health laws Protect populations Advocate for the rights of people Regulate health care and health care financing Ensure professional accountability for care provided Nurses are mandatory reporters of suspected abuse or neglect of patients
The Uniform Determination of Death Act Cardiopulmonary standard irreversible cessation of circulatory and respiratory functions Whole-brain standard irreversible cessation of all functions of the brain and brainstem Organ recovery Documentation of death Autopsy Family request Patient written request prior to death Agency policy or requirement by law Reasonable grounds Health care provider has not seen the patient in over 36 hours proceeding death
Death with Dignity Death with dignity also known as physician-assisted suicide Terminal disease incurable and irreversible diseases that has been medically confirmed and will produce death within 6 months ANA and AACN view points CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE Torts Consent Termination of Pregnancy or Abortion Issues Nursing Students Malpractice Insurance Abandonment and Assignment Issues
Torts Intentional Torts Assault Battery False imprisonment Quasi-Intentional Torts Invasion of Privacy Defamation of Character Unintentional Torts Negligence Malpractice Intentional Torts Assault intentional threat toward another person that places that person in reasonable fear Battery intentional offensive touching without consent or lawful justification False imprisonment unjustified restraint of a person without legal reason
Quasi-Intentional Torts Invasion of Privacy Right to be free from unwanted intrusion into private affairs Invasion of privacy that may include release of patient medical information to unauthorized person Patient s must authorize the release of information and designate to who the health care information may be released Defamation of Character Publication of false statements that result in damage to a person s reputation Slander speak falsely about another Libel written defamation of character (false charting in medical record) Unintentional Torts Negligence Conduct that falls below the generally accepted standard of care of a reasonably prudent person Law establishes standard of care to protect others Malpractice Type of negligence occurring when nursing care falls below standard of care Avoid by following standards of care give competent care, and communicate with other health care providers Timely, truthful, legible and signed documentation Provide and document patient decision making
Consent Signed consent necessary for admission Separate consent forms for specialized procedures Special considerations for deaf, illiterate, non-english speaking Informed choice and informed consent Informed Consent Patient s agreement to have medical procedure after receiving full disclosure of risks, benefits, alternatives and consequences of refusal Key elements of informed consent: Explanation of procedure/treatment Names and qualifications of people performing and assisting Description of serious harm/death that may occur as a result of procedure Explanation of alternative therapies Patient knows they have the right to refuse Patient know they have the right to refuse after procedure has begun
Termination of Pregnancy or Abortion Issues 1973 - Fundamental right to privacy including decision to terminate First trimester End pregnancy without state regulations Second trimester regulations regarding the person terminating and the facility Third trimester interest of state is to protect the fetus prohibiting termination 1989 Court narrowed the earlier decision Some states require viability testing before conducting abortions Some states require parent consent or judicial decision if a minor Malpractice Insurance Professional liability contract between nurse and insurance company Insurance provides malpractice and professional defense coverage If alleged breach in care violated Nurse Practice Act the investigation may not be covered by employer s insurance coverage Court costs and attorney fees are expensive Nurses should have personal liability insurance to defend action against their license
Abandonment and Assignment Issues Abandonment occurs when a nurse refuses to provide care A nurse may refuse an assignment when: Nurse lacks knowledge or skill Care exceeding Nurse Practice Act is expected Health of nurse/unborn child is directly threatened Orientation to unit has not been completed Nurse clearly states/documents objection on basis of moral, ethical, religious grounds Nurse clinical judgement impaired as a result of fatigue resulting in patient safety risk Short Staffing Nursing shortages or staff downsizing leads to inadequate staffing Agencies have guidelines for determining staffing ratios Legal issues occur when not enough nurses are available
Floating Float from one area to the next based on census load/patient acuities Inform supervisor of any lack of experience Request orientation to unit Learn policies of the agency regarding floating and expectations Health Care Providers Orders Nurses follow provider orders unless they believe they are in error, violate policy, or are harmful to patient Assess all orders, and clarify when needed May utilize chain of command to inform direct supervisor or questionable orders Nurses carrying out inaccurate/inappropriate orders are legally responsible for harm to the patient
Risk Management and Quality Assurance Rationale is to development of organizational system of ensuring appropriate, quality health care by identifying potential hazards and eliminating them Occurrence/incident report provides database for further investigation to determine deviations from standards of care Risk management requires complete documentation Unit nurses are risk managers Review of Key Points Civil law system - protect person s private rights; Criminal law system deals with rights of individuals and society defined by legislative statutes Nurse is liable for malpractice Patients are entitled to confidential health care Nurses must follow standards of care Witnessing consents means confirming patient informed consent Staffing standards determine staff ratios Document all events surrounding death Report possible criminal activities Nurses are patient advocates Nurses file incident/occurrence reports
Resource Potter, P.A., Perry, A.G., Hall, A., & Stockert, P.A. (2017). Fundamentals of Nursing. St Louis, MO: Mosby Elsevier. Contact Information Nebraska Health Care Association Licensed Practical Nurse Association of Nebraska 1200 Libra Drive, Suite 100 Lincoln, NE 68512 402-435-3551 nhca@nehca.org