CASE STUDY: Madison Wills worked night shift on a neonatal intensive care unit (NICU) at a major medical center. She assumed the care of a very sick premat
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CASE STUDY:
Madison Wills worked night shift on a neonatal intensive care unit (NICU) at a major medical center. She assumed the care of a very sick premature infant who weighed 1 kg (a little over 2 lb). Sylvia Smithson had been the infant’s nurse during the day shift. Sylvia had started the infant’s intravenous (IV) antibiotic infusion at 6:30 p.m., just before shift change. She reported that the infant’s IV line in his arm was flowing without difficulty and the IV site had no redness or swelling.
When Madison assessed the infant at 7:45 after the end-of-shift report, she noted that the baby’s arm was swollen and that the IV had infiltrated (was no longer in the vein). When she stopped the medication, she also noted that the dose on the antibiotics was incorrect and was much too large for a very small infant.
Answer the following questions:
- What is the first thing that Madison should do after discovering these two problems?
- Which of these problems (the infiltration or the dosing) was the most significant?
- What is the nurse’s responsibility when an antibiotic is prepared by the pharmacy?
- Did malpractice occur? Why or why not?
- Who would you hold responsible for the errors which occurred? Why?
- What could have been done to prevent the errors?
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Legal Aspects of Nursing Practice NURS 2300
State Boards of Nursing
Purpose of licensing: To protect the public health, safety, and welfare of the
people (not nurses!) All states have a mandatory licensure law for the
practice of nursing to safeguard the public. Thus, only licensed nurses – RN or LVN/LPN – can
practice nursing.
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Nurse Practice Act Objectives of NPA: Defines the practice of professional nursing Sets the minimum educational qualifications and other
requirements for licensure Determines the legal titles and abbreviations nurses
may use Provides for disciplinary action of licensees for certain
causes In many states, NPA is a statutory law affecting nursing practice within the bounds of the state. Nursing Practice Act – defines and controls nursing
https://www.bon.texas.gov/pdfs/law_rules_pdfs/nursin g_practice_act_pdfs/npa2013.pdf
Copyright © 2017 by Elsevier Inc. All rights reserved.
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Composition of the Board of Nursing (BON)
Members appointed by the Governor with advice and consent of senate (13 Members)
1 APN; 2 RNs; 3 LVNs; 1 Nurse Faculty LVN Program; 1 Nurse Faculty ADN; 1 Nurse Faculty BSN; 4 Public Members
State Boards of Nursing and Nursing Education
The state boards of nursing have the authority to set and enforce minimum criteria for nursing education criteria.
An applicant for licensure must graduate from a state- approved nursing education program.
Copyright © 2017 by Elsevier Inc. All rights reserved.
5
National Council of Licensure Examination for Registered Nurses (NCLEX- RN)
The licensure exam is updated regularly and tests critical thinking and nursing competence in all phases of the nursing process.
Computerized adaptive testing Minimum: 75 Maximum: 145 Duration: 5 hours How does computerized adaptive testing work? Video:
The Next Generation NCLEX Uses Computer Adaptive Testing ( CAT) | NCSBN
Copyright © 2017 by Elsevier Inc. All rights reserved.
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Licensure by Endorsement
Endorsement – the RN may practice in different states without having to take another licensing exam
Requirements: Proof of licensure in another state Licensure fee
https://www.bon.texas.gov/forms/rninq.asp
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Nurse Licensure Compact: A Mutual Recognition Model of Licensure
As of January, 2018- eNLC is now in place https://nurse.org/articles/enhanced-compact-multi-state-license-eNLC/
Each state that wishes to participate in the compact must pass legislation enabling the board of nursing to enter into the interstate NLC.
https://www.bon.texas.gov/discipline_and_complaints_imposter_alerts.asp
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State Boards of Nursing and Sanctions
The state boards of nursing has the power to sanction a nurse for performing professional functions that are dangerous to the patient or general public. Probation Suspension Revocation
Most common reason for disciplining nurses: Practicing while under the influence of alcohol or drugs (diverted from workplace).
Copyright © 2017 by Elsevier Inc. All rights reserved.
9
Legal Risks in Professional Nursing Practice
Malpractice occurs when a professional fails to act as a reasonably prudent professional would have acted under the same circumstances.
Malpractice may occur by Commission – doing something that should not
have been done Omission – failing to do things that should have
been done
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Legal Risks in Professional Nursing Practice
Four Elements of a Cause of Action for Negligence 1. The professional (nurse) has assumed the
duty of care (responsibility for the patient’s care; Lunsford Case)
2. The professional (nurse) breached the duty of care by failing to meet the standard of care.
3. The failure of the professional (nurse) to meet the standard of care was the proximate cause of the injury.
4. The injury is proved.
Copyright © 2017 by Elsevier Inc. All rights reserved.
11
Delegation and Malpractice
Professional nurses may delegate independent nursing activities (as well as medical functions that have been delegated to them) to other nursing personnel.
State nurse practice acts do not give LPNs or LVNs the authority to delegate.
Copyright © 2017 by Elsevier Inc. All rights reserved.
12
Delegation and Malpractice
Professional RNs retain accountability for acts delegated to another person. RN is responsible for determining that the
delegated person (delegatee) is competent to perform the delegated act.
The delegatee is responsible for carrying out the delegated act safely.
The professional nurse remains legally liable, however, for the nursing acts delegated to others unless the delegatee is also a licensed professional whose scope includes the assigned act.
Copyright © 2017 by Elsevier Inc. All rights reserved.
13
Delegation and Ethical Implications
ANA Code of Ethics for Nurses Provision 4.4: Delegation of Nurse Activities (2015) The nurse must make reasonable efforts to assess individual competence when assigning selected components of nursing care to other healthcare workers.
This assessment involves evaluating the knowledge, skills, and experience of the individual to whom the care is assigned, the complexity of the assigned tasks, and the health status of the patient.
Nurses may not delegate responsibilities such as assessment and evaluation; they may delegate tasks. Employer policies or directives do not relieve the nurse of responsibility for making judgments about the delegation and assignment of nursing care tasks (p. 2).
Copyright © 2017 by Elsevier Inc. All rights reserved.
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FIVE MOST FREQUENT ALLEGATIONS
1. Failure to ensure patient safety
2. Improper treatment or performance of treatment
3. Failure to monitor and report
4. Medication errors 5. Failure to follow
facility’s policy and procedure
Malpractice vs Peer Review
Malpractice-Actual injury, Money for compensation, Courts-judges & juries, Statute of limitations
Peer Review-Patient exposed to unnecessary risk of harm, license restrictions, peer review committees and the BON, No Statute of Limitations
Peer Review
Enacted in 1987 as part of the Professional Nursing Quality Assurance Act
Organizations with 10 or more RNs required to have peer review procedure
Peer Review
1. RN is reviewed at employer (hospital) 2. Complaint is received by BON 3. Informal Hearing at BON 4. Agreed Order/ No agreement 5. Formal Charges filed at State Office of Administrative
Hearings 6. Formal Hearing/Admin. Law Judge 7. State Court
Peer Review
The fact of the discipline remains on the RN’s/LVN’s record and is public information
National Data Bank
The names of all disciplined nurses are sent to the National Practitioner’s Data Bank and the information is available to all nursing licensing boards
https://www.bon.texas.gov/discipline_and_co mplaints_disciplinary_action.asp
Avoiding Malpractice Maintain open, honest, respectful relationships and communication with
patients and family members.
Patients are less likely to sue if they feel that a nurse has been caring and professional.
Don't offer opinions when a patient asks what you think is wrong with him-you may be accused of making a medical diagnosis.
Don't criticize health care providers or their actions when you are with patients.
Maintain confidentiality in the health care setting.
Avoiding Malpractice
Maintain competence in your specialty area of practice.
Attend relevant continuing education classes.
Attend relevant hospital in-service programs.
Expand your knowledge and technical skills.
Avoiding Malpractice
Know legal principles and incorporate them into everyday practice. Keep up to date on your state's nurse practice act.
Keep up to date on hospital policies and procedures.
Practice within the bounds of professional licensure. Perform only the nursing skills allowed within your scope of
practice and that you are competent to perform.
Avoiding Malpractice Know your strengths and weaknesses. Don't accept a clinical assignment you don't
feel competent to perform.
Evaluate your assignment with your supervisor
Accept only those duties you can perform competently
Let an experienced nurse on the unit assume responsibilities for the specialized duties.
Document all nursing care accurately.
If care is not documented, courts assume it was not rendered.
When documenting care on the patient's chart, use the FACT mnemonic: be f actual, a ccurate, c omplete, and timely.
Informed Consent
Three Major Conditions of Informed Consent 1. Consent must be given voluntarily. 2. Consent must be given by an individual
with the capacity and competence to understand.
3. The patient must be given enough information.
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Informed Consent and the Role of the Nurse
Unless primary providers, nurses collaborate with the primary provider.
A nurse may witness a patient’s signing but is not responsible for explaining the proposed treatment.
The nurse is not responsible for evaluating whether the physician has truly explained the significant risks, benefits, and alternative treatments.
The nurse is responsible for determining that the elements for valid consent are in place, providing feedback if the patient wishes to change consent, and communicating the patient’s need for further information to the primary provider.
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Confidentiality
Confidentiality – legal and ethical concern. Protection of private information gathered about a patient during provision of care. The Code of Ethics for Nurses Provision 3.1
states that: “…the nurse has a duty to maintain
confidentiality of all patient information, both personal and clinical in the work setting and off duty in all venues, including social media and any other means of communication Nurses are responsible for providing accurate, relevant data to members of the health care team and others who have a need to know” (ANA, 2015).
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Health Insurance Portability and Accountability Act (HIPAA) of 1996
What does this mean for nurses?
What are the consequences?
Case studies
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Confidentiality and Social Media
NCSBN (2011): A Nurse’s Guide to the Use of Social Media
Confidentiality and HIPAA regulations place significant limitations on the content of nurses’ social media activities and comments.
NCSBN identified six common myths and misunderstanding regarding social media. Video:
Copyright © 2017 by Elsevier Inc. All rights reserved.
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Social Media Do's
Nurses should talk about themselves, the nursing profession, their family, hobbies, and interest
Never talk about patients or identifiable coworkers
Avoid identifying your employer on your social media profiles
Don’t post anything online that you wouldn’t say in front of your boss or human resources
Uplift the nursing profession
Social Media Don'ts
Don’t use the employer’s internet to post on social media sites–just don’t post to social media while at work
Realize that nothing online is ever really anonymous Become keenly aware of your employer’s social media
policies Don’t identify your employer on your personal profiles Don’t do anything you would be embarrassed to say
to your mother, your clergy, your boss, or a potential employer
Don’t do anything that could degrade or embarrass your profession
- Legal Aspects of Nursing Practice
- State Boards of Nursing
- Nurse Practice Act
- Composition of the Board of Nursing (BON)
- State Boards of Nursing and Nursing Education
- National Council of Licensure Examination for Registered Nurs
- Licensure by Endorsement
- Nurse Licensure Compact: A Mutual Recognition Model of Licensu
- State Boards of Nursing and Sanctions
- Legal Risks in Professional Nursing Practice
- Legal Risks in Professional Nursing Practice (2)
- Delegation and Malpractice
- Delegation and Malpractice (2)
- Delegation and Ethical Implications
- Slide 15
- Malpractice vs Peer Review
- Peer Review
- Peer Review
- Peer Review (2)
- National Data Bank
- Avoiding Malpractice
- Avoiding Malpractice (2)
- Avoiding Malpractice (3)
- Avoiding Malpractice (4)
- Informed Consent
- Informed Consent and the Role of the Nurse
- Confidentiality
- Health Insurance Portability and Accountability Act (HIPAA) of
- Confidentiality and Social Media
- Social Media Do's
- Social Media Don'ts
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