Essentials of Nursing Leadership & Management, 4th Edition

Essentials of Nursing Leadership & Management, 4th Edition
CHAPTER 3
NURSING PRACTICE AND

THE LAW
GENERAL PRINCIPLES
Meaning of Law
 Statutory law
 Common law
 Administrative law
Sources of Law
 The Constitution
 Statutes
 Administrative
Types of Law
 Criminal law
 Civil law
Criminal Law
 Criminal acts are considered offenses
against the state
 Three categories of criminal law
 Felony
 Misdemeanor
 Juvenile
Civil Law
 Usually involve the violation of one
person’s rights against another’s rights
 Tort
 Quasi-intentional tort
 Negligence
 Malpractice
Other Laws Relevant to

Nursing
 Good Samaritan laws
 Confidentiality
 Slander and libel
 False imprisonment
 Assault and battery
STANDARDS OF
PRACTICE
Nursing Standards
 Established as guidelines for the

profession to ensure quality of care
 Also used as criteria to determine whether
appropriate care has been delivered
Types of Standards
 Internal standards
 Organizational standards
 Accepted state and national standards
 Nurse Practice Acts
 Patient Care Partnership
Internal Standards
 Developed by institutions
 Institutional policies
 Maintained in policy and procedure
manuals
Boards of Nursing
 Develop the Nurse Practice Acts along with
state legislatures
 The courts have upheld the authority of the
boards of nursing to regulate standards
 With the expanded role of nursing, it is
important to clarify the distinction between
nursing and medicine
Uses of Standards in Nursing

Negligence or Malpractice
 Standards are used as a guide
 State, local, or national standards
 Institutional policies that alter or adhere to the
nursing standards of care
 Expert opinions on appropriate standards of care
 Available literature substantiating current
standards
INFORMED CONSENT
Informed Consent
 Without informed consent many medical
procedures could be considered battery
 Consent to treatment by the client gives the
health-care personnel the right to deliver
care without fear of prosecution
Informed Consent
 The physician obtains the consent
 Gives the client the information
 States the risks and advantages
 The nurse may be involved in the process
by gaining signatures on the appropriate
forms
Helpful Hints
 A mentally competent adult has voluntarily
given consent
 The client understands exactly what he or
she is consenting to
 The consent includes the risks, alternative
treatments, and outcomes
 The consent is written
STAYING OUT OF COURT

Prevention
 Keep yourself informed about new
information related to your area of practice
 Insist that the health-care institution keep
personnel informed of all changes in
policies and procedures and in the
management of new technological
advances
Prevention
 Always follow the standards of care or
practice for your institution
 Delegate tasks and procedures to
appropriate personnel
 Identify clients at risk for problems such as
falls or the development of decubiti
Prevention
 Establish and maintain a safe environment
 Document precisely and carefully
 Write detailed incident reports
 File incident reports with appropriate
personnel and departments
 Recognize client behaviors that may cause
problems
COMMON CAUSES OF
NEGLIGENCE
Common Causes of
Negligence
 Client falls
 Equipment injuries
 Failure to monitor
 Failure to communicate
 Medication errors
 Medical errors
AVOIDING MEDICATION
ERRORS
Medication Errors
 Right drug
 Right dose
 Right route
 Right time
 Right client
 Right documentation
APPROPRIATE
DOCUMENTATION
Tips for Credible

Documentation
 Contemporaneous
 Accurate
 Truthful
 Appropriate
COMMON ACTIONS
LEADING TO
MALPRACTICE SUITS
The 6 Fs
 Failure to appropriately assess a client
 Failure to report changes in client status
 Failure to document in the client record
 Failure to obtain informed consent
 Failure to report a coworker’s negligence
 Failure to provide adequate education
The 2 Big Bad Ones
 Altering or falsifying a record

 Violation of an internal or external standard
of practice
If a Problem Arises
 When served with a complaint,
immediately contact legal counsel
 Never sign any documents without
legal counsel
 Notify your malpractice carrier if
covered; notify your institution
immediately
 Keep all correspondence: written
and verbal
END-OF-LIFE DECISIONS
End-of-Life Decisions
 DNR orders
 Advance directives
 The “living will”
 Durable power of attorney
 Health-care surrogate
Mandatory Overtime
 Increased demand due to nursing

shortages
 Physical and mental fatigue
 Increased physical and emotional stress
 Decreased concentration
Licensure
 In the United States, granted through the

state government via state boards of
nursing (NCLEX-RN)
Qualifications for Licensure

 Graduation from an approved nursing
program
 English proficiency
 Disclosure of criminal conviction
NCLEX-RN Examination
 Computerized Adaptive Testing (CAT)

 Minimum and maximum number of
questions
 Regulated length of time to complete the
examination
NCLEX-RN Examination
 Based on client needs and the nursing

process
 Multiple choice and alternative item formats
 Fill in the blank
 Drag and drop
Preparing for the NCLEX-RN
 Review courses
 Review books
 Videos
 DVDs
Moving?
 Endorsement
 Multistate licensure
Disciplinary Action
 State boards of nursing
 Major Issues:
 Falsifying documents
 Felony
 Drugs or alcohol
 Functioning outside the scope of practice
 Abuse
Conclusion
 Nurses need to be aware of the Nurse
Practice Act in their states
 Nurses need to familiarize themselves with
their institutions’ standards of care
 Nurses need to understand the most
common causes of negligence
 Nurses need to document accurately and
appropriately

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What are the different types of laws discussed in the document?

What standards are used to determine appropriate nursing care?

Essentials of Nursing Leadership & Management, 4th Edition

NURSING PRACTICE AND

Other Laws Relevant to

 Established as guidelines for the

Uses of Standards in Nursing

STAYING OUT OF COURT

Tips for Credible

The 2 Big Bad Ones

 Altering or falsifying a record

 Increased demand due to nursing

 In the United States, granted through the

Qualifications for Licensure

 Computerized Adaptive Testing (CAT)

 Based on client needs and the nursing

Preparing for the NCLEX-RN

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