Legal Aspects of Nursing CANVAS

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Legal Aspects of
Nursing
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Learning Outcomes
1. List sources of law and types of laws.
2. Describe ways nurse practice acts, standards of care,
and agency policies and procedures affect the scope of
nursing practice.
3. Describe the purpose and essential elements of
informed consent.
4. Recognize the nurse’s legal responsibilities with
selected aspects of nursing practice.
Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Learning Outcomes
5. Discriminate between negligence and professional
negligence/malpractice.
6. Delineate the elements of professional negligence.
7. Compare and contrast intentional torts (assault/battery,
false imprisonment, invasion of privacy, defamation) and
unintentional torts (professional negligence).
8. Describe the laws and strategies that protect the nurse
from litigation.
9. Discuss the legal responsibilities of nursing students.
Introduction
• Knowledge of laws needed to:
– Ensure that the nurse’s decisions and actions are
consistent with current legal principles
– Protect the nurse from liability
General Legal Concepts
• Law
– The sum of total rules and regulations by which a
society is governed
– Created by people
– Exists to regulate all persons
Functions of the Law in Nursing
• Framework for establishing which nursing actions in the
care of clients are legal
• Differentiates nurse’s responsibilities from those of other
health professionals
• Helps establish boundaries of independent nursing action
• Assists in maintaining standard of nursing practice by
making nurses accountable under the law
Figure 4-1 Overview of Sources of Law
Nurses as Witnesses
• Advised that any nurse who is asked to testify seek
advice of an attorney
• Expert witness
– Special training, experience, or skill in relevant area
and allowed by court to offer opinion on a related
issue
Regulation of Nursing Practice
• Defining scope of nursing practice, licensing
requirements, and standards of care for the purpose of
protecting the public
Nurse Practice Acts
• Define and describe scope of nursing practice
• Control practice through licensing
Credentialing
• Process of determining and maintaining competence in
nursing practice
• Licensure
– Legal permit that government agency grants to
individuals to engage in profession and use title
Legal Roles of Nurses
• Provider of service
– Liability
▪ Being legally responsible for one’s obligations and
actions
– Contractual obligations
▪ Nurse’s duty to render care
• Employee or contractor for service
– Contractual relationships vary among practice
settings.
– Respondeat superior
▪ “Let the master answer”
▪ Employer assumes responsibility for employee
▪ Nurse still held liable as individual in situations of
inappropriate behavior
• Citizen
– Apply to clients and nurses
– Right
▪ Privilege or fundamental power to which individual
entitled unless revoked by law or voluntarily given
up
– Responsibility
▪ Obligation associated with a right
Selected Legal Aspects of Nursing
Practice
• As client advocates
– Right to informed consent or refusal
• Identify, report violent behavior and neglect of vulnerable
clients
• Duty to report nurse suspected of chemical impairment
Informed Consent
• Purpose
– Provides client with complete information prior to
obtaining agreement by client to accept a course of
treatment or procedure
Informed Consent
• Express consent
– Oral or written agreement
• Implied consent
– Individual’s nonverbal behavior indicates agreement.
– Medical emergency when a person cannot express
content because of physical condition
Informed Consent
• Essential elements
– Consent must be voluntary.
– Consent must be given by client or individual with
capacity to understand.
– Must be given enough information to be the ultimate
decision maker
– Client must not feel coerced.
• Cultural perspective needs to be considered.
Informed Consent
• Exceptions
– Except in specific circumstances, the following
individuals cannot provide informed consent:
▪ A minor, person 18 years or younger
▪ The unconscious or person injured in such as way
that they are unable to consent
▪ A mentally ill person judged by professionals to be
incompetent
Informed Consent
• Nurse’s role
– Client gave consent voluntarily.
– Signature is authentic.
– Client appears competent to give consent.
– Client has right to refuse even after signing consent
form.
– Documentation important aspect
Figure 4-3
Obtaining informed consent is the responsibility of the individual performing the

procedure. The nurse may be asked to witness the client’s signature on the consent form
Delegation
• The process for a nurse to direct another person to
perform nursing tasks and activities
• “Allowing a delegate to perform a specific nursing activity,
skill, or procedure that is beyond the delegate’s traditional
role and not routinely performed” (NCSBN, 2016).
• Nurse must know scope of practice of UAP
– Whether UAP competent to perform task
• Five rights of delegation
Violence, Abuse, and Neglect
• Includes domestic violence, child abuse, abuse of older
adults, and sexual abuse
• Nurses are mandated reporters.
– Required by law to report suspected abuse, neglect,
or exploitation
– Detect cases at an early stage, protect children, and
facilitate provision of services
Death and Related Issues
• Do-not-resuscitate orders
– Generally written when client or proxy wishes for no
resuscitation
– Values and choices given highest priority
– DNR explicitly discussed with client, family, and
designated decision maker, and health care team
Death and Related Issues
• Do-not-resuscitate orders
– DNR clearly documented, reviewed, and updated
– Other care should not be withdrawn.
Areas of Potential Liability in Nursing
• Crime
– Felony, manslaughter, misdemeanor
• Tort
– Unintentional or intentional
Crimes and Torts
• Crime
– An act committed in violation of public (criminal) law
– Punishable by a fine or imprisonment
– Does not have to be intended in order to be a crime
▪ Example: Accidentally administering an additional
and lethal dose of a narcotic to relieve discomfort
Crimes and Torts
• Felony
– Serious nature (e.g.,murder)
– Punishable by term in prison
– Manslaughter
▪ Second-degree murder
Crimes and Torts
• Misdemeanor
– Less serious
– Punishable by a fine or short-term jail sentence, or
both
– Example: A nurse who slaps a client's face
Crimes and Torts
• Tort
– Civil wrong against a person or a person’s property
– Based on fault
▪ Something done incorrectly
▪ Something omitted
Crimes and Torts
• Unintentional torts
– Negligence
▪ Misconduct or practice below standard expected of
ordinary, reasonable, prudent person
– Places another person at risk for harm
– Applies to anyone
Crimes and Torts
– Gross negligence
▪ Extreme lack of knowledge, decision making, or
skill that should have been known that put others
at risk for harm
– Malpractice (“professional negligence”)
▪ Negligence that occurs while the person is
performing as a professional
▪ Applies to physicians, dentists, lawyers, and
generally includes nurses
Crimes and Torts (7 of 9)
– Malpractice
▪ Elements present to prove malpractice
– Duty
– Breach of duty
– Foreseeability
– Causation
– Harm or injury
– Damages
▪ Res ipsa loquitur
Crimes and Torts (8 of 9)
– Malpractice
▪ Measures to prevent malpractice
– Check and recheck medications
• Medication error
– Check side rails before leaving a client
• Client safety
Crimes and Torts
– Malpractice
▪ Measures to prevent malpractice
– Do not ignore a client’s complaint
• Failure to observe and take appropriate
action
– Right client
• Mistaken identity
Intentional Torts
• Assault
– Attempt or threat to touch another person unjustifiably
• Battery
– Willful touching of person (including clothes or
something carried) that may or may not cause harm
Intentional Torts
• False imprisonment
– Unjustifiable detention of a person without legal
warrant to confine the person
• Invasion of privacy
– Direct wrong of a personal nature
– Unnecessary discussions, gossip
Intentional Torts
• Defamation
– Communications that are false
– Libel
▪ Defamation by means of print, writing, or pictures
– Slander
▪ Defamation by spoken word
Social Media
• Inappropriate use leads to loss of jobs, discipline from
board of nursing
• Standards of professionalism the same online as in any
other circumstance
• Do not take photos, videos of clients on personal devices
• Maintain professional boundaries
• Do not transmit individually identifiable client information
• Report any identified breach of confidentiality or privacy.
Loss of Client Property
• Nurses are expected to take reasonable precaution to
safeguard a client’s property.
– Can be held liable for its loss or damage
Unprofessional Conduct
• Incompetence or gross negligence
• Conviction for practicing without a license
• Falsification of client’s records
• Illegally obtaining, using, or possessing controlled
substances
• Need to retain professional boundaries
Unprofessional Conduct
• Violation of professional ethical codes
• Breach of confidentiality
• Fraud
• Refusing to care for clients of specific socioeconomic or
cultural origins
Legal Protections in Nursing Practice
• Following nurse practice act and standards is major legal

safeguard for nurses
• Accurate, complete documentation necessary
Good Samaritan Acts
• Protect health care providers providing assistance at an
emergency scene against claims of malpractice
• Some states have statutes requiring people to stop and
aid persons in danger.
Good Samaritan Acts
• Guidelines for nurses who choose to render emergency
care include:
– Limit actions to those normally considered first aid, if
possible
– Do not perform actions which the nurse does not
know how to perform
– Offer assistance but do not insist
– Have someone call or go for additional help
Good Samaritan Acts
• Guidelines for nurses who choose to render emergency
care include:
– Do not leave the scene until the injured person leaves
or another qualified person take over
– Do not accept compensation
Carrying out a Physician’s Orders
• Nurses expected to analyze procedures and medications
ordered by the physician
• Seek clarification for ambiguous or seemingly erroneous
orders
• Categories nurses should question
– Any order a client questions
– Any order if the client’s condition changed
Carrying out a Physician’s Orders
• Categories nurses should question:
– Verbal orders to avoid miscommunication.
▪ Question and record.
– Any order that is illegible, unclear, or incomplete.
Documentation
• Medical chart is a legal document.
• Nurses need to provide accurate and complete
documentation of the nursing care provided.
• Failure to document can constitute negligence.
• Insufficient or inaccurate assessments can hinder proper
diagnosis and treatment causing harm to client.
Reporting Crimes, Torts, and Unsafe
Practices
• Practices that endanger client health and safety

– Alcohol, drug use
– Theft
▪ From client or agency
Reporting Crimes, Torts, and Unsafe
Practices
• Also known as whistle-blowing

• Write clear description, factual, complete
• Be credible
• Obtain support from trustworthy person
• Sign your name
• Report at lowest possible level first
• Follow through
Legal Responsibilities of Students
• Responsible for own action and liable for their own acts
of negligence
• Lower standards are not applied to nursing students
• Function within scope of education, job description and
nurse practice act
Legal Responsibilities of Students
• Follow procedures and policies
• Make sure they are prepared to carry out the necessary
care for assigned clients.
• Ask for additional help or supervision in situations they
feel inadequately prepared
• Comply with the policies of the agency in which they
obtain their clinical experience.
• Comply with the policies and definitions of responsibility
supplied by the school of nursing.

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Angelite Prayer

Almighty God, we glorify you for giving us the

Oh, Holy Guardian Angels, guide us and protect us!

Slides in this presentation contain

• Cultural perspective needs to be considered.

Obtaining informed consent is the responsibility of the individual performing the

• Following nurse practice act and standards is major legal

• Practices that endanger client health and safety

• Also known as whistle-blowing

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