CHAPTER 22 LEGAL ASPECTS OF NURSING LEADERSHIP Laws- rules of conduct, established and enforced by authority, which prohibit extremes

in behavior so that one can live without fear for oneself or ones property Public law- consists of constitutional law, criminal law and administrative law Civil law- governs hoe people relate to each other in everyday matters and consists of contract law and tort law Nurses can be affected by: a. Criminal law- if they commit a criminal act or are victims of a crime b. Administrative law- federal regulations that prevent discrimination due to age or disability c. Civil law- specifically tort law Tort law i. tort- private or civil wrong or injury, including action for bad faith, breach of contract, for which the court will provide a remedy in the form of an action for damages ii. Tort can be any of the following: a. Denial of persons legal rights b. Failure to comply with public duty c. Failure to perform private duty that harms another person iii. Tort can be unintentional such as malpractice or neglect or it can be intentional such as assault and battery iv. Tort charges that a nurse can face include assault and battery, false imprisonment, and invasion of privacy, defamation, and fraud Nurse practice act- establishes the scope of practice for licensed practical nurses and registered nurses and differentiates the practice of nursing from the practice of medicine Negligence- failure of an individual not to perform an act or to perform an act that a Jamie Francis C. Ray MFR RN

reasonable, prudent person would or would not perform in a similar set of circumstances Malpractice- is a professional negligence and refers to any misconduct or lack of skill in carrying our professional responsibilities LEGAL ISSUES SPECIFIC TO NURSING: A. Patient care issues i. Medication and IV errors a. Wrong medication or incorrect dosage b. Wrongly administered c. Wrong patient d. Administering a medication to which a patient has a known allergy ii. Injuries a. Caused by equipment used b. Caused by restraints placed on patient c. Falls iii. Responsibility a. Patient is prematurely discharged b. Patient refusing care c. Nurse fails to follow up physician or other health care providers when there is a change in patients condition iv. Errors due to language barriers a. Physicians and staff from other countries b. Pt. whose primary language is not English v. Home care a. Essential to know the chain of command for notifying supervisors and physicians of change in patient status b. Aware of how patient equipment works and how to ensure that the equipment functions properly c. Appropriate delegation to assistive staff DOCUMENTATION AND CHARTING i. Rules for appropriate documentation and charting a. Chart all interventions b. Spell out instructions and discharge planning

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c. Be sure to identify an assessment of patient understanding Charting dos a. Limit use of abbreviations to those approved by the organization b. Include time, date and signature on each entry c. Follow hospital policy regarding corrections/deletions/amend ments Charting donts a. Dont use chart to accuse or blame others b. record observations c. describe pt. behavior d. Dont be afraid to amend the chart, using approved procedures, to clarify or provide more info. Common charting omissions that should be included a. Abnormal vital signs and in nursing actions taken b. in cardiac arrest c. when pt. is being transferred d. pt. teaching e. pt. refusal of treatment f. any instructions relayed by telephone or e-mail incidents and incident reports a. generally an internal procedure but can be used in court in limited circumstances b. accurately record all details c. provide objective description of any incident and any action taken in response d. never provide info about how the incident could have been avoided e. document pt. assessment and monitoring after he incident f. if the nurse is not sure whether info should be included, check with the nurse manager, supervisor before making a permanent record the dangers of charting by exception; out of the ordinary findings are charted a. some organizations adopted this method to save time

b. does not provide evidence of appropriate nursing care provided c. thorough charting means safer patient care and sounder evidence in case of litigation TELEPHONE TRIAGE 1. in the best interest of the pt. nurses should avoid advice over the phone unless in a position as an advise nurse 2. use protocols such as symptombased protocols and standing orders for consistency and legal protection 3. attempt to ensure the pt. understanding and compliance once instructions are given 4. document all aspects of conversations, including the question asked by the pt., S/Sx and advice given GROUND RULES FOR EFFECTIVE NURSEPHYSICIAN-PT. COMMUNICATION 1. nurse must communicate accurately both verbally and in writing 2. nurse should immediately document all incidents and changes in pt. condition 3. charting should be factual, legible, no errors and be accurate and complete NURSES RIGHTS AND RESPONSIBILITIES A. Injuries caused by a pt. i. nurse has the right to press charges if the pt. threatens or intentionally injures the nurse ii. nurses are entitled to workers compensation when injured B. matching assignment and skills i. nurse can refuse an assignment that is beyond their scope of practice or skill level ii. nurses should feel free to question a supervisor who assigns a task for which the nurse is not prepared or qualified C. refusing an assignment D. when nurses disagree with physicians

Jamie Francis C. Ray MFR RN

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sexual harassment and job discrimination i. sexual harassment- unwanted sexual advances, request for sexual favors and other verbal or physical conduct of a sexual nature

CURRENT LEGAL PROTECTIONS FOR NURSES A. Good Samaritan law B. Skillful communication C. Excellent relationship with pt. and families D. Risk management E. Malpractice insurance CHAPTER 23 ETHICAL ISSUES IN NURSING LEADERSHIP ETHICS- the science that deals with the principles of right and wrong, good and bad and governs our relationships with others and that is based on personal beliefs and values Bioethics- the ethics specific to health care Ethical theories 1. Utilitarianism- decisions based on what will provide the greatest good for the greatest number of people 2. Teleology- value of a situation is determined by its consequences 3. Deontology- an act is good only if it springs from goodwill. the end justifies the means MORALITY- behavior in accordance with custom or tradition and usually reflects personal or religious beliefs VIRTUE- Possessing moral goodness, the quality of engaging in ethical thinking and actions 4 characteristics of a person of virtue 1. 2. 3. 4. Compassion Discernment Trustworthiness Integrity

Quid pro quo: when a supervisor makes submission to sexual demands a requirement for continued employment or basis for employment decisions Hostile environment- when someones sexual conduct is pervasive or severe enough to intimidate or offend an employee or interfere with his or her ability to perform a job PROTECTING NURSING LICENSURE Actions to avoid: 1. 2. 3. 4. 5. 6. negligence incompetence abusive behavior drug and alcohol abuse physical and mental impairment fraud

Decision by the nursing board Censure- disapproval of nurses actions and records this in the minutes Letter of reprimand- a more severe expression of disapproval of nurses actions Probation- nurses professional activities are closely monitored for a period of time License suspension- prohibited from practicing for a period of time Revocation- severe penalty; prohibits a nurse from ever practicing again Other legal risks/issues for nurses A. B. C. D. E. F. G. managed care downsizing emergency care HIV.AIDS DNR Telemedicine Multistate practices/compacts

Ethical principles and rules: Beneficence- duty to do good to others Nonmaleficence- principle of doing no harm Justice- principle of fairness that an individual receives what is due, owed, or legitimately claimed

Jamie Francis C. Ray MFR RN

Autonomy- respect for individual liberty and persons right to self determination Fidelity- principle of keeping ones promise or word Respect- right of people to make their own decisions Veracity- obligation to tell the truth Historical/philosophical influences guiding ethical perspective and nursing practice: A. Religious B. Womens issues C. Philosophy of nursing- rational investigation of truths and principles of knowledge, reality and human conduct D. Values- personal beliefs about the truth of ideals, standards, principles and behavior that give meaning and direction to a persons life Values clarification- is the process of analyzing ones values to better understand what is important a. Choosing- assumes that choices are made freely and that in choosing, a person analyzes the consequences of other alternatives b. Prizing- beliefs that are selected are valued c. Acting- chosen beliefs are consistently demonstrated through a persons behavior Steps in ethical decision making 1. Gather data 2. Identify participants 3. Determine moral perspectives and development of participants 4. Determine desired outcomes 5. Identify options 6. Take actions on the choice 7. Evaluate outcomes of action chosen Special ethical issues a. cost containment vs. cost of available technology b. pt. rights

CHAPTER 24 10 WAYS TO BECOME A LEADER

1. Make a commitment to lifelong learning 2. Learn to write well 3. Join a professional nursing association 4. Get involved in the community 5. Teach 6. Get politically involved 7. Get certified 8. Serve on communities in your organizations 9. Give yourself a break 10. Be proud to be a nurse

Jamie Francis C. Ray MFR RN