Legal Issues in Nursing (PowerPoint) by gjjur4356

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 Legal Issues in

    Class 23
December 1, 2010
                           Class Objectives:
                      The Student Will Be Able To
1.     Discuss legal issues surrounding regulated professions
       and professional licensure
2.     Discuss entry-level competencies for Registered Nurses
       as outlined by CRNNS
3.     Identify and discuss examples of legal proceedings in
       which nurses have been involved
4.     Discuss legal issues in nursing practice in Canada such
       as use of drugs and controlled substances and death
       and dying.
5.     Discuss the importance of accurate documentation
6.     Define terms and discuss issues surrounding
       professional competence and unintentional and
       intentional torts (terms listed on slide 42)
Class 23, Dec. 1/10                                        2
Liability Protection
   Professional Liability Protection- all nurses need to have
    professional protection.
   Canadian Nurses Protective Society is a nonprofit protective
    society designed to protect nurses and provide legal support
    when needed. Free service. Most publicly funded HC facilities
    carry malpractice insurance & are liable if the employee is
    working within the normal scope of practice.
   Good Samaritan Act- provide emergency care at the scene of an
    accident. In Nova Scotia it is the Volunteer Services Act .
         Action is judged on what any reasonable nurse would do.
         The act protects the person who provided assistance in the emergency
          situation. In Nova Scotia and in most provinces, nurses are protected.

Class 23, Dec. 1/10                                                                3

       You must know enough
       about the law and legal
       boundaries in order to
1.     Your clients’ rights
2.     Yourself from liability

Class 23, Dec. 1/10              4
Licensure (Review)
   Nursing is regulated provincially and territorially. In NS nurses are licensed &
    regulated by the CRNNS as authorized by the Registered Nurses Act of Nova
    Scotia (2006).

   All nurses must be licensed to practice in their province or territory where
    they plan to work.
   Nurses must
      Hold a licence to practice as an RN & must not have had their
          current license suspended or revoked
         Pay their annual dues on time and
         Attest to their competency. (In NS all RN complete a document titled
          “Building Your Profile”.

   Ex. Nurses can have their license revoked for stealing drugs in the work
    place. Nurses who practice without a licence break the law and are subject to

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   Only the nurse who holds a valid
    nursing licence is authorized to use the
    designation Registered Nurse, or the
    abbreviations R.N. and to practise as a
    registered nurse in Nova Scotia.

CRNNS Website:

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   Nursing Students – are responsible to function
    within their scope of practice. They are legally
    liable if their actions cause harm to clients.
   Always remember: Never take on more
    than what has been taught / learned at a
    particular point in the nursing program.
         If there is an error, the student nurse, the nurse educator, the university,
          and healthcare facility will have to share the responsibility.

Class 23, Dec. 1/10                                                                      7
          Entry Level Competencies
In Nova Scotia, the professional practice of nursing is defined in the Registered
    Nurses Act (2006) and Regulations, and reflected in the Standards for
    Nursing Practice and Code of Ethics for Registered Nurses.

   In addition to the Standards and Code, which apply to both novice and
    experienced registered nurses, the College establishes competencies that
    entry-level nurses in Nova Scotia are expected to demonstrate upon
    graduation from an approved nursing education program. At completion of
    the BScN Program you should have met and exceeded the listed 127

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                 College of Registered Nurses of Nova Scotia
                     Entry Level Competency Categories
    Professional Responsibility and Accountability (1-20 competencies)
    Specialized Body of Knowledge (21-37)
    Competent Application of Knowledge: Ongoing Comprehensive Assessment
    Collaborates with Clients to Develop Client-Centered Healthcare plans (53-63)
    Provides Nursing Care in Collaboration with Clients (64-84)
    Ongoing Evaluation of Client Care (85-89)
    Ethical Practice (90-104)
    Service to the Public (105-118)
    Self-Regulation (119-127)

    Class 23, Dec. 1/10                                                              9
Build Your Practice Upon

 Professional                     Standards for Nursing
 Code of Ethics
 Entry Level Competency
                      •The Law Requires It
                      •Your Patients & Public trust you to do so
                      •Your Profession Requires it
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Preventing Negligence
 Follow the standards of care & code of ethics &
  give competent health care
 Insist on appropriate orientation as a staff
  member & practice
 Continuing competency - always
 Adequate staffing and communication
 Caring rapport with the client
 Careful and complete documentation
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                 Unacceptable Practice
“Unacceptable practice or behaviour is defined
   under four main categories:
1. Incompetence
2. Incapacity
3. Professional misconduct
4. Conduct unbecoming the profession.
When nursing practice/behaviour is unacceptable
   someone must intervene.
        CRNNS Website:

Class 23, Dec. 1/10                                                       12
Legal Liability
    In the event of a malpractice suit - standards
    and the Code of Ethics are used to judge
    whether the nurse acted as any reasonably
    prudent nurse with the same knowledge,
    education and experience would in the same

   Legal liability is clear if the nurse did not act
    within accepted standards

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Legal Liability
Liability- to be Legally Responsible

 Tort-           A civil wrong against an individual or
  property violating another person’s right’s. May
  or may not be on purpose.
 Two categories of Torts:
       Unintentional torts – i.e. negligence (medication
       error, fall, wrong treatment).
       Intentional torts- ie: an act which is done deliberately
       (assault, battery, invasion of privacy, defamation).

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Intentional Torts
    Conduct that creates in another
    person apprehension or fear of                 False Imprisonment
    imminent harmful or offensive         Confined or held against a person’s
    contact                                  will
    No actual contact is needed
    Threatening to give an injection                Invasion of privacy
    when the client has refused           Right to confidentiality. According to
    consent                                  the Code of Ethics, client’s
                 Battery                     information will only be shared
   Intentional physical contact without      with the immediate healthcare
    the other person’s permission            team.
                                          Nurses, however, by law may be
                                             required to disclose information
        Defamation of character              about a patient. Ex. child abuse
    Ridiculing other, slander, may           case
    apply to client or a colleague

Class 23, Dec. 1/10                                                             15
    Unintentional Torts
   Negligence (Malpractice)-
    (nursing conduct that falls           May be Found negligent if:
    below a standard of care              the nurse owed a duty to the
    established by law)                    client
   -carelessly causing harm, no          the nurse did not carry out
    intent is needed for negligence        that duty
    to occur
                                          the client was injured
   - attempting a procedure not
                                          the nurses failure to carry
    trained or licensed to perform
                                           out the duty caused the
See Potter & Perry, 2010, pg 105-107       injury

    Class 23, Dec. 1/10                                               16
Abandonment and assignment
   Speak up if assigned          Do not leave the unit if
    more than a reasonable         there is inadequate staff
    workload.                      present.
   Report any problems           A nurse who leaves the
                                   patient, can be charged
    concerning shortage and        with abandonment or
    keep a copy of what you        neglecting the client.
    have submitted or any         Float nurse- inform
    verbal conversation that       supervisor of any lack of
    took place regarding the       experience you may
    situation.                     have.
                                  A supervisor can be held
                                   liable if they give a nurse
                                   an assignment they are
Class 23, Dec. 1/10                unable to perform.         17
  Communicating Information
1) Documentation: Anything written or printed that is
    relied on as a record or proof for authorized persons - a
    record of observations and care used by all health care
    professionals. Do not document a nursing activity before
    it is carried out. Patient’s medical record can serve as a
    legal document

2) Reporting: Communication of information to
  another - may be written or oral.

What are incident reports? What is their purpose?
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                                                                 Examples
   Incident Report                                                  Medication error
                                                                       an incorrect drug, dose,
                                                                        form, quantity, route,
    A report    written                                                concentration, rate of
                                                                        administration, time; or
       following any event                                              omission
       that is not                                                     Needle stick injury

                                                                       Client falls
       consistent with the                                             Wrong therapy

       routine operation                                               Anything leading to
                                                                        patient, staff, student,
       of a health care                                                 visitor injury

       unit or routine of                                              Unusual event – bullying

                                                                       Violation of

       client care                                                      confidentiality./ privacy…

Purpose to record ASAP what happened & consequence; to provide a record in order to analyze & prevent in future
   Class 23, Dec. 1/10                                                                                            19
               Confidential Information
                   and Disclosure
   Disclosure Required:
       To prevent clear and imminent danger to
       the client or others
       When legal requirements demand that
       confidential material be revealed
       When a child is in need of protection.

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Drug Regulation
     Administration of drugs is regulated by the law.
    Two Federal acts that control drug
    administration include:The Food and Drug Act &
    Controlled Drugs and Substance Act
 -Be familiar with policies at work.
   -Administer drugs according to the physician’s order and
    question any orders that do not seem correct.
   -Can be found negligent if a drug is administered

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                 Controlled Substances &
                     Student Nurses
   Narcotics are ordered and used to help
    control acute and chronic pain in many
    instances. Narcotics are kept in a secure
    and locked cupboard. It is illegal for a
    student nurse to have access or carry an
    access key for the controlled substance.
   All narcotic drugs must be signed out by a
    licensed Nurse.

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Informed consent- agreement to allow something to happen. All information
    including the risks are disclosed. Parents are legal guardians for their
   Competency to sign consent must be determined.

Must include:
 A brief complete explanation of the procedure
 Names and qualifications of people performing and assisting in the
 Clients need to be informed about the harmful consequences if treatment is
 An explanation of alternatives as well as the risks of doing nothing

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 Nurses may witness the signature but the
  physician is responsible to provide the
  information to the client
 Nurses may share liability with
  physicians or other healthcare personnel if
  an error is made.
 Nurse must follow up if they believe the client
  has not understood

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Exception: Informed Consent
   A true emergency is an exception to the usual
    requirement to obtain informed consent.

   The rationale for this exception is that a reasonable
    person would normally consent to the treatment and
    that the delay necessary to obtain consent would have
    adverse consequences for the patient. This justification
    is grounded in the ethical principle of beneficence.

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          Age of Majority Legislation
   All provinces in Canada have age of
    majority legislation that has implications
    for informed consent by school-age
    children. This age varies from 18 to 19.
    Students below this age are considered

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                 Age of Majority In N.S.

    In Nova Scotia the age of majority is 19. Any
    person under this age is considered a minor.
    There is no legislation that grants or denies any
    decision making entitlement to minors. The
    common law doctrine of the “mature minor”
    therefore plays a significant role in determining
    minors’ entitlement to make health care

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   The mature minor doctrine supports the position
    that a minor who can understand and appreciate
    the nature and consequences of his/her decision
    and its alternatives is able to give a valid
    consent regardless of age.
   In most cases, children entitled to make
    personal decisions in Nova Scotia will have
    reached adolescence.

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    In Canada, the Age Of Sexual Consent Is Age 16
                              (Since May 1, 2008).
   Any suspicion of abuse or neglect in regard to a child under the
    age of 16 (sixteen) must be reported immediately.
   Sexual activity with a person under the age of 18 (eighteen) and
    a person in a position of trust, authority or dependency (for
    example, a nurse, teacher, neighbor, parent, older sibling,
    babysitter, relative, clergy, or coach), or in any relation to
    pornography or prostitution is reportable immediately.
   Anyone under the age of 12 cannot give consent for sex ever.
   Anyone 12-13 yrs. old may consent with someone two years
    older, but no more.
   Anyone 14-15 yrs. old may consent with someone five years
    older, but no more.
                      Data from Family & Children’s Services, April, 2009
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              What is an Advance Directive?
   An Advance Directive is a legal document prepared and signed by a person
    in advance of a severe illness or injury, or if they are no longer mentally
    capable, which will guide health care providers when providing health care
    and treatment. It may give instructions -- i.e., state what treatment or care
    someone wants to receive or not receive if he or she becomes unable to
    make medical decisions
   An Advance Directive
      names a health care agent
      make decision about life sustaining procedures in the event of terminal
        condition, persistent vegetative state & end stage condition.
   In N.S. the advance directives will identify a person (a proxy) who would be
    responsible for making treatment decisions on behalf of the person if she or
    he becomes mentally incapable.

   More comprehensive than a living will


Class 23, Dec. 1/10                                                             30
Living Will
   A living will is a more limited type of advance
    directive because the person only make decisions
    about life sustaining procedures in the event that
    death from a terminal condition is imminent, despite
    the application of life sustaining procedures or they
    are in a future state of incompetence.

                           (Potter & Perry 2010, p. 111).

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Communicable Diseases

 The care of people with communicable
    diseases such as AIDS, hepatitis, SARS has
    legal implications for nurses. Nurses must not
    discriminate, have the legal obligation to provide
    care to all assigned clients
   Nurses can be reprimanded or fired if they
    refuse to care for a client. Only exception is if the
    client’s wishes goes against the law, and
    therefore against the nurse's moral beliefs. Care
    is provided until alternate arrangements are
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Death and Dying

 Euthanasia is illegal
 Distinction between killing and letting die.
 When clients no longer wish treatment to
  prolong life, the nurse’s focus will be to
  provide supportive care and treat the
  patient with dignity and respect.

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Advance Directive

   Mechanism which enables competent individuals to plan
    for a time when he or she may lack the mental capability
    to make medical treatment decisions. Required to follow
    the directives.
   Assumes 2 forms: a) it is an instructional directive (
    spells everything out very clearly) b) proxy directive (
    appoints a person to make treatment decisions on his or
    her behalf) A person can be charged with battery if a
    proxy’s direction is not followed.

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Living Will

   A Living will is a document where the person
    makes an anticipatory refusal of life- prolonging
    measures in the case where he or she may
    become mentally incompetent

   Note that the advance directive encompasses more
    than just refusal of life support measures

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                          #1 Why Should Nurses’ be
                          Familiar with the Law, Professional Regulations,
                          Standards, Competencies and Ethics?

    CNA’s Code of Ethics & the provincial regulatory body
     (CRNNS) impose professional requirements with respect to
     nurses’ level of professional knowledge & skill.

     Failure to meet these requirements, or undertaking the
     practice of nursing without adequate education, leaves the
     nurse open to discipline from the regulatory body (CRNNS), &
     if conduct is serious enough, by the civil and/or criminal courts.

    Class 23, Dec. 1/10                                                      36
# 2 Why Should Nurses’ be
Familiar with the Law, Professional Regulations,
Standards, Competencies and Ethics??

   Nurses have access to drugs that are
    heavily regulated by legislation and
    hospital/agency procedures governing
    their use, dispensation, and handling.

   Professional, civil and criminal
    consequences can flow from a breach of
    such laws.

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#3 Why Should Nurses’ be
Familiar with the Law, Professional Regulations, Standards,
Competencies and Ethics?

   The everyday actions and decisions made by nurses
    affect the basic rights of patients.
   These actions & decisions may involve going beyond
    the usual consensual barriers.
   The nurse bears the onus of ensuring that any action
    undertaken or treatment administered is:
         in the patient’s best interest and
         is consistent with the patient’s wishes.

   Failure to do so leaves the nurse open to the risk of civil suit
    for damages from the non-consenting patient or next of kin, as
    well as consequences imposed by professional body (CRNNS).
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# 4 Why Should Nurses’ be Familiar with the Law, Professional
Regulations, Standards Competencies and Ethics?

   Nurses’ have access to confidential information
    about individuals in their care.
   They have the legal & ethical obligation to keep all
    such information confidential, & not to divulge it
    without the patient’s consent.
   Knowledge about the law, rules of evidence, ethics
    & judicial system provide a framework for the nurse
    when determining whether to disclose.

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                      # 5 Why Should Nurses’ be
                      Familiar with the Law, Professional Regulations,
                      Standards, Competencies and Ethics

   Ensuring a high standard of
    reporting/documentation is important in maintaining
    effective communication, which is key to professional
    nursing practice.
       Inadequate documentation or failure to review client
        information & history have a negative influence on quality of
       Failure to communicate effectively can result in a breach of
        standards, ethics & law.

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                      # 6 Why Should Nurses’ be
                      Familiar with the Law, Professional Regulations,
                      Standards, Competencies and Ethics

   Nurses, like all Canadians, Under the Charter of Rights
    & Freedoms, have the right to privacy, respect, and to
    freedom of expression- the right to think, say, write, or
    otherwise act, in accordance with their beliefs.
   However these rights must be considered in the context
    of nurse’s responsibilities as professionals and of their
    obligation to patients and clients

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Know Terms
   Advanced Directive                    Incident Report
         Living Will                     Informed Consent
   Assault
                                          Withdrawal of consent
   Battery
                                          Negligence
   Living Will
   Common Law                            Standards of Care
                                               Internal standards of care
   Entry Level Competencies
   Euthanasia                            Torts
                                               Intentional
   Invasion of Privacy
                                               Unintentional
   Letting die

                               Potter & Perry (2010, Chapter 9, pp. 102-113
Class 23, Dec. 1/10                                                           42
  1.     Legal issues surrounding regulated professions
         and professional licensure
  2.     Entry-level competencies for Registered Nurses as
         outlined by CRNNS
  3.     Legal proceedings in which nurses have been
  4.     Legal issues in nursing practice in Canada such
         as use of drugs and controlled substances and
         death and dying.
  5.     Importance of accurate documentation
  6.     Define terms: slide 42

Class 23, Dec. 1/10                                          43

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