Unit 3

Regulation

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Regulation of Nursing Practice Protection of Public Licensure Certification

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Licensure Permission to practice Establishes minimum competence Enforced by Board of Nursing Board established through Practice Act Elected Board in North Carolina

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Certification Competence established above minimum criteria

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Functions of Board of Nursing Govern own operation Approved/deny Schools of Nursing Examine/license applicants Review licenses Regulate specialty practice Discipline

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Authority of Board of Nursing Legislative - rules and regulations Quasijudicial - hearings Administrative - license control

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Types of Licensure Mandatory Licensure: regulates practice Permissive Licensure: protects title only Institutional Licensure: government regulates institution

who in turn regulates staff practice

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Nurse Practice Acts 1903: North Carolina had first permissive

Nurse Practice Act 1938: New York had first mandatory Nurse Practice Act

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Elements of Nurse Practice Acts Definition of Nursing Requirements for licensure Exemptions - Grandfather clause Licensing across jurisdictions:

reciprocity, endorsement, examination, waiver

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Disciplinary Hearings Filing of complaint Review of complaint Disciplinary action Appeal to court for reversion

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Expanded Practice Scope Nurse Practice Act NP Rules and Regulations Medical Practice Act Joint Statements Standing Orders

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Updating Practice Acts Legislative action: amendments Rules and Regulations Sunset Laws

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Advanced Roles Nurse Anesthesia, 1878 Nurse Midwifery, late 1800’s Nurse Practitioners, 1965

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Issues for NPs Prescriptive Authority Admitting privileges Reimbursement Direct Access to provider

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Common Areas of Liability Medication Errors Falls/Restraints Failure to assess Failure to communicate Technology Suicide prevention Discharges - Patient Advocate

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False Imprisonment Unjustifiable detention of person without legal warrant to

confine person Must be knowledge of imprisonment by patient for it to

occur Incompetent, mentally ill, or persons posing a threat to

society may be detained against will

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Conversion of Property Interference with right to possession of patient’s property Need to have adequate justification of action

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Intentional Infliction of Emotional Distress Professional conduct goes beyond that tolerated by

society Conduct calculated to cause mental distress Conduct causes mental distress

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Invasion of Privacy Unreasonable unwarranted interference with individual's

solitude Patient has right against 1) Appropriation of plaintiff’s

name or picture for defendant’s sole advantage; 2) Intrusion by defendant upon patient’s seclusion or affairs; 3) Publication by the defendant of facts that place the patient in a false light; 4) Public disclosure of private facts about the patient by hospital staff or medical personnel

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Defamation Comprised of slander (oral) and libel (written) Wrongful injury to another’s reputation Five elements Defamatory language that adversely affects reputation Defamatory language concerning living person

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Defamation Continued Publication to a third party or several persons Damage to person’s reputation Fault on part of defendant in writing or telling another the

defamatory language

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Defenses against intentional torts Consent or implied by law through:

prevention of loss of life or limb; person incapable; no reasonable reason to believe consent would not be given; reasonable person in similar circumstances would give consent

Truth in defamation cases

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Defenses Against Torts Continued Privilege - to protect public and private interests.

Example - recommendation from former to prospective employer; appropriate channels used; truthful; objective terms

Disclosure Statutes: reporting of information for health reasons

Intentional torts mitigated by retraction, if provoked

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Defenses to Nonintentional Torts Release: only compensated for negative action Contributory negligence: patient contributes to negative

action Assumption of risk: Plaintiff understood and is partially

responsible Immunity Statutes: Example - Good Samaritan Law

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Statute of Limitation In most states, 2 to 4 years, or with a child, until age of

maturity In North Carolina, 3 years for most cases

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Informed Consent Expressed or implied; written or oral, complete or partial Major exceptions: Emergency , therapeutic privilege,

patient waiver, prior patient knowledge or common knowledge

Other exceptions: preservation of life, protection of minors, prevention of self destruction, maintenance of ethical integrity, protection of public’s health