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Flashcards in Chapt 4 Legal Deck (21):

Knowledge of the laws that regulate and affect nursing practice is important for 2 reasons:

To ensure that the nurse’s decisions and actions are consistent with current legal principles.
To protect the nurse from liability.


Functions of the Law in Nursing

It provides a framework for establishing which nursing actions in the care of clients/patients are legal.
It differentiates the nurse’s responsibilities from those of other health professionals.
It helps establish the boundaries of the independent nursing action.
It assists in maintaining a standard of nursing practice by making nurses accountable under the law.


Sources of law: .
Constitutional Law

– the Constitution of the US is the supreme law of the country. It creates legal rights and responsibilities and is the foundation for the system of justice.


Sources of law:
Legislation (Statutory Law)

– enacted by any legislative body are called statutory laws. When federal and state laws conflict, federal law supersedes. The regulation of nursing is a function of state law. State legislatures pass statues the define and regulate nursing – nurse practice acts


Sources of law:
Common Law

– Laws evolving from court decisions are referred to as common law. Common Law is continually being adapted and expanded. In deciding specific controversies – to arrive at a ruling in a particular case, the court applies words, to arrive at a ruling in a particular case, the court applies the same rules and principles in previous, similar cases


Sources of law:
Administrative Law

– A state legislature passes a statue, an administrative agency is given the authority to create rules and regulations to enforce the statutory laws.
Example: State Boards of Nursing write rules and regulations to implement and enforce a nurse practice act, which was created through statutory laws.


Nurse Practice Acts

Each state has a nurse practice act, which protects the public by legally defining and describing the “scope of nursing practice.”
It acts to legally control nursing practice through licensing requirements.
Requires different license or have an additional clause that pertains to actions that may be performed only by nurses with advanced education.
Nursing practice acts, although similar, do differ from state to state. The may; differ in their scope of practice definitions and in licensing and license renewal requirements.



Credentialing is the process of determining and maintaining competence in nursing practice.
The process is one way in which the nursing profession maintains standards of practice and accountability for the educational preparation of its members.
Includes: licensure (a legal permit that a government agency grants to individuals to practice a profession), certification (validating that an individual nurse has met minimum standards of nursing competence) and accreditation (to ensure that schools preparing nurses maintain minimum standards of education


Standards of Care

The purpose is to protect the consumer.
Are skills and learning commonly possessed by members of a profession. (Guido, 2010)
Are used to evaluate the quality of care nurses provide and therefore, become legal guidelines for nursing practice.


Standards of care: 2 categories

Internal Standards of care include: nurses job description, education, and expertise, and institutional polices and procedures.
External Standards consist of nurse practice acts, Professional organizations (ANA), nursing specialty practice organizations, and Federal organizations and federal guidelines.


Informed Consent

Is an agreement by a client to accept a course of treatment or a procedure after being provided complete information, including the benefits and risks of treatment, alternatives to the treatment, and prognosis if not treated by a health care provider.
Two types of consent:
Express consent
Implied consent


Nurses role in informed consent

Nurses Role:
The nurse is not responsible for explaining the procedure but for witnessing the client’s signature on the form.
The nurse’s signature confirms: consent voluntarily, the signature is authentic, and the client was of age and had capacity and competence to give consent, and client was given enough information to make an informed consent.


DNR Orders

Written to indicate that the goal of treatment is a comfortable, dignified death and further life-sustaining measures are not indicated.
DNI Orders: Do not intubate, but provide other measures; e.g. medications, Oxygen via ambu bag.


ANA (2003) recommendations related to DNR orders

Competent client’s values and choices should always be given highest priority, even when these wishes conflict with those of the family or HCP.
When the client is incompetent, an advance directive or the proxy decision makers acting for the client should make health care treatment decisions.
A DNR decision should always be the subject of explicit discussion between the client, client family, and designated decision maker acting on the client’s behalf, and the health care team.
DNR orders must be clearly documented, reviewed, and updated periodically to reflect changes in the client’s condition. Such document is required to meet standards of the Joint Commission.
A DNR order is separate from other aspects of a client’s care and does not imply that other types of care should be withdrawn.
Each health care organization should have a mechanisms to resolve conflicts between clients, their families, and HCP; e.g. Hospital Ethics Committee


Other Legal Issues

Violence, abuse and neglect
Americans with Disabilities Act
Impaired Nurses
Sexual Harassment
Death and Related Issues – Advance Health Care Directives, autopsy, and Organ donations.



Negligence is misconduct or practice that is below the standards expected of an ordinary, reasonable, and prudent person. Both nonmedical & professional persons can be liable for negligent acts.
Gross negligence involves extreme lack of knowledge, skill, or decision making that the person clearly should have known would put others at risk from harm.



Malpractice is professional negligence that occurred while the person was performing as a professional. Applies to primary care providers, dentists, lawyers, and nurses


Health Insurance Portability and Accountability Act (HIPAA)

Charts must be secure, nonpublic location to prevent the public from viewing or accessing.
Place clipboards face down.
Printed copies of protected health information should not be left unattended at a printer or fax machine.
Verify the number dialed before faxing personal health information.
Encrypt personal health information when transmitting by email.
Access to protected health information is limited to those with authorized to obtain the information.


Code of Ethics for Nurses (ANA, 2005)

States to protect that the “nurse promotes, advocates for and strives the health, safety, and rights of the patient.”
Nurses are responsible for retaining their professional boundaries.
Unethical conduct includes violation of professional ethical codes, breach of confidentiality, fraud, or refusing to care for clients of specific socioeconomic or cultural origins.
Nurses at all levels of nursing practice, can be reported to national data banks. The Healthcare Integrity and Protection Data Bank HIPDB) was created for the reporting of civil judgments or criminal convictions related to health care and licensure or certification actions


Legal Protection in Nursing

Good Samaritan Acts
Professional Liability Insurance
Carrying out a Physician’s Orders
Providing Competent nursing care
Incident Report


Legal Responsibilities of Students

Nursing students are responsible for their own actions of negligence committed during the course of clinical experiences.
They are legally held to the same standards of skill and competence as a registered professional nurse.
Any case of negligence involving students, the hospital/agency, and the educational institution will be held potentially liable for negligent actions by students.