Legal considerations Legal considerations for nursing practicefor nursing practice

Legal limits for nursingLegal limits for nursing Nurse practice acts: describe and define the legal Nurse practice acts: describe and define the legal

boundaries of nursing practice within each stateboundaries of nursing practice within each state

Vary from state to state, especially for Vary from state to state, especially for advanced practice nurses (family nurse advanced practice nurses (family nurse practitioners, clinical nurse specialists)practitioners, clinical nurse specialists)

Standards of care: legal guidelines for nursing Standards of care: legal guidelines for nursing practicepractice

Defined by nurse practice acts, ANA, and state Defined by nurse practice acts, ANA, and state boards of nursingboards of nursing

Standards of careStandards of care In a malpractice lawsuit, nursing conduct/care is In a malpractice lawsuit, nursing conduct/care is

compared to the nursing standards of care for compared to the nursing standards of care for that statethat state

Court looks to see if the nurse acted as any Court looks to see if the nurse acted as any reasonably prudent nurse would act under the reasonably prudent nurse would act under the same or similar circumstancessame or similar circumstances

Breach of nursing standards:Breach of nursing standards: if care did not meet if care did not meet set standards of care, must be proven in set standards of care, must be proven in negligence or malpractice lawsuitsnegligence or malpractice lawsuits

Negligence & MalpracticeNegligence & Malpractice

Nursing care that falls below defined standards of Nursing care that falls below defined standards of carecare

Malpractice:Malpractice: professional negligence professional negligence

Nursing malpractice:Nursing malpractice: when nursing care falls when nursing care falls below defined standards of carebelow defined standards of care

MalpracticeMalpractice

The following must be established in order for The following must be established in order for nurses to be found guilty of malpractice:nurses to be found guilty of malpractice:

1.1. The nurse was responsible for caring for the The nurse was responsible for caring for the patientpatient

2.2. The nurse did not carry out that careThe nurse did not carry out that care

3.3. The patient was injured as a resultThe patient was injured as a result

4.4. The patient’s injury was due to the nurse’s The patient’s injury was due to the nurse’s failure to provide adequate carefailure to provide adequate care

NegligenceNegligence

Nurses may be held liable for negligence if their Nurses may be held liable for negligence if their care does not meet the standards of nursing care care does not meet the standards of nursing care for that statefor that state

Avoiding negligence:Avoiding negligence: Carefully follow standards of care and providing Carefully follow standards of care and providing

competent care competent care Communicate with other healthcare Communicate with other healthcare

professionalsprofessionals Develop caring relationships with patients and Develop caring relationships with patients and

familiesfamilies Carefully document assessments, care, and Carefully document assessments, care, and

patient outcomespatient outcomes

Avoiding negligenceAvoiding negligence Stay aware of current nursing literature in areas Stay aware of current nursing literature in areas

of clinical practice or specialtyof clinical practice or specialty

Know and follow clinical policies and guidelines Know and follow clinical policies and guidelines for facilitiesfor facilities

Be aware of common causes of patient injury and Be aware of common causes of patient injury and work to prevent suchwork to prevent such

Communicate with patients and their families so Communicate with patients and their families so that they are aware of nursing care providedthat they are aware of nursing care provided

Communicate patient changes to physicians Communicate patient changes to physicians promptly and document carefullypromptly and document carefully

ConsentConsent A signed consent form is required for procedures A signed consent form is required for procedures

and careand care State laws designate who is legally able to give State laws designate who is legally able to give

consent for careconsent for care Caution must be taken with patients who are:Caution must be taken with patients who are:

Hard of hearingHard of hearing Unable to speak EnglishUnable to speak English Under 18 years of ageUnder 18 years of age Sedated Sedated Mentally illMentally ill

Informed consentInformed consent Patient’s agreement to procedure or care after Patient’s agreement to procedure or care after

being informed of risks, benefits, alternatives, being informed of risks, benefits, alternatives, and consequencesand consequences

Health care providers must present information Health care providers must present information so that patient can understand it, in order to so that patient can understand it, in order to make an informed choicemake an informed choice

If no informed consent, patient may charge If no informed consent, patient may charge negligence or batterynegligence or battery

Nurses & informed consentNurses & informed consent

In most cases, is not the nurses’ responsibility to In most cases, is not the nurses’ responsibility to obtain consentobtain consent

Nurses are often asked to witness patient Nurses are often asked to witness patient signature on consent formsignature on consent form

Means that patient voluntarily gave consent, Means that patient voluntarily gave consent, signature is authentic, and patient appears signature is authentic, and patient appears competent to give consentcompetent to give consent

Student nursesStudent nurses Are liable if they cause harm to patientsAre liable if they cause harm to patients

Do notDo not do skills that you have not been taught! do skills that you have not been taught! Make sure that you are carefully supervised when Make sure that you are carefully supervised when

you perform procedures with patientsyou perform procedures with patients Medication administrationMedication administration IV starts, catheterization, suctioning, etcIV starts, catheterization, suctioning, etc

Prior to giving medications:Prior to giving medications: Make sure that you check patient ID band Make sure that you check patient ID band FIRSTFIRST!! Look up each medication so that you know what Look up each medication so that you know what

you are giving!you are giving! Check for patient allergies Check for patient allergies FIRSTFIRST!!

Short staffingShort staffing Legal problems may occur if there is insufficient Legal problems may occur if there is insufficient

staff to provide patient carestaff to provide patient care

Staffing problems should be brought to the Staffing problems should be brought to the attention of the nursing supervisorattention of the nursing supervisor

Written protests may be made to facility Written protests may be made to facility administrationadministration

Nurses must not walk out or refuse assignment due Nurses must not walk out or refuse assignment due to short staffingto short staffing

May be considered insubordination and result in May be considered insubordination and result in disciplinary actiondisciplinary action

Will make patient care staffing problem even Will make patient care staffing problem even worseworse

Physician’s ordersPhysician’s orders Sometimes physicians may give orders over the Sometimes physicians may give orders over the

phone, especially late at night.phone, especially late at night. Only RNs can take orders over the phoneOnly RNs can take orders over the phone

They They cannotcannot be taken by LPNs, nursing be taken by LPNs, nursing assistants, unit secretaries, or other staff assistants, unit secretaries, or other staff members.members.

They may not be left in voice mailThey may not be left in voice mail

Best bet-Best bet- don’t let doctors give you verbal orders don’t let doctors give you verbal orders (unless it is an emergency!) (unless it is an emergency!) Hand the chart to the doctor and ask him to Hand the chart to the doctor and ask him to

write the order insteadwrite the order instead

Physician’s ordersPhysician’s orders Nurses are obligated to follow physicians’ orders Nurses are obligated to follow physicians’ orders

for patient carefor patient care

If a nurse believes that an order is wrong or may If a nurse believes that an order is wrong or may harm a patient, the nurse must notify the harm a patient, the nurse must notify the physician to clarify the orderphysician to clarify the order

If the physician insists, the nurse should notify If the physician insists, the nurse should notify the nursing supervisor to address the problemthe nursing supervisor to address the problem

A nurse should not follow a doctor’s order that A nurse should not follow a doctor’s order that may result in harm to the patient- may be legally may result in harm to the patient- may be legally responsible for any harm suffered by the patientresponsible for any harm suffered by the patient

Myths about student nursesMyths about student nurses

MYTH:MYTH: Nursing students don’t have to worry Nursing students don’t have to worry about making mistakes with patients because about making mistakes with patients because they are working under the RN’s license.they are working under the RN’s license.

REALITY: REALITY: If a client is harmed as a direct result of If a client is harmed as a direct result of a nursing student’s actions or lack of action, the a nursing student’s actions or lack of action, the liability for the incorrect action is generally liability for the incorrect action is generally shared by the student, instructor, hospital or shared by the student, instructor, hospital or health care facility, and the university or health care facility, and the university or educational institution. educational institution. Student nurses may be Student nurses may be named in malpractice lawsuits!named in malpractice lawsuits!

Myths about student nursesMyths about student nurses MYTH:MYTH: Nursing students are only glorified nursing Nursing students are only glorified nursing

assistants.assistants.

REALITY:REALITY: While in clinical, While in clinical, student nurses are student nurses are expected to perform as professional nursesexpected to perform as professional nurses (as an (as an RN would in providing safe client care). Nursing RN would in providing safe client care). Nursing students are not working in the same capacity as students are not working in the same capacity as nursing assistants and therefore are expected to nursing assistants and therefore are expected to provide a higher level of care than nursing provide a higher level of care than nursing assistants. assistants.

Myths about student nursesMyths about student nurses

MYTH:MYTH: Nursing students don’t have to hear report Nursing students don’t have to hear report about their patients because all the decisions about their patients because all the decisions about care are made by the RNabout care are made by the RN

REALITY:REALITY: Staff nurses may serve as preceptors, Staff nurses may serve as preceptors, but that does not excuse the student from but that does not excuse the student from performing at the level of a RN. That includes performing at the level of a RN. That includes planning care, implementing interventions, and planning care, implementing interventions, and

evaluating outcomes.evaluating outcomes.

Myths about student nursesMyths about student nurses

MYTH:MYTH: Nursing students will never be asked to Nursing students will never be asked to perform skills that they don’t know how to do.perform skills that they don’t know how to do.

REALITY:REALITY: Nurse preceptors are not always aware of Nurse preceptors are not always aware of which skills have been learned by the nursing which skills have been learned by the nursing students. Students may be asked to perform students. Students may be asked to perform skills that they have not been taught yet.skills that they have not been taught yet.

When in clinical:When in clinical:

If you are asked to perform a skill which you have If you are asked to perform a skill which you have not been taught yet or which you do not feel not been taught yet or which you do not feel comfortable doing, comfortable doing, let your instructor and the let your instructor and the RN know!RN know!

They may:They may:

Perform the procedure and allow you to Perform the procedure and allow you to observeobserve

Review the procedure with you and allow you Review the procedure with you and allow you to assistto assist

When in clinical:When in clinical:

Do notDo not perform a skill that you have not been perform a skill that you have not been taught or you do not feel comfortable doingtaught or you do not feel comfortable doing

Use your clinical instructor as a resource- Use your clinical instructor as a resource- if you if you are unsure of something, ASK!are unsure of something, ASK!

LOOK BEFORE YOU LEAP!LOOK BEFORE YOU LEAP!

Do not make rash decisions in clinical- take you Do not make rash decisions in clinical- take you time and make decisions carefully.time and make decisions carefully.

Here are some other Here are some other suggestions for when you suggestions for when you

are in clinical…are in clinical…

When in clinical:When in clinical:

MAKE SURE THAT YOU HAVE THE RIGHT MAKE SURE THAT YOU HAVE THE RIGHT PATIENT!!!PATIENT!!!

Check the ID band Check the ID band BEFOREBEFORE you do you do anything with a patient!anything with a patient!

Look up Look up everyevery medication before you give it! medication before you give it!

You need to know the drugs you are giving, in You need to know the drugs you are giving, in order to make sure that is appropriate for the order to make sure that is appropriate for the patient and watch for side effectspatient and watch for side effects

Your clinical instructor WILL expect this!Your clinical instructor WILL expect this!

When in clinical:When in clinical:

The facility may require your instructor to sign The facility may require your instructor to sign your medication sheets.your medication sheets.

Make sure this is done Make sure this is done beforebefore you leave clinical you leave clinical for the dayfor the day

Sign your name with your first initial, last name, Sign your name with your first initial, last name, and credentials (OUSN)and credentials (OUSN)

Document Document onlyonly in black ink! in black ink!

When in clinical:When in clinical:

Be on time, ready to go! Nurses are busy getting Be on time, ready to go! Nurses are busy getting report and don’t have time to deal with nursing report and don’t have time to deal with nursing students who show up late.students who show up late.

Treat the nursing staff (RNs Treat the nursing staff (RNs and nursing and nursing assistantsassistants) with respect and thank them for their ) with respect and thank them for their assistance.assistance.

Nursing assistants are a huge help to nursing Nursing assistants are a huge help to nursing students- students- they know where stuff isthey know where stuff is! !

Stay on their good side!Stay on their good side!

When in clinical:When in clinical: Work with your classmates!Work with your classmates!

Nursing school and clinicals are hard enough Nursing school and clinicals are hard enough without having to go it totally alonewithout having to go it totally alone

If your patient is sleeping, see if one of your If your patient is sleeping, see if one of your classmates needs a hand with somethingclassmates needs a hand with something

If you get to do something really cool or your If you get to do something really cool or your patient has an unusual wound or heart patient has an unusual wound or heart murmur, share it with your classmates so that murmur, share it with your classmates so that they can learn about it too!they can learn about it too!