NURSING REGULATORY MECHANISMS AND CONSUMER ACT

INTRODUCTION
The standard of nursing care delivery is set by certain regulations of nursing practice called
“nurse practice acts’. Nurse practice acts are legally defined and describe regulations of nursing
actions by an administrative board such as a state board of nurse examiners. These boards
generally have the authority to regulate nursing practice and education within the states.
OBJECTIVES
General objectives
At the end of the class the students will be able understand in detail regarding nursing regulatory
mechanisms, patient rights and consumer protection act
Specific objectives
At the end of the class the students will be able to
 Discuss nursing regulatory bodies
 Describe the process of accreditation
 Explain the agencies of accreditation
 Discuss regarding licensure
 Discuss the licensure activities
 Explain the process of renewal
 Discuss the consumer protection act
 Describe the CPA forums
 Discuss the CPA councils
TERMINOLOGIES
Appeal: (law) a legal proceeding in which the appellant resorts to a higher court for the purpose
of obtaining a review of a lower court decision and a reversal of the lower court's judgment or
the granting of a new trial
Licensure: The act of giving a formal (usually written) authorization
Accreditation: The act of granting credit or recognition (especially with respect to educational
institution that maintains suitable standards)
Jurisdiction: (law) the right and power to interpret and apply the law
Adjournment: The act of postponing to another time or place
NURSING REGULATORY MECHANISMS
The main functions of these regulations include
 To protect patient or society
 To define the scope of nursing practice
 To identify the minimum level of nursing care that must be provided to clients
The regulatory bodies that define the laws and regulations in nursing practice are the nursing
councils at the international national and state levels. Such as
 International council of nurses
 Indian nursing council
 State nursing council

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ACCREDITATION
The concept of accreditation of educational programs in nursing is very important. Accrediting is
the process whereby an organization or agency recognizes a college or university or a program of
study as having met certain predetermined qualifications and standard
Accreditation refers to a voluntary review process of educational programs by a professional
organization. The organization is called an accrediting agency is invited to compare the
educational quality of the program with established standard and criteria.
Accreditations has four major purposes which include the following
 Maintenance of adequate admission requirements
 Maintenance of minimum academic standards
 Stimulation of institutional self improvements, and
 Protection of institutions of higher education against educationally socially harmful
pressures
Accreditation is vital to the welfare of institution of higher education. Accrediting organizations
in higher education are generally classed into three types
i. National accrediting agency
ii. National professional accrediting agency
iii. State accrediting bodies
National agencies
National accrediting agencies are concerned with appraising the total activities of the institutions
of higher learning, and with safe guarding the quality of liberal education, the foundation of
professional programs in colleges and universities. Each agency establishes criteria for the
evaluation of institutions in its region it reviews those institutions periodically, and it publishes
from time to time a list of those agencies which it has accredited.
India has following all India Educational Councils:
 Central advisory board of education
 All India council for Elementary education
 All India council for secondary education
 University grants commission
 All India council for technical education
 National assessment and Accreditation council
National Professional Accrediting Agency
These professional groups aim to foster research, to improve service to the public and the
number of individuals admitted to the profession. Controlling admissions is vital to a
professional group particularly in the early stages when the professional is struggling for status.
In India, particularly in the field of health, national professional accrediting agencies have
existed.
 Medical Council of India
 Indian Nursing Council
 Dental council of India

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  Pharmacy council of India
 Central council of Indian system of Medicine
Indian nursing council, (INC) is the official accrediting agency for all programs of nursing,
which include Diploma (GNM), Bsc Nursing (both basic and post basic), NM/Msc N /M.phil
(Masters) and PhD (Doctoral programs in Nursing)
NURSING LICENSURE
The registry of nurses initiated by Nightingale provided institutions and clients with the means to
ascertain the skills and knowledge of graduates. However, this was not enough. As nursing
programs proliferated, variations developed among the programs. Educational programs were
structured to meet the needs of the host hospital. Another method was needed to distinguish
those trained in providing nursing care. This method led to nurses developing criteria for
licensure. The primary purpose of licensure was, and still is, the protection of the public.
Current licensure activities
Efforts to provide common definitions of nursing practice, standards of education, and testing for
entry into practice across state boundaries have been successful, although nurses are still required
to apply for licensure in each state in which they practice. With the mobility of nurses, the
movement toward telecommunications, and care of clients across wide distances, state boards of
nursing recognized the need to provide practicing nurses with more than procedures of
endorsement of their initial license. This need has led to further changes in nursing licensure. In
1997, the Delegate Assembly of the National council of state Boards of Nursing moved to a new
level of nursing regulation. The assembly approved a resolution endorsing a mutual recognition
model of nursing regulation. Through this model individual state boards will develop an
interstate compact allowing nurses licensed in one state to practice in all other states and
territories. Nurses will be responsible for following the laws and regulations of those states,
although they will not be required to apply for individual state licensure.
COMPONENTS OF NURSING PRACTICE ACTS
All nursing practice acts include two essential components. First each includes statements that
refer to protecting the health and safety of the public. The second is protection of the title of RN.
This protection is ensured by describing those individuals covered by the regulations and those
excluded from the act. The legal title, registered nurse, is reserved for those meeting the
requirements to practice nursing in the state. A section of each nursing practice act describes the
requirements for licensure. An initial requirement is graduation from high school and an
accredited nursing program.
ENTRY INTO PRACTICE
Each nursing practice act includes the requirements and procedures necessary for initial entry
into nursing practice. There are several steps necessary in obtaining a license to practice nursing.
Candidates for licensure must submit evidence of graduation as defined by each state. Frequently
a transcript of course work, a diploma or letter from the dean of the program attesting to the
graduation of the applicant is necessary.

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A temporary permit may be available for nurses moving from one state to another. The process
of obtaining a license in another state is to apply for licensure by endorsement. Nurses licensed
in one jurisdiction apply for licensure in a second jurisdiction by submitting a letter to the second
state board of nursing. Typically evidence for the new license is similar to that for initial
licensure. In addition, proof of the nurse’s current license to practice will be required.
RENEWAL OF LICENSURE
In addition to outlining requirements for initial licensure, each nursing practice act includes
information on renewal of licensure requirements. These regulations define the period; a license
is valid and any additional requirements for renewal of licensure. All nurses are expected to
remain competent to practice through various means of continuing education.
CONSUMER PROTECTION ACT
Till recently, all cases of disputes regarding negligence on the part of doctors or hospitals were
raised in a court of law. It was filed either under the law of torts to claim damages or under the
relevant sections (304A, 336,337 and 338) of the IPC, to get the negligent punished. However,
after the introduction of the consumer protection act, a drastic change has taken place and
litigants are preferring claims through the district, state or National forums. The two main
reasons for this are that hardly any costs are involved in this procedure, and the case is decided in
a short span of 3 to 4 months.
Consumer protection laws are designed to ensure fair competition and the free flow of truthful
information in the marketplace. The laws are designed to prevent businesses that engage in fraud
or specified unfair practices from gaining an advantage over competitors and may provide
additional protection for the weak and those unable to take care of themselves. Consumer
Protection laws are a form of government regulation which aim to protect the interests of
consumers. For example, a government may require businesses to disclose detailed information
about products—particularly in areas where safety or public health is an issue, such as food.
Consumer protection is linked to the idea of "consumer rights" (that consumers have various
rights as consumers), and to the formation of consumer organizations which help consumers
make better choices in the marketplace.
The Consumer Protection Act of India is also quite specific about what a complaint is, under the
law’s definitions. First and foremost, the complaint must be made in writing and should concern
an unfair action by a business or individual acting in a commercial setting. Defects in goods or
unsatisfactory service can be the subject of written complaints, as can excessively high charges
for goods or services.
Consumers are not charged a fee for filing such complaints. Decisions may involve complete
removal of any defect in a product and replacement of the product. Refunds are specifically
provided for in the law.
A PRIMER ON CONSUMER PROTECTION ACT
Consumer protection act (CPA in short) was enacted by Parliament in December 1986 and came
into force on 1 September 1987. The aim of act is to provide a simple, speedy and inexpensive
redressal for consumer grievances relating to defective goods, deficient services and unfair trade
practices.
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The consumer protection Act defines the obligation of traders and manufacturers as well as of
service providers, and if the consumer feels that the goods provided or the services given are not
to his satisfaction, are defective, and below the standards prescribed normally, he is entitled for
what he has paid.
Under the CPA, courts have been established at District levels, as the District Consumer
Redressal Forum, at the state level as the state Consumer Redressal Commission and at the
National level as the National Consumer Redressal Commission. These have three members
including the chairman who usually is a sitting judge or retired judge of District Court or State
High Court or of Supreme Court of India, respectively, and other two members one of whom has
to be a woman
The District Forum can award compensation up to rupees five lakhs, while the state commission
can award compensation up to rupees twenty lakhs. The National Commission usually deals with
appeals made against the judgments of the state commissions, and can award any amount of
compensation
Though the medical profession was initially exempted from the Consumer Protection Act. As
stated above, but on 13-11-1995, the Supreme Court of India in its judgment in civil appeal no
688 of 1993, in case of IMA vs VP Shanta and others held that medical practitioner can be sued
under Consumer Protection Act 1986, for any negligence. The court held that any services
rendered by Doctors, hospitals are covered in the service as defined under section 2 (1)(0) of the
CPA 1986.
CONSUMER PROTECTION COUNCILS
They are at two levels namely Central and State protection councils
Central consumer protection council
The objectives of this council shall be to promote and protect the rights of consumer such as,
 The right to be protected against the marketing of goods and services which are
hazardous to life and property
 The right to be informed about the quality, quantity, potency , purity, standard and price
of goods and services, as the case may be so as to protect the consumer against unfair
trade practices
 The right to be assured , wherever possible, access to variety of goods and services at
competitive prices
 The right to be heard and to be assured that the consumers interest will receive due
consideration at appropriate forums
 The right to seek redressal against unfair trade practices
State consumer protection councils
The state council shall consists of following members
 The minister incharge of consumer affairs in the state Government, who shall be its
Chairman and
 Such number of other official or non official members representing such interest as may
be prescribed by state Government

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  The State Council shall meet as and when necessary, but not less than two meetings shall
be held every year
The objective of every state council shall be to promote and protect within the state , the rights of
consumer
DEFINITIONS
CONSUMER
Consumer means any person who hires any services for a consideration, and includes any
beneficiary of such services other than the person who hires the services, when such services are
availed of with the approval of the first mentioned person
The status of a patient is that of a consumer, because the patient pays for the services or has the
liability to which may be by full down payment, in installments or under any deferred payment
system. If a person has received free services without paying for the same, he cannot be called a
consumer. This is why government hospitals providing services without any charges are outside
the preview of the act
A person who avails himself of the facility of a government hospital is not a consumer because
the facility offered in government hospitals is not service hired for a consideration. For
deficiency of service in government hospitals, the aggrieved person will have to file a claim in
civil court. If the conduct of the hospital doctor amounts to criminal negligence, the patient can
cause to prosecute the doctor in criminal court.
COMPLAINT
It means any allegation in writing made by a complainant that
 The goods bought by him or agreed to be bought by him suffer from one or more defects
 An unfair trade practice or restrictive practice has been adopted by any trade
DEFECT
Means any fault , imperfection or short comings in the quality, potency, purity or standard which
is required to be maintained by or under any contract or as is claimed by the trader in any manner
whatsoever in relation to goods.
DEFECIENCY
Deficiency is any fault, imperfection, shortcoming or inadequacy in the quality, nature and
manner of performance in pursuance of a contract or otherwise in relation to the service
SERVICE
Service means service of any description but excludes free service and personal service.
Treatment in a hospital (excluding government hospitals) on payment amounts to hiring of
service for a consideration. Therefore, a complaint would lie if there is deficiency in service
rendered by a member of the medical profession
TIME LIMITATION
A claim for compensation under CPA must be filed at a Forum within three years of the subject
matter of the complaint (e.g.; death) having arisen
If an amendment to the act, presently under consideration of the government is passed, this
period is likely to be raised to one year
At the district forum, a case has to be heard within three months of being filed
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PATIENT’S BILL OF RIGHTS
The health care rights of patients have been the subject of much public debate and legislative
action in the latter half of the 20th century. The fundamental right to quality medical care and
compensation for medical malpractice, the right to informed consent, and the right to health care
privacy, are all protected under United States congressional law. While these and other laws
ensure many rights for medical patients, the changing nature of medical knowledge and care also
ensures the continued need to regulate the relationships among patients, care-givers, and care-
giving institutions. But quite apart from any legal issues, the recognition that patients have rights
can transform the doctor-patient relationship from an authoritative and paternalistic one into a
true partnership, with the result that the quality of medical care is enhanced.
The government is concerned about the deteriorating services in medical care both in private
nursing homes and public hospitals. Consumer organizations are also pressing for a charter of
right of consumers of medical services.
The legislative controls of nursing practice primarily protect the rights of the patients. Until the
1960’s patients had few rights; in fact, patients often were denied basic human rights during a
time when they were vulnerable. In 1973, however, the American Hospital association published
its first patient bill of rights.
 The patient has the right to considerate and respectful care
 The patient has the right to and is encouraged to obtain from physicians and their direct
care givers relevant, current, and understandable information concerning diagnosis,
treatment and prognosis
 The patient has the right to make decisions about the plan of care prior to and during the
course of treatment and to refuse a recommended treatment or plan of care to the extent
permitted by law and hospital policy and to be informed of the medical consequences of
this action. In case of such refusal, the patient is entitled to other appropriate care and
notify patients of any policy that might affect patient choice within the institution
 The patient has the right to have an advance directive (such as living will, health care
proxy or durable power of attorney for health care) concerning treatment or designating a
surrogate decision maker with the expectation that the hospital will honor the intent of
that directive to the extent permitted by law and hospital policy
 The patient has the right to every consideration of privacy. Case discussion, consultation,
examination, and treatment should be conducted so as to protect each patients privacy
 The patient has the right to expect that all communications and records pertaining to
his/her care will be treated as confidential by the hospital, except in cases such as
suspected abuse and public health hazards when reporting is permitted or required by
law. The patient has the right to expect that the hospital will emphasize the
confidentiality of this information when it releases it to any other parties entitled to
review information in these records
 The patients has the right to review the records pertaining to his/her medical care and to
have the information explained or interpreted as necessary, except when restricted by law

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  The patient has the right to expect that, within its capacity and policies, a hospital will
make reasonable response to the request of a patient for appropriate and medically
indicated care and services. The hospital must provide evaluation, service, and/or referral
as indicated by the urgency of the case. When medically appropriate and legally
permissible, or when a patient has so requested, a patient may be transferred to another
facility. The institution to which the patient is to be transferred must first have accepted
the patient for transfer. The patient must also have the benefit of complete information
and explanation concerning the need for, risks, benefits, and alternatives such a transfer
 The patient has the right to ask and to be informed of the existence of business
relationships among the hospital, educational institutions, other health care providers, or
payers that may influence the patients treatment and care
 The patient has the right to consent to or decline to participate in proposed research
studies or human experimentation affecting care and treatment or requiring direct patient
involvement, and to have those studies fully explained prior to consent. A patient who
declines to participate in research or human experimentation is entitled to the most
effective care that the hospital can otherwise provide
 The patient has the right to expect reasonable continuity of care when appropriate and to
be informed by physicians and other care givers of available and realistic patient care
options when hospital care is no longer appropriate
 The patient has the right to be informed of hospital policies and practices that relate to
patient care, treatment and responsibilities. The patient has the right to be informed of
available resources for resolving disputes, grievances and conflicts, such as ethics
committees, patient representatives, or other mechanisms available in the institution. The
patient has the right to be informed of the hospitals charges for services and available
payment methods.
A bill of rights that has become law or state regulation has the most legal authority because it
provides the patient with legal recourse. Today, patients are more assertive and involved in their
health care. They have more information to review when looking at treatment options and are
demanding to be participants in decision making about their health care. The patient’s right to
information and participation in medical care decisions has led to conflicts in the areas of
informed consent and access to medical records. Although the manager has a responsibility to
see that all patient rights are met in the unit, the areas that are particularly sensitive involve the
right to privacy and personal liberty, both guaranteed by the constitution.
Patient Responsibilities
In order to receive optimal care, patient and his family are responsible for:

 Providing accurate information about present illness and past medical history and wishes
for your medical care.
 Seeking clarification when necessary to fully understand health problems and the
proposed plan of care.
 Following through on agreed plan of care.

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 Considering and respecting the rights of others.
 Being courteous.
 Providing accurate information for insurance claims and working with the Health System
to make
payment arrangements when necessary so that others can benefit from the services
provided here.
 Following visitation policies of University Hospital.

BIBLIOGRAPHY
1. AG Chandorkar, Hospital administration and planning. Paras publishing: 2 nd edition:
New Delhi; 2009.
2. Barbara cherry, Susan R. Jacob. Contemporary nursing issues, trends &management:
Mosby publishers; Philadelphia; 1999.
3. BT Basavanthappa, Nursing Administration. 2nd edition, Jaypee Publishers ;
NewDelhi;2009