LEGAL PROBLEMS IN NURSING

LAW AND NURSING PRACTICE

Johnasse Sebastian C. Naval, RN
OBJECTIVE
TO BECOME FAMILIAR WITH THA BASICS
OF LEGAL ASPECTS OF PROFESSIONAL
NURSING PRACTICE
INTRODUCTION
Nursing practice is governed by many
legal concepts. Knowledge of laws that
affect nursing practice is needed to ensure
nurses decisions and actions in work area
and also it will protect the nurse from
liability.

It is the supreme law of the country

Fundamental law written or unwritten, that
establishes the character of government
by defining the basic principle to which a
society must conform.
LEGISLATION ( STATUATORY LAW )
Laws enacted by any legislative body are
called statutory laws.
A written law passed by a legislature on
the state or federal level
(LEGISLATURE: AN OFFICIALLY ELECTED
OR OTHERWISE SELECTED BODY OF
PEOPLE
VESTED
WITH
THE
RESPONSIBILITY & POWER TO MAKE LAWS
FOR A POLITICAL UNIT, SUCH AS A STATE
OR UNIT.)

LAW
DEFINITION
THE SUM TOTAL OF RULES AND
REGULATIONS BY WHICH A SOCIETY IS
GOVERNED. AS SUCH, LAW IS CREATED BY
PEOPLE AND EXISTS TO REGULATE ALL
PERSONS
( GUIDO, 2001,P.2. )
FUNCTIONS OF LAW IN NURSING
It provides a framework for which nursing
actions in the care of clients are legal
Protect clients rights
It
helps
to
make
boundaries
of
independent nursing action.
It assists in maintaining a standard of
nursing practice by making nurses
accountable under the law
How to Protect yourself
Know your state laws affecting nursing
practice.
Follow your states nurse practice act rules
& regulations.
Deliver safe, competent nursing care.
Develop & use your critical thinking
abilities & skills.
SOURCES OF LAW
CONSTITUTIONAL LAW

Administrative Law
When a state legislature passes a statute,
an administrative agency is given
authority to create rules & regulations to
enforce the statutory laws.
e.g.: STATE BOARDS OF NURSING
WRITES RULES AND REGULATIONS TO
ENFORCE & IMPLEMENT NURSE PRACTICE
ACT, WHICH WAS CREATED BY STATUTORY
LAW.
Common law
Laws evolving from court decisions are
referred to as common law.
Law developed by judges through decision
of courts and similar tribunals.
Types of law
Public law: it refers to the body of law that
deals
with
relationship
between
individuals and the government and the
governmental agencies.
Important segment of public law is
criminal law. Which deals with safety and
welfare of the public. E.g.: theft,
manslaughter, homicide etc.,

Private law or civil law : It is the body of

the law that deals with relationship among
private individuals.
It is again classified into contract law and
tort law
Contract law : is the enforcement of
agreements among private individuals.
Tort law: It defines and enforces duties and
rights among private individuals that are
not based on the contractual agreement.
E.g.: INVASION OF PRIVACY, ASSAULT AND
BATTERY
Selected Categories of law affecting
nurses
Category
CONSTITUTIONAL
STATUTORY ACT
CRIMINAL
Example
Due Process
Equal Protection
Nurse Practice Act
Sexual Harassment laws
Theft, Homicide, Sexual assault
Active euthanasia
Illegal Possession of Controlled drugs
CONTRACTS
TORTS
Nurse and client
Nurse and employer
Nurse and insurance
Negligence/malpractice
Invasion of privacy
Assault and battery
Abandonment
Regulation of nursing practice
Regulation for nursing practice helps to
bring a standard in nursing care and thus
to protect the public.
1. Nurse Practice act
2. Credentialing
3. Standards of care
1. NURSE PRACTICE ACTS
Each state has a nurse practice act, which
protects the public by legally defining and

describing the scope of nursing practice

and it is also legally control nursing
practice through licensing requirements.
But acts differ from country to country.
2. CREDENTIALING
Credentialing
is
the
process
of
determining
and maintaining competence in nursing
practice.
Credentialing process helps to maintain
standards of practice & accountability for
educational preparation of its members.
1. Licensure
2.Certification
3. Accreditation
Licensure
A license is a legal permit that a
government agency grants to individual to
engage in the practice of profession & to
use a particular title.
Each country has its own method to grant
or maintain and revoke the licensure.
However a nurse can practice any where
within the country with her states
licensure. This is known as mutual
recognition model.
Certification
Certification is the voluntary practice of
validating that an individual nurse has met
minimum
standards
of
nursing
competence in specialty areas such as
maternal-child health nursing, pediatrics,
school nursing etc.,
Accreditation
It is the function of a state board of
nursing is to ensure that schools preparing
nurses maintain minimum standard of
education.
3.STANDARD OF CARE
Standard of care are the skills and learning
commonly possessed by members of a
profession.

These standards are used to evaluate the

quality of care nurses provide and,
therefore, become legal guidelines for
nursing practice.
It can be
internal job description,
education, policy & procedures
external Nurse practice
act, Professional organizations
It is important for a nurse remain
competent through reading professional
journals
and
attending
continuing
education and in-service programs.

LEGAL ROLE OF NURSE

Legal roles of nurses
1. Provider of service
2. Employee or contractor for service
3. citizen
1. Provider of service
The nurse is expected to provide safe &
competent care.
Nurse is liable to his/her action. Liability is
the quality or state of being legally
responsible for ones obligations and to
make financial restitution for wrongful act.
For example: A nurse can refuse a task
if the nurse will feel that it may harm the
client and it can be reported to the
supervisor
2. Employee or contractor for service
It vary among practice settings.
A independent nurse practitioner has an
independent contractual relationship with
the client.
Nurse who is employed by an agency
works as an representative of the agency.
cont

The nurse in the role of employee or

contractor for service has obligations to
the employer, the client, and other
personnel.
Nursing care provided must be within the
limitations and term specified.

The rights & responsibilities of a nurse in

the role of citizen are the same as those of
any individual under legal the system.
A right is a privilege or fundamental power
A
responsibility
is
the
obligation
associated with the right
SELECTED LEGAL ASPECT OF NURSING
PRACTICE
INFORMED CONSENT
DELEGATION
VIOLENCE, ABUSE & NEGLECT
CONTROLLED SUBSTANCES
ABORTIONS
DEATH & REALTED ISSUES
SEXUAL HARASSEMENT
INFORMED CONSENT
It 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, alternative to the treatment,
and prognosis if not treated by a health
care provider.
DELEGATION
Delegation is defined as transferring a
competent individual the authority to
perform a selected nursing task in a
selected situation.

VIOLENCE, ABUSE & NEGLECT

Violent behavior can include domestic
violence, child abuse, elder abuse, and
sexual abuse.
Neglect is the absence of care necessary
to maintain the health & safety of a
vulnerable individual such as a child or
elder.
To use wrongly or improperly or to hurt or
injure someone.
CONTROLLED SUBSTANCES

3. citizen

Controlled substances mainly include

stimulants,
depressants,
narcotics,
hallucinogens etc.,
Misuse of these leads to criminal
penalties.
ABORTIONS
To save the life of the woman
Yes
To preserve physical health Yes
To preserve mental health
Yes
DEATH & REALTED ISSUES
Nurses role in legal issues related to death
is prescribed by the laws of the region and
the policies of the health care institution.
Beliefs and attitudes about deaths, its
causes and the soul also vary among
cultures
SEXUAL HARASSEMENT
Sexual
harassment
is
defined
as
unwelcome sexual advances, requests for
sexual favors, and other verbal or physical
conduct of a sexual nature.
Areas of potential liability in nursing
Nursing liability is usually involved with
tort law.
It is important for a nurse to know the
differences
between
malpractice
(unintentional torts) and intentional torts.
CRIMES & TORTS
A crime is an act committed in violation of
public (criminal) law and punishable by a
fine or imprisonment.
Crimes are punished through criminal
action by the state against an individual.
Crimes are punished through criminal
action by the state against an individual. It
may be in terms of imprisonment or by a
fine.
Crimes again classified into FELONY and
MISDEMEANOR
Felony is a crime of a serious nature, such
as murder, punished by a term in prison.
A misdemeanor is an offense of a less
serious nature and is usually punishable

by a fine or short term jail sentence, or

both.
A tort is a civil wrong committed against a
person or a persons property.
In other words, the person or persons
claimed to be responsible for the tort are
sued for the damages.
Torts
are
again
classified
into
unintentional tort and intentional tort.
UNINTENTIONAL TORT
Negligence and malpractice are examples
of unintentional torts.
Negligence is misconduct or practice that
is below the standard expected of an
ordinary, reasonable, and prudent person.
Such conduct places another person at
risk for harm.
Malpractice is professional negligence
that is, negligence that occurred while the
person was performing as a professional.
There are 6 elements must be present for
a case of nursing malpractice to be
proven.
1. Duty: The nurse must have a
relationship with the client that involves
providing care and following an acceptable
standard of care.
2. Breach of duty: Standard of care that is
expected in the specific situation but that
the nurse did not observe.
3. Foreseeability: A link must exist
between the nurses act and the injury
occurred.
4. Causation: It must be proved that harm
occurred as a direct result of nurses
failure to follow the standard of care.
5. Harm or injury: The client must
demonstrate some type of harm or injury (
physical, financial, or emotional)
6. Damages: If malpractice caused the
injury, the nurse is held liable for damages
that may be compensated.
INTENTIONAL TORTS
The defendant executed
purpose or with intent.

the

act

on

There are mainly 5 intentional torts which

is related with nursing
1.Assault
2.Battery
3.False Imprisonment
4. Invasion of privacy
5.Defamation
Assault: It is an attempt or threat to touch
another person unjustifiably.
e.g.: a nurse who threatens a client with
an injection for refusing an oral medicine.
2.Battery: is the willful touching of a
person that may or may not harm. E.g.: a
nurse threatens an gives an injection
without consent.
3.
False
imprisonment:
It
is
the
unjustifiable detention of a person without
legal warrant or confine the person.
e.g.: not allowing a person to go LAMA or
insisting a client to confine on bed
4. Invasion of privacy: It injures the feeling
of a person and does not take into account
the effect of revealed information on the
standing of the person in the community.
5. Defamation: It is a communication that
is false, or made with a careless disregard
for the truth. e.g.: a nurse writes in her
nurses notes that a physician is
incompetent or telling a client that her
colleague is incompetent.
LOSS OF CLIENT PROPERTY
Loss of client property, dentures, jewelry,
money etc.,
Nurses are expected to take reasonable
precautions to safeguard clients property
UNPROFESSIONAL CONDUCT
It includes incompetence
or gross
negligence, conviction for practicing
without a license, falsification of client
record, and illegally obtaining, using, or
possessing controlled substances.

LEGAL PROTECTION IN NURSING PRACTICE

Good Samaritan act
Professional liability Insurance
Carrying out a physician order
- Question any order a if the clients
condition has changed
- Question any order that is illegal,
unclear, or incomplete.
4. Providing Competent Nursing Care
5. Record keeping
6. The incident report
REPORTING,
CRIMES,
TORTS,
AND
UNSAFEPRACTICES
Nurses may need to report nursing
colleagues or other health professional for
practices that endanger the health and
safety of clients.