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Fundamentals of Canadian Nursing Concepts Process and Practice Canadian 3rd Edition Kozier Solutions Manual 1
Fundamentals of Canadian Nursing Concepts Process and Practice Canadian 3rd Edition Kozier Solutions Manual 1
Chapter 6
ACCOUNTABILITY AND
LEGAL ASPECTS OF NURSING
OVERVIEW
This chapter describes the history and sources of Canadian law, and the regulatory considerations in
nursing and their impact on nursing practice in Canada. Information is presented that identifies aspects of
professional regulation and their role in governing the practice of nursing, including expanding scope of
nursing practice. Measures of accountability and discipline in nursing practice, as well as the legal roles of
provider of service and employer contractor for service in nursing. The potential for tort liability is
discussed along with informed consent, confidentiality, problematic substance use and chemical
dependency. Legal issues and safe practices in documentation, telephone advice, incident reports and
reports of unsafe practice are also discussed. Ways that nurses and nursing students can minimize their risk
of liability and maximize their legal protection in nursing practice is also discussed.
LEARNING OBJECTIVE 1
Describe the history and sources of Canadian Law (p. 97-98).
2. Law can be defined as “the sum total of rules and regulations by which a society is governed. As such,
law is created by people and exists to regulate all persons Laws can be divided into different types of
laws. The three main types are common law, civil law and statutory law.
3. Common law is sometimes called case law or judge made law where judges interpret and apply
principles from similar decisions in previous cases (precedents) to the particular case before them to
reach a decision. For this reason, in reality, no two cases are identical, and common law develops
through judges making distinctions between cases and determining when an earlier case is not
applicable to the case being considered.
5. Statutory Law refers to laws that come into existence when the parliament or the legislatures of a
province or territory pass laws of a more local nature. Laws enacted by either of these legislative
bodies are called statutes, legislation, or acts. When Parliament or one of the legislatures enacts
legislation, that legislation then supersedes any case law dealing with the same subject.
LEARNING OBJECTIVE 2
Identify regulatory considerations in nursing and their impact on the practice of nursing in Canada
(p. 98-99, Table 6.2).
2. Provincial and Territorial Regulatory Bodies: Nurses have been granted an exclusivity of practice (a
right of self-government or self- regulation) and an obligation to monitor and discipline their own
membership (Canadian Nurses Association [CNA], 2007). The provincial and territorial nursing
regulatory bodies, such as the College of Registered Nurses of British Columbia (CRNBC), the
College and Association of Registered Nurses of Alberta (CARNA), the Saskatchewan Registered
Nurses’ Association (SRNA), or the College of Nurses of Ontario (CNO), are given their authority by
provincial and territorial governments through legislation. Through such legislation and the associated
regulations, these bodies are charged with regulating entry into the profession, approving entry-level
nursing education programs, setting standards of competent practice, establishing continuing
competence or education and quality assurance improvement programs, and drafting bylaws for the
general and day-to-day governance of the profession. All entry-level nursing education programs must
receive approval from their regulatory body in order for their graduates to write the registration
examination and apply for registration. Approval is based on the nursing education programs meeting
the standards and competencies set by the regulatory bodies. Accreditation for baccalaureate
programs is completed by the Canadian Association of Schools of Nursing (CASN). The laws
regulating nursing in the provinces and territories (other than Ontario and Quebec) are fairly uniform.
Several provinces have umbrella legislation containing general provisions regarding all recognized
health care professionals within the province, as well as companion legislation relating specifically to
nursing (see Table 6.2).
LEARNING OBJECTIVE 3
Identify selected aspects of professional regulation and their role in governing the practice of nursing,
including expanding the scope of nursing practice (p. 100).
2. Certification is a voluntary practice that proves that a nurse has met minimum standards of nursing
competence in specialty areas, such as perinatal nursing, pediatrics, mental health, gerontology, or
critical care nursing. The CNA offers certification in many areas.
3. Expanding role of Registered Nurses: Recently, the development of policy and legislation to expand
the scope of RNs’ practice has become a prominent issue across the country. In 2008, the CNA
published Advanced Nursing Practice: A National Framework, which includes information about
various aspects of advanced nursing practice (ANP), such as competencies, educational preparation,
and regulation (CNA, 2008a).
4. Nursing Practice Standards: The establishment of nursing practice standards is essential for a self-
regulating profession. Nursing practice standards are generally broad in nature to capture the varied
roles and practice settings in which nurses practise. Standards are also used as a template for nurses to
assess their own nursing practice annually to determine their professional development goals and meet
continuing competence requirements set out by the provincial or territorial body. It is the responsibility
of all regulated members to understand their practice standards and apply them to their nursing
practices
LEARNING OBJECTIVE 4
Discuss measures of accountability and discipline in nursing practice (p. 101).
2. Complaint Process: Each provincial and territorial nursing body has a mechanism in place to review
the conduct of its members to ensure safe and ethical nursing practice. They are required to investigate
complaints against RNs and discipline those members who fail to meet the standards of the profession.
The complaint process comprises a number of steps, including the complaint intake or receipt and
initial assessment, the investigation process, the review process, and possibly a hearing and an appeal.
The disciplinary role is central to the regulatory body’s duty to protect the public, is taken very
seriously, and can have significant consequences for the registrant. When a case involves either civil
or criminal wrongs, further legal consequences may follow, separate and apart from the provincial and
territorial regulatory body discipline process.
LEARNING OBJECTIVE 5
Identify the two interdependent legal roles of provider of service and employer or contractor for service
in nursing (p. 101-102).
2. Provider of Service: The nurse is expected to provide safe and competent care so that no harm
(physical, psychological, or material) comes to the recipient of the service. When delegating care to
others, the nurse is responsible for ensuring that this delegation is appropriate and that those delegated
have the skills to fulfill the functions. The standards of care by which a nurse acts or fails to act are
legally defined by nurse practice acts and by the rule of reasonable and prudent action. The
contractual obligations of a nurse toward a patient may be either implied or specifically stated.
3. Employee or Contractor for Service: Nurses, whether in independent practice or as employees, have
employment contracts. A contract is an agreement between two or more persons that creates an
obligation to do or not do a particular thing. Contractual relationships vary among practice settings.
If a nurse working as an employee is found negligent, the court may order that damages be paid by the
nurse’s employer pursuant to the doctrine of vicarious liability.
LEARNING OBJECTIVE 6
Discuss areas of potential tort liability in nursing (p.102-106).
I could hear the sad words but could see nothing, except that Achon
had arisen, his white hands clasping the balustrade before him, and his
eyes peering downward in the direction of the voices. He looked, as he
stood, like some obscene bird of prey watching for his quarry to come
within striking distance. There was a movement among the soldiers, who
parted to make room for the doomed man, and then two by two the
mournful procession came into sight, the monks before and behind the
prisoner, chanting the last verse of the hymn. As they passed the gallery
beneath Achon they stopped for a moment, and he leaned forward like a
stooping vulture to look at Marcilly, and at that moment the morning sun
came out in glorious light, and with it a fresh breeze arose. The two,
destroyer and victim, faced each other, a smile of infernal malice on
Achon’s face, Marcilly pale, but calm and proud. Then Achon made a
slight gesture with his hand, the procession moved onward, and I boldly
stepped out of my concealment, and stood behind the soldiers. No one
noticed me—all eyes were on the man who was about to die.