Legal Issues in Nursing

Nursing is neither boring nor predictable. In few other professions, nurses are present at life’s

most momentous events, from birth to death, from crisis to recovery. For those who thrive on

variety and the full spectrum of human drama, every day brings a range of new situations. Thus

this essay will elaborate on the legal issues in nursing practice, where it will focus on application

of law to nursing practice, importance of law to nursing practice and will highlight on the

importance of nursing registration and nursing licensure and some of the professional

misconduct that can lead to de registration and removal of nursing licensure. It will also shed

some light on the nursing roles and responsibilities. However, it will also discuss about

dangerous drug policy and the legal responsibilities of the nurse which are very important in

order to become a professional nurse.

To begin with, nurses like other licensed professionals, are regulated by various state laws. One

important state law that directly affects the practice of nursing is the nursing practice act.

Nursing practice acts originated to protect the public from unsafe and unlicensed practice, by

regulating nursing practice and nursing education. Nursing practice acts define nursing, set

standards for the nursing profession and give guidance regarding scope of practice issues. Hence,

health care poses a risk of harm to the public if practiced by professionals who are unprepared or

incompetent, so individuals are governed by laws and rules to minimize the risk. (De Laune.S C

& Ladner, P.K, p. 100, 2011). Thus, laws are very important in nursing. A working knowledge of

the law and how it impacts on nursing practice is essential. Nurses need to have a rudimentary

understanding of law and how it affects nursing practice as an obligation to the nursing

profession and to the client. It provides guidance for nursing actions. It helps to set the

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limitations of independent nursing actions. It helps in maintaining standards of nursing practices

and it differentiates the nurse’s responsibilities from other health professional. Over the years,

nursing practice has expanded dramatically. Resulting in roles and responsibilities have changed.

Laws are rules to help protect people and keeps society functioning. As a nurse, must understand

and accept the legal responsibilities of the practice. The court expects the nurse to obey the laws

that affect his/her practice. Ignorance of the law is not a valid defence in any legal case. Nurses’

act affects all aspects of nursing practice.

Moreover, registration is particularly important in regulation of health system, because public

protection, safe and dignity care are the most important goal in health regulation. Registration is

compulsory in nursing as being registered it provides a permit to practice and authorizes to use

the designation RN. The RN designation means a recognized professional and legally authorized

to practice. It assures other health professionals and colleagues that an individual is competent

and reinforces public trust in profession. (Potter and Perry p. 50, 1997).Thus, applicant must

satisfy the council that he/she has qualifications approved and then can be recognized by the

council for the purposes of registration. Nursing students also need to register with Fiji Nursing

Council to be able to access the clinical area for learning and overseas post graduate. To add on,

an individual cannot be registered unless he or she is medically fit to provide proper and safe

nursing care authorized by registration on the register[s]; and is fit, proper and safe to practice

nursing. Maintaining registration requirements helps ensure a continuing high standard of care.

Furthermore, every nursing practice has to be accompanied by rightful acceptance to be part of

the nursing processes and activities in any society. The nursing license is a document that gives a

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right for the nursing activities to be done, not just for progression, but also for the same of

improving life and health in any human setting. Licensure is a process by which a governmental

agency through the board of nursing entitles a person to practice (Westric.S.J p.120, 2014). The

licensure protects the public and regulates the profession. It also assures the public that the

person is qualified to assume duties as a professional practitioner. Hence, license is issued by a

governmental entity (FNC) and it provides assurance to the public that the nurse has met

predetermined standards. The purpose of professional license is that it protects the public from

harm by setting minimal qualifications and competencies for safe entry-level practitioners. Thus,

all nurses in Fiji (Government/Private) has to fill a form, CPD-20points annually, medical report

every 3years, police clearance every 5years and annual fees for different levels for renewing

their license. Failure to fulfil the requirements or even when the license has expired, the nurse is

then practicing nursing without a license, is a direct violation of State Nurse Practice Acts hence

direct results in suspension. Licensure regulates and controls nursing practices and it also makes

nursing profession have quality attenuations that separate it from other medical fields.

Moving on, the code of professional conduct is the manner in which acting; in which a person

behaves which acting in a professional capacity. A nurse must practice in a safe and competent

manner, also within scope of nursing. The professional misconduct can lead to de registration

and removal of nursing licensure; for instance violation of ethical standards set out for

profession. A failure to meet standards results in breaching of standard of practice. Some of the

misconduct practices include; physically, emotionally or verbally abusing patient or even

stealing from patient. Failing to care for patient’s property and committing serious criminal

offences. Failing to keep proper records and not obtaining informed consent and breaching

confidentiality are also misconducts. Some other examples include; practising the profession

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while impaired and misappropriating property from the workplace or a client also leads to de

registration and removal from licensure. Hence, to prevent the misconducts and being de

registered nurses should do proper documentation, maintain safety of the patient. Always use

proper equipment and accurate administration of drugs. Manage risk and maintain clients’

confidentiality. Continue education and sustain professional responsibility and limitations.

(Pozgar.G.D.p. 200, 2013). To add on, nurses must be aware of own limitation requirement

related to the profession including the scope of practice. Thus, the expectation is that nurses

observe the standards of practice associated with carrying out their duties in a manner that is

safe, responsible, and provides acceptable care to clients.

Moving on, dangerous drug means any drug, other than a controlled substance, unsafe for self-

medication or unsupervised use. The dangerous drug policy is an intended guide to registered

nurses under the provisions of the dangerous drug legislation. It is a document that explains those

responsibilities and obligations with particular emphasis on the controlled drugs and scheduled

drugs. The dangerous drug legislation governs the format, recording and inventories of

dangerous drugs and requires that all records are to be up to date, durable for a period of two

years and without evidence of tampering. The pharmacist is assigned to a hospital, the

pharmacist or senior pharmacist is to be responsible person for the dangerous drug. When a

pharmacist is not assigned to a hospital, the matron is to be the responsible person for dangerous

drug. Due to its addictive nature, cautions must always be exercised when procuring, storing,

accessing, administering and recording the balance of these classification of drugs on a daily

basis by the registered nurse on duty. It is very important and critical too therefore, that

registered nurses in public practice are to ensure that no action or omission on their part of

responsibility is detrimental to the interests, conduct or safety of clients. Registered nurse are

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accountable to their practice. (MOH/NMNPB, 2010) Thus, as a public servant registered nurses

in public practice must act with care and diligence in the course of employment in the public

service.

To add on, along with many roles nurses has many responsibilities as well. The Registered Nurse

in charge of a ward or department is responsible for the ordering of dangerous drugs used in the

area. The responsibility for orderings can be delegated to another registered nurse, however the

legal responsibility remains with the registered nurse in charge. Dangerous drug order books

must be stored in a locked cupboard.  The registered nurse in charge must ensure that access to

dangerous drug order book is restricted to those staff authorised to order only. For instance,

dangerous drug for ward use must only be ordered on a dangerous drug order book. A separate

page must be used for each item ordered. The entry must clearly detail; the name of hospital,

ward/department and the date. Drug name, form, and strength and ampoule size if more than one

available. The total quantity required in dosage unites for example; number of tablets, ampoules

or millilitres. The order must contain the signature and printed name of the registered nurse.

(MOH/NMNPB, 2010) Thus, it is recommended that practice ordering of dangerous drug to a

minimum, whilst ensuring that they are adequate to meet normal patient demand.

However, proper and accurate storage is essential for dangerous drugs as it is very expensive and

very effective drugs. Thus, nurses has vital responsibilities in storage of dangerous drug.

Location should be suitable for stock of dangerous drug and it should be a locked in a double

lock cupboard prevent unauthorised access to the drugs. For existing or any new dangerous drug

cupboards or rooms, the pharmacy department may be contacted for advice. Within wards and

department, all dangerous drugs must be stored in a locked cupboard, which can only be opened

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by registered nurse in-charge. General responsibilities of the nurse for the storage of dangerous

drugs include the following: cupboards must be kept locked when not in use. Keys must only be

available to authorised members of staff and at any time the key holder should be readily

identifiable. No other medicines or items should normally be stored in the dangerous drug

cupboard. Dangerous drug cupboard must be locked away when not in use. Ensure that the keys

are kept secure when not in use. (MOH/NMNPB, 2010) Hence, care should be taken on the

storage.

Moreover, dangerous drugs should be administered immediately after preparation or after

drawing up in a syringe and the unused portion discarded. The responsibilities of nurse while

administering the dangerous drug include; it is a requirement for two people, one of who is

suitably qualified registered nurse to be involved. The second person can be either a registered

nurse, a student nurse (if the drug route is not intravenous) or a doctor and both must be present

during the whole of the administration procedure and both should independently check

appropriate details at the bedside. Hence, this is a two-step process where, one is the check at the

drug cupboard, step two is the check at the patient’s bedside. Checks relate to; the patient's name

and date of birth - on their name band and on asking the patient - corresponds with the details on

the prescription. Confirm the patient is not allergic to the drug and the correct date and time of

administration with correct drug name. The dose requested is correct in relation to the

prescription form and is safe for the patient. The drug details on the original ampoule. Volume of

bolus/infusion and make sure accurate route and rate of administration. Check expiry date/time.

Thus, both practitioners should sign the TPAR alongside the date and time of administration,

verifying that the dangerous drug has been administered correctly. Another responsibility of the

nurse is that while taking out the drugs from the cupboard, the register should be filled and

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signed. The following should be filled in; date and time when dose administered, name of

patient, quantity administered. Form (name, formulation and strength) administered.

Name/signature and printed name of nurse administering the dose. Name/signature and printed

name of witness to the administration and also balance in stock. Finally, when only part of an

ampoule is used, the nurse should record the amount administered and the amount discarded. 

This should be witnessed by a second registered nurse who should also sign the record.

(MOH/NMNPB, 2010).

Furthermore, nurses are part of daily care and they play a critical responsibility. Unused doses,

part doses or partly used prepared doses of dangerous drugs must be destroyed promptly and

witnessed by a registered nurse.  The dangerous drug to be discarded must be rendered

irretrievable by emptying the contents of ampoule/vial, syringe or infusion bag into a

pharmaceutical waste bin (generally yellow plastic).  Liquids should be rendered secure by use

of a self-setting compound (such as Pre-Gel or equivalent).  Tablets should be crushed, where

possible and capsules should be opened prior to disposal. Full details of the destruction must be

recorded in the dangerous drug register (for part ampoules or other unused doses) or on the

patient's prescribing/recording chart (for partly used prepared doses) including the names and

signatures of those involved. Used medicated patches may still contain a small quantity of active

drug and therefore should be folded in half and disposed of in a pharmaceutical waste bin.

Dangerous drugs which have expired or are no longer required (stock or patients own) must be

returned to the hospital pharmacy or to the government pharmacy. (MOH/NMNPB, 2010) Thus,

dangerous drug can only be destroyed by the chief pharmacist, government pharmacy except in

specific circumstances.

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In addition to, theft of medicines is a serious criminal offence. Nurses also play responsibilities

in the proper care of the medications and any theft or significant loss should be immediately

reported to the senior pharmacist of the hospital or the chief pharmacist at the government

pharmacy. Hence, any member of staff who has reason to believe that medicines have been

taken without authority has a duty to report their concerns to the nurse in charge of the clinical

area. All concerns will be treated in the strictest confidence regardless of whether the subsequent

review substantiates these concerns.  All investigations is carried out in a discreet manner. The

nurse in charge takes reasonable steps to ensure that medicines are in fact missing, for example

check administration records; cupboards not normally used for storage of medicines and

pharmacy delivery records. If the nurse in charge is unable to satisfy him or herself that all

medicines can be accounted for, they report their suspicions to the Senior Clinical Pharmacist

and the relevant Service Manager at the earliest opportunity. Immediate action is required,

consideration is to be given to police. (MOH/NMNPB, 2010) Thus, the significant event

management policy must be followed in the event of any such incident.

In the nutshell, nurses need to keep themselves abreast with the latest changes in policy and the

law. Practically implementing the principles may require knowledge and skills which can be

developed with experience. Nurses have an ethical and legal responsibility to maintain the

currency of their practice in today’s changing health care system and to be familiar with the

nursing practice act. The state nursing practice act is the single most important piece of

legislation affecting nursing practice. Nursing practice acts are not checklists. They contain

general statements of appropriate professional nursing actions. The nurse must incorporate the

nursing practice act with his or her educational background, previous work experience,

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institutional policies, and technological advancements. The main purpose of nursing practice acts

is to protect the public from unsafe practitioners, and the ultimate goal is competent, quality

nursing care provided by qualified practitioners. Thus, nurses play an important role in the

provision of dangerous drug, and this is seen with the responsibilities they have. While people

have always considered the roles of nurses to be dependent on that of doctors, they play a bigger

role in the provision.

No of words: 2000

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 Reference

 De Laune.S C & Ladner, P.K (2011). Fundamentals of Nursing Standards & Practice.(4th

ed.).Delmar Cengage Learning.

 Nurse, Midwives, Nurse Practitioner Board-Policy and Procedures, 2010. Policy on

Dangerous Drugs.

 Potter and Perry (1997).Fundamentals of Nursing Practice (4thed).USA:McMillian.

 Pozgar.G.D. (2013).Legal and Ethical Issues for Health Professionals (3rded).USA:Jones

Bartlett Learning.

 Westrick.S.J. (2014). Essentials of Nursing Law and Ethics (2nd ed).Burlington: Bartlet

Learning.

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