Nursing Chapter 4 Homework Review The Institutions Policy For Dnr Orders

14 CHAPTER 4 / Legal Aspects of Nursing

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1

List sources of law and types of laws.

Concepts for Lecture

1. The primary sources of law include constitutions, statutes, adminis-

trative agencies, and decisions of courts.

2. Laws can be divided into different types of laws. The two main types

are public law and private or civil law.

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2

Describe ways nurse practice acts, credentialing, standards of care, and agen-

cy policies and procedures affect the scope of nursing practice.

Concepts for Lecture

1. Each state has a nurse practice act, which protects the public by le–

gally defining and describing the scope of nursing practice and legal-

ly controlling practice through licensing requirements. Although

similar, the acts do differ from state to state. Standards of care are

the skills and learning commonly possessed by members of a profes-

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Compare and contrast the state-based licensure model and the mutual recog-

nition model for multistate licensure.

Concepts for Lecture

1. A license is a legal permit that a government agency grants to en-

gage in the practice of a profession and to use a particular title. A

nursing license is mandatory in all states.

board of nursing licensed all nurses practicing in the state, and a

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LEGAL ASPECTS OF NURSING

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• Provide the students with a list of situations that

might occur in nursing practice and have them

classify the problems under the type of law in-

volved (for example, a nurse witnesses a health

care provider strike a client).

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• Obtain copies of the nurse practice act, standards

for the American Nurses Association, and the

standards of several specialty nursing organiza-

tions. Have the students identify how these affect

the scope of practice and protect the public.

• Have the students review the licensing require-

ments for the state and relate these to public safe-

ty.

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• Obtain the policy and procedures books for

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• Have the students access the NCSBN website to

determine whether the state participates in the

mutual recognition model.

• Have the students review the state licensure

requirements and compare them to those of an-

other state.

• Give the students examples of telehealth situa-

tions, and have the students determine whether

multiple licensure would be required for a nurse

involved in these situations.

CHAPTER 4 / Legal Aspects of Nursing 15

In response, the National Council of State Boards of Nursing

(NCSBN) developed a new regulatory model, the mutual state

recognition model, which allows for multistate licensure (see Box 4–

1). The state legislatures initiate and decide on the establishment of

an interstate compact called the Nurse Licensure Compact (NLC), an

agreement between two or more states to create a mutual recognition

model. Then, a nurse who is not under discipline can practice across

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Describe the purpose and essential elements of informed consent.

Concepts for Lecture

1. 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

or individual with the capacity and competence to understand, and

the client or individual must be given enough information to be the

ultimate decision maker.

For consent to be voluntarily given, the client must not feel co-

erced or give consent to avoid disapproval of the health care provid-

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• Discuss the difference between obtaining in-

formed consent and witnessing the client’s signa-

ture on a consent form.

• Obtain informed consent forms from clinical

agencies, and compare the information on the

forms with the general guidelines given in the

textbook for information to be included on a con-

sent form.

• Review policies for obtaining informed con-

sent forms in the institution.

16 CHAPTER 4 / Legal Aspects of Nursing

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Describe the purpose of the Americans with Disabilities Act.

Concepts for Lecture

1. The Americans with Disabilities Act (ADA) prohibits discrimination

on the basis of disability in employment, public services, and public

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Discuss the impaired nurse and available diversion or peer assistance pro-

grams.

Concepts for Lecture

1. The impaired nurse refers to a nurse whose ability to perform the

2. Professional nursing organizations such as the American Nurses As-

sociation (ANA), the American Association of Nurse Anesthetists

(AANA), the International Nurses Society on Addictions (IntNSA),

and the National Student Nurses’ Association (NSNA) have passed

resolutions to ensure that student nurses and nurses with chemical

dependencies receive treatment and support, not discipline and deri-

sion.

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• Develop questions regarding the ADA, and as-

sign students to go to the ADA website Q & A

section to obtain answers and report findings to

the class.

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• Discuss the impaired nurse program for the state.

• Have the students discuss what they would do if

they recognized that a peer had come to the clin-

ical setting while intoxicated.

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Recognize the nurse’s legal responsibilities with selected aspects of nursing

practice.

Concepts for Lecture

1. Nurses need to know the legal aspects related to their many different

roles. These include legal aspects related to informed consent,

The nurse’s role in informed consent is not to explain the proce-

dure but to witness the client’s signature on the form. The nurse’s

whether the NPA permits delegation, whether the NPA provides a

list of what can be delegated, and whether the NPA has issued any

guidelines explaining nurses’ responsibility when delegating.

procedures will include information regarding the reporting proce-

dure, to whom incidents should be reported, the investigative pro-

cess, and how confidentiality will be protected.

Abortion laws provide specific guidelines about what is legally

permissible; however, the Supreme Court and state legislatures con-

The Patient Self–Determination Act (1991) requires all health

care facilities receiving Medicare and Medicaid reimbursement to

recognize advance directives, ask clients whether they have advance

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• Ask the students to bring in magazine and news-

paper articles about health-related legal issues.

Use these as a basis for discussion.

• Distribute procedures that a nurse might consider

delegating to an unlicensed assistive person.

Have the students discuss in small groups wheth-

er the procedure fits the criteria for delegation.

• Review the state’s requirements for reporting

child and adult abuse.

to comply with advance health care directives.

• Have the students investigate who has the au-

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when the client is incompetent, advance health directives or the

proxy decision maker should make the health care decisions; the

DNR decision should always be the subject of explicit discussion;

the DNR order should be clearly documented, reviewed, and updated

periodically; and a DNR order is separate from other aspects of the

manner of death. In some states where right–to-die statutes exist,

physicians are permitted to prescribe lethal doses of medication.

An inquest is a legal inquiry into the cause or manner of death. It

is conducted under the jurisdiction of a coroner or medical examiner.

Agency policy dictates who is responsible for reporting deaths to the

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Discriminate between negligence and malpractice.

Concepts for Lecture

1. Negligence and malpractice are examples of unintentional torts.

Negligence is misconduct or practice that is below the standard

2.

Malpractice is negligence that occurred while the person was performing

as a professional. It applies to physicians, dentists, and lawyers, and gen-

erally includes nurses (Box 4–4).

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• Invite a guest speaker who is both a nurse and an

attorney, or an attorney familiar with health-

related legal issues, to discuss legal aspects relat-

ed to nursing. Provide students with several case

studies illustrating negligence or malpractice and

have students identify these.

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Concepts for Lecture

1. Six elements must be present for a case of nursing malpractice to be

proven: duty, breach of duty, foreseeability, causation, harm or inju-

ry, and damages.

Duty means the nurse must have (or should have had) a relation-

ship with the client that involves providing care and following an ac-

Causation means that it must be proved that the harm occurred

as a direct result of the nurse’s failure to follow the standard of care

and the nurse could have (or should have) known that failure to fol-

low the standard could result in such harm.

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Concepts for Lecture

1. Unintentional torts (negligence and malpractice) do not require in-

tent but do require the element of harm.

2. With intentional torts the defendant executed the act on purpose or

with intent. No harm need be caused by intentional torts for liability

not cause harm. To be actionable at law, the touching must be wrong

in some way (for example, performing a procedure without consent).

False imprisonment is the unjustifiable detention of a person

without legal warrant to confine the person. If it is accompanied by

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• Review the institution’s policies and procedures

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• Discuss informed consent and its relationship

to battery.

• Review the type of client information that is

reportable in the state.

20 CHAPTER 4 / Legal Aspects of Nursing

less disregard for the truth, and results in injury to the reputation of a

person.

Two types of defamation include libel and slander. Libel is def-

amation by means of print, writing, or pictures. Slander is defama-

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Describe the four specific areas of the Health Insurance Portability and Ac-

countability Act and their impact on nursing practice.

Concepts for Lecture

1. HIPAA includes four specific areas:

• Electronic transfer of information among organizations. Instead of

each health provider using its own electronic format to transact

claims and report other information, HIPAA implements a national

2. Examples of HIPAA compliance and nursing practice include:

• Charts should be in a secure, nonpublic location to prevent the

public from viewing or accessing confidential health information.

• Place clipboards face down.

• Printed copies of protected health information should not be left

CHAPTER 4 / Legal Aspects of Nursing 21

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Describe the laws and strategies that protect the nurse from litigation.

Concepts for Lecture

1. Laws and strategies are in place to protect the nurse against litiga-

2. Because of the increase in the number of malpractice lawsuits

3. Nurses are expected to analyze procedures and medications ordered

by the physician. It is the nurse’s responsibility to seek clarification

5. Accurate and complete documentation is also a critical component of

legal protection for the nurse.

6.

An incident report (also called an unusual occurrence report) is an agen-

cy record of an accident or unusual occurrence. Incident reports are used

to make all the facts available to agency personnel, to contribute to sta-

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Discuss the legal responsibilities of nursing students.

Concepts for Lecture

1. Nursing students are responsible for their own actions and liable for

2. Nursing students are not considered employees of the agencies in

which they receive clinical experience. In cases of negligence in-

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• This is an excellent point to discuss common

nursing student problems such as leaving the

unit without appropriate notification, asking

for guidance when they are uncertain about

how to proceed, who to ask for help (experi-

enced nurses, not peers), or other problems

3. Students in clinical situations must be assigned learning experiences

4. To fulfill responsibilities to clients and to minimize chances for lia-

bility, nursing students need to:

• Make sure students are prepared to carry out the necessary care for

5.

Students who work as part-time or temporary nursing assistants or aides