Nr203 Test 5 Legal Issues-Nurse Practice Act

Front 1

What is Nursing

Back 1

“The diagnosis and treatment of human responses to health and illness. This is the core or essence of nursing"

Front 2

Nursing is accountable for ensuring that its members act in the public interest and provide that unique service that has been designated to them by society.
this is called _________ _______

Back 2

Professional Regulation

Front 3

Professional nursing is a process...

Back 3

“Process in which substantial specialized knowledge derived from the biological, physical, and behavioral sciences is applied to: changes in the normal health processes or who require assistance in the maintenance of health or the prevention or management of illness, injury or infirmity; administration, supervision or teaching of the process”

Front 4

Individual RN’s Responsibility

Back 4

The registered nurse is responsible and accountable both professionally and legally

Each registered nurse is responsible and accountable for making decisions and practicing in accordance to his / her educational background and experience within the statutory parameters of the Nurse Practice Act. Nurses are individually licensed, individually liable for nursing judgement and action.

Front 5

Nurse-Patient Relationship-Standard of Care

Back 5

Two concepts basic to the practice of professional nursing are the relationship that occurs between the nurse and the patient and the standard of care delivered to the patient.
Both concepts encompass legal and professional dimensions

Front 6

Reliance Relationship

Back 6

The nurse-patient relationship has a Legal status that arises whenever a nurse renders nursing care to another person.
Once the relationship has been established the patient has the right to believe that the nurse has the duty to act in the patient’s best interest.

Front 7

Standard of Care

Back 7

The degree of care that a person of ordinary prudence, charged with the same duties, would assume or others would assume in like circumstances. (Aiken, 1994).
Standards are the criteria for evaluation of practice.
Minimal level of expertise that must be delivered to the patient

Front 8

Nursing License
Protect your license:

Back 8

License is a privilege not a right
Protect your license:
Don’t let anyone borrow it
Don’t let anyone copy without “copy” written on the copy
If lost, report immediately
Report change of address to state board
Practice within scope
Know your nurse practice act

Front 9

Nursing License
Revocation of license

Back 9

Revocation of license
License is your property
Legal basis of the 14th amendment to the constitution
No one can take it away form you without just cause as long as you renew license according to the law
Difficult to revoke unless linked to performance

Front 10

State Board of Nursing

Back 10

Functions as a “consumer advocate” for Kansas consumers of health care
Establishes and Enforces minimum qualifications for entry into nursing practice
Determining appropriate disciplinary measures for nurses who violate the Nurse Practice Act
Created to protect the public form the incompetent and/or unauthorized practice of nursing

Front 11

State Board of Nursing

Back 11

Members are appointed by Governor
11 Members
Serve for 4 year terms for 1st appointment, 2 year term for 2nd appointment
6 RN
2 LPN
1 LMHT
2 General Public
Responsibilities:
Setting standards for entry into practice
Developing administrative rules to define and implement the provisions of the Nurse Practice Act
Issuance of Licenses
Disciplining Nurses who have committed violations of the Nurse Practice Act

Front 12

NURSE PRACTICE ACT

Back 12

Contains laws and administrative regulations that define nursing practice and establishes legal standards.
Each state has a practice act that varies in scope from state to state.
Nurse practice acts are the most important legal statutes and administrative rules regulating the practice of nursing.

Front 13

NURSE PRACTICE ACT

Back 13

Safeguards the public by setting standards for nursing education and practice
Investigation of violations of standards
A nurse practicing in a state is accountable for adhering to the legal requirements of that state.
Enacted by the legislature to ensure the public that all nurses licensed in Kansas meet and maintain minimum standards of competency.

Front 14

NURSE PRACTICE ACT

Back 14

a set of laws establishing the scope of practice for all licensed nurses in Kansas, and a process for enforcing minimum standards of competency

Front 15

NURSE PRACTICE ACT

Back 15

Hospital staffing patterns , labor practices, or employment criteria are not within the jurisdiction of the Nurse Practice Act

Front 16

COMPETENT PRACTICE

Back 16

SINGLE MOST IMPORTANT SAFEGUARD TO ENSURE PROTECTION AGAINST LEGAL LIABILITY

Front 17

LIABILITY

Back 17

Personal Liability
Nurses are responsible and accountable for their own action or inaction
Organizational Liability
Vicarious Liability: Not negligent themselves but assumed negligence due to association
Respondeat Superior: “Let the Master Speak”
Doctrine that holds employer responsible for the actions of the employee

This includes being asked to do things that are not within standards of care.
Organizations are liable for monitoring ongoing competency and educational opportunities for staff.

Front 18

Organization Liability

Back 18

Organization Liability
The organization is responsible for its own wrongful conduct.
Includes:
Duty to hire, supervise, and maintain qualified, competent, and adequate staff
Duty to provide, inspect, repair, and maintain reasonably adequate equipment
Duty to maintain safety
This is why organizations have annual competency requirements and mandatory inservices.

Front 19

Liability Insurance

Back 19

Important for nurse to care own insurance
Nurse may be sued as an individual
Employer has insurance, but primary objective will be to protect the organization
Nurses managers are not responsible for the actions of others, but are responsible for supervision, delegation, and disciplinary actions
Be very careful about throwing around the phrase “My license is on the line” Make sure you know what you are saying and implying when making that statement.

Front 20

Professional Malpractice

Back 20

The failure of a person with a professional education and skills to act in a reasonable and prudent manner.
Also known as “professional negligence”

Front 21

Six Elements Required for Malpractice Liability

Back 21

Six Elements Required for Malpractice Liability

Duty owed to the patient
Breach of the duty of care
Falling below standard of care
Foreseeability
Causation
Injury
Must be physical, not psychological or transient
Damages
Must show financial harm as malpractice is nonintentional and unintended

All 6 elements must be met for malpractice liability. Foreseeability: the concept that certain events may reasonably be expected to cause specific results. Nurses must have prior knowledge or information that failure to meet a standard of care may result in harm. Ex: identified fall risk patient / no precautions taken. Causation: Nurses actions or lack of actions directly caused harm: failure to treat a hypoglycemic patient

Front 22

Management Issues

Back 22

Delegation and Supervision
Must be aware of staff’s knowledge, skills, and competence
Staffing
Organization required to provide adequate staffing
Job Reassignment
No legal basis for refusing to float
Policies and Procedures of Organization
Incompetent Practice
Due care requires managers to address incompetent/ unsafe practice

Front 23

INFORMED CONSENT

Back 23

Authorization by either the patient or legal representative to “do” something to the patient and is based on 3 principles:
Legal capacity
Determined by age and competency
Voluntary action
Patient not coerced by fraud, duress, or deceit
Comprehension
Sufficient information to make decision, including informed refusal

Front 24

Nursing’s Role in Signing Informed Consent

Back 24

What does your signature say on the informed consent?
Attesting only to the voluntary nature of the patient’s signature
If there are questions from the patient/ family that cause you to be concerned with the accuracy and / or sufficiency of information, what should you do?

Front 25

PRIVACY AND CONFIDENTIALITY

Back 25

Privacy: the patient’s right to protection against unreasonable and unwarranted interference with his or her solitude

Confidentiality: The right to privacy of the medical record

“NEED TO KNOW” basis!!

Front 26

WHERE, WHAT, and WHEN

Back 26

Caution regarding conversations about patients (is is appropriate?)
Where are the conversations occurring?
Patient designating who may receive information
Reviewing patients’ charts

Front 27

MEDICAL RECORDS

Back 27

Patients have a right to their medical record, however state law mandates when this right becomes active
Most states give the right of access ONLY after the medical record is COMPLETED, therefore patients have the right to review their chart after discharge

Front 28

The Nurse’s Responsibility

Back 28

Supervision of the medical record with the patient
If a family member is requesting, must have patient’s signed consent
Explain only entries that are being questioned
Make entry in chart regarding patient’s review of the chart and questions asked

Front 29

Medical Records

Back 29

Patients may request a “COPY” of their medical record at their own expense.
The medical record belongs to the institution as a business record, the original must remain with institution.

Front 30

HIPAA

Back 30

Requires healthcare organizations to make sure prudent safeguards are in place to prevent unauthorized access or harm to Protected Health Information (PHI)
Definition of PHI: Individually identifiable health information that is transmitted in any form, electronic or otherwise.

Front 31

HIPPA

Back 31

Protecting patient information is cornerstone to building trust relationship between provider and the patient.
Consistent with good health care ethics.
HIPPA compliance is sound business. Failure to protect patient confidentiality may harm organizational reputation and accreditation status.

Front 32

HIPAA

Back 32

Gives patients more control over their health information
Sets boundaries on the use and release of health records
Establishes safeguards that health care providers and others must achieve to protect the privacy of health information

Front 33

HIPPA

Back 33

2 types of penalties for failure to comply:
Unintentionally commit a violation:
Civil monetary penalty of up to $100 per violation, up to an annual maximum of $25,000
Intentional disclosure of information:
Criminal penalties of up to $250,000 in fines and up to 10 years in prison, per violation

Front 34

Why is the HIPAA Privacy Rule Needed?

Back 34

Prior to HIPAA, personal health information could be distributed- with or without notice or authorization- for reasons that had nothing to do with a patient’s medical treatment or health care reimbursement. For example, unless forbidden by a State or local law, prior to HIPAA, health information could be passed on to a mortgage company or credit card company that could be used to deny loan applications, etc.

Front 35

INCIDENT REPORTS

Back 35

Internal documentation of unusual occurrence. STATE ONLY FACTS!
Historically, considered to be non-discoverable, however recent litigation has changed that principle
NEVER, NEVER note the existence of an incident report in the official medical record (This immediately makes the incident report discoverable in court.

Front 36

Kansas Risk Management Statute

Back 36

All health care providers are required under this statute to report “an act by a health care provider which:
(1) is or may be below the applicable standard of care and has a reasonable probability of causing injury to a patient
(2) may be grounds for disciplinary action by the appropriate licensing agency
Willful failure to report is punishable as a Class C misdemeanor

Front 37

Incident Forms

Back 37

Should be completed within 24 hours of being knowledgeable of the event.
Notify immediate supervisor or Risk Management if immediate intervention is required

Front 38

What is reported?

Back 38

Medication errors
Patient abuse
Patient falls
Property damage
Clinical omissions
Surgery to wrong body part
Suicide attempt

Infant abduction
Any patient injury
Staff or physician behavior that is inappropriate
Staff or physician drug or alcohol impairment
Delays in treatment

Front 39

Standard of Care Determination

Back 39

SOC 1 – Standard of care met
SOC 2 - Standard of care not met, no harm came to the patient
SOC 3 – Standard of care not met, harm occurred, or if breach were to occur again, probable harm to pt
SOC 4 – Standard of care not met, possible grounds for disciplinary action